Livestock ownership is associated with higher odds of anaemia among preschool-aged children, but not women of reproductive age in Ghana

Andrew D Jones, Esi K Colecraft, Raphael B Awuah, Sandra Boatemaa, Nathalie J Lambrecht, Leonard Kofi Adjorlolo, Mark L Wilson, Andrew D Jones, Esi K Colecraft, Raphael B Awuah, Sandra Boatemaa, Nathalie J Lambrecht, Leonard Kofi Adjorlolo, Mark L Wilson

Abstract

Livestock ownership may influence anaemia through complex and possibly contradictory mechanisms. In this study, we aimed to determine the association of household livestock ownership with anaemia among women aged 15-49 years and children aged 6-59 months in Ghana and to examine the contribution of animal source foods (ASFs) to consumption patterns as a potential mechanism mediating this association. We analysed data on 4,441 women and 2,735 children from the 2014 Ghana Demographic and Health Survey and 16,772 households from the Ghana Living Standards Survey Round 6. Haemoglobin measurements were used to define anaemia (non-pregnant women: <120 g/L; children: <110 g/L). Child- and household-level ASF consumption data were collected from 24-hour food group intake and food consumption and expenditure surveys, respectively. In multiple logistic regression models, household livestock ownership was associated with anaemia among children (OR, 95% CI: 1.5 [1.1, 2.0]), but not women (1.0 [0.83, 1.2]). Household ownership of chickens was associated with higher odds of anaemia among children (1.6 [1.2, 2.2]), but ownership of other animal species was not associated with anaemia among women or children. In path analyses, we observed no evidence of mediation of the association of household livestock ownership with child anaemia by ASF consumption. Ownership of livestock likely has limited importance for consumption of ASFs among young children in Ghana and may in fact place children at an increased risk of anaemia. Further research is needed to elucidate if and how pathogen exposure associated with livestock rearing may underlie this increased risk of anaemia.

Keywords: Ghana; anaemia; animal source foods; livestock; malaria; poultry.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

© 2018 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.

References

    1. Ahenkorah, B. , Nsiah, K. , & Baffoe, P. (2016). Sociodemographic and obstetric characteristics of anaemic pregnant women attending antenatal clinic in Bolgatanga Regional Hospital. Scientifica, 2016, 1–8.
    1. Asale, A. , Duchateau, L. , Devleesschauwer, B. , Huisman, G. , & Yewhalaw, D. (2017). Zooprophylaxis as a control strategy for malaria caused by the vector Anopheles arabiensis (Diptera: Culicidae): A systematic review. Infect Dis Poverty, 6, 160.
    1. Azzarri, C. , Zezza, A. , Haile, B. , & Cross, E. (2015). Does livestock ownership affect animal source foods consumption and child nutritional status? Evidence from rural Uganda. Journal of Development Studies, 51, 1034–1059.
    1. Balarajan, Y. , Ramakrishnan, U. , Ozaltin, E. , Shankar, A. H. , & Subramanian, S. V. (2011). Anaemia in low‐income and middle‐income countries. Lancet, 378, 2123–2135.
    1. Bentley, M. E. , & Griffiths, P. L. (2003). The burden of anemia among women in India. European Journal of Clinical Nutrition, 57, 52–60.
    1. Burkot, T. R. , Dye, C. , & Graves, P. M. (1989). An analysis of some factors determining the sporozoite rates, human blood indexes, and biting rates of members of the Anopheles punctulatus complex in Papua New Guinea. The American Journal of Tropical Medicine and Hygiene, 40, 229–234.
    1. Campbell, D. I. , Elia, M. , & Lunn, P. G. (2003). Growth faltering in rural Gambian infants is associated with impaired small intestinal barrier function, leading to endotoxemia and systemic inflammation. The Journal of Nutrition, 133, 1332–1338.
    1. Claro, R. M. , Levy, R. B. , Bandoni, D. H. , & Mondini, L. (2010). Per capita versus adult‐equivalent estimates of calorie availability in household budget surveys. Cadernos de Saúde Pública, 26, 2188–2195.
