Parul Christian
Dados Biográficos
| ID | 3700552 |
|---|---|
| NOME | Parul Christian |
| PRENOMES | Parul |
| SOBRENOME | Christian |
| ASSINATURA | CHRISTIAN P |
| AFILIAÇÕES | Joanne Katz, Keith P. West Jr, Lee Wu, Elizabeth Kimbrough Pradhan, Parul Christian, and Steven C. LeClerq are with the Department of International Health, Center for Human Nutrition, Johns Hopkins School of Hygiene and Public Health, Baltimore, Md. Subarna K. Khatry and Sharada Ram Shrestha are with the Nepal Nutrition Intervention Project, Sarlahi, Kathmandu, Nepal. |
| VERIFICADO | Não |
| TOTAL DE OBRAS | 49 |
| TOTAL DE CITAÇÕES | 10 |
| TOTAL COMO AUTOR | 49 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 1989 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2026 |
| ÍNDICE H | 3 |
Untargeted and targeted fortified balanced energy-protein (BEP) dietary supplementation during pregnancy and birth outcomes
Antenatal balanced energy-protein (BEP) dietary supplementation is a WHO recommendation in undernourished settings, but limited evidence exists on targeting individuals based on nutritional status. We assessed the impact of untargeted and targeted fortified BEP supplementation during pregnancy on birth outcomes, compared with multiple micronutrient supplements (MMS) as control. In a four-arm, cluster-randomised controlled trial pregnant women rec…
Measuring feasibility
We sought to assess the feasibility of mainstreaming balanced energy protein supplementation, a maternal nutrition intervention, into Bangladesh’s routine antenatal care system in tandem with an ongoing effectiveness trial in northwestern Bangladesh. Feasibility is an implementation science outcome defined as the extent to which a new intervention can be implemented successfully in a given context. We found feasibility difficult to measure using …
The impact of enhancing nutrition and antenatal infection treatment on birth outcomes in Amhara, Ethiopia
INTRODUCTION: We aimed to determine the impact of antenatal interventions to optimise maternal nutrition and infection management on birth outcomes in Ethiopia. METHODS: We conducted a pragmatic, open-label, 2×2 factorial randomised clinical effectiveness study among pregnant women enrolled <24 weeks gestation in 12 rural health centres in Amhara, Ethiopia. Eligible health centres were randomised to deliver an enhanced nutrition package (ENP) (ir…
Factors associated with Nugent-bacterial vaginosis in pregnancy and postpartum among women in rural northwestern Bangladesh
Community-based longitudinal data on factors linked to bacterial vaginosis (BV) during and after pregnancy in Bangladesh are limited. Using data from a rural randomized trial of vitamin A and β-carotene supplementation, we examined factors associated with Nugent-score–assessed BV. Self-collected vaginal swabs from 1,812 participants were obtained in early pregnancy, late pregnancy, and 3 months postpartum for Nugent scoring. We analyzed associati…
The influence of nutritional status, the home environment, and schooling on behavioral outcomes of hyperactivity and inattention among grade-school children in rural Nepal
Attention-deficit/hyperactivity disorder (ADHD) in children is characterized by frequent inattention and/or hyperactivity that can affect child development, including learning, social adaptation, and mental health. Despite the impact of these behaviors, data on the prevalence and risk factors of child behavioral and neurodevelopmental disorders in low- and middle-income countries are limited. This paper aims to identify maternal, child and enviro…
Caregiver Feeding Behaviours and Child Dietary Diversity and Growth in Rural Bangladesh
This study examined relations between caregiver feeding behaviours, child dietary diversity and anthropometry at 24 months of age in rural Bangladesh. Twenty-four hours dietary recall, weight and length data were collected on 4733 children. Factor analysis was applied to an 11-item caregiver feeding behaviours scale administered at 24 months, revealing two constructs: responsive/involved (five items) and forceful (six items); each dichotomised to…
A formative study of the sociocultural influences on dietary behaviours during pregnancy in rural Bangladesh
Balanced energy protein supplementation (BEP) is recommended for contexts of high maternal undernutrition by the World Health Organization. Despite recent improvements in undernutrition, Bangladesh remains a context where BEP could help accelerate progress towards nutrition goals. In preparation for an effective trial testing a fortified BEP, a qualitative study was undertaken to better understand sociocultural factors influencing dietary behavio…
Early childhood height is a determinant of young adult stature in rural Nepal
Shorter young children become shorter adults but predictive effects can vary by sex, age assessed, and may be influenced by year or season of measurement
Changes in urbanicity and household availability of and proximity to food vendors from 2004 to 2020 in a rural district of northwestern Bangladesh
