L'anémie de l'enfant reste un problème d'importance pour la santé mondiale, malgré les décennies de recherche visant à comprendre son étiologie et à développer des interventions efficaces pour réduire sa prévalence et ses conséquences. Bien que les facteurs de risque individuels de l'anémie soient connus, y compris les facteurs liés à la malnutrition et à la morbidité, l'interaction entre lesdits facteurs est moins documentée dans des contextes où les enfants sont fréquemment exposés à plusieurs facteurs en même temps. Cette étude vise à documenter les efforts de lutte contre l'anémie du programme MICAH qui a été mis en oeuvre au Ghana, au Malawi et en Tanzanie. Ensuite, en utilisant les données relatives à la fois au processus et à l'évaluation colligées au cours du programme, elle vise à mieux comprendre les facteurs de risque d'anémie chez les jeunes enfants dans ces contextes et à comprendre comment les relations entre ces facteurs peuvent avoir changé au fil du temps lors de l'intervention. Spécifiquement, cette étude vérifie s‘il y a des preuves d'une réduction de la vulnérabilité des enfants aux facteurs de risque associés à l'anémie dans chaque contexte. Un examen de la documentation a été réalisé afin de caractériser le contexte du programme et des interventions, leur l'intensité et étendue. Les données transversales sur la nutrition et l'état de santé des enfants âgés de 24 à 59 mois (N = 2405) obtenues en 2000 et 2004 à partir des enquêtes d'évaluation du programme MICAH au Ghana, au Malawi et en Tanzanie, ont été utilisées pour décrire la prévalence de l'anémie. Les modèles polynomiaux de régression logistique et linéaire ont été utilisés pour estimer les risques d'anémie légère et d'anémie modérée / sévère et les niveaux d‘hémoglobine associés à des groupes de variables. Les estimations du risque attribuable à une population (RAP) ont aussi été calculées. Une anémie (Hb <110 g/L) a touché au moins 60% des enfants dans les trois pays; l'anémie modérée / sévère (<100 g/L) constituait la majorité des cas. Une forte diminution de l'anémie a été observée entre 2000 et 2004 au Ghana, mais seulement une légère baisse au Malawi et en Tanzanie. Le risque d'anémie modérée / sévère était associé au retard de croissance chez les enfants du Ghana (OR 2,68, IC 95% 1,70-4,23) et du Malawi (OR 1,71; 1,29-2,27) mais pas de la Tanzanie (OR 1,29; 0,87- 1,92). Le paludisme et les maladies récentes étaient associées à une hémoglobine plus basse. Une atténuation de cette association en 2004 a été observée seulement au Malawi pour le paludisme et au Ghana pour les maladies récentes. Le risque d'anémie modérée / sévère était 44% moindre chez les enfants âgés de 48 à 59 mois comparativement aux enfants de 24 à 35 mois dans les trois pays et cela n'a pas changé entre 2000 et 2004. Les RAP estimés ont montré qu‘environ un cinquième des cas d‘anémie modérée à sévère était attribuable au retard de croissance au Ghana et Malawi, mais pas en Tanzanie. Des RAP moindres et dépendants des contextes ont été trouvés pour le paludisme et les maladies récentes. Dans ces zones d‘intervention intégrées de santé et de nutrition la relation de certains facteurs de risque à l'anémie se modifia avec le temps. Le retard de croissance est resté toutefois un facteur de risque indépendant et non mitigé de l'anémie. Une réduction efficace des causes de la malnutrition chronique est nécessaire afin de réduire la vulnérabilité des enfants et de garantir un impact maximum des programmes de lutte contre l'anémie. Une mitigation de l'impact du paludisme peut par contre être visée dans les régions endémiques. / Childhood anaemia remains a problem of global health importance, despite decades of research to understand its aetiology and develop effective interventions to reduce its prevalence and consequences. While the individual risk factors for anaemia in young children are known, including factors related to undernutrition and morbidity, much less is known about the interaction amongst these in contexts where children are frequently exposed to several at the same time. This study seeks to document the anaemia control efforts of the Micronutrient and Health (MICAH) program implemented in Ghana, Malawi and Tanzania and use both process and evaluation data collected during the program to better understand the risk factors for anaemia in young children in these contexts and how these risk relationships may have changed over