    1. Colecraft, E. , Marquis, G. S. , Aryeetey, R. , Sakyi‐Dawson, O. , Lartey, A. , Ahunu, B. , … Huff‐Lonergan, E. (2006). Constraints on the use of animal source foods for young children in Ghana: A participatory rapid appraisal approach. Ecology of Food and Nutrition, 45, 351–377.
    1. Curtis, V. , & Cairncross, S. (2003). Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. The Lancet Infectious Diseases, 3, 275–281.
    1. Donnelly, B. , Berrang‐Ford, L. , Ross, N. A. , & Michel, P. (2015). A systematic, realist review of zooprophylaxis for malaria control. Malaria Journal, 14, 313.
    1. Dror, D. K. , & Allen, L. H. (2011). The importance of milk and other animal‐source foods for children in low‐income countries. Food and Nutrition Bulletin, 32, 227–243.
    1. Ehrhardt, S. , Burchard, G. D. , Mantel, C. , Cramer, J. P. , Kaiser, S. , Kubo, M. , … Mockenhaupt, F. P. (2006). Malaria, anemia, and malnutrition in african children‐defining intervention priorities. The Journal of Infectious Diseases, 194, 108–114.
    1. Esrey, S. A. (1996). Water, waste, and well‐being: A multicountry study. American Journal of Epidemiology, 143, 608–623.
    1. Ezzati, M. , Lopez, A. D. , Rodgers, A. A. , & Murray, C. J. L. (2004). Comparative quantification of health risks: Global and regional burden of disease attributable to selected major risk factors. Geneva, Switzerland: World Health Organization.
    1. FAO, WHO, & UNU (2004). Human energy requirements. Report of a Joint FAO/WHO/UNU Expert Consultation In Rome. Italy: FAO.
    1. Flores‐Martinez, A. , Zanello, G. , Shankar, B. , & Poole, N. (2016). Reducing anemia prevalence in afghanistan: Socioeconomic correlates and the particular role of agricultural assets. PLoS One, 11, e0156878.
    1. Galal, O. M. , Harrison, G. G. , Abdou, A. I. , & Zein el Abedin, A. (1987). The impact of a small‐scale agricultural intervention on socio‐economic and health status. Food Nutr (Roma), 13, 35–43.
    1. George, C. M. , Oldja, L. , Biswas, S. , Perin, J. , Lee, G. O. , Kosek, M. , … Faruque, A. G. (2015a). Geophagy is associated with environmental enteropathy and stunting in children in rural Bangladesh. The American Journal of Tropical Medicine and Hygiene, 92, 1117–1124.
    1. George, C. M. , Oldja, L. , Biswas, S. K. , Perin, J. , Lee, G. O. , Ahmed, S. , … Faruque, A. G. (2015b). Fecal markers of environmental enteropathy are associated with animal exposure and caregiver hygiene in Bangladesh. The American Journal of Tropical Medicine and Hygiene, 93, 269–275.
    1. Ghana Statistical Service (2014). Ghana living standards survey round 6 main report. Accra, Ghana: Ghana Statistical Service.
    1. Ghana Statistical Service, Ghana Health Service, & ICF International . (2015). Ghana demographic and health survey 2014. Rockville, MD: ICF International.
    1. Guerrant, R. L. , Hughes, J. M. , Lima, N. L. , & Crane, J. (1990). Diarrhea in developed and developing countries: Magnitude, special settings, and etiologies. Reviews of Infectious Diseases, 12, S41–S50.
    1. Haldar, K. , & Mohandas, N. (2009). Malaria, erythrocytic infection, and anemia. Hematology. American Society of Hematology. Education Program, 87–93.
    1. Harvey, S. A. , Winch, P. J. , Leontsini, E. , Torres Gayoso, C. , Lopez Romero, S. , Gilman, R. H. , & Oberhelman, R. A. (2003). Domestic poultry‐raising practices in a Peruvian shantytown: Implications for control of Campylobacter jejuni‐associated diarrhea. Acta Tropica, 86, 41–54.
    1. Headey, D. , & Hirvonen, K. (2016). Is exposure to poultry harmful to child nutrition? An observational analysis for rural Ethiopia. PLoS One, 11, e0160590.