Over a 16-year period, this rural area of Bangladesh became more urbanized, increasing the availability of and proximity to markets, grocery shops, and tea shops. Further research is needed to see how these changes impact rural residents' intake and nutritional status
Acceptability of a balanced energy protein (BEP) supplement for pregnant women in Bangladesh
Balanced energy protein (BEP) supplementation in pregnancy is recommended in the context of undernutrition for the reduction of small-for-gestational age neonates and stillbirths. To inform an effectiveness trial, we evaluated the acceptability of a packaged, ready-to-eat fortified BEP product among women of reproductive age and their health care providers (HCPs) in rural Bangladesh and explored the feasibility of adhering to daily supplementatio…
Effect of multiple micronutrient supplements v . iron and folic acid supplements on neonatal mortality
Neonatal mortality did not differ between MMS and IFA regardless of Fe dose in either supplement
Protecting infants from natural disasters
Revisiting maternal and child undernutrition in low-income and middle-income countries
Thinness and fecundability
Undernutrition may affect fecundability, but few studies have quantified this relationship. In rural Bangladesh, where newlywed couples face strong pressures to become pregnant, we assessed fecundability, estimated by time to pregnancy (TTP), and its association with preconceptional thinness among nulligravid, newlywed female adolescents. During 2001-2002, 5,516 newlywed women aged 12-19 years participated in a home-based, 5-weekly surveillance s…
Household food insecurity is associated with low dietary diversity among pregnant and lactating women in rural Malawi
Objective To examine the association between household food insecurity and dietary diversity in the past 24h (dietary diversity score (DDS, range: 0–9); minimum dietary diversity (MDD, consumption of three or more food groups); consumption of nine separate food groups) among pregnant and lactating women in rural Malawi. Design Cross-sectional study. Setting Two rural districts in Central Malawi. Subjects Pregnant ( n 589) and lactating ( n 641) w…
Adolescent Undernutrition
Background: Adolescents, comprised of 10–19 year olds, form the largest generation of young people in our history. There are an estimated 1.8 billion adolescents in the world, with 90% residing in low- and middle-income countries. The burden of disease among adolescents has its origins in infectious and injury-related causes, but nutritional deficiencies, suboptimal linear growth, and undernutrition are major public health problems, even as overw…
Levels and correlates of nutritional status of women of childbearing age in rural Bangladesh
Objective The present study examined the prevalence of and risk factors for malnutrition in a population-based cohort of women of childbearing age in rural Bangladesh. Design A cross-sectional study that collected pre-pregnancy weight, height, and data on selected risk factors for nutritional status of women. Setting The study was conducted in Sylhet District of Bangladesh. Subjects Study subjects included 13 230 non-pregnant women of childbearin…
Physical and sociocultural facilitators and barriers to access and utilization of a nutrition program in rural Malawi
Childhood stunting holds consequences for child development. A nutrition program delivering small-quantity lipid based nutrient supplements (SQ-LNS) to children 6-23 months and child feeding messages was implemented in Malawi to reduce stunting. This study sought to understand the facilitators and barriers to program participation using in-depth interviews, pile sorts, direct observations, and focus group discussions with caretakers, village lead…
Modelling stunting in LiST
Smoothing of children's measured lengths/heights increased the strength of the association between stunting at a given age and stunting at an earlier age. Using odds ratios based on smoothed lengths/heights in LiST resulted in a small reduction in the attenuation of intervention effects with age and thus some increase in the estimated benefits, and may better reflect the true benefits of early nutritional interventions
Risk of Depressive Symptoms Associated with Morbidity in Postpartum Women in Rural Bangladesh
Effects of a community-based nutrition promotion programme on child feeding and hygiene practices among caregivers in rural Eastern Ethiopia
Objective To evaluate the effectiveness of a community-based participatory nutrition promotion (CPNP) programme involving a 2-week group nutrition session in improving child feeding and hygiene practices among caregivers. Design Cluster randomized trial. In the intervention area (six clusters), the CPNP programme was added to the context of government nutrition programmes; the control area (six clusters) received the government programme only. Ch…
Implementation, utilization and influence of a community-based participatory nutrition promotion programme in rural Ethiopia
