Effectiveness of nutritional supplementation during the first 1000-days of life to reduce child undernutrition: A cluster randomized controlled trial in Pakistan

Effect of nutrition-related infodemics and social media on maternal experience: A nationwide survey in a low/middle income country

BACKGROUND

Undernutrition is a crucial cause of morbidity and mortality among children in low- or middle-income countries (LMICs). A better understanding of maternal general healthy nutrition knowledge, as well as misbeliefs, is highly essential, especially in such settings. In the current era of infodemics, it is very strenuous for mothers to select not only the right source for maternal nutrition information but the correct information as well.

AIM

To assess maternal healthy nutritional knowledge and nutrition-related misbeliefs and misinformation in an LMIC, and to determine the sources of such information and their assessment methods.

METHODS

This cross-sectional analytical observational study enrolled 5148 randomly selected Egyptian mothers who had one or more children less than 15 years old. The data were collected through online questionnaire forms: One was for the general nutrition knowledge assessment, and the other was for the nutritional myth score. Sources of information and ways of evaluating internet sources using the Currency, Relevance, Authority, Accuracy, and Purpose test were additionally analyzed.

RESULTS

The mean general nutrition knowledge score was 29 ± 9, with a percent score of 70.8% ± 12.1% (total score: 41). The median myth score was 9 (interquartile range: 6, 12; total score: 18). The primary sources of nutrition knowledge for the enrolled mothers were social media platforms (55%). Half of the mothers managed information for currency and authority, except for considering the author's contact information. More than 60% regularly checked information for accuracy and purpose. The mothers with significant nutrition knowledge checked periodically for the author's contact information (P = 0.012). The nutrition myth score was significantly lower among mothers who periodically checked the evidence of the information (P = 0.016). Mothers dependent on their healthcare providers as the primary source of their general nutritional knowledge were less likely to hold myths by 13% (P = 0.044). However, using social media increased the likelihood of having myths among mothers by approximately 1.2 (P = 0.001).

CONCLUSION

Social media platforms were found to be the primary source of maternal nutrition information in the current era of infodemics. However, healthcare providers were the only source for decreasing the incidence of maternal myths among the surveyed mothers.

Lipid-based nutrient supplements for prevention of child undernutrition: when less may be more

BACKGROUND

Both small-quantity and medium-quantity lipid-based nutrient supplements (LNS) have been used for the prevention of child undernutrition. A meta-analysis of 14 trials of small-quantity lipid-based nutrient supplements (SQ-LNS) - no LNS showed effects on length-for-age z-score {LAZ, +0.14 [95% confidence interval (CI): 0.11, 0.16]} and weight-for-length z-score [WLZ, +0.08 (0.06, 0.10)] z-scores, as well as prevalence ratios (95% CI) for stunting [LAZ < -2, 0.88 (0.85, 0.91)] and wasting [WLZ < -2, 0.86 (0.80, 0.93)]. However, little is known about the effects of medium-quantity lipid-based nutrient supplements (MQ-LNS) on growth.

OBJECTIVES

We aimed to examine the effects of preventive MQ-LNS (∼250-499 kcal/d) provided at ∼6-23 mo of age on growth outcomes - no LNS or provision of SQ-LNS.

METHODS

We conducted a systematic review of studies of MQ-LNS for prevention, and categorized them as providing <6 mo - ≥6 mo of supplementation; for the latter category, we conducted a meta-analysis, with the main outcomes being change in WLZ and LAZ, and prevalence of wasting and stunting.

RESULTS

Three studies provided MQ-LNS for 3-5 mo (seasonal) for children 6-36 mo of age, and did not show consistent effects on growth outcomes. Eight studies provided MQ-LNS for 6-18 mo, generally starting at 6 mo of age; in the meta-analysis (max total n = 13,954), MQ-LNS increased WLZ [+0.09 (95% CI: 0.05, 0.13)] and reduced wasting [0.89 (0.81, 0.97)], but had no effect on LAZ [+0.04 (-0.02, 0.11)] or stunting [0.97 (0.92, 1.02)] - no LNS. Two studies directly compared SQ-LNS and MQ-LNS and showed no significant differences in growth outcomes.

CONCLUSIONS

The current evidence suggests that MQ-LNS offer no added benefits over SQ-LNS, although further studies directly comparing MQ-LNS with SQ-LNS would be useful. One possible explanation is incomplete consumption of the MQ-LNS ration and thus lower than desirable intake of certain nutrients.

TRIAL REGISTRATION NUMBER

Registry and registry number for systematic reviews or meta-analyses: Registered with PROSPERO as CRD42022382448 on December 18, 2022: =https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022382448.

Development and validation of the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa

BACKGROUND

In Sub-Saharan Africa, the nutritional status of children born to teenage mothers deserves critical attention. Maternal knowledge and attitudes concerning infant and young child feeding (IYCF) may predict actual practices and child nutritional status. This study created and validated the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa.

METHODS

A literature search on IYCF knowledge and attitude gaps in teenage mothers generated scale items. Ten nutrition experts and six teenage mothers assessed content validity and comprehensibility, respectively. Construct validation was conducted by item response theory (IRT) and confirmatory factor analysis (CFA), in 150 teenage mothers in rural communities of Abuja, Nigeria. Model fit parameters were estimated by standardized chi-square tests. Internal consistency reliability was determined by marginal reliability and Cronbach's alpha. In a sub-sample of 40 women who completed the questionnaire two weeks later, test-retest reliability was assessed via intraclass correlations.

RESULTS

The IRT analysis retained 23 knowledge items on infant food type, breastfeeding and complementary feeding, with acceptable discrimination and difficulty. CFA produced a six-factor solution (exclusive breastfeeding, breast milk expression, meal frequency, responsive feeding, dietary diversity, and barriers) with 17 attitude items. Confirmatory fit and Tucker Lewis indices > 0.9; Root Mean Square Errors of Approximation and Standardized Root Mean Square Residuals < 0.08, showed good model fit. Overall Cronbach's alpha of the attitude scale (0.843), subscales (≥ 0.6) and high intraclass correlation coefficients (> 0.75) indicated reliability.

CONCLUSION

The Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa is a valid assessment tool for IYCF knowledge and attitudes of teenage mothers.

Drivers of Nutritional Change in Pakistan: A Decomposition Analysis

The global reduction in child undernutrition highlights the international and national commitment to prioritizing future generations' health. This study aims to find out the previous trends in nutrition and the key drivers of these changes in different regions of Pakistan. For empirical investigation, we employed a regression-based decomposition model by using two distinct rounds of demographic and health surveys: 2012-13 and 2017-18. Results showed children with stunted growth reduced substantially in Balochistan, while Punjab exhibited the highest progress for underweight children. Regression estimates showed that maternal nutritional status and household wealth were more pronounced in reducing all measures of child malnutrition. Some determinants, including mother age at marriage and prenatal visits to the hospital, are significant only for long-term nutritional status-stunting, while mother education contributed to reducing wasted and underweight children. The rest of the factors, like father education and household environment, appear to play a humble role in explaining nutritional improvements. From disaggregated analysis based on different regions, we found that modeled factors used in this study explained changes disproportionately. Thus, it is recommended to use multidimensional nutrition policies incorporating a broader range of sectors, and region-specific programs should be designed for more effective outcomes.