    1. Headey, D. , Nguyen, P. , Kim, S. , Rawat, R. , Ruel, M. , & Menon, P. (2017). Is exposure to animal feces harmful to child nutrition and health outcomes? A multicountry observational analysis. The American Journal of Tropical Medicine and Hygiene, 96, 961–969.
    1. Herrero, M. , Grace, D. , Njuki, J. , Johnson, N. , Enahoro, D. , Silvestri, S. , & Rufino, M. C. (2013). The roles of livestock in developing countries. Animal, 7(Suppl 1), 3–18.
    1. Hoffman, D. , Riethmuller, P. , & Steane, D. (2003). Some issues associated with the livestock industries of the developing countries of Asia: Opening Pandora's Box. Journal of Food, Agriculture and Environment, 1, 148–154.
    1. Horton, S. , & Ross, J. (2003). The economics of iron deficiency. Food Policy, 28(1), 51–75.
    1. Humphrey, J. H. (2009). Child undernutrition, tropical enteropathy, toilets, and handwashing. Lancet, 374, 1032–1035.
    1. Hurrell, R. F. , Reddy, M. B. , Juillerat, M. , & Cook, J. D. (2006). Meat protein fractions enhance nonheme iron absorption in humans. The Journal of Nutrition, 136, 2808–2812.
    1. Iannotti, L. L. , Delnatus, J. R. , Odom, A. R. , Eaton, J. C. , Griggs, J. J. , Brown, S. , & Wolff, P. B. (2015). Determinants of anemia and hemoglobin concentration in Haitian school‐aged children. The American Journal of Tropical Medicine and Hygiene, 93, 1092–1098.
    1. Jahnke, H. E. (1982). Livestock production systems and livestock development in tropical Africa. Kiel: Kieler Wissenschaftsverlag Vauk.
    1. Jaleta, K. T. , Hill, S. R. , Birgersson, G. , Tekie, H. , & Ignell, R. (2016). Chicken volatiles repel host‐seeking malaria mosquitoes. Malaria Journal, 15, 354.
    1. Jariseta, Z. R. , Dary, O. , Fiedler, J. L. , & Franklin, N. (2012). Comparison of estimates of the nutrient density of the diet of women and children in Uganda by Household Consumption and Expenditures Surveys (HCES) and 24‐hour recall. Food and Nutrition Bulletin, 33, S199–S207.
    1. Korenromp, E. L. , Armstrong‐Schellenberg, J. R. M. , Williams, B. G. , Nahlen, B. L. , & Snow, R. W. (2004). Impact of malaria control on childhood anaemia in Africa—A quantitative review. Tropical Medicine & International Health, 9, 1050–1065.
    1. Kotloff, K. L. , Nataro, J. P. , Blackwelder, W. C. , Nasrin, D. , Farag, T. H. , Panchalingam, S. , … Levine, M. M. (2013). Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): A prospective, case‐control study. Lancet, 382, 209–222.
    1. Lee, G. , Pan, W. , Peñataro Yori, P. , Paredes Olortegui, M. , Tilley, D. , Gregory, M. , … Kosek, M. (2013). Symptomatic and asymptomatic campylobacter infections associated with reduced growth in Peruvian children. PLoS Neglected Tropical Diseases, 7, e2036.
    1. Leroy, J. L. , & Frongillo, E. A. (2007). Can interventions to promote animal production ameliorate undernutrition? The Journal of Nutrition, 137, 2311–2316.
    1. Lin, A. , Arnold, B. F. , Afreen, S. , Goto, R. , Huda, T. M. , Haque, R. , … Luby, S. P. (2013). Household environmental conditions are associated with enteropathy and impaired growth in rural Bangladesh. The American Journal of Tropical Medicine and Hygiene, 89, 130–137.
    1. Lozoff, B. , Beard, J. , Connor, J. , Barbara, F. , Georgieff, M. , & Schallert, T. (2006). Long‐lasting neural and behavioral effects of iron deficiency in infancy. Nutrition, 64, S34–S43.
    1. Lozoff, B. , Jimenez, E. , Hagen, J. , Mollen, E. , & Wolf, A. W. (2000). Poorer behavioral and developmental outcome more than 10 years after treatment for iron deficiency in infancy. Pediatrics, 105, e51.
