Mother's nutrition-related knowledge and child nutrition outcomes: Empirical evidence from Nigeria

Factors Influencing Wasting in Children Under 5 in Arid Regions of Kenya

Child wasting is a major public health problem in low- and middle-income countries. Our study aimed to identify immediate, underlying and basic factors influencing wasting among children in Turkana and Samburu, two arid and semi-arid regions in Kenya. Data are from a longitudinal study of children under 3 years of age at baseline, with follow-up every 4 months for 2 years. Generalized estimating equations were used to assess risk factors of wasting in this population. Among immediate factors, children who recently experienced diarrhoea had 19% and 23% higher odds of wasting, and those who consumed animal-source foods had 12% and 22% lower odds of wasting in Turkana and Samburu, respectively. Among underlying factors, children in Turkana whose caregivers used alcohol had 32% higher odds of wasting, whereas there was no effect of household food insecurity or factors related to water and sanitation on wasting in either county. Children in Turkana whose caregivers had 3-5 or 6 or more children had 39% and 70% higher odds, whereas those in female-headed households had 34% and 81% higher odds of wasting in Turkana and Samburu, respectively. Male children also had increased odds of wasting; 21% and 41% in Turkana and Samburu, respectively. Children in Turkana's fisherfolk communities had 36% higher odds of wasting compared with those in urban or peri-urban areas. Key risk factors for wasting included child sex, reported diarrhoea, caregiver's use of alcohol (in Turkana), caregiver's number of children, female-headed households and fisherfolk livelihood (in Turkana) while consuming animal-source foods was associated with lower risk. Interventions should target these intersecting factors to reduce wasting in these counties.

Investigating the correlations between nutrition literacy of mothers and offspring physical growth and development, dietary diversity and quality, and vitamin levels

OBJECTIVE

To investigate the relationship between nutrition literacy (NL) of mothers and physical growth and development, dietary diversity and quality, and vitamin levels of their children aged 24-59 months.

METHODS

A cross-sectional survey-based study was conducted at well-child outpatient clinic. Eighty-eight mother-child pairs included. Mother's Evaluation Instrument of Nutrition Literacy for Adults (EINLA) scores and child anthropometric z-scores, age when reaching six gross motor milestones, dietary diversity and the Mediterranean Diet Quality Index scores, and serum vitamin A, B1, B2, B12, C, D, and E levels were measured. Two independent groups comparison statistics and Spearman rank correlations were performed.

RESULTS

Thirty-four mothers (38.6%) had borderline and 54 mothers (61.4%) had adequate NL level. The percentages of wasted and acutely malnourished children were higher in the borderline NL group (17.6% vs. 1.9%, p=0.005 and 14.7% vs. 1.9%, p=0.030, respectively). There was no significant correlation between maternal EINLA score and child motor skill acquisition, dietary diversity, or serum vitamin status (p>0.05). There was a correlation between maternal EINLA score and child dietary quality score (r=0.218, p=0.041).

CONCLUSION

Increasing NL of mothers may be a step toward improving the dietary quality of children and reducing the burden of child undernutrition.

A Process Evaluation Revealed That Flexibility Was Key to Delivering Nutrition Education to Vulnerable Tribal Groups in India

BackgroundThis study is a process evaluation of a nutrition education intervention that is part of a large-scale development program targeting vulnerable tribal groups in Odisha, India.ObjectiveThe objectives are to examine whether the intervention is operating as planned (implementation fidelity), investigate potential pathways to achieve greater impact, and provide recommendations on how to design nutrition education interventions in similar contexts.MethodsA program impact pathway forms the basis of this process evaluation, tracing inputs, processes, outputs, outcomes, and impacts. The study's mixed-methods approach includes semistructured interviews, focus group discussions, and Process Net-Mapping. Narrative analysis was applied to examine the transcripts. Data were analyzed in the context of the program impact pathway.ResultsThe intervention was not delivered as intended (low implementation fidelity). Flexibility was key in providing nutrition education to beneficiaries despite challenges, such as the inability to utilize behavior change communication, inadequate funding, and language and cultural barriers. Despite low fidelity, the qualitative results show that the intervention improved awareness of nutrition and health among beneficiaries.ConclusionsProviding adequate resources for training frontline workers and beneficiaries is required for nutrition education programs to achieve their desired effectiveness and impact. Utilizing existing organizations, integration into production-based interventions, and incorporating easy-to-understand nutrition models, practical demonstrations, and videos would increase frontline worker and beneficiary engagement and understanding, leading to improved maternal and child nutritional and health outcomes.

What Do Mothers Know About Nutrition? Impacts on Childhood Nutrition Outcomes in Sub-Saharan Africa

INTRODUCTION

Globally, the prevalence of undernutrition is highest in the sub-Saharan African region with over a third of the world's stunted children residing in this region. Many studies have explored child nutrition in sub-Saharan Africa, but they often overlook the intricate nuances of maternal knowledge. We examined the association between maternal nutritional knowledge and childhood nutritional outcomes.

METHODS

This was a secondary analysis utilizing data from the Demographic and Health Survey of eight sub-Saharan African countries that were conducted between 2019 and 2022, focusing on children aged 6 to 23 months. The study used latent class analysis to identify discrete patterns of nutrition and health-related knowledge and mixed-effects logistic regression to assess their association with childhood nutritional outcomes namely, stunting and wasting. Statistical significance was determined at p < 0.05.

RESULTS

Most participants knew the importance of colostrum (76.8%) and continued breastfeeding (76.7%), as well as immunization (60.0%) and diarrhoea prevention and treatment strategies (65.1%). However, only 24.49% knew about family planning. Children of high knowledge group/class had a 17% lower risk of childhood stunting (crude model; COR = 0.83; 95%CI: 0.77, 0.90, adjusted model; AOR = 0.89; 95%CI: 0.82, 0.97) and a 22% lower risk of wasting (COR = 0.78; 95%CI: 0.69, 0.89, adjusted model; AOR = 0.84; 95%CI: 0.73, 0.96) compared to those from the low knowledge group/class.

CONCLUSION

These results highlight the pivotal role of maternal knowledge in shaping children's health outcomes and emphasize the urgent need for targeted interventions and comprehensive maternal education programs to address the identified knowledge gaps and improve child health outcomes.

Development and validation of a food and nutrition literacy questionnaire for Chinese parents of children with functional constipation (FNLQ-p)

Objectives

Childhood functional constipation is a widespread condition with a global prevalence. Dietary interventions play a crucial role in the management of childhood constipation. Hence, the development and validation of a specialized food and nutrition literacy assessment tool for parents of school-aged children with functional constipation is of paramount significance.

Methods

On the basis of literature review, the first draft was formed, and the results of expert correspondence and pre survey were combined to delete and modify the first draft. In the second stage, 459 parents of school-age children with constipation were invited to fill out the questionnaire. Item analysis, exploratory factor analysis, and confirmatory factor analysis were then conducted to assess the questionnaire's reliability and validity.

Results

The final scale comprises 4 dimensions and 25 items. Exploratory factor analysis extracted four common factors (nutrition knowledge, nutrition skills, nutrition interaction, nutrition evaluation), and the cumulative variance contribution rate was 64. 532%. The content validity index (I-CVI) of each item level is 0.86-1, the content validity index (S-CVI) at the scale level is 0.96. The overall Cronbach'sα coefficient was 0.85. Confirmatory factor analysis supported the four-factor structure derived from exploratory analysis, with all relevant fit indices meeting standard criteria.

Conclusions

The food and nutrition literacy questionnaire developed in our study had good validity and reliability, making it a useful tool for assessing the food and nutrition literacy among parents of school-aged children diagnosed with functional constipation.

Does Mother's Nutritional Knowledge Level Affect Anthropometric Measurements of 0-2 Year Old Infants?

The objective of this study was to investigate the relationship between maternal nutritional knowledge and anthropometric indices in children under 2 years of age. The Infant Nutrition Attitude Scale (IOWA) was administered to all participated mothers. The IOWA was developed to assess women's attitudes toward breastfeeding and their choice of infant feeding method. The IOWA score of mothers who fed their infants only formula and only complementary foods was found to be statistically significantly lower than the IOWA score of mothers who breastfed (p < .05). In summary, the higher the IOWA score, the longer the duration of breastfeeding. No statistically significant correlation was found between the IOWA and infants' anthropometric measurements (p > .05).

