The Healthy Baby Flipbook: piloting home-based counseling for refugee mothers to improve infant feeding and water, sanitation, and hygiene (WASH) practices

Evidence on Strategies for Integrating Nutrition Interventions with Health and Immunization Systems in Conflict-affected Areas of Low- and Lower-middle-income Settings-A Systematic Review

CONTEXT

Pervasive conflict and war adversely affect a nation's sustainable development. Health and health systems deteriorate, causing long-lasting impacts on diets and nutrition. For the most vulnerable, integrated models of delivery of essential nutrition interventions are critical for the efficiency and sustainability of programs in these settings.

OBJECTIVE

The objective of this systematic review was to provide evidence on coverage, utilization, and impact of integrated programs in conflict-affected, low- and middle-income countries (LMICs).

DATA SOURCES

A database search was conducted in MEDLINE, Embase, CINAHL, and CENTRAL from January 1, 2000 to February 14, 2024. Gray literature was also reviewed.

DATA EXTRACTION

Quantitative and qualitative studies, including observational or intervention designs, and reviews and program evaluations conducted in LMICs, focusing on women (≥19 years) and children (0-19 years) were included. Data extraction and risk-of-bias assessment were conducted independently by 2 investigators using a standardized tool.

DATA ANALYSIS

In total, 93 studies (103 reports) were included from 25 countries, including 32 unique gray literature records. The conflict-affected regions included South-East Asia (n = 27), Eastern-Mediterranean (n = 8), Africa (n = 58), and the Americas (n = 1). The review distinguished programs based on nutrition-specific, nutrition-sensitive, and health components. Although the coverage and utilization of integrated nutrition and health programs has been substantial, the impact of the strategies on health and nutrition has been limited. The meta-analysis found no significant differences in rates of wasting among children under 5 years; however, it showed that children who received an integrated strategy experienced a 28% lower risk of underweight (P = .007) and a 12% reduced risk of stunting (P = .05) compared with those who did not.

CONCLUSION

This review has provided an in-depth insight into integrated nutrition and health strategies in conflict-affected settings, identifying key facilitators and barriers that can inform future policy and program design. Integrating nutrition programs into health systems and enhancing government and community ownership could enhance efficiency and sustainability, given challenging environments.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration No. CRD42022373993.

Predictors of Neonatal Jaundice Admissions: A Comparative Study Between Thai and Myanmar Mothers Residing in Thailand

Purpose

This study aimed to explore the relationship between maternal health literacy, preventive practices, and neonatal jaundice admissions among Thai and Myanmar mothers.

Patients and Methods

A cross-sectional predictive design was employed with 400 mothers of full-term infants, including 200 Thai and 200 Myanmar mothers, recruited from a provincial hospital in Thailand. Data were collected in two phases: baseline demographic and clinical data were obtained before discharge, and maternal health literacy and preventive practices were assessed post-discharge when infants were 4-5 days old. Logistic regression was used to examine associations between maternal health literacy, preventive practices, and neonatal jaundice admissions, adjusting for covariates such as maternal age and education.

Results

Maternal health literacy and preventive practices were significantly associated with reduced neonatal jaundice admissions among Thai mothers. However, after adjusting for covariates, these factors were not independent predictors, suggesting that Thailand's universal healthcare and postpartum education programs mitigate individual limitations. For Myanmar mothers, maternal health literacy was the sole significant predictor of neonatal jaundice admissions, reflecting its critical role in resource-limited settings. Preventive practices were not significant predictors, likely due to systemic barriers such as language challenges, limited healthcare access, reliance on traditional remedies, and insufficient skills to observe and manage early signs of neonatal jaundice effectively.

Conclusion

Maternal health literacy plays a pivotal role in shaping neonatal jaundice outcomes, particularly for immigrant mothers in resource-limited contexts. Strengthening bilingual education, culturally tailored healthcare support, and expanding resources for migrant populations are essential to reducing disparities and improving neonatal outcomes in low- and middle-income countries.

The effect of home nurse visits on infant weight and breastfeeding: Systematic review and meta-analysis

AIMS

The primary aim of this systematic review and meta-analysis is to evaluate the effects of home nurse visiting on infant weight and breastfeeding; the secondary aim is to determine the duration, frequency and content of home visits.

METHODS

A systematic search of the PubMed, CINAHL, Embase (Ovid), Web of Science, Google Scholar and DergiPark databases for publications between September 2000 and January 2019 was conducted using established methods in compliance with the PRISMA-P declaration guideline. Two authors independently evaluated the studies for inclusion and bias, extracted the data and checked their accuracy.

RESULTS

This meta-analysis includes a total of 34 studies, 28 on breastfeeding and nine on infant weight. The average effect size of the 28 studies investigating the effect on breastfeeding was found to be OR: 2.24; 95% CI: 1.73-2.90; p < 0.001. The average effect size of the nine studies investigating the effect on infant weight was found to be ES: 0.197; 95% CI: 0.027-0.368; p < 0.05.