time during the intervention. Specifically, this study tests whether there is evidence of a reduction in child vulnerability to the risk factors associated with anaemia in each context. A review of program documentation was conducted to characterize the program contexts and interventions, including estimates of intensity and reach. Cross-sectional data on the nutrition and health status of children 24-59 mo (N=2405) obtained in 2000 and 2004 from community-based program evaluation surveys in Ghana, Malawi and Tanzania, were used to describe the prevalence of anaemia. Multinomial logistic and linear regression models were used to estimate the risk of mild and moderate/severe anaemia and low haemoglobin, respectively, associated with groups of variables. Population attributable risk (PAR) estimates were also calculated. Anaemia (haemoglobin <110 g/L) affected at least 60% of children in all three countries; moderate/severe anaemia (<100 g/L) accounted for the majority of cases. A large decrease in anaemia was observed between 2000 and 2004 in Ghana, but only a small decrease in Malawi and Tanzania. The risk of moderate/severe anaemia was associated with stunting in children from Ghana (OR 2.68; 95% CI 1.70, 4.23) and Malawi (OR 1.71; 1.29, 2.27) but not Tanzania (OR 1.29; 0.87, 1.92). Malaria and recent illness was associated with lower Hb overall; attenuation of this association in 2004 was observed only in Malawi for malaria and Ghana for illness. Children 48-59 mo were at least 44% less likely than those 24-35 mo to have moderate/severe anaemia in all three countries and this did not change between 2000 and 2004. PAR estimates showed that roughly one fifth of moderate/severe anaemia cases were attributable to stunting in Ghana and Malawi but not Tanzania. Lower and context-variable PAR estimates were found for malaria and recent illness. Integrated health and nutrition interventions altered the relationship of some but not all risk factors for anaemia. Stunting remained an independent and non-buffered risk factor for anaemia. Effectively reducing the causes of chronic undernutrition is required in order to reduce child vulnerability and ensure maximum impact of anaemia control programs. Some buffering of malaria impact may be achieved in endemic settings.

Este projeto, analisou a distribuição dos neurônios nos plexos mioentérico (PM) e submucoso (PS) imunorreativos aos receptores P2X2 (ir) e P2X7 (ir), calbindina (Calb-ir), calretinina (Calr-ir), colina acetil transferase (ChAT-ir) e ao óxido nítrico sintase (NOS-ir) do colo distal de ratos submetidos à desnutrição a renutrição protéica. Utilizaram-se colos distais de ratos nutridos (N42), desnutridos (D42) e renutridos (RN42). Os resultados do plexo PM, demonstraram que 100% dos neurônios Calb-ir, Calr-ir, ChAT-ir e NOS-ir, expressavam os receptores P2X2-ir e P2X7-ir nos três grupos. A densidade neuronal no PM, demonstrou um aumento de 20% a 97% dos neurônios receptores P2X2-7-ir, Calr-ir, ChAT-ir e NOS-ir e no PS foi de 29% a 75%, ambos D42 e recuperação no RN42. O perfil neuronal P2X7-ir, Calb-ir, Calr-ir e ChAT-ir do PM demonstrou diminuição de 28% a 40% e no PS os neurônios P2X2-7-ir, Calb-ir e ChAT-ir de 19% a 47% no D42. Concluí-se que, a desnutrição afeta os neurônios entéricos havendo recuperação na renutrição, podendo influenciar nas funções gastrintestinais. / The aim of the work was to analyze the distal colon myenteric (MN) and submucous (SN) neurons immunoreactive for P2X2-7 receptors, calbindin (Calb-ir), calretinin (Calr-ir), choline acetyltransferase (ChAT) and nitric oxide synthase (NOS) of the animals submitted to undernutrition and refeeding proteic. Distal colon was used from nourished (N42), undernourished (D42) and refeeding (RN42) rats. The results have shown 100% coexpression of the myenteric and submucous Calb-ir, Calr-ir, ChAt-ir e NOS-ir neurons with P2X2-7-ir receptors. The MN density have shown increase of the 20% and 97% of the P2X2-7-ir, Calr-ir, ChAT-ir e NOS-ir neurons of the D42 group, and the SN have been increased 29% a 75% in the D42 group. In the MN neuronal profile have shown decrease P2X7-ir, Calb-ir, Calr-ir and ChAT-ir neurons of the 28% to 40% and in the PS P2X2-7-ir, Calb-ir and ChAT-ir of the 19% a 47% neurons in the D42 group. I concluded that, the undernutrition affects the enteric neurons and there was recuperation in the refeeding, this can influence the gastrintestinal functions.