Objective A community-based participatory nutrition promotion (CPNP) programme, involving a 2-week group nutrition session, attempted to improve child feeding and hygiene. The implementation, utilization and influence of the CPNP programme were examined by programme impact pathway (PIP) analysis. Design Five CPNP programme components were evaluated: (i) degree of implementation; (ii) participants’ perception of the nutrition sessions; (iii) parti…
Effectiveness of a community‐based nutrition programme to improve child growth in rural Ethiopia
Few trials have shown that promoting complementary feeding among young children is effective in improving child linear growth in resource-challenged settings. We designed a community-based participatory nutrition promotion (CPNP) programme adapting a Positive Deviance/Hearth approach that engaged mothers in 2-week nutrition sessions using the principles of 'learning by doing' around child feeding. We aimed to test the effectiveness of the CPNP fo…
Availability of emergency obstetric care (EmOC) among public and private health facilities in rural northwest Bangladesh
Although EmOC availability and readiness was higher among the surveyed seven most commonly visited private clinics, public facilities appeared to be more affordable for C-section and more geographically accessible. Strategies to retain anesthesiologists and surgeons, such as non-financial incentives, are needed to improve EmOC provision in the public sector. Centralized blood banks are recommended to streamline safe blood acquisition for obstetri…
Evaluation of a Novel Single-administration Food Frequency Questionnaire for Assessing Seasonally Varied Dietary Patterns among Women in Rural Nepal
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-…
Protecting infants from natural disasters
Epidemiology of tornado destruction in rural northern Bangladesh
The epidemiology of tornado-related disasters in the developing world is poorly understood. An August 2005 post-tornado cohort study in rural Bangladesh identified elevated levels of death and injury among the elderly (≥ 60 years of age) (adjusted odds ratio (AOR) = 8.9 (95 per cent confidence interval (CI): 3.9-20.2) and AOR = 1.6 (95 per cent CI: 1.4-1.8), respectively), as compared to 15-24 year-olds, and among those outdoors versus indoors du…
An ethnographic study of night blindness "ratauni" among women in the Terai of Nepal
Night blindness is the most common ocular condition representing moderate-to-severe vitamin A deficiency in children. Very little, however, is known about maternal night blindness, which has recently been reported to occur frequently during pregnancy in parts of south-east Asia. In Nepal, the prevalence of night blindness is reported to be 16%. We carried out an ethnographic study of night blindness during pregnancy in the south-eastern, rural pl…
An Index of Community-Level Socioeconomic Composition for Global Health Research
Socioeconomic determinants of child nutritional status in rural and tribal India
Weight of 4223 children (0–72 months of age) of rural and tribal villages of Panchmahals district (Gujarat State, India) was measured and expressed as percent of the NCHS median. Household socioeconomic status was assessed by interviewing the head of the family. Nutrition knowledge of mothers was evaluated to determine its effect on the nutritional status of their children. Difference in mean weight for age for socioeconomic, maternal and child f…
Analysis of the nutritional health consequences for Indian children during drought
The major objective was to define the effect of drought on malnutrition and morbidity in rural Indian children. A comparative data set collected in the year before the commencement of drought and after three years of drought enabled the study of child nutrition and health status differences between drought and non‐drought periods. Since the effect of drought is dependent on several factors, such as relief works provided by the government, socioec…
An ethnographic study of night blindness "ratauni" among women in the Terai of Nepal
Night blindness is the most common ocular condition representing moderate-to-severe vitamin A deficiency in children. Very little, however, is known about maternal night blindness, which has recently been reported to occur frequently during pregnancy in parts of south-east Asia. In Nepal, the prevalence of night blindness is reported to be 16%. We carried out an ethnographic study of night blindness during pregnancy in the south-eastern, rural pl…
The role of vitamins in the prevention and control of anaemia
Objective While iron deficiency is regarded as the major cause of nutritional anaemia, changes in vitamins A, B 12 , C and E, folic acid and riboflavin status have also been linked to its development and control. This paper provides a systematic review of vitamin supplementation trials relating to the control of nutritional anaemia. Methods A MEDLINE search was used to find reports of vitamin supplementation trials that reported changes in anaemi…