Mother's education and nutritional status as correlates of child stunting, wasting, underweight, and overweight in Nigeria: Evidence from 2018 Demographic and Health Survey

Aim: This study examined the nexus between mother's education and nutritional status and their relationships with child stunting, wasting, underweight, and overweight. Methods: The data of 34,193 under-five (U-5) children from the 2018 Nigeria Demographic and Health Survey (NDHS) were analyzed using descriptive statistics, and binary and complementary log-logistic regression models. Results: The prevalence of child stunting, wasting, underweight, and overweight were 36.51%, 6.92%, 21.73%, and 2.05%, respectively. Compared to children born to mothers with at least secondary education, uneducated women's children (odds ratio (OR) = 1.55; 95% confidence interval (CI) = 1.32-1.82) and those of women with primary education (OR = 1.49; 95% CI = 1.28-1.72) were more likely to be stunted. Similarly, children born to uneducated women (OR = 1.51; 95% CI = 1.24-1.83) were more likely to be underweight than women with at least secondary education. The likelihood of child underweight (OR = 1.71; 95% CI = 1.45-2.01) and wasting (rate ratio (RR) = 1.82; 95% CI = 1.47-2.26) were higher among underweight mothers, respectively, than those with normal body mass index (BMI). The likelihood of child stunting (OR = 0.75; 95% CI = 0.67-0.84) and underweight (OR = 0.66; 95% CI = 0.57-0.77) were lower among obese/overweight mothers compared to those with normal BMI, but their children were more likely to be overweight (RR = 1.77; 95% CI = 1.27-2.48). Conclusion: Attainment of higher education by mothers should be promoted to prevent childhood nutritional imbalances, and sensitization on healthy dietary habits and lifestyles should be promoted among women, especially the overweight/obese, to reduce their risk of having overweight children.

Temporal variation of chronic child malnutrition in the context of strengthening healthcare services in Burkina Faso: an Oaxaca-Blinder multivariate decomposition analysis

Malnutrition seriously affects children's health, survival, and future productivity. According to the literature, increasing the supply of health services should help reduce the spread of malnutrition. This article analyses the sources of changes in the decline of chronic malnutrition during the 2000s, where there was an increase in the supply of health services in Burkina Faso. We used data from demographic and health surveys conducted in 2003 and 2010 in Burkina Faso. Malnutrition was defined according to the recommendations of the World Health Organization, while using standards of growth which are current and uniform for the two periods of study considered. We analyzed the source of temporal variation of chronic malnutrition through the Oaxaca-Blinder multivariate decomposition of the proportion of children suffering from chronic malnutrition. The analyses showed that the relative extent of chronic malnutrition in children decreased significantly, from 43.4% (CI 95%: 42.3-44.4) in 2003 to 34.7% (CI 95%: 33.6-35.9) in 2010. A quarter of this variation is due to a change in characteristics (composition effect), and the remaining 74.74% is due to a difference in coefficients (performance or behavior effect). Improved access to health services played a crucial role in reducing the scale of chronic malnutrition between 2003 and 2010. Other factors, such as educating mothers and urbanization, also contributed significantly. This study shows that improving access to health services is crucial for reducing chronic malnutrition. So, programs tackling child malnutrition must first and foremost ensure that children have access to health services.

Minimum acceptable diet and associated factors among children aged 6-23 months in Ethiopia: a systematic review and meta-analysis

BACKGROUND

To ensure a child's full growth, health, and development during infancy and the early years, adequate nutrition is crucial. A crucial window of opportunity for ensuring children's proper growth and development through adequate eating exists during the first two years of life. According to the evidence of the efficacy of interventions, achieving universal coverage of optimal breastfeeding could prevent 13% of deaths in children under the age of 5 worldwide, and using complementary feeding methods appropriately would lead to an additional 6% decrease in under-five mortality.

METHODS

From several electronic databases, all published, unpublished, and gray literature was extracted and exported into EndNote version X20. For further analysis of the review, the retrieved data from the excel sheet were imported into the statistical software program Stata version. Metanalysis was used to determine the prevalence of MAD, and a random effects model was used to estimate the pooled prevalence of MAD. The DerSimonian-Laird Random effects model (REM) was used to combine the determinant factors from all qualifying papers for the meta-analysis, and the heterogeneity was independently assessed using a χ2 test, Q statistics, and matching I2 statistics. To retrieve the extent of publication bias, funnel plots were scattered and tested for asymmetry and, additionally, Egger's test was computed with the user-written "meta bias" command in Stata (version 11) software. To end, sensitivity analyses with trim and fill were performed.

RESULTS

The pooled estimate of the overall prevalence of minimum acceptable diet in 16 studies in Ethiopia was 22% with (95% CI: 16, 28%) with a random effect model. However, eight papers were filled during trim and fill in order to counteract the small study effect. The overall filled pooled estimate was 7.9% with (95%CI: 11, 14.8%). Maternal education (primary and secondary) is 1.714 (95% CI 1.244,2.363) and 2.150(95% CI: 1.449,3.190), respectively, Ages of children with range of 12-17 months (2.158 (95% CI 1. 9,3.006) and 18-23 months 2.948(95% CI: 1.675,5.190)), Nutrition information ((1.883 (95% CI 1.169,3.032)) media exposure (1.778(95% CI: 1.396,2.265), and maternal knowledge (2.449 (95% CI 1.232, 5.027) were significantly associated with MAD.

CONCLUSION

The pooled estimate of the overall prevalence of minimum acceptable diet in 16 studies in Ethiopia were low. Maternal education (primary and secondary), ages of child with range of 12-17 month and 18-23 months, mothers having nutrition information, mothers who have media exposure,and mothers having good knowledge were significantly associated with Minimum acceptable diet. The government, NGO, and other stakeholders should focus on improving Minimum acceptable diet among 6 to 23 months of children through promoting with mass media, focuses on nutrition council during critical contact point in health facility, and doing capacity building for the mothers/caregivers.

Nutrition knowledge and health vulnerability of mothers of pre-school children in north-central, Nigeria

OBJECTIVE

This study explores the contribution of nutrition knowledge to the health status of pre-school children's mothers in Niger State, North-Central, Nigeria.

DESIGN

The study is a descriptive cross-sectional design using a quantitative data collection method.

SETTING/PARTICIPANTS

A multi-stage sampling technique was used to recruit 450 mothers of pre-school children across Niger state, Nigeria. Chi-square and linear regression were used to test the level of statistical significance (at p < 0.05). Socioeconomic and demographic information, anthropometric indices and nutrition knowledge were obtained using semi-structured questionnaires. Feeding patterns were also assessed using a qualitative 7-day dietary recall.

RESULT

The results showed that the majority (63.8%) of the mothers were within 26-35 years, and more than half (51.6%) of the mothers lacked knowledge of a "balanced diet". Fruits, vegetables, and dairy products were the least consumed food group among the mothers (7.1% and 9.1%, respectively). Place of residence, occupation, and method of waste disposal were significantly associated with maternal minimum dietary diversity adequacy (p<0.05). Over half (57.6%) of the mothers were within the normal BMI range, and the mean waist/hip ratio was 0.82± 0.08. Social media/online was the most (36.4%) explored source of nutrition information among the mothers. This study shows no significant association between nutrition knowledge and adequacy of minimum dietary diversity among the mothers of preschool children (p = 0.09, χ2 = 13.682).

CONCLUSION

Dietary diversity among mothers was associated with the socioeconomic status and BMI of the mothers, which were strong determinants of meal quality and health outcomes in Nigeria and other developing countries experiencing food insecurity.

An overview of the nutritional status of childbearing age women, children and adolescents living in a rural area of Madagascar: preliminary results of the Tany Vao project

OBJECTIVE

To describe the food consumption, nutrition knowledge and nutritional assessment of childbearing age women and their children, living in rural villages in Madagascar. The results presented are related to the Tany Vao research study.

DESIGN

A cross-sectional pilot study.

SETTING

The study was carried out in Ampanitosoha village on Nosy Mitsio island in Madagascar.

PARTICIPANTS

32 women (14-49 years) and 36 children and adolescents (2-17 years).

RESULTS

70 % of the women lacked nutrition knowledge and did not reach the Minimum Dietary Diversity Index for Women cut-off. The median BMI was 21·1 kg/m2 but 55·2 % of the women exceeded the cut-off for waist-to-hip ratio, 51·7 % for waist-to-height ratio and 81·2 % for mid-upper arm circumference (MUAC). Almost all had adequate intake of energy, protein and carbohydrates, while 27·6 % had excessive fat intake and 75·9 % of added sugars. Over half of the women did not meet the micronutrients Reference Daily Intake (RDI). For children, the MUAC z-score was lower for boys than for girls (P-value = 0·041).