Foi descrita a presença do receptor P2X2 no sistema nervoso entérico e foi constatado que a desnutrição afeta os neurônios mioentéricos. Este projeto analisou os neurônios dos plexos mioentérico (PM) e submucoso (PS) imunorreativos ao receptor P2X2(ir), calbindina (Calb-ir), calretinina (Calr-ir), colina acetil transferase (ChAT-ir) e ao óxido nítrico sintase (NOS-ir) do íleo de ratos submetidos à desnutrição protéica pré e pós-natal e a renutrição pós-natal. Foram utilizados íleos de animais nutridos (N42), desnutridos (D42) e renutridos (RN42). Os resultados do PM e PS demonstraram 100% de neurônios Calb-ir, Calr-ir, ChAt-ir e NOS-ir expressavam o receptor P2X2-ir nos grupos. As densidades neuronais do PM e PS demonstraram aumento de 30% e 25% respectivamente, dos neurônios receptor P2X2-ir, Calr-ir, ChAT-ir e NOS-ir no grupo D42 e, recuperação no grupo RN42, os neurônios Calb-ir aumentaram 60% no PS. O perfil neuronal do PM mostrou diminuição de 26% nos neurônios receptor P2X2-ir e Calr-ir no grupo D42 e, no PS houve diminuição nos neurônios receptor P2X2-ir. Concluiu que a desnutrição afetou os neurônios entéricos e houve recuperação na renutrição, isto pode influenciar as funções do trato gastrintestinal. / It is showed the expression of the P2X2 receptor in the enteric nervous system; it was observed that undernutrition affect the myenteric neurons. This project analyzed the ileum myenteric (MN) and submucous (SN) neurons immunoreactive to P2X2 receptor, calbindin (Calb-ir), calretinin (Calr-ir), coline acetil transferase (ChAT) and nitric oxide sintase (NOS) of the animals submitted to pre- and postnatal protein deprivation and postnatal refeeding. Ileum was used from nourished (N42), undernourished (D42) and Refeeding (RN42) animals. The results showed 100% coexpression myenteric and submucous Calb-ir, Calr-ir, ChAt-ir e NOS-ir neurons with P2X2-ir receptor. The myenteric and submucos neuronal density showed increase of the 30% and 25% respectively, of the P2X2-ir, Calr-ir, ChAT-ir e NOS-ir neurons of the D42 group, the Calb-ir neurons increase 60% in the SN. It was observed in the MN neuronal profile decrease of the 26% of the P2X2-ir and Calr-ir in the RN42 group and recover in the RN42, there was decrease of the P2X2-ir receptor neurons in the submucous plexus. The conclusion demonstrated that undernutrition affects the enteric neurons and there was recuperation in the refeeding, this can influence the gastrointestinal functions.