Determinants of Maternal Vitamin A or Beta-Carotene Supplementation Coverage
Success rates of community-based micronutrient supplementation programs may be enhanced if local residents take primary responsibility for distribution of supplements. Hence this study attempts to identify such characteristics among village-based women hired to deliver nutritional supplements to women of childbearing age in Nepal. Between 1994 and 1997 a community randomized placebo trial was conducted in the Sarlahi district to assess the impact…
Eating Down in Pregnancy
Adequate nutrition during pregnancy, vital for the health of the mother and the newborn, may be influenced by pregnancy-related food beliefs. This study explores food-related beliefs and practices specifically related to reducing food intake in pregnancy in a rural community in Nepal by combining ethnographic and quantitative data collected from pregnant Nepali women. A large proportion (60%) of women reported reducing rice intake during pregnanc…
Preterm delivery but not intrauterine growth retardation is associated with young maternal age among primiparae in rural Nepal
Pregnancy during adolescence is associated with adverse birth outcomes, including preterm delivery and low birthweight. The nutrient availability to the fetus may be limited if the mother is still growing. This research aims to study the effects of pregnancy during adolescence in a nutritionally poor environment in rural Nepal. This study utilized data from a randomized controlled trial of micronutrient supplementation during pregnancy in south-e…
The post‐partum mid‐upper arm circumference of adolescents is reduced by pregnancy in rural Nepal
The purpose of this study was to examine whether changes in the mid‐upper arm circumference (MUAC) in pregnancy and early post‐partum varied by maternal age. The MUAC of 3359 nulliparous pregnant women ≤25 years of age in rural Nepal was measured in early pregnancy and at 3 months post‐delivery of a live‐born infant. Regression was used to model the change in MUAC and prevalence of MUAC < 20 cm by maternal age, adjusted for confounders. A total o…
Difference in ponderal growth and body composition among pregnant vs. never-pregnant adolescents varies by birth outcomes
Recently, we showed that following pregnancy and 6 months of lactation, adolescents cease linear growth and have reduced fat and lean mass in rural Bangladesh. Here, we examined whether these changes varied by pregnancy outcomes such as fetal loss, low birthweight (LBW) and neonatal mortality. Anthropometric measurements were taken among 12-19-year-old primigravidae (n = 229) in early pregnancy and at 6 months post-partum. Never-pregnant adolesce…
Predictors of stunting and thinness in post-menarcheal adolescent girls in rural Bangladesh
Objective To assess the nutritional status and risk factors of undernutrition in post-menarcheal girls in rural northern Bangladesh. Design Cross-sectional data on anthropometric measurements, dietary intake, work activity, morbidity and socio-economic status were collected from 12- to 19-year-old primigravidae ( n 209) and never-pregnant adolescents ( n 456) matched on age and time since menarche. Multiple regression analyses were conducted to d…
Iodine status in pregnancy and household salt iodine content in rural Bangladesh
Adequate maternal iodine intake is essential during pregnancy for the development of the foetus. To assess the extent of iodine insufficiency and its association with household iodized salt in rural Bangladesh, we measured urinary iodine and household salt iodine content among pregnant women in early (≤16 weeks, n = 1376) and late (≥32 weeks, n = 1114) pregnancy. Salt (∼20 g) and a spot urine sample (∼10 mL) were collected from women participatin…
Determinants of compliance to antenatal micronutrient supplementation and women’s perceptions of supplement use in rural Nepal
Objective We examined factors affecting compliance to antenatal micronutrient supplementation and women’s perceptions of supplement use. Design Randomized controlled supplementation trial of four alternative combinations of micronutrients given during pregnancy through to 3 months postpartum. Women were visited twice weekly to monitor compliance and to replenish tablets by female study workers. At 6 weeks postpartum women with live births ( n 409…
Epidemiology of tornado destruction in rural northern Bangladesh
The epidemiology of tornado-related disasters in the developing world is poorly understood. An August 2005 post-tornado cohort study in rural Bangladesh identified elevated levels of death and injury among the elderly (≥ 60 years of age) (adjusted odds ratio (AOR) = 8.9 (95 per cent confidence interval (CI): 3.9-20.2) and AOR = 1.6 (95 per cent CI: 1.4-1.8), respectively), as compared to 15-24 year-olds, and among those outdoors versus indoors du…
Pregnancy registration systems can enhance health systems, increase accountability and reduce mortality