    1. Luby, S.P. (2017). Results from WASH‐Benefits Bangladesh on child growth, diarrheal disease and cognitive development. Paper presented at Experimental Biology, Chicago, IL.
    1. Marquis, G. S. , Habicht, J. P. , Lanata, C. F. , Black, R. E. , & Rasmussen, K. M. (1997). Association of breastfeeding and stunting in Peruvian toddlers: An example of reverse causality. International Journal of Epidemiology, 26, 349–356.
    1. Marquis, G. S. , Ventura, G. , Gilman, R. H. , Porras, E. , Miranda, E. , Carbajal, L. , & Pentafiel, M. (1990). Fecal contamination of shanty town toddlers in households with non‐corralled poultry, Lima, Peru. American Journal of Public Health, 80, 146–149.
    1. Martinez, L. , Collazo, G. , Cabrera, L. , Bernabe‐Ortiz, A. , Ramos‐Peña, Y. , & Oberhelman, R. (2013). Free‐ranging chickens in households in a periurban shantytown in Peru—Attitudes and practices 10 years after a community‐based intervention project. The American Journal of Tropical Medicine and Hygiene, 89, 229–231.
    1. Miller, E. M. (2010). Maternal hemoglobin depletion in a settled northern Kenyan pastoral population. American Journal of Human Biology, 22, 768–774.
    1. Minakawa, N. , Mutero, C. M. , Githure, J. I. , Beier, J. C. , & Yan, G. (1999). Spatial distribution and habitat characterization of anopheline mosquito larvae in Western Kenya. The American Journal of Tropical Medicine and Hygiene, 61, 1010–1016.
    1. Moore, C. E. , Nget, P. , Saroeun, M. , Kuong, S. , Chanthou, S. , Kumar, V. , … Parry, C. M. (2015). Intestinal parasite infections in symptomatic children attending hospital in Siem Reap, Cambodia. PLoS One, 10, e0123719.
    1. Morceau, F. , Dicato, M. , & Diederich, M. (2009). Pro‐inflammatory cytokine‐mediated anemia: Regarding molecular mechanisms of erythropoiesis. Mediators of Inflammation, 2009(2009), 11 10.1155/2009/405016
    1. Mosites, E. , Thumbi, S. M. , Otiang, E. , McElwain, T. F. , Njenga, M. K. , Rabinowitz, P. M. , … Walson, J. L. (2016). Relations between household livestock ownership, livestock disease, and young child growth. The Journal of Nutrition, 146, 1118–1124.
    1. Murphy, S. P. , & Allen, L. H. (2003). Nutritional importance of animal source foods. The Journal of Nutrition, 133, 3932S–3935S.
    1. Naska, A. , Vasdekis, V. G. , & Trichopoulou, A. (2001). A preliminary assessment of the use of household budget survey data for the prediction of individual food consumption. Public Health Nutrition, 4, 1159–1165.
    1. Neumann, C. , Harris, D. M. , & Rogers, L. M. (2002). Contribution of animal source foods in improving diet quality and function in children in the developing world. Nutrition Research, 22, 193–220.
    1. Ngure, F. M. , Humphrey, J. H. , Mbuya, M. N. N. , Majo, F. , Mutasa, K. , Govha, M. , … Stoltzfus, R. J. (2013). Formative research on hygiene behaviors and geophagy among infants and young children and implications of exposure to fecal bacteria. The American Journal of Tropical Medicine and Hygiene, 89, 709–716.
    1. Nordenberg, D. , Yip, R. , & Binkin, N. J. (1990). The effect of cigarette smoking on hemoglobin levels and anemia screening. JAMA, 264, 1556–1559.
    1. Oberhelman, R. A. , Gilman, R. H. , Sheen, P. , Cordova, J. , Taylor, D. N. , Zimic, M. , … Price, L. J. (2003). Campylobacter transmission in a Peruvian shantytown: A longitudinal study using strain typing of campylobacter isolates from chickens and humans in household clusters. The Journal of Infectious Diseases, 187, 260–269.
    1. Oberhelman, R. A. , Gilman, R. H. , Sheen, P. , Cordova, J. , Zimic, M. , Cabrera, L. , … Perez, J. (2006). An intervention‐control study of corralling of free‐ranging chickens to control Campylobacter infections among children in a Peruvian periurban shantytown. The American Journal of Tropical Medicine and Hygiene, 74, 1054–1059.