O principal objetivo deste trabalho foi verificar o efeito do trauma sub-aquático e da estimulação tátil, a longo prazo, no comportamento exploratório de animais submetidos à desnutrição protéica precoce, no teste do labirinto em cruz elevado (LCE). Sabe-se que a desnutrição protéica precoce, além de provocar redução no peso corporal e cerebral, produz alterações estruturais, neuroquímicas e funcionais no Sistema Nervoso Central, levando a alterações no comportamento. Utilizou-se ratos machos provenientes de ninhadas controle (16% de proteína) ou desnutridas (6% de proteína), após o desmame. Os animais receberam ou não estimulação tátil – do nascimento aos 70 dias de idade. No 71º dia, os animais de cada grupo foi submetida ao trauma sub-aquático por 60 segundos, e testada por 5 minutos no LCE. A desnutrição protéica reduziu o peso corporal tanto das ratas-mães quanto dos filhotes. Quando testados no LCE, os animais desnutridos apresentaram-se menos ansiosos e/ou mais impulsivos. A estimulação tátil recuperou parte do peso dos filhotes desnutridos, porém apresentou caráter ansiogênico. O trauma sub-aquático diminuiu a exploração dos braços abertos nos grupos desnutridos. Os dados sugerem que os efeitos da dieta dependem da interação com outros fatores ambientais como a estimulação tátil e o trauma sub-aquático. / Early protein malnutrition, besides reducing body and brain weights, causes structural, neurochemical and functional changes in Central Nervous System, leading to behavioral alterations. The principal aim of the present study was to evaluate the interaction of sub-aquatic trauma and chronic tactile stimulation on the exploratory behavior of malnourished rats, in the elevated plus-maze test (EPM). For this purpose, we used male rats fed by lactating female rats, receiving either 6% (malnourished) or 16% (well-nourished) protein diets. After weaning (21 days), the animals continued to receive the same diets as in the lactating period until 49 days of age, when they all started to receive a regular lab chow diet – period of nutritional recovery for the malnourished rats. Control and malnourished animals were divided in two groups: the first one received tactile stimulation from birth to 70 days of age, while the other group was not stimulated. On day 71st, half of the animals of each group was submitted to the sub-aquatic trauma for 60 seconds and tested for 5 minutes in the EPM, while the others were kept in their cages before the test. Protein malnutrition reduced the body weight of the dams as well as of the pups. When tested in EPM, malnourished animals showed less anxiety and/or more impulsiveness. Tactile stimulation recovered part of the weight of the malnourished animals, although it presented an anxiogenic profile. Sub-aquatic trauma decreased the open arms exploration. These data suggest that the effects of the diet are dependent on the interaction between tactile stimulation and sub-aquatic trauma.

O objetivo desta pesquisa foi avaliar qualitativa e quantitativamente, através de técnicas histológicas e histoquímicas, o córtex cerebral de ratos submetidos a uma subnutrição protéica e posterior recuperação precoce e tardia. Foram utilizados ratos Wistar submetidos às seguintes dietas nutricionais: dieta padrão - normoprotéica - \"AIN-93G\", contendo 20% de proteína (caseína) e dieta hipoprotéica - \"AIN-93G\", contendo 5% desta mesma proteína, durante os períodos experimentais de 42 e 60 dias. Os grupos experimentais foram formados por animais que desde o acasalamento até a eutanásia foram submetidos à dieta normoprotéica (grupos nutridos N42 e N60) e à dieta hipoprotéica (grupos subnutridos S42 e S60). O grupo renutrido precoce (Rp42) foi constituído por animais subnutridos que, a partir do 22º dia passaram a receber a dieta normoprotéica até 42 dias de idade; animais subnutridos que a partir do 43º dia receberam a dieta normoprotéica até 60 dias de idade, constituíram o grupo renutrido tardio (Rt60). Uma vez formado os grupos experimentais no momento do desmame (21 dias) todos os animais foram alojados e assistidos em gaiolas metabólicas. Características comportamentais e físicas foram avaliadas, bem como os seguintes aspectos morfométricos: pesos corporais e encefálicos; comprimento naso-anal, circunferência abdominal, índice de Lee (que avalia o grau de adiposidade) e as dimensões encefálicas. Para as avaliações quantitativas estruturais foram empregadas técnicas histológicas (H.E. e violeta Cresil) e histoquímica (&beta;-Nicotinamide Adenine dinucleotide phosphate - NADPH) para neurônios nitrérgicos. Foram avaliados parâmetros como: número de neurônios, densidade neuronal, área neuronal e o perfil da área dos neurônios corticais e nas camadas corticais. Em linhas gerais, para os parâmetros aqui avaliados, desde o nascimento até o sacrifício inerente a cada grupo experimental (42 e 60 dias), os animais dos grupos subnutridos (S42 e S60) apresentaram valores menores do que os respectivos grupos controle (N42 e N60), exceto no índice de Lee, significativamente maior do que nos animais nutridos. Os grupos renutridos, independentemente se precoce (Rp42) ou tardio (Rt60) conseguem alguma recuperação em alguns parâmetros avaliados como peso encefálico, dimensões encefálicas e espessura cortical; porém outros como o peso corporal, e a área neuronal foram gravemente afetados. Todavia quando se observa a razão peso encefálico/peso corporal, os animais dos grupos subnutridos relativamente aos animais controles nutridos, apesar do peso corporal menor apresentam uma razão maior do que os respectivos controles, sugerindo ser o encéfalo menos afetado pela subnutrição do que o peso corporal. A subnutrição promoveu acentuada diminuição na área dos neurônios corticais e nitrérgicos, não recuperada com a renutrição, independentemente se precoce ou tardia. Portanto, conforme o proposto e com a metodologia utilizada no presente estudo pesquisa, os resultados permitem concluir que frente às condições de subnutrição, o organismo pode sofrer alterações irreparáveis dependendo do momento da vida em que ocorre, e que a renutrição pode promover recuperação ou mesmo adaptações em alguns parâmetros, preferencialmente se ocorrer em fases mais precoces. / The objective of this study was to evaluate qualitative and quantitatively, through histological and histochemical techniques, the cerebral cortex of rats subjected to protein undernutrition subsequent to early and late recovery. Were used Wistar rats fed with standard (normal) diet-\"AIN-93G\" containing 20% of protein (casein), and hypoproteic diet- \"AIN-93G\" containing 5% of casein during experimental periods of 42 and 60 days. The experimental groups were performed by animals fed with normal diet from mating to euthanasia (nourished groups N42 and N60), and to hypoproteic diet (undernourished groups S42 and S60). The early re-nourished group (Rp42) was composed by undernourished animals fed with normal diet from 22nd day, whereas late re-nourished group (Rt60) was composed by undernourished animals fed with normal diet from 43rd to 60 days of age. Once established the experimental groups at weaning (21 days), all animals were housed and assisted in metabolic cages. Physical and behavioral characteristics were examined, as well as, morphometric aspects: body and brain weight; naso-anal length, abdominal circumference, Lee index (evaluation of fat deposit), and brain measures. For quantitative evaluation, histologic techniques (H.E. and Violet Cresyl), and Histochemistry (&beta;-Nicotinamide Adenine dinucleotide phosphate - NADPH) for nitrergic neurons were performed. The number of neurons, neuronal density, neuronal area and profile of cortical neurons in cortical layers area were analyzed. Animals from S42 and S60 groups shown lower average compared to respective controls (N42 and N60), except in the Lee index, that was significantly higher than in nourished animals. Were observed that re-nourished groups either early (Rp42) or late (Rt60) have recovered in some parameters evaluated such as brain weight, brain measures and cortical thickness; however other parameters like body mass, and neuronal area was highly affected. Relatively to the proportion brain weight/body mass, animals from undernourished group although exhibit low body mass, shown higher proportion than respective control nourished, thus suggesting that brain is less affected by undernutrition than body mass. The undernutrition promoted great decreasing of cortical and nitrergic neurons area; the area was not recovered by early and/or late re-nourishment. In the view of the objectives and methodology used in the present study, we can be conclude that in under-nutrition conditions the body can go through irreversible changes depending on period of occurrence; additionally, re-nourishment can promote recovery or adaptations in some parameters preferentially if occur in early phases.