As many low- to middle-income countries strive to achieve targets of reduced maternal, neonatal and infant mortality set by the Millennium Development Goals, health system innovations which can accelerate progress are being carefully examined. Among these are technologies and systems which aim to strengthen frontline health workers and the health systems within which they work, by enabling the registration of pregnancies, births and outcomes. Acc…
Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries
Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries
BACKGROUND: Low- and middle-income countries continue to experience a large burden of stunting; 148 million children were estimated to be stunted, around 30-40% of all children in 2011. In many of these countries, foetal growth restriction (FGR) is common, as is subsequent growth faltering in the first 2 years. Although there is agreement that stunting involves both prenatal and postnatal growth failure, the extent to which FGR contributes to stu…
Maternal and child undernutrition and overweight in low-income and middle-income countries
Low‐birthweight rates higher among B angladeshi neonates measured during active birth surveillance compared to national survey data
Birth size is an important gauge of fetal and neonatal health. Birth size measurements were collected within 72 h of life for 16 290 live born, singleton infants in rural Bangladesh from 2004 to 2007. Gestational age was calculated based on the date of last menstrual period. Newborns were classified as small-for-gestational age (SGA) based on a birthweight below the 10th percentile for gestational age, using three sets of US reference data. Birth…
A cross-sectional study of the prevalence and risk factors for hypertension in rural Nepali women
Although the prevalence of hypertension was low in this cohort, it was more prevalent among the poorer women and was strongly associated with other cardiovascular risks. These associations at a relatively young age may confer greater risk for cardiovascular disease among women in later life, indicating the need for interventions to reduce the progression from pre-hypertension to hypertension
Plasma zinc, vitamin B 12 and α-tocopherol are positively and plasma γ-tocopherol is negatively associated with Hb concentration in early pregnancy in north-west Bangladesh
Objective The objective of the current analysis was to explore the association of multiple micronutrients with Hb concentration among pregnant women in a South Asian setting, a topic that has not been adequately explored. Design Sociodemographic, anthropometric and micronutrient status (plasma ferritin, transferrin receptor, retinol, α- and γ-tocopherol, folate, vitamin B 12 , Zn) and Hb concentration were assessed at early pregnancy. Setting The…
Every Newborn
Antenatal micronutrient supplementation and third trimester cortisol and erythropoietin concentrations
Antenatal iron and multiple micronutrient supplementation has been shown in randomized trials to improve birthweight, although mechanisms are unknown. We examined late pregnancy serum erythropoietin (EPO) and cortisol concentrations in relation to maternal micronutrient supplementation and iron status indicators (haemoglobin, serum ferritin, soluble transferrin receptor) in 737 rural Nepalese women to explore evidence of stress or anaemia-associa…
Availability of emergency obstetric care (EmOC) among public and private health facilities in rural northwest Bangladesh
Although EmOC availability and readiness was higher among the surveyed seven most commonly visited private clinics, public facilities appeared to be more affordable for C-section and more geographically accessible. Strategies to retain anesthesiologists and surgeons, such as non-financial incentives, are needed to improve EmOC provision in the public sector. Centralized blood banks are recommended to streamline safe blood acquisition for obstetri…
Evaluation of a Novel Single-administration Food Frequency Questionnaire for Assessing Seasonally Varied Dietary Patterns among Women in Rural Nepal
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-…
Preferred Delivery Method and Acceptability of Wheat-Soy Blend (WSB++) as a Daily Complementary Food Supplement in Northwest Bangladesh
Fortified blended foods (FBFs) are widely used to prevent undernutrition in early childhood in food-insecure settings. We field tested enhanced Wheat Soy Blend (WSB++)-a FBF fortified with micronutrients, milk powder, sugar, and oil-in preparation for a complementary food supplement (CFS) trial in rural northwestern Bangladesh. Formative work was conducted to determine the optimal delivery method (cooked vs. not) for this CFS, to examine mothers'…
Medicine (45 obras) · Child Nutrition and Water Access (31 obras) · Environmental health (29 obras) · Pregnancy (20 obras) · Demography (18 obras) · Birth, Development, and Health (14 obras) · Demography (14 obras) · Internal Medicine (14 obras) · Global Maternal and Child Health (13 obras) · Micronutrient (13 obras)