    1. Oliveira, M. A. A. , & Osório, M. M. (2005). Consumo de leite de vaca e anemia ferropriva na infância. Jornal de Pediatria, 81, 361–367.
    1. Olney, D. K. , Pedehombga, A. , Ruel, M. T. , & Dillon, A. (2015). A 2‐year integrated agriculture and nutrition and health behavior change communication program targeted to women in Burkina Faso reduces anemia, wasting, and diarrhea in children 3–12.9 months of age at baseline: A cluster‐randomized controlled trial. The Journal of Nutrition, 145, 1317–1324. 10.3945/jn.114.203539
    1. Olney, D. K. , Talukder, A. , Iannotti, L. L. , Ruel, M. T. , & Quinn, V. (2009). Assessing impact and impact pathways of a homestead food production program on household and child nutrition in Cambodia. Food and Nutrition Bulletin, 30, 355–369.
    1. Osbjer, K. , Boqvist, S. , Sokerya, S. , Chheng, K. , San, S. , Davun, H. , … Magnusson, U. (2016). Risk factors associated with Campylobacter detected by PCR in humans and animals in rural Cambodia. Epidemiology and Infection, 144, 2979–2988.
    1. Osei, A. , Pandey, P. , Nielsen, J. , Pries, A. , Spiro, D. , Davis, D. , … Haselow, N. (2016). Combining home garden, poultry, and nutrition education program targeted to families with young children improved anemia among children and anemia and underweight among nonpregnant women in Nepal. Food and Nutrition Bulletin, 38, 49–64.
    1. Pasricha, S. R. , Drakesmith, H. , Black, J. , Hipgrave, D. , & Biggs, B. A. (2013). Control of iron deficiency anemia in low‐ and middle‐income countries. Blood, 121, 2607–2617.
    1. Petry, N. , Olofin, I. , Hurrell, R. F. , Boy, E. , Wirth, J. P. , Moursi, M. , … Rohner, F. (2016). The proportion of anemia associated with iron deficiency in low, medium, and high human development index countries: A systematic analysis of national surveys. Nutrients, 8 10.3390/nu8110693
    1. Prendergast, A. J. , Humphrey, J. H. , Mutasa, K. , Majo, F. D. , Rukobo, S. , Govha, M. , … Stoltzfus, R. J. (2015). Assessment of environmental enteric dysfunction in the SHINE Trial: Methods and challenges. Clinical Infectious Diseases, 61, S726–S732.
    1. Prendergast, A. J. , Rukobo, S. , Chasekwa, B. , Mutasa, K. , Ntozini, R. , Mbuya, M. N. N. , … Humphrey, J. H. (2014). Stunting is characterized by chronic inflammation in Zimbabwean infants. PLoS One, 9, e86928 10.1371/journal.pone.0086928
    1. Prüss‐Ustün, A. , Bartram, J. , Clasen, T. , Colford, J. M. , Cumming, O. , Curtis, V. , … Cairncross, S. (2014). Burden of disease from inadequate water, sanitation and hygiene in low‐ and middle‐income settings: A retrospective analysis of data from 145 countries. Tropical Medicine & International Health, 19, 894–905.
    1. Randolph, T. F. , Schelling, E. , Grace, D. , Nicholson, C. F. , Leroy, J. L. , Cole, D. C. , … Ruel, M. (2007). Invited review: Role of livestock in human nutrition and health for poverty reduction in developing countries. Journal of Animal Science, 85, 2788–2800.
    1. Rawlins, R. , Pimkina, S. , Barrett, C. B. , Pedersen, S. , & Wydick, B. (2014). Got milk? The impact of Heifer international's livestock donation programs in Rwanda on nutritional outcomes. Food Policy, 44, 202–213.
    1. Rutstein, S.O. , & Johnson, K. (2004). The DHS wealth index. Calverton, MD: ORC Macro.
    1. Shapira, N. (2009). Modified egg as a nutritional supplement during peak brain development: a new target for fortification. Nutrition and Health, 20, 107–118.