La malnutrition à l’admission en réanimation pédiatrique est fréquente et associée à une augmentation de la morbi-mortalité. Néanmoins, la plupart des études, limitées à une évaluation statique du statut nutritionnel, ne permettent pas une analyse fine de l’impact de la malnutrition. Une approche systémique associerait en plus d’une évaluation nutritionnelle statique, une analyse dynamique dans le temps, une analyse de la composition corporelle et une analyse physiopathologique et étiologique. Cette approche globale a été appliquée dans 4 études prospectives observationnelles, incluant des enfants sévèrement agressés de plus de 36 semaines d’âge corrigé. Il en ressort que la dénutrition globale à l’admission est fréquente (23,7%) et que la cassure des courbes de croissance avant l’admission est associée à une augmentation de la durée de séjour de 3 jours. L’enfant sévèrement agressé présente à l’admission des taux plasmatiques abaissés de 6 micronutriments impliqués dans le stress oxydant (Sélénium, Zinc, Cuivre, Vitamines C, E et bêta-carotène), proportionnellement au nombre de défaillances d’organe. La dénutrition globale et la fonte musculaire acquises en cours de séjour sont des phénomènes fréquents, précoces et importants, associés à une durée de séjour prolongée. Les changements métaboliques liés à l’agression sévère conduisent à une dénutrition. Ces processus adaptatifs sont parfois dépassés et la dénutrition pourra à son tour aggraver le pronostic. La bonne compréhension de la physiopathologie sous-jacente et un suivi systémique et systématique du statut nutritionnel sont les éléments indispensables à l’évaluation des stratégies nutritionnelles / Malnutrition at pediatric Intensive care unit (PICU) admission is frequent and associated with impaired outcomes. However, most studies have focused solely on a static definition. A holistic approach would improve the description of malnutrition: this would include both a static and dynamic assessment of nutritional status, together with body composition assessment and with malnutrition classified based on its patho-physiology and etiology. This holistic assessment of malnutrition has been applied and examined in four observational studies which included critically ill children older than 36 gestational weeks (corrected age). These found that malnutrition was frequent at PICU admission (27.3%) and faltering growth prior to PICU admission was associated with an increased length of PICU stay (+3 days). Critically ill children present at admission with decreased plasma levels of 6 micro-nutrients (Selenium, Copper, Zinc, Vitamin C, E and beta-carotene) involved in anti-oxidative stress pathways. Nutritional status deterioration during PICU stay, and associated muscle mass loss occurred frequently and were intense. This early phenomenon was associated with extended length of PICU stay. A profound critical illness related metabolic shift leads to malnutrition as an adaptive process. However, malnutrition may also negatively impact on outcomes in this setting. These studies have led to a clearer understanding of the underlying patho-physiology. This, combined with a more systematic and holistic nutritional assessment, will enable implementation and assessment of nutritional strategies aiming to improve the functional outcome of critically ill children

Thesis advisor: John Michalczyk / Why do we eat the foods that we do? This question is one that is not often considered by individuals as they go about their daily lives, but can have large implications on public health – for, there is a strong, physiological connection between food consumption and one’s health and wellbeing. Accordingly, when reflecting upon the health of a nation it is often important to consider its nutritional status. Ultimately, many determinants can contribute to how and why an individual eats certain foods, as can be seen in Ecuador. In this Latin American country, for instance, historical, socioeconomic, cultural, behavioral, socioeconomic, and environmental factors (among others) can be seen to influence the different diets – and by extension, the nutritional statuses – of different ethnic, regional, and geographic populations. Though common across Ecuador, discrepancies among these groups are particularly noticeable in the highland region, the Sierra. Overall, this paper examines the different forms of malnutrition, their implications on one’s health, and their prevalence across Ecuador. Additionally, it considers how the Ecuadorian diet was shaped, and how different subcuisines lend themselves to varying forms of malnutrition. Specifically, this paper focuses on the Sierra, given that levels of malnutrition are noticeably higher in this region, and that this highland area is home to large rural and indigenous communities who are most significantly impacted by the region’s nutritional conditions. / Thesis (BS) — Boston College, 2017. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Arts and Sciences Honors Program. / Discipline: .

Background: India has the highest number of undernourished children worldwide. Understanding trends, predictors, and consequences of child undernutrition is important to inform strategy for addressing this public health crisis. Methods: We used data from four National Family Health Surveys (1992-93, 1998-99, 2005-6, 2015-16 NFHS) to examine trends of undernutrition before and after the 2005 implementation of the National Rural Health Mission, India’s flagship public health initiative (Aim 1). We used the 2016 NFHS to build a predictive model that identifies infants at-risk for child undernutrition (Aim 2). Lastly, we used data from the 2005 and 2012 India Human Development Surveys to investigate the consequences of early childhood undernutrition (Aim 3). Results: NRHM was more effective at addressing acute than chronic undernutrition but its prioritization on high focus states resulted in an increase of acute undernutrition among children living in normal focus states. We demonstrate that it is feasible to predict 5-year risk of child undernutrition at the time of birth. Child undernutrition is associated with adverse physical and cognitive outcomes during pre-adolescent years, with female undernourished children experiencing the worst outcomes. Higher female education in the household helps overcome gender and nutrition-based disadvantage among Indian children. Conclusion: There is an urgent need to reduce nutrition-related disparities among Indian children. Short-term strategy could include a predictive model that can be used to more effectively provide resources and intervention to the most disadvantaged population. Long term strategy should focus on elevating women’s status through improved female education in India.

Contexte. La sous-nutrition est un problème de santé publique, surtout pour les femmes et les enfants dans les pays en voie de développement. Des tabous alimentaire pour cette population existent dans plusieurs régions du monde. Ce mémoire décrit la recherche sur les tabous alimentaires et les facteurs qui peuvent influencer la diversité alimentaire des femmes en âge de procréer. Cette recherche fait partie d’un projet d’intervention qui vise à réduire la mortalité maternelle et infantile dans le Sud et la Grand’Anse d’Haïti, un pays où environ la moitié des femmes en âge de procréer sont anémiques et un tier des enfants d’âge préscolaire ont une carence en vitamine A (WHO 2009, ICF 2018). Objectifs. L’objectif de ce projet est d’identifier et comprendre les tabous alimentaires qui existent chez les femmes enceintes et allaitantes dans la région. Un deuxième objectif est d’identifier les déterminants de la diversité alimentaire des femmes en âge de procréer et de déterminer si les femmes enceintes ou allaitantes ont une alimentation moins diversifiée que les femmes qui ne le sont pas. Méthode. Le devis mixte combine la recherche qualitative et quantitative. Les données qualitatives ont été recueillies avec des groupes de discussion. Pour la collecte de données quantitatives, des entretiens ont été menées auprès de mères d’enfants de moins de cinq ans, suivi par un relevé alimentaire de 24 heures. La diversité alimentaire des participantes a été évaluée avec la DAM-F de la FAO. Les déterminants de la diversité alimentaire ont été identifiés avec des analyses de régression logistique. Résultats. Les participantes des groupes de discussion ont identifié plus de 100 tabous alimentaires. La diversité alimentaire a été influencée par la région, ainsi que les caractéristiques du ménage et de la mère. Les femmes allaitantes atteignent moins souvent une diversité alimentaire minimale et consomment moins souvent les aliments des « autres légumes » et « autres fruits », mais ces résultats sont significatifs seulement dans le modèle non ajusté. Conclusion. Les tabous alimentaires pour les femmes enceintes ou allaitantes existent dans le Grand’Anse et le Sud d’Haïti. Il y a une grande variété de croyances entre les communautés et même dans la même commune. Ces restrictions alimentaires peuvent diminuer la consommation de micronutriments comme la vitamine A et le fer dans une population déjà à risque de malnutrition. Des messages clés à inclure dans les activités éducatives du projet vont être formulés à partir des résultats de la recherche. / Context. Undernutrition, including micronutrient deficiencies, is a global public health issue, particularly for women and children in developing countries. Dietary taboos in this population have been found to exist in many regions of the world, including in Haiti. This thesis describes research looking at dietary taboos and other factors impacting dietary diversity of Women of Reproductive Age (WRA). It is part of an intervention project aiming to decrease maternal and child mortality in the South and Grand’Anse of Haiti, a country where approximately half of WRA are anemic and one third of preschool-age children are deficient in vitamin A (WHO 2009, ICF 2018). Objectives. The objective of this research is to identify and understand food taboos for pregnant and breastfeeding women in the area, to determine what factors influence dietary diversity of WRA and if pregnant or breastfeeding women consume a diet that is less diverse than that of a woman who is not. Methodology. The research design included both qualitative and quantitative components. Qualitative data regarding food taboos was collected through focus groups. Quantitative data was collected through surveys and 24-hour recalls done with WRA who have a child under the age of five. Dietary diversity of survey participants was assessed using the FAO’s MDD-W and it’s determinants were analyzed through adjusted logistic regression calculations. Results. The focus groups revealed over 100 dietary taboos. Determinants of dietary diversity were related to the region, as well as characteristics of the household and mother. Breastfeeding women were less likely to attain the MDD-W and to consume “other fruits” and “other vegetables” though these findings were only significant in the non-adjusted model. Conclusion. Dietary taboos exist in the Grand’Anse and South areas of Haiti for pregnant and breastfeeding women. These taboos vary largely between communes and even within the same community. The restriction of these foods could negatively impact the dietary intake of many micronutrients, including vitamin A and iron. Key messages to include at educative activities through the intervention project will be formed based on results of this work.

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