CONCLUSION

There is an association between nurse home visits and breastfeeding and infant weight. Home visits by nurses should continue to remain within the nursing role and be analysed appropriately for mother and baby health.

Food Security Interventions among Refugees around the Globe: A Scoping Review

There are 26 million refugees globally, with as many as 80% facing food insecurity irrespective of location. Food insecurity results in malnutrition beginning at an early age and disproportionately affects certain groups such as women. Food security is a complex issue and must consider gender, policies, social and cultural contexts that refugees face. Our aim is to assess what is known about food security interventions in refugees and identify existing gaps in knowledge. This scoping review followed the guidelines set out in the PRISMA Extension for Scoping Reviews. We included all articles that discussed food security interventions in refugees published between 2010 and 2020. A total of 57 articles were eligible for this study with most interventions providing cash, vouchers, or food transfers; urban agriculture, gardening, animal husbandry, or foraging; nutrition education; and infant and young child feeding. Urban agriculture and nutrition education were more prevalent in destination countries. While urban agriculture was a focus of the FAO and cash/voucher interventions were implemented by the WFP, the level of collaboration between UN agencies was unclear. Food security was directly measured in 39% of studies, half of which used the UN's Food Consumption Score, and the remainder using a variety of methods. As substantiated in the literature, gender considerations are vital to the success of food security interventions, and although studies include this in the planning process, few see gender considerations through to implementation. Including host communities in food security interventions improves the refugee-host relationship. Collaboration should be encouraged among aid organizations. To assess intervention efficacy, food security should be measured with a consistent tool. With the number of refugees in the world continuing to rise, further efforts are required to transition from acute aid to sustainability through livelihood strategies.

Environmental health conditions in the transitional stage of forcible displacement: A systematic scoping review

In 2019, 30,000 people were forced to leave their homes due to conflict, persecution, and natural disaster each day. Eighty-five percent of refugees live in developing countries, and they often face underfunded and inadequate environmental health services. Many displaced persons live in camps and other temporary settlements long after the displacement event occurs. However, there is little evidence on environmental health conditions in the transitional phase-defined by the United Nations High Commissioner for Refugees as six months to two years after displacement. To address this gap in research, we conducted a systematic scoping review of environmental health conditions, exposures, and outcomes in transitional displacement settings, as well as reported obstacles and recommendations for improvement. Eighty-eight publications met the inclusion criteria. Water supply was the most frequently discussed environmental health topic. Overcrowding was the most common risk factor reported, Vibrio cholerae was the most common pathogen reported, and diarrhea was the most commonly reported health outcome. Obstacles and recommendations were categorized as institutional, political or implementation-based. Identified knowledge gaps included minimal information on setting logistics and on topics such as menstrual hygiene, oral hygiene and fomite contamination. In order to improve environmental health conditions in transitional displacement settings, all levels of government and non-governmental organizations should increase collaboration to improve resource provision. This study is the first to report on environmental health conditions in this important time of transition between the emergency and protracted stages of displacement.

Feeding practices and risk factors for chronic infant undernutrition among refugees and migrants along the Thailand-Myanmar border: a mixed-methods study

BACKGROUND

This study aims to provide a comprehensive understanding of maternal risk factors, infant risk factors and maternal infant feeding practices among refugees and migrants along the Thailand-Myanmar border.

METHODS

This study employed a mixed-methods approach with two components: (1) cross-sectional survey (n = 390) and (2) focus group discussions (n = 63). Participants were chosen from one of three clinics providing antenatal and delivery services for Karen and Burman refugees and migrants along the border. Participants were pregnant women and mother-infant dyads.

RESULTS

Refugee and migrant mothers demonstrated high rates of suboptimal breastfeeding and low rates of minimum dietary diversity and acceptable diet. Multivariable regression models showed infant stunting (AOR: 2.08, 95% CI: 1.12, 3.84, p = 0.020) and underweight (AOR: 2.26, 95% CI: 1.17, 4.36, p = 0.015) to have increased odds among migrants, while each 5 cm increase in maternal height had decreased odds of stunting (AOR: 0.50, 95% CI: 0.38, 0.66, p < 0.001) and underweight (AOR: 0.64, 95% CI: 0.48, 0.85, p = 0.002). In addition, small-for-gestational-age adjusted for length of gestation, infant age and gender increased odds of infant's stunting (AOR: 3.42, 95% CI: 1.88, 6.22, p < 0.001) and underweight (AOR: 4.44, 95% CI: 2.36, 8.34, p < 0.001). Using the Integrated Behavioural Model, focus group discussions explained the cross-sectional findings in characterising attitudes, perceived norms, and personal agency as they relate to maternal nutrition, infant malnutrition, and infant feeding practices.

CONCLUSIONS

Inadequate infant feeding practices are widespread in refugee and migrant communities along the Thailand-Myanmar border. Risk factors particular to maternal nutrition and infant birth should be considered for future programming to reduce the burden of chronic malnutrition in infants.