    1. SPRING, & Ghana Health Service (2016). Ghana: Landscape analysis of anemia and anemia programming. Arlington, VA: SPRING.
    1. Stekel, A. , Olivares, M. , Cayazzo, M. , Chadud, P. , Llaguno, S. , & Pizarro, F. (1988). Prevention of iron deficiency by milk fortification. II. A field trial with a full‐fat acidified milk. The American Journal of Clinical Nutrition, 47, 265–269.
    1. Stevens, G. A. , Finucane, M. M. , De‐Regil, L. M. , Paciorek, C. J. , Flaxman, S. R. , Branca, F. , … Ezzati, M. (2013). Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non‐pregnant women for 1995–2011: A systematic analysis of population‐representative data. Lancet Globalization and Health, 1, e16–e25.
    1. Tengco, L. W. , Rayco‐Solon, P. , Solon, J. A. , Sarol, J. N. Jr. , & Solon, F. S. (2008). Determinants of anemia among preschool children in the Philippines. Journal of the American College of Nutrition, 27, 229–243.
    1. Vasco, K. , Graham, J. P. , & Trueba, G. (2016). Detection of zoonotic enteropathogens in children and domestic animals in a semirural community in Ecuador. Applied and Environmental Microbiology, 82, 4218–4224.
    1. Villalpando, S. , Shamah, T. , Rivera, J. A. , Lara, Y. , & Monterrubio, E. (2006). Fortifying milk with ferrous gluconate and zinc oxide in a public nutrition program reduced the prevalence of anemia in toddlers. The Journal of Nutrition, 136, 2633–2637.
    1. Wagstaff, A. , Bustreo, F. , Bryce, J. , Claeson, M. , & The WHO–World Bank Child Health and Poverty Working (2004). Child health: Reaching the poor. American Journal of Public Health, 94, 726–736.
    1. Weatherall, D. J. (2001). The thalassemias In Beutler B., Lichtman M. A., Coller B. S., Kipps T. J., & Seligsohn S. (Eds.), Williams hematology (6th ed.) (pp. 562–564). New York, NY: McGraw‐Hill.
    1. Weiss, G. , & Goodnough, L. T. (2005). Anemia of chronic disease. The New England Journal of Medicine, 352, 1011–1023.
    1. Weisz, A. J. , Manary, M. J. , Stephenson, K. , Agapova, S. , Manary, F. G. , Thakwalakwa, C. , … Manary, M. J. (2012). Abnormal gut integrity is associated with reduced linear growth in rural Malawian children. Journal of Pediatric Gastroenterology and Nutrition, 55, 747–750.
    1. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation . Improved and unimproved water sources and sanitation facilities. Retrieved from .
    1. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation . Millennium development goals indicators. proportion of population using an improved drinking water source. Retrieved from .
    1. Wilson, T. , Pearson, A. , Bradbear, N. , Jayasuriya, A. , Laswai, H. , Mtenga, L. , … Smith, R. (2005). Livestock products–Valuable and more valuable In Owen E. A., Kitalyi A., Jayasuriya N., & Smith T. (Eds.), Livestock and wealth creation: Improving the husbandry of animals kept by resource‐poor people in developing countries (pp. 109–126). Nottingham, UK: Nottingham University Press.
    1. Wirth, J. P. , Rohner, F. , Woodruff, B. A. , Chiwile, F. , Yankson, H. , Koroma, A. S. , … Hodges, M. H. (2016). Anemia, micronutrient deficiencies, and malaria in children and women in sierra leone prior to the ebola outbreak—Findings of a cross‐sectional study. PLoS One, 11, e0155031.
    1. World Health Organization (2011). Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva, Switzerland: World Health Organization.
    1. World Health Organization (2015). The global prevalence of anaemia in 2011. Geneva, Switzerland: World Health Organization.
    1. Zambrano, L. D. , Levy, K. , Menezes, N. P. , & Freeman, M. C. (2014). Human diarrhea infections associated with domestic animal husbandry: A systematic review and meta‐analysis. Transactions of the Royal Society of Tropical Medicine and Hygiene, 108, 313–325.
    1. Ziegler, E. E. (2011). Consumption of cow's milk as a cause of iron deficiency in infants and toddlers. Nutrition Reviews, 69, S37–S42.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel