Papers by Raschida Bouhouch
Seminars in Perinatology, Aug 1, 2015
High rates of child mortality and lost developmental potential in children under 5 years of age r... more High rates of child mortality and lost developmental potential in children under 5 years of age remain important challenges and drivers of inequity in the developing world. Substantive progress has been made toward Millennium Development Goal (MDG) 4 to improve child survival, but as we move into the post-2015 sustainable development agenda, much more work is needed to ensure that all children can realize their full and holistic physical, cognitive, psychological, and socio-emotional development potential. This article presents child survival and development as a continuous and multifaceted process and suggests that a life-course perspective of child development should be at the core of future policy making, programing, and research. We suggest that increased attention to child development, beyond child survival, is key to operationalize the sustainable development goals (SDGs), address inequities, build on the demographic dividend, and maximize gains in human potential. An important step toward implementation will be to increase integration of existing interventions for child survival and child development. Integrated interventions have numerous potential benefits, including optimization of resource use, potential additive impacts across multiple domains of health and development, and opportunity to realize a more holistic approach to client-centered care. However, a notable challenge to integration is the continued division between the health sector and other sectors that support child development. Despite these barriers, empirical evidence is available to suggest that successful multi-sectoral coordination is feasible and leads to improved short-and long-term outcomes in human, social, and economic development.
The FASEB Journal, Apr 1, 2013
The Lancet Diabetes & Endocrinology, Mar 1, 2014
Background Iodine defi ciency in infants can damage the developing brain and increase mortality. ... more Background Iodine defi ciency in infants can damage the developing brain and increase mortality. Present recommendations state that oral iodised oil should be given to breastfeeding mothers to correct iodine defi ciency in infancy when iodised salt is not available, and that direct supplementation should be given to infants who are not being breastfed or receiving iodine-fortifi ed complimentary foods. However, there is little evidence for these recommendations. We aimed to assess the safety and effi cacy of direct versus indirect supplementation of the infant. Methods We did this double blind, randomised, placebo-controlled trial in Morocco. Healthy breastfeeding mothers and their term newborn babies (aged ≤8 weeks) were block randomised by clinic day to receive either: one dose of 400 mg iodine to the mother and placebo to the infant (indirect infant supplementation), or one dose of about 100 mg iodine to the infant and placebo to the mother (direct infant supplementation). Randomisation was masked to participants and investigators. Coprimary outcomes were: maternal and infant urinary iodine concentrations, breastmilk iodine concentration, maternal and infant thyroid-stimulating hormone (TSH) concentrations, maternal and infant thyroxine (T 4) concentrations, and infant growth. These outcomes were measured at baseline, and when infants were aged about 3 months, 6 months, and 9 months, and the two groups were compared using mixed eff ects models. This study is registered with ClinicalTrials.gov, number NCT01126125. Findings We recruited 241 mother-infant pairs between Feb 25, and Aug 10, 2010, and completed data collection by Aug 6, 2011. At baseline, median urinary iodine concentration was 35 μg/L (IQR 29-40) in mothers and 73 μg/L (29-237) in infants, suggesting iodine defi ciency. During the study, maternal urinary iodine concentration (p=0•011), breastmilk iodine concentration (p<0•0001), and infant urinary iodine concentration (p=0•042) were higher in the indirect infant supplementation group than in the direct supplementation group. Maternal TSH (p=0•276) and T 4 (p=0•074) concentrations did not diff er between the groups over the course of the study, nor did infant TSH (p=0•597) and T 4 (p=0•184) concentrations, but the number of infants with thyroid hypofunction was lower (p=0•023) in the indirect supplementation group than the direct supplementation group. The infant groups did not diff er in anthropomorphic measures, except that length-forage Z score was slightly greater in the direct infant supplementation group (p=0•032). At 3 months and 6 months of age, median infant urinary iodine concentration in the indirect infant supplementation group was suffi cient (>100 μg/L), whereas infant urinary iodine concentration was suffi cient only at 6 months in the direct supplementation group. There were no serious adverse events in either group. Interpretation In regions of moderate-to-severe iodine defi ciency without eff ective salt iodisation, lactating women who receive one dose of 400 mg iodine as oral iodised oil soon after delivery can provide adequate iodine to their infants through breastmilk for at least 6 months, enabling the infants to achieve euthyroidism. Direct supplementation is less eff ective in improving infant iodine status.