CONCLUSIONS

These results underline the importance of increasing women's nutritional knowledge to promote healthy pregnancy and lactation. Moreover, it is fundamental to provide people living in rural areas with sustainable tools to improve dietary diversity and support long-term health.

Factors associated with child and maternal dietary diversity in the urban areas of Bangladesh

Dietary diversity is an indicator of nutrition that has been found positively associated with diet quality, micronutrient adequacy, and improved maternal health and child growth. Due to the cultural responsibility of women in providing food at the household level, their status is very important to perform this role. Hence, this study has been conducted on the status of dietary diversity of the mother and child to understand how it relates to various factors of women in urban settings. Data were obtained from 1978 mother-child pairs living in different cities in Bangladesh. The foods taken by the women and children were categorized into 10 and 7 groups to measure women's dietary diversity (WDD) and children's dietary diversity (CDD), respectively. The study found that more than three-fourths of the mothers and half of the children had low dietary diversity. The household wealth holdings and access to resources by the women were found inadequate, while two-thirds of them had the lowest to medium level of nutritional knowledge. The binomial logistic regression model was used to measure the factors influencing WDD and CDD. The findings also indicated that children's dietary diversity was influenced by the mother's age, education, supportive attitude and behavior of husband, and access to and control over resources. While the household wealth index can enhance both child and mother's dietary variety, nutrition knowledge, dietary counseling, and access to and control over resources can improve maternal dietary diversity. This study recommends improving women's socioeconomic status by increasing their wealth and access to resources and enhancing their nutrition knowledge by providing food and nutrition counseling.

Analysis of Determinants of Stunting and Identifications of Stunting Risk Profiles Among Under 2-Year-Old Children in Ethiopia. A Latent Class Analysis

Background

Childhood stunting has a long-term impact on cognitive development and overall well-being. Understanding varying stunting profiles is crucial for targeted interventions and effective policy-making. Therefore, our study aimed to identify the determinants and stunting risk profiles among 2-year-old children in Ethiopia.

Methods and materials

A cross-sectional study was conducted on 395 mother-child pairs attending selected public health centers for growth monitoring and promotion under 5 outpatient departments and immunization services. The data were collected by face-to-face interviews, with the anthropometric data collected using the procedure stipulated by the World Health Organization. The data were entered using Epi Data version 4.6 and exported to STATA 16 and Jamovi version 2.3.28 for analysis. Bayesian logistic regression analysis was conducted to identify potential factors of stunting. Likewise, lifecycle assessment analysis (LCA) was used to examine the heterogeneity of the magnitude of stunting.

Results

The overall prevalence of stunting in children under 24 months was 47.34% (95% confidence interval (CI): 42.44-52.29%). The LCA identified 3 distinct risk profiles. The first profile is Class 1, which is labeled as low-risk, comprised 23.8% of the children, and had the lowest prevalence of stunting (23.4%). This group characterized as having a lower risk to stunting. The second profile is Class 2, which is identified as high-risk, comprised 47.1%, and had a high prevalence of stunting (66.7%), indicating a higher susceptibility to stunting compared to Class 1. The third profile is Class 3, which is categorized as mixed-risk and had a moderate stunting prevalence of 35.7%, indicating a complex interplay of factors contributing to stunting.

Conclusion

Our study identified 3 distinct risk profiles for stunting in young children. A substantial amount (almost half) is in the high-risk category, where stunting is far more common. The identification of stunting profiles necessitates considering heterogeneity in risk factors in interventions. Healthcare practitioners should screen, provide nutrition counseling, and promote breastfeeding. Policymakers should strengthen social safety nets and support primary education.

Women's education and attitudes toward malaria in children: Evidence from Nigeria

This study examined the effect of women's educational level on their perceptions regarding the deadliness of malaria in children. The regression results revealed that women with primary education did not differ statistically from the reference category (i.e. women with no education) in terms of their likelihood of perceiving malaria as a deadly disease in children. In contrast, women with secondary education were 4.3 percentage points more likely to perceive malaria as a deadly disease compared to the reference category. Similarly, women with higher education were 8 percentage points more likely to perceive malaria as a deadly disease compared to the reference category. These results highlight the crucial role of women's education in shaping their perceptions of disease in children, which also has implications for child health outcomes.

Neighbourhood mothers' education and its differential impact on stunting: Evidence from 30 Sub-Saharan African countries

The study used data from Demographic and Health Surveys for 30 Sub-Saharan African countries to investigate differences in the residential effects of mothers' education on stunting. Multilevel logistic regressions were employed to examine the neighbourhood effects of mothers' education on stunting. The study found that although a higher proportion of mothers with secondary education in a neighbourhood, irrespective of the residence type (rural or urban), reduces a child's probability of being stunted, this effect is stronger for children residing in rural areas than those in the urban. Achieving a target of at least 75 per cent of mothers obtaining secondary education and higher will bridge the rural-urban gap in stunting in Sub-Saharan Africa.

Assessing the effect of mHealth on child feeding practice in African countries: systematic and meta-analysis

INTRODUCTION

Poor child feeding practice is a public health problem in Africa. Mobile health (mHealth) is a supportive intervention to improve this problem; however, the evidence available in the current literature is inconsistent and inconclusive in Africa. Some studies state that exclusive breastfeeding is not different between controls and mHealth interventions in the first month. Other studies state that health providers need additional training for the success of mHealth interventions.

OBJECTIVE

This systematic review and meta-analysis aims to provide the summarized effect of mHealth on child-feeding practices in Africa to improve future planning and decisions.

METHOD

We conducted a systematic review and meta-analysis based on the published and unpublished evidence gathered from PubMed, Web of Science, Cochrane Library, and Embase databases between January 1, 2000, and March 1, 2022. Studies included were randomized control trials and experimental studies that compared mHealth to standards of care among postpartum women. Preferred Reporting Items for Systematic Review and Meta-analysis guidelines followed for the reporting.

RESULTS

After screening 1188 studies, we identified six studies that fulfilled the study criteria. These studies had 2913 participants with the number of total intervention groups 1627 [1627/2913 = 56%]. Five studies were completed within 24 weeks while one required 12 weeks. We included two RCTs, two cluster RCTs, and two quasi-experimental studies all used mHealth as the major intervention and usual care as controls. We found significant improvement in child-feeding practices among intervention groups.

CONCLUSION

This systematic review and meta-analysis showed that the application of mHealth improved child-feeding practices in Africa. Although the finding is compelling, the authors recommend high-quality studies and mHealth interventions that consider sample size, design, regional differences, and environmental constraints to enhance policy decisions. The place of residence, access, low socioeconomic development, poor socio-demographic characteristics, low women empowerment, and low women's education might cause high heterogeneity in the included regions and need consideration during interventions.

REGISTRATION NUMBER

PROSPERO: CRD42022346950.

A systematic review of the relationship between household food insecurity and childhood undernutrition

BACKGROUND

This systematic review aims to investigate the association between household food insecurity (HFIS) and undernutrition in children under 5 years old, thereby informing policymakers on the vital factors needed to be considered in tailoring an effective strategy to tackle childhood undernutrition and ultimately HFIS.

METHODS

We performed a systematic review that examined household food insecurity among the undernourished under-five children. PubMed, Cochrane, EBSCO Host, Web of Science and Cumulative Index to Nursing and Allied Health Literature were searched from 1 January 2012 to 1 April 2022, for relevant articles. Outcome measures were stunting, underweight or wasting. Of the 2779 abstracts screened, 36 studies that fulfilled the inclusion and exclusion criteria were included. A range of tools had been used to measure HFIS, the most common being Household Food Insecurity Access Scale. HFIS has been found to be significantly associated with undernutrition, particularly stunting and underweight. This is observed proportionately across all national income levels.

CONCLUSIONS

Sustainable and inclusive economic growth, which aims to reduce income, education and gender inequality, should be a key policy goal in the minimizing food insecurity and childhood undernutrition. Multisectoral interventions are needed to address these issues.

Mother's Nutrition Literacy and Offspring Anemia: A Comparison Study in a Single Center

OBJECTIVE

It is known that mother's knowledge about nutrition is associated with the prevalence of anemia in their children. The aim of this study was to evaluate the frequency of iron deficiency without anemia (ID), iron deficiency anemia (IDA), and anemia in children according to the level of mother's nutrition literacy (NL).

MATERIALS AND METHODS

A cross-sectional study was conducted in a well-child outpatient clinic. The study included healthy children aged between 24 and 59 months and their mothers. Scores of the mothers on the Nutrition Literacy Assessment Tool for Adults and children's anthropometric z-scores, dietary diversity and Mediterranean Diet Quality Index scores, and children's hemoglobin and ferritin levels were collected. Two-group comparison analysis was performed.

RESULTS

Ninety mother-child pairs were included. While 36 mothers (40%) had borderline and 54 (60%) mothers had adequate NL, 15 children (16.7%) had ID, 5 (5.6%) children had IDA, and a total of 18 children (20%) had nutritional anemia. The percentage of wasted children was higher in the group with borderline NL (13.9% vs. 1.9%, P = .036). The percentage of children with ID, IDA, or other nutritional anemia was not different between the borderline and adequate NL groups (30.6% vs. 40.7%, P = .326).

CONCLUSION

The frequency of ID, IDA, or other nutritional anemia in children does not differ significantly between mothers with borderline and adequate NL. Increasing NL of mothers could be a step toward reducing the burden of child undernutrition.

Nutrition knowledge, attitudes, and dietary practices among parents of children and adolescents in Weifang, China: A cross-sectional study

Parent's nutrition knowledge, attitudes, and dietary practices (KAP) play imperative roles in preventing malnutrition for themselves and their children. Our study aimed to determine the status and contributing factors of nutrition KAP among parents of children and adolescents. A total of 1746 parents (mean age 39.67 ± 5.38 years, females accounting for 69.82%) of primary and junior high school students in Weifang, China, completed a self-reported KAP questionnaire in August 2021. An analysis of Pearson product-moment correlation was conducted to determine the relationship between knowledge, attitudes, and practices. Chi-square test, followed by a multivariable robust Poisson regression analysis, was performed to identify the contributing factors to parents' KAP. A 65.94% awareness rate of nutritional knowledge was observed. The correlations between nutrition knowledge and attitudes (r = 0.03, P = 0.23), knowledge and practices (r = 0.02, P = 0.34), and attitudes and practices (r = 0.16, P < 0.01) were relatively weak. After adjusting for other contributing factors, females [prevalence ratio (PR) = 1.28, 95% confidence interval (CI) = 1.13-1.45], participants with secondary education (PR = 4.64, 95% CI = 1.60-13.50), junior college education (PR = 5.87, 95% CI = 2.01-17.13) and college degree or above education (PR = 6.58, 95% CI = 2.25-19.23) acquired higher nutrition knowledge scores. Moreover, healthy diet behaviors were more commonly implemented by females than males (PR = 1.42, 95% CI = 1.14-1.76), and which needed to be improved in those with abnormal body mass indexes (BMIs) [overweight (PR = 0.86, 95% CI = 0.74-0.99) and obese (PR = 0.76, 95% CI = 0.56-0.99)]. It was necessary for nutrition KAP promotion to be emphasized in nutritional knowledge and dietary practices, as well as health behavior guidance, especially for parents with low education and elevated BMIs.

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.

Association between maternal decision-making and mental health and the nutritional status of children under 6 years of age in sub-urban Nigeria

BACKGROUND

We assessed the association between decision-making power and mental health status of mothers and the nutritional status of their children less than 6 years old in Ile-Ife, Nigeria.

METHODS

This was a secondary data analysis of 1549 mother-child dyads collected through a household survey conducted between December 2019 and January 2020. The independent variables were maternal decision-making and mental health status (general anxiety, depressive symptoms, parental stress). The dependent variable was the child's nutritional status (thinness, stunting, underweight and overweight). Confounders were maternal income, age, and education status, and the child's age and sex. The associations between the dependent and independent variables were determined using multivariable binary logistic regression analysis after adjusting for confounders. The adjusted odds ratios (AORs) were determined.

RESULTS

Children of mothers with mild general anxiety had lower odds of stunting than children of mothers with normal anxiety (AOR: 0.72; p = 0.034). Mothers who did not make decisions on children's access to health care (AOR: 0.65; p < 0.001) had children with lower odds of being thin than those whose mothers made decisions on their access to health care. Children of mothers with clinically significant parenting stress levels (AOR: 0.75; p = 0.033), severe depressive symptoms (AOR: 0.70; p = 0.041) and who were not decision makers on the access of their children to health care (AOR: 0.79; p = 0.035) had lower odds of underweight.

CONCLUSIONS

Maternal decision-making status and mental health status were associated with the nutritional status of children less than 6 years in a sub-urban community in Nigeria. Further studies are needed to understand how maternal mental health is associated with the nutritional status of Nigerian preschool children.

Sustainability and scalability of egg consumption in Burkina Faso for infant and young child feeding

Introduction

Malnutrition is a significant challenge to the health of women and children in Burkina Faso. Given the critical role of animal source food on the health of infants and young children (IYC), interventions continue to explore the potential for eggs to prevent malnutrition.

Methods

Using data from the Un Oeuf intervention, which significantly increased IYC egg consumption, combined with quantitative and qualitative data from endline and 3-month follow-up, we explore the barriers and facilitating factors to IYC egg consumption and the sustainability and scalability of the intervention.

Results

Child egg consumption was high at follow-up in the Control, Partial, and Full Intervention arms (83.3, 88.2%, and 100, respectively). The Full Intervention arm had the highest mean number of eggs consumed (2.9, 2.6, and 5.7), which reflected a slight reduction from endline (6.2). All participants owned chickens at follow-up (100%), however, flock size varied. The Full Intervention arm had more chickens (mean 8.8) than the Control (5.1) or Partial Intervention (6.2) arms, which was a 50% reduction in below endline (18.5 chickens). Qualitative results indicate that chicken ownership, education about the nutritional value of eggs, and spousal support facilitated IYC egg consumption. Barriers included egg production, cultural taboos, and animal health. Motivational factors reported included the observed improvement in child health, increased availability of mothers' time, and mothers' financial independence. Knowledge sharing within the Full and Partial Intervention groups was widely reported, and the sustainability of IYC egg consumption was reinforced by accountability among mothers and to community leaders, flipbooks distributed during the project, and high motivation.

Discussion

Main findings indicate that mothers who received the full Un Oeuf intervention were able to overcome barriers to feeding their child an egg daily, were able to improve their livelihood, were motivated to continue feeding their child eggs, and saw the addition of eggs into the child's diet as sustainable. Future nutrition sensitive agriculture interventions should consider tailoring this approach for other LMIC contexts. Future research is needed to explore a possible threshold in the number of household chickens necessary to continuously feed a child an egg a day.

COVID-19, food insecurity and dietary diversity of households: Survey evidence from Nigeria

The policy measures of the government of Nigeria to restrain the spread of COVID-19, particularly in the initial three months (April - June 2020) led to significant disruptions to household livelihoods and food security. We investigate the effects of COVID-19 on food security and dietary diversity of households; focusing on the pathways through which income loss, endowments of wealth, social capital, and safety net programs moderate the severity of households' food security and dietary diversity. Primary data obtained from a telephone survey of 1,031 Nigerian households were analyzed using ordered logit and negative binomial models. Our results show that income losses due to the COVID-19 restrictive measures had pushed households into a more severe food insecurity and less diverse nutritional outcomes. Regarding wealth effects, livestock ownership significantly cushioned households from falling into a more severe food insecurity amid the pandemic. We found that because of the pandemic's indiscriminate effect across communities, the potential of social capital as an informal support mechanism might have been eroded to enable households to cope with shocks. Furthermore, safety net programs by the government and NGOs did not provide significant protection to households from falling into severe food insecurity and malnutrition amid the pandemic. We suggest three policy propositions - prioritize investment in local job creation to curb income loss; build the wealth base of households (e.g., land tenure security or livestock) to enhance resilience to shocks; and target safety nets and other social support programs spatially, temporally, and across social groups to enhance the effectiveness of such programs amid shocks.

Association between the dietary literacy of children's daily diet providers and school-age children's nutritional status and eating behaviours: a cross-sectional study

BACKGROUND

Overweight and obesity rates have increased rapidly in Chinese school-age children, and previous studies have indicated that poor dietary literacy can lead to unhealthy eating behaviours. However, few studies have investigated the association between the dietary literacy of daily diet providers and the eating behaviours and nutritional status of school-age children raised by the providers. Thus, we aimed to explore this association.

METHODS

We collected data on the eating behaviours and nutritional status of children in two primary schools in Anhui Province, as well as the dietary literacy of their daily diet providers. T-tests, one-way ANOVA, chi-square tests, and multiple linear regression were used to analyse the association.

RESULTS

We found significant differences in the scores on the Questionnaire of Children's Daily Diet Providers' Dietary Literacy (QCDDPDL) by region, relationship with the child, age, and educational level of the daily diet provider (all p < .05). Moreover, the children in the low QCDDPDL score group were inclined to engage in unhealthy eating behaviours such as emotional undereating and overeating (p < .05). In addition, the incidence of overweight and obesity was higher in the low QCDDPDL attitude score group than in the high score group (p = .006).

CONCLUSIONS

Our study showed that the dietary literacy of diet providers may influence children's health and eating behaviours. Improving the dietary literacy of diet providers may promote the health status and eating behaviours of school-age children.

The Multidimension of Malnutrition among School Children in a Rural Area, South Africa: A Mixed Methods Approach

To address childhood malnutrition, the use of multifaceted methodologies, such as mixed methods research, is required to inform effective and contextual interventions. However, this remains limited in studying malnutrition among school children in a South African context, notwithstanding its persistence. We adopted a convergent parallel mixed methods design to best understand the magnitude of malnutrition through multilevel influences in a rural area. A quantitative survey determined the magnitude of malnutrition and associated factors among school children and their mothers (n = 508), parallel to a qualitative study, which explored mothers' insights into the influences of child growth and nutrition in interviews using seven focus group discussions. Mixed methods integration was achieved through convergence of the quantitative constructs developed from measured variables for malnutrition and related factors with ten emergent qualitative themes using a joint display analysis to compare the findings and generate meta-inferences. Qualitative themes on food unavailability and affordability, poor feeding beliefs and practices, and decision to purchase foods were consistent with the quantified poor socio-demographic status of mothers. Furthermore, the qualitative data explained the high prevalence of undernutrition among children but did not corroborate the high estimated households' food security in the quantitative survey. The misperceptions of mothers on child growth agreed with limited food knowledge as well as lack of knowledge on child growth gathered during the survey. Moreover, mothers believed that their children were growing well despite the high presence of childhood undernutrition. Mothers further overrated the effectiveness of school feeding programmes in providing healthy food to children as compared to their household food. They reported high incidence of food allergies, diarrhea, and vomiting caused by food consumed at school which resulted in children not eating certain foods. This might have impacted on the nutritional status of children since mothers depended on the school feeding program to provide food for their children. The ambiguity of cultural influences in relation to child growth was evident and substantiated during qualitative interview. Mixed methods integration offered a better understanding of malnutrition from empirical findings on interrelated factors at child, maternal, household, and school levels. This study points to a need for multilevel, informed, and contextual multidimensional interventions to contribute towards addressing childhood malnutrition in South Africa.

The combined effect of institutional quality and capital flows on food and nutrition security and undernourishment in Sub-Saharan Africa

Issues related to malnutrition, broadly defined, have received a growing attention in recent years, not only in connection with the Sustainable Development Goals but also recently with the unprecedented Covid-19 pandemic. At the same time, there exists a complex interaction between institutions, capital flows, and food and nutrition security that has received less attention in the relevant literature. In this paper we estimate a series of dynamic panel data models to examine the impact of institutional quality and capital flows on food security, nutrition security and undernourishment by using panel data for 25 SSA countries over the period 1996 to 2018. One of the key contributions of the paper is the use of both aggregate and disaggregated capital flows to examine the impact on both food and nutrition security, a dimension that has been surprisingly neglected in most of the relevant literature. We combine this with the interaction of various types of capital flows with an institutional quality index we constructed from various governance indicators to examine the impact of institutions on the overall nexus. Finally, we examine the impact not only on food and nutrition security but also on undernourishment. Our findings clearly demonstrate the importance of a heterogeneity approach and reflect on earlier work regarding the role of institutional quality in the overall nexus between external capital flows and various measures of food and nutrition security which leads, and as expected, to an interesting variation in the results obtained, depending on the type of capital flows and the interaction with the governance indicators.

Factors associated with childhood chronic malnutrition in West and Central Africa: a scoping review

Chronic malnutrition is a major public health concern that is the focus of a large body of scientific research. However, there is no synthesis of knowledge about the factors associated with this disease in West and Central Africa, where its prevalence is particularly high. We conducted a systematic search for scientific articles published between January 1st, 2000, and October 15th, 2020, that focus on chronic malnutrition in children in West and Central Africa. We queried CAIRN, PubMed, CINAHL, MEDLINE, Scopus, and Google Scholar databases for this purpose. The search process followed the recommendations of Arksey and O'Malley. Items reported in this review follow the PRISMA-ScR guidelines. Sixty articles involving children from a total of twenty (20) countries, mainly Ghana and Nigeria, were included in the final analysis. The data used were predominantly cross-sectional and were mainly drawn from demographic and health surveys. The analysis revealed that chronic malnutrition in children is associated with sociocultural, economic, and healthcare factors related to the characteristics of children, mothers, households, and communities. The association with children's vulnerability to disease, maternal education, purchasing power, and autonomy need to be further investigated in West and Central Africa. Further analysis using longitudinal data is also needed to better understand the factors associated with chronic malnutrition in West and Central Africa.

Maternal Risk Factor on Incidence of Stunting in South Sumatera

BACKGROUND: Stunting is an adverse result condition of unfulfilled nutritional intake during pregnancy and early childhood, which affects the children’s maximum height and optimal cognitive potential. Stunting is influenced by numerous factors, both from the mother and children. Research has proven that factors related to mothers of children under 5 have essential roles in the incidence of stunting. AIM: This study intends to analyze the influence of maternal risk factors on the incidence of stunting in children under 5 in districts/cities in South Sumatra. METHODS: This study is quantitative research with a cross-sectional design, with secondary data sources from Basic Health Research 2018, carried out in 17 districts/cities in South Sumatra. RESULTS: The mothers’ characteristics most significantly related to stunting in children under 5 in the South Sumatra region are the mother’s height and mother’s education. Mothers with a height <150 cm have a 1.547 times higher risk of having stunting children (95% CI: 1.281–1.868), and mothers with low education have a 1.521 times higher risk of having stunting children (95% CI: 1.094–2.116). Moreover, mothers with secondary education are at 1.473 times higher risk of having stunting children (95% CI: 1.073–2.020). CONCLUSION: The maternal risk factors most associated with stunting in children under five in South Sumatra are maternal height and mother’s education.

Nutrition Outcomes of Under-five Children of Smallholder Farm Households: Do Higher Commercialization Levels Lead to Better Nutritional Status?

The study investigated the nutritional status of under-five children of farm households. The study utilized primary data from 352 farm households with 140 under-five children. Household crop commercialization index (CCI) was used to estimate cassava farm household crop sale ratio and categorize the households into four commercialization levels while WHO Anthro software was employed to analyze under-five children anthropometric indices such as weight-for-age z-score (WAZ), height-for-age z-score (HAZ) and weight-for-height z-score (WHZ). Logit regression model (LRM) was used to examine the drivers of under-five children's nutritional status of farm households. The study found that 42.9%, 7.9% and 3.6% of the children are stunted, underweight and wasted respectively. The highest stunting level was recorded in zero level households (CCI 1). Although, some higher CCI households (medium-high and very-high level) recorded increased percent of stunted children. This revealed that being a member of low or high-level commercialization households may not guarantee better nutritional status of young children of farm households. The results of LRM indicated that the predictors of children nutritional status were child's age, farm size, access to electricity, healthcare and commercialization variables. Moreover, weak positive and negative relationships exist between CCI and children's nutrition outcomes as measured by the z-scores. The study recommended maternal nutrition-sensitive education intervention that can improve nutrition knowledge of mothers and provision of infrastructure that enhance increased farm production and promote healthy living among farm households.

Determinants of Feeding Patterns with Stunting in Children in the Coastal Area of Bengkulu City

BACKGROUND: The age of 0–2 years is a golden period for human growth and development known as the “golden age,” characterized by rapid growth. This period is the First 1000 Days of Life (HPK). The proper diet greatly affects the nutritional status of children. AIM: The purpose of the study was to determine child feeding patterns with the incidence of stunting in children in the Coastal area of Bengkulu City. METHODS: This study was an analytical observational study with a cross-sectional design. The research sample was children under five aged 6–24 months in the coastal area of Bengkulu City as many as 75 children were selected using the accidental sampling technique. Children’s nutritional intake using the Semi Food Frequency questionnaire for energy, protein, fat, carbohydrates, calcium, iron, zinc, and phosphorus. Nutritional intake data were processed by nutrisurvey. Data analysis with Chi-square test and the level of significant 0.05. RESULTS: The frequency of food consumed by children 6–24 months in the form of mashed food 2 times a day was 54.2%, soft food 3 times a day was 54.5%, and family food 3 times a day was 82.5%. The percentage of children with energy, protein, fat, and carbohydrate intake below the recommendation was much higher in normal children (in sequence 84.6%, 81.8%, 84.9%, and 86.3%) compare to stunted children (in sequence 15.4%, 18.2%, 15.1%, and 13.7%). Likewise, calcium, fe, zinc, and phosphor intake below the recommendation was much higher in normal children (in sequence 82%, 85.5%, 80.6%, and 82.1%) compare to stunted children (in sequence 18%, 14.5%, 19.4%, and 17.9%). CONCLUSIONS: There was no relationship between the type of food, macronutrient and micronutrient intake with stunting. Education and counseling at Integrated Healthcare Center need to be carried out, regarding the importance of consuming the proper food and the proper frequency of eating, surveys of nutritional consumption and routine health checks for pregnant women and children under five.

Evaluation of anthropometric indices and their relationship with maternal nutritional literacy and selected socio-economic and demographic variables among children under 5 years old

Background

Considering the destructive effects of malnutrition on the growth, development, and health of children and the importance of identifying the factors affecting it, the present study aimed to investigate the status of anthropometric indices and their relationship with maternal nutritional literacy and selected socio-economic and demographic variables among children under 5 years old.

Methods

This cross-sectional study was conducted on 405 mothers with children under 5 years old in Urmia, Iran. The data collection tool consisted of two parts. The first part was the demographic and socio-economic information of mother and child and the second part was the Evaluation Instrument of Nutrition Literacy on Adults; EINLA.

Results

There was statistically significant relationship between maternal nutritional literacy with weight-for-age, height-for-age, and weight-for-height indices; between weight-for-age index with maternal education, gestational weight gain, and mean weight, as well as mean height of the mother; between weight-for-age and weight-for-height indices with child gender, type of milk consumed, status of starting complementary foods, and history of acute respiratory infection, as well as diarrhea; and finally between height-for-age with family income status.

Conclusions

It is suggested that mothers with low nutritional literacy, mothers whose gestational weight gain was not normal, children whose family income is low, boy child, children with a history of disease, children who consume powdered milk and children who have not started complementary foods at the right time be given priority when designing and implementing educational interventions to enhance nutritional status and anthropometric indices of children.

Nutritional Education to the Nutritional Maternal Knowledge and Iron Intake among Toddlers with Anemia

BACKGROUND: In general, maternal knowledge about nutrition and health affects food habits, influencing the child’s nutritional or iron intake. One effort to improve children’s iron status is by providing maternal nutrition education. AIM: The purpose of this study was to analyze the effect of a nutrition education intervention on maternal knowledge and toddlers’ iron intake to prevent anemia among children under five. Paired t-test was used to analyze differences in knowledge, nutrient intake, consumption of iron sources, and hemoglobin (Hb) status of children before and after nutrition education interventions. METHODS: This study was a Quasi Experiment with a one-group pre-posttest design. The subjects of this study were 40 toddlers consisting of two groups, namely, 20 toddlers in the intervention group and 20 toddlers in the control group. Mother’s knowledge about anemia, while nutrient intake, food sources containing iron were analyzed using Paired T-test. RESULTS: The results of this study indicated a significant effect of a nutrition education intervention on improvement of maternal knowledge (p = 0.000), energy intake (p = 0.001), carbohydrates (p = 0.038), fat (0.047), iron (0.031), and consumption of iron food sources including chicken (p = 0.000) and fish (p = 0.005). However, no significant effect was identified on the Hb level of toddlers (p = 0.66). CONCLUSION: Nutrition education intervention significantly affected the mother’s knowledge and toddlers’ iron intake but did not affect the Hb levels of toddlers.

Investigating food insecurity, health and environment-related factors, and agricultural commercialization in Southwestern Nigeria: evidence from smallholder farming households

Hunger and food insecurity remained some of the serious challenges facing our world in present time with great concerns from Sub-Saharan Africa especially countries like Nigeria. This study investigates food insecurity (FI), health and environment-related factors, and agricultural commercialization among smallholder farm households. This study was conducted in Southwestern Nigeria utilizing cross-sectional survey data from 352 farm households and employed multi-stage sampling procedure. The household FI levels was determined using food insecurity access scale (HFIAS), crop commercialization index (CCI) was used to compute each household's CCI (four levels), while ordered logit model was used to analyse factors influencing FI. Health and environment-related factors' access were assessed across each FI category. The results indicated that about 13% of cassava farm households are non-participant in the marketing of their produce. The findings revealed that less than 20%, 30%. and 40% of households in all four FI categories had access to piped water, improved toilet facilities, and electricity respectively. The ordered logit regression analysis indicated that age, gender, education level, farm experience, nonfarm income, and ownership of motorcycle significantly influencing FI in the study areas. Therefore, this study stressed the implementation of policy actions capable of promoting rural infrastructure development that will lead to increased agricultural production, marketing, and improved quality of life of rural dwellers.

Effect of Mother's Nutritional Knowledge and Hygiene Practices on School-Going Adolescents Living in Dhaka City of Bangladesh

BACKGROUND

Adolescence which is a critical stage for growth and development is influenced by various issues along with maternal nutritional knowledge, control over their earnings, freedom of movement, and participation in household decision-making over child's health care.

OBJECTIVE

This study focused on assessing mothers' nutritional knowledge and hygiene practices and their effect on dietary diversity as well as the nutritional status of school-going adolescents of Dhaka city.

METHODS

A community-based cross-sectional study was conducted at 44 schools in Dhaka city. A total of 710 school-going adolescents aged 10-17 years were randomly selected and their mothers were interviewed for assessing their knowledge on nutrition and hygiene practices. One-way ANOVA and multivariate linear regression were used to examine the association between dietary diversity and the nutritional status of the adolescents with their mother's nutritional knowledge and hygiene practices.

RESULTS

About one-third (35.8%) of the mothers maintained hygiene and sanitation satisfactorily. Although 53.1% of them had satisfactory general knowledge about a healthy diet, only 6.5% showed good knowledge of the nutritional value of food. The prevalence of stunting, thin, and overweight was 8, 4.6, and 5.8%, respectively. Fair hygiene practices were positively associated (P = 0.048) with height for age z-score. Maternal knowledge on the nutritional value of food was positively associated (P = 0.027) with the dietary diversity of the adolescents.

CONCLUSION

Adequate nutritional knowledge and hygiene practices of the mothers have positive effects on children's dietary diversity and nutritional status. Providing nutrition education to mothers would ensure better nutritional status and improved dietary practices for their children.

Does Mothers' Awareness of Health and Nutrition Matter? A Case Study of Child Malnutrition in Marginalized Rural Community of Punjab, Pakistan

Maternal nutritional awareness might reduce the risk of malnutrition in children. This study assesses the impact of mothers' nutritional and health awareness (MNHA) on the nutritional status of pre-school children in rural South Punjab. Using a proportionate purposive simple random sampling technique we collect data with the help of a self-administered questionnaire on height, age, the weight of children, and socio-economic profile from 384 rural households in one of the marginalized districts of Punjab. The study applied the binary logistic regression model to compute the probability of malnutrition. The results indicate that malnutrition was high in the district (the prevalence rate for underweight is 46.1%, for stunting 34.83%, and for wasting is 15.49%). Around 91.84% of malnourished children belonged to the low MNHA category compared to medium (5.61%) and high (2.55%) MNHA categories. The results further show that the prevalence of moderate and severe stunting, wasting, and underweight in low MNHA categories was much higher with large differences compared to both medium and high MNHA categories. The binary logistic regression results depict that, across the household deprivation index (HDS), the odds of a child becoming malnourished were lower in households HDS-2 category (OR = 0.02, 95% CI: 0.01–0.89), and odds were also lower in households HDS-3 category (OR = 0.001, 95% CI: 0.001–0.16). Similarly, across the scores of MNHA index, the odds of malnutrition were lower among the children of those mothers who had medium MNHA (OR = 0.04, 95% CI: 0.002–1.24), and also the probability of child malnutrition was lower among the children of mothers who had high MNHA (OR = 0.008, 95% CI: 0.002–0.29). The study urges that well-resourced, targeted, and coordinated health and nutritional education and awareness programs are required to tackle malnutrition.