Anthropologie, 2015
Interet du travail: Les elements traces metalliques sont susceptibles de constituer un veritable ... more Interet du travail: Les elements traces metalliques sont susceptibles de constituer un veritable danger. D’ou l’interet de cet article qui met en evidence l’impact du plomb sur la sante d’une population infantile vivant dans la region de Marrakech. Objectif: Le travail concerne une etude transversale qui vise a evaluer la prevalence du saturnisme chronique et de l'anemie ferriprive chez les enfants de quatre zones de la ville de Marrakech (zone miniere, zone medina, zone azzouzia et zone temoin). Resultats : Cette etude montre que l'anemie legere, microcytaire et hypochrome, due a une carence en fer est un probleme important au niveau des deux zones d’etude (zone miniere et zone azzouzia). De plus les resultats montrent que sur 462 eleves (de 3 a 9 ans) nous n’avons pas enregistre de cas graves de contamination au plomb. Neanmoins, le risque saturnin existe toujours vu la charge en plomb des facteurs environnementaux. En outre, la prevalence de l’anemie globale au niveau de ...
International journal of innovation and scientific research, 2015
The objective of the study is to evaluate the prevalence of intestinal parasites in a population ... more The objective of the study is to evaluate the prevalence of intestinal parasites in a population of children (3 to 14 years) in the Mrabtine region province of Marrakech, Morocco.Fecal samples were collected from 90 students (41 boys (45.6%) and 49 girls (54.4%)) and examined for intestinal parasites by three coproscopic techniques: direct examination and concentration technique Kato-Katz.It emerges that the overall prevalence was 27.8% (12.2% for boys and 15.6% for girls). The distribution of intestinal parasites detected in stool samples was as follows: 14 (15.6 %) Giardia intestinalis, 4 (4.4 %) Ascaris lumbricoides, 3 (3.3 %) Blastocystis spp, 2 (2.2 %) for Enterobius vermicularis and Endolimax nana and finally, 1(1.1 %) for Pentatrichomonas hominis, Hymenolepis nana and Iodamoeba butschlii . The prevalence of intestinal parasites in this region was higher compared to other regions of Morocco. In this regard, the preliminary findings of this study can be used as a basis for deve...
The aim of this study is to investigate lead contamination in food chain and evaluate the consequ... more The aim of this study is to investigate lead contamination in food chain and evaluate the consequent health risks to local residents in three different sites in the Marrakech urban area, compared to a rural reference region far from any source of lead contamination. The following three urban sites that have been selected to have different potential routes of lead exposure: a) old unimproved water pipes (the Medina); b) agricultural land irrigated from untreated urban wastewater (El Azzozia); and c) a mining site (Drâa Lesfer region) were considered in this study. Samples were collected from three compartments: drinking water, soils and plants (edible part). The levels of lead contamination in these compartments were measured. Transfer factors of lead from soils to plants and the eventual health risk of this metal were calculated. The results showed that lead concentration in drinking water of all sites was below the drinking water safety limit. However, soils and plants from mining ...
Seminars in Perinatology, 2015
High rates of child mortality and lost developmental potential in children under 5 years of age r... more High rates of child mortality and lost developmental potential in children under 5 years of age remain important challenges and drivers of inequity in the developing world. Substantive progress has been made toward Millennium Development Goal (MDG) 4 to improve child survival, but as we move into the post-2015 sustainable development agenda, much more work is needed to ensure that all children can realize their full and holistic physical, cognitive, psychological, and socio-emotional development potential. This article presents child survival and development as a continuous and multifaceted process and suggests that a life-course perspective of child development should be at the core of future policy making, programing, and research. We suggest that increased attention to child development, beyond child survival, is key to operationalize the sustainable development goals (SDGs), address inequities, build on the demographic dividend, and maximize gains in human potential. An important step toward implementation will be to increase integration of existing interventions for child survival and child development. Integrated interventions have numerous potential benefits, including optimization of resource use, potential additive impacts across multiple domains of health and development, and opportunity to realize a more holistic approach to client-centered care. However, a notable challenge to integration is the continued division between the health sector and other sectors that support child development. Despite these barriers, empirical evidence is available to suggest that successful multi-sectoral coordination is feasible and leads to improved short- and long-term outcomes in human, social, and economic development.
American Journal of Clinical Nutrition, 2016
Background: Lead is a common neurotoxicant and its absorption may be increased in iron deficiency... more Background: Lead is a common neurotoxicant and its absorption may be increased in iron deficiency (ID). Thus, iron fortification to prevent ID in populations is a promising lead mitigation strategy. Two common fortificants are ferrous sulfate (FeSO 4) and ferric sodium EDTA (NaFeEDTA). EDTA can chelate iron and lead. Objectives: Our study objective was to determine the effects of iron and EDTA, alone and in combination, on blood lead (BPb) concentration, iron status, and cognition. Design: In this 2 3 2 factorial, double-blind placebo-controlled trial, 457 lead-exposed Moroccan children were stratified by school and grade and randomly assigned to consume biscuits (6 d/wk at school) containing 1) w8 mg Fe as FeSO 4 , 2) w8 mg Fe as NaFeEDTA that contained w41 mg EDTA, 3) w41 mg EDTA as sodium EDTA (Na 2 EDTA), or 4) placebo for 28 wk. The primary outcome was BPb concentration; secondary outcomes were iron status and cognitive outcomes from subtests of the Kaufman Assessment Battery for Children and the Hopkins Verbal Learning Test. These outcomes were measured at baseline and endpoint. All data were analyzed by intention-to-treat. Results: The adjusted geometric mean BPb concentration at baseline was 4.3 mg/dL (95% CI: 4.2, 4.3 mg/dL), and at endpoint these values were 3.3 mg/dL (95% CI: 3.1, 3.5 mg/dL) for FeSO 4 , 2.9 mg/dL (95% CI: 2.7, 3.0 mg/dL) for NaFeEDTA, 3.3 mg/dL (95% CI: 3.1, 3.5 mg/dL) for EDTA, and 3.7 mg/dL (95% CI: 3.5, 3.9 mg/dL) for placebo. We found an effect of iron (P = 0.009) and EDTA (P = 0.012) for reduced BPb concentrations at endpoint, but no iron 3 EDTA interaction. Iron fortification improved iron status, but there were no positive effects of iron or EDTA on cognitive test scores. Conclusions: Food fortification with iron and EDTA additively reduces BPb concentrations. Our findings suggest that NaFeEDTA should be the iron fortificant of choice in lead-exposed populations. This trial was registered at clinicaltrials.gov as NCT01573013.
BMJ (Clinical research ed.), Jan 14, 2015
Early childhood years are critical for human development. It is the time when the brain develops ... more Early childhood years are critical for human development. It is the time when the brain develops most rapidly and the neural connections are formed that are the foundation of a child's physical and mental health and lifelong health and well-being. Adverse experiences in early childhood increase the risk for poor social and health outcomes: low educational attainment, economic dependency, increased violence, crime, substance misuse, and poor mental health, and a greater risk of adult-onset non-communicable diseases, such as obesity, cardiovascular disease, and diabetes. Millions of children globally are living in deprived and vulnerable circumstances and it is estimated that over 200 million children under 5 years of age are unable to attain their full developmental potential. While the global community has made great strides in helping children to survive, too many are unable to thrive. Effective interventions to protect and promote early child development are available and feasible for implementation at scale, in the health, nutrition, education and social protection sectors. They include support for optimal infant and young child feeding; prevention and management of childhood illness; parents to develop skills of sensitivity and responsiveness, play and communication; social protection measures such as conditional cash transfers; attention to maternal physical and mental health and timely intervention; maternal education, quality child care and preschool education. Sustainable development requires a healthy population. Countries will only be able to reap the benefits of the demographic dividend if they invest in people early. Early childhood, including the first three of years of a child's life, is a window of opportunity that cannot be missed.
The Lancet Diabetes & Endocrinology, 2014
Background Iodine defi ciency in infants can damage the developing brain and increase mortality. ... more Background Iodine defi ciency in infants can damage the developing brain and increase mortality. Present recommendations state that oral iodised oil should be given to breastfeeding mothers to correct iodine defi ciency in infancy when iodised salt is not available, and that direct supplementation should be given to infants who are not being breastfed or receiving iodine-fortifi ed complimentary foods. However, there is little evidence for these recommendations. We aimed to assess the safety and effi cacy of direct versus indirect supplementation of the infant.
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Papers by Raschida Bouhouch