Association between Mother's Education and Infant and Young Child Feeding Practices in South Asia

The association between mother's education and the World Health Organization's (WHO's) eight Infant and Young Child Feeding (IYCF) core indicators has yet to be explored in South Asia (SA). This study aimed to explore the association between mother's education and the WHO's eight IYCF core indicators in SA. We analyzed data from the most recent nationally representative Demographic and Health Surveys of six South Asian Countries (SACs)-Afghanistan, Bangladesh, India, Maldives, Nepal, and Pakistan. We found significantly higher odds (adjusted odds ratio, AOR, 1.13 to 1.47) among mothers who completed secondary or higher education than among mothers with education levels below secondary for the following seven IYCF indicators: early initiation of breastfeeding (EIBF), exclusive breastfeeding under 6 months (EBF), the introduction of solid, semisolid or soft foods (ISSSF), minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD), and consumption of iron-rich or iron-fortified foods (CIRF); the exception was for the indicator of continued breastfeeding at one year. Country-specific analyses revealed significantly higher odds in EIBF (AOR 1.14; 95% CI: 1.11, 1.18) and EBF (AOR 1.27; 95% CI: 1.19, 1.34) among mothers with secondary or higher education levels in India. In contrast, the odds were lower for EIBF in Bangladesh and for EBF in Pakistan among mothers with secondary or higher education levels. For country-specific analyses for complementary feeding indicators such as ISSSF, MDD, MMF, MAD, and CIRF, significantly higher odds (AOR, 1.15 to 2.34) were also observed among mothers with secondary or higher education levels. These findings demonstrate a strong positive association between mother's education and IYCF indicators. Strengthening national policies to educate women at least to the secondary level in SACs might be a cost-effective intervention for improving IYCF practices.

The Evolution of Food Security: Where Are We Now, Where Should We Go Next?

Food security is one of the most challenging topics globally; however, the concept of food security has taken on additional dimensions that are general and are less detailed. This study aims to identify the intellectual structure of food security research and the changes in this structure. This paper analyzed 3169 documents from the Web of Science database through a bibliometric review. A review of the published documents shows an increasing trend over the past 46 years. In accordance with co-occurrence analysis, 125 keywords were grouped into five clusters: food security and sustainable development; food security and socioeconomic factors; food security policy and governance; coping strategies for poverty, inequality, and hunger; and modern food security management. This study identifies four streams within food security research: sustainability and environmental, socioeconomic, cultural, and political factors. The paper concludes that even though food security might investigate many significant areas, other new dimensions should still be considered. Further gaps in the literature emerge that present avenues for future research directions. Reviewing indicators and techniques of food security assessment and identifying high-risk groups should be a priority.

Dietary patterns of 5-year-old children and their correlates: findings from a multi-ethnic Asian cohort

There is limited data on the dietary patterns of 5-year-old children in Asia. The study examined childhood dietary patterns and their maternal and child correlates in a multi-ethnic Asian cohort. Based on caregiver-reported 1-month quantitative FFQ of 777 children from the Growing Up in Singapore Towards healthy Outcomes cohort, cluster analysis identified two mutually exclusive clusters. Children in the 'Unhealthy' cluster (43·9 %) consumed more fries, processed meat, biscuits and ice cream, and less fish, fruits and vegetables compared with those in the 'Healthy' cluster (56·1 %). Children with mothers of lower educational attainment had twice the odds of being assigned to the 'Unhealthy' cluster (adjusted OR (95 % CI) = 2·19 (95 % CI 1·49-3·24)). Children of Malay and Indian ethnicities had higher odds of being assigned to the 'Unhealthy' cluster (adjusted OR = 25·46 (95 % CI 15·40, 42·10) and 4·03 (95 % CI 2·68-6·06), respectively), relative to Chinese ethnicity. In conclusion, this study identified two dietary patterns in children, labelled as the 'Unhealthy' and 'Healthy' clusters. Mothers' educational attainment and ethnicity were two correlates that were associated with the children's assignments to the clusters. These findings can assist in informing health promotion programmes targeted at Asian children.

Mother Empowerment Model in Stunting Prevention and Intervention through Stunting Early Detection Training

BACKGROUND: Stunting is a condition of failure to thrive under 5-year-old due to chronic malnutrition causing the children become too short for their age. The contribution of this research is to prevent and reduce stunting through Stunting Early Detection training. AIM: The objective of the current research is to develop a model for mother empowerment in preventing and intervention stunting in children through stunting early detection training. METHODS: Phase I is the development of a mother empowerment model in the prevention and intervention of stunting in children using a survey with a cross sectional design. Phase II is the implementation of the model using Quasi Experimental Nonrandomized Prepost Control Group Design. RESULTS: The results of the study obtained that mothers who had good characteristics increased their knowledge 0.423 (p = 0.000). Mothers who have good knowledge increase their mother commitment 0.230 (p = 0.004), mothers who have a good commitment reduce stunting in children 0.448 (p = 0.000), mothers who have good knowledge increase family support 0.236 (p = 0.040), and good family support reduces stunting 0.257 (p = 0.011). CONCLUSION: A new finding is the formation of a Mother Empowerment Model in the Prevention and Intervention of Stunting through Stunting Early Detection Training where mother commitment is the most influential factor.

Dietary diversity, environment and health-related factors of under-five children: evidence from cassava commercialization households in rural South-West Nigeria

Diverse and quality diets are crucial to sustainable growth and development of under-five children, especially those of rural farming households. This study investigated the dietary diversity, environment, and health-related factors of young children. The study employed the use of cross-sectional survey data from 140 under-five children of cassava farming households in Ogun and Oyo states, South-West Nigeria. The study estimated factors influencing dietary diversity of under-five children and assessed children dietary diversity, and the availability of some environment and health-related factors of the farming households. The findings indicated that 98.7% and 97.5% of children consumed grains, with roots and tubers while 36.7% and 36.3% consumed legumes in Ogun and Oyo states respectively. The results also found that 48.6% of children sampled met the minimum cut-off point of 4 food groups with dietary diversity mean score of 3.28. The logit regression analysis indicated that child's age, mothers' age, distance to farm, and food expenditure were among the significant determinants of children dietary diversity. Therefore, this study seeks the collaborative efforts of stakeholders in providing nutrition-sensitive intervention programs for household members, especially mothers and young children in order to promote consumption of diversified diets and enhance healthy living of rural farming households.

Validation of a Food Knowledge Questionnaire on Tanzanian Women of Childbearing Age

The present manuscript describes the validation of a food knowledge questionnaire (FKQ) for Tanzanian childbearing age women. The FKQ was derived from the Ugandan version and was adapted according to Tanzanian culture and food habits, including 114 closed-ended questions, divided into five different sections. The FKQ was administered to 671 Tanzanian childbearing-age women who were eligible if they: (i) were aged between 14 and 49 years old, (ii) had not been diagnosed with any disease and (iii) lived in the urban or peri-urban area of the Arusha and Morogoro region. The validation process of the FKQ was conducted in Tanzania and the recruitment occurred between August and October 2020. The final version of the validated questionnaire was characterized by a total of 88 questions, divided into ten different sections; each section aimed to investigate a different aspect of food knowledge, except for section A, which collected information related to the social and demographic characteristics of the respondent. The food knowledge questionnaire showed good construct validity and content validity to assess knowledge and food practices in Tanzanian women of childbearing age and could be used in future studies to identify women at higher risk of unhealthy eating habits and food choices.

Effect of maternal and child factors on stunting: partial least squares structural equation modeling

BACKGROUND

Stunting is affected by various factors from mother and child. Previous studies assessed only one or more influencing variables. Unfortunately, nor the significant influence of maternal and child factors nor the indicators contributing to maternal and child factors that affect the stunting incidence have ever been analyzed.

PURPOSE

This study analyzed the effect of maternal and child factors on stunting and the significant indicators that shape the maternal and child factors that impact stunting.

METHODS

This was a case-control study. Overall, 132 stunted children and 132 nonstunted children in Purbalingga Regency, Central Java Province, participated in the research. Direct interviews and medical record reviews were conducted to assess the studied variables. The research data were tested using the partial least squares structural equation with a formative model.

RESULTS

Maternal factors directly affected the occurrence of stunting (t=3.527, P<0.001) with an effect of 30.3%. Maternal factors also contributed a significant indirect effect on stunting through child factors (t=4.762, P<0.001) with an effect of 28.2%. Child factors affected the occurrence of stunting (t= 5.749, P<0.001) with an effect of 49.8%. The child factor was influenced by maternal factor with an effect of 56.7% (t=10.014, P<0.001). The moderation analysis results demonstrated that maternal and child factors were moderate predictive variables of stunting occurrence.

CONCLUSION

Child factors have more significant and direct effects on stunting than maternal factors but are greatly affected by them.

Household food insecurity is associated with child’s dietary diversity score among primary school children in two districts in Ghana

Background: Dietary diversity is generally considered as a good indicator of nutrient adequacy and is influenced by various factors at the national, household, and individual levels. Objective: The present study sought to determine the relationships between household food insecurity, primary caregivers’ nutrition knowledge, and dietary diversity of school-aged children in Ghana. Methods: This forms part of a longitudinal study conducted in the Ayawaso West Municipal district in Accra (urban setting) and the Upper Manya Krobo district (rural setting) in Ghana. Data were collected from a total of 116 caregiver-child dyads using 24-h dietary recall and a short version of the US 12-month Household Food Security Survey Module. Nutrition knowledge and sociodemographic data were obtained using a structured questionnaire. Multivariable logistic regression was used to check for factors associated with children’s dietary diversity. Results: Majority of households reported food insecurity, with a higher percentage of insecure households located in the rural area (88.9% vs. 46.5%, P ≤ 0.0001), compared to the urban setting. Diet diversity among the study children was low, with a mean (standard deviation [SD]) of 5.8 (2.1) out of 14 food groups. Children living in food insecure households were three times more likely to have received low diverse diet compared to those from food secure households (adjusted odds ratio [OR] =3.3, 95% confidence interval [CI]: 1.4–8.0). Caregivers’ nutrition knowledge was, however, not related to children’s dietary diversity. Discussion and conclusion: Household food insecurity was a main predictor of dietary diversity among school-age children in this study. Thus, caregiver knowledge in nutrition may not be enough, particularly in the presence of food insecurity to guarantee adequate nutrition for school-aged children.

Complementary Feeding Practices and Influencing Factors Among Children Under 2 Years of Age: A Cross-Sectional Study in Indonesia

PURPOSE

This study aimed to analyze the practice of complementary feeding and its influencing factors in children under 2 years of age in Indonesia.

METHODS

This cross-sectional study used data obtained from the 2017 National Socioeconomic Survey. The sample totaled 1,751 households with children under 2 years of age, who received complementary feeding in urban and rural communities. Furthermore, the practice of complementary feeding was evaluated on the basis of the variations in provided food grouped into two categories: complete and incomplete. This study applied bivariate and multivariate analytical methods. Multivariate analysis was performed using binary logistic regression.

RESULTS

The proportion of children under 2 years of age who received complementary feeding with complete variant food was 15.9%, while that with incomplete variant food was 84.1%. Furthermore, the factor influencing the practice of complementary feeding among the children was the mother's educational level (odds ratio: 1.481, 95% confidence interval: 0.245-0.943).

CONCLUSION

Complete complementary feeding, which involves a variety of food sources, is the best approach to improve the nutritional status of infants. Therefore, the source of food for complementary feeding must be accessible to all communities.

COVID-19-Induced Disruptions of School Feeding Services Exacerbate Food Insecurity in Nigeria

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic and associated lockdown measures have disrupted educational and nutrition services globally. Understanding the overall and differential impacts of disruption of nutritional (school feeding) services is critical for designing effective post-COVID-19 recovery policies.

OBJECTIVES

The aim of this study was to examine the impact of COVID-19-induced disruption of school feeding services on household food security in Nigeria.

METHODS

We combined household-level, pre-COVID-19 in-person survey data with postpandemic phone survey data, along with local government area (LGA)-level information on access to school feeding services. We used a difference-in-difference approach and examined temporal trends in the food security of households with and without access to school feeding services. Of the sampled households, 83% live in LGAs with school feeding services.

RESULTS

Households experienced an increase in food insecurity in the post-COVID-19 survey round. The share of households skipping a meal increased by 47 percentage points (95% CI: 44-50 percentage points). COVID-19-induced disruptions of school feeding services increased households' experiences of food insecurity, increasing the probability of skipping a meal by 9 percentage points (95% CI: 3-17 percentage points) and the likelihood of going without eating for a whole day by 3 percentage points (95% CI: 2-11 percentage points). Disruption of school feeding services is associated with a 0.2 SD (95% CI: 0.04-0.41 SD) increase in the food insecurity index. Households residing in states experiencing strict lockdown measures reported further deterioration in food insecurity. Single mothers and poorer households experienced relatively larger deteriorations in food security due to disruption of school feeding services.

CONCLUSIONS

Our findings show that COVID-19-induced disruptions in educational and nutritional services have exacerbated households' food insecurity in Nigeria. These findings can inform the designs of immediate and medium-term policy responses, including the designs of social protection policies and alternative programs to substitute nutritional services affected by the pandemic.

Drivers of Millet Consumption Among School Aged Children in Central Tanzania

Background: Iron and zinc deficiency are common public health problems in low-income countries largely due to poor consumption of iron and zinc rich foods. It has previously been observed that 57% of school aged children (SAC) in Tanzania suffer from anemia. In addition, estimates indicate that over 25% of the population have inadequate zinc intake. Pearl millet is an example of a nutrient dense, resilient cereal crop, that can be promoted to diversify diets and combat iron and zinc deficiency. This study overall aim was to increase pearl millet consumption among school aged (5 – 12 years) children. As part of the study, we investigated, the drivers of food choice relating to pearl millet consumption.

Methods: The study was a cross-sectional study of randomly selected households in Kongwa district, Dodoma region of Tanzania. In total, 128 women of reproductive age (20 – 49 years) were randomly selected for the study. A study questionnaire consisting of 66 items, was developed and validated. The constructs in the questionnaire were categorized in two groups: internal and external factors. Respondents were asked to indicate their level of agreement or disagreement with statements read to them by interviewers. The scores on intention and behavior constructs were based on the number of times caregivers intended to, or had fed their school going children with pearl millet in the referent month. Intention was considered high if it was higher than the median intention score of the group, and low if it was equal to or lower than the median scores. Correlations and multiple linear regressions were performed to measure association between constructs and to identify predictive constructs. The Mann-Whitney U test was used for score comparison.

Results: There was a significant difference between intention and behavior among those who did not consume pearl millet (P = 0.003), and those who consumed pearl millet two or more times a week, in the same month (P = 0.01). Knowledge was significantly correlated with behavior identity (ρ = 0.58, P = 0.001), while health behavior identity was significantly correlated with intention (ρ = 0.31, P = 0.001). Intention of caregivers was significantly and positively correlated (ρ = 0.44, P = 0.001) with and predicted consumption of pearl millet (ρ = 0.87, P = 0.067).

Conclusion: Increasing knowledge or awareness on nutritional benefits of pearl millet among caregivers may increase consumption of pearl millet by children of school going age.

Phenomenology Study of Stunting Nutrition for Babies in the Work Area of Pante Kuyun Health Center, Aceh Jaya District

BACKGROUND: Stunting causes organs not to grow and develop optimally. One of the factors that indirectly influence stunting in children is the mother’s parenting style. Parenting includes the family’s ability to provide time, attention, and support in meeting the physical, mental and social needs of children growing in the family. AIM: This is to find out the nutrition parenting patterns of children who are stunted in the working area of the Health Center Pante Kuyun, Aceh Jaya Regency. METHODS: This study uses qualitative methods with a phenomenological approach. This research was conducted in the working area of Pante Kuyun Health Center, Aceh Jaya Regency. The research was carried out for 1 month, starting from August to September. The choice of research location was due to the high incidence of stunting in the area. The number of samples was determined 15 people consisting of 10 children under five who were stunted, two people as the head of the Health Center, and two community leaders from various elements. This study uses recording devices, video recording devices (camcorders), tape recorders, group discussion guidelines, and field notes. Data analysis techniques used in qualitative research include transcript analysis of interview results, data reduction, analysis, data interpretation, and triangulation. RESULTS: Stunting is closely related to the social construction of society. There are differences in social constructs that shape the parenting styles’ understanding for toddlers who are stunted. During pregnancy, most mothers follow the restrictions recommended by their parents and in-laws. The number of taboo foods to be consumed during pregnancy to breastfeeding generally comes from the food group of animal protein sources such as squid, shrimp, crab, shellfish, and so on. These foods are believed to cause the, etc., become sticky, making it difficult for the delivery process, and milk is difficult to pass. It turns out that the customs, culture, and hereditary habits that continue to be carried out influence stunting in children under five. The pattern of nutrition parenting during the postpartum, postpartum period also causes stunting. During postpartum, the culture in society prohibits food other than white rice, and the fish is only anchovies. It turns out that the lack of intake during the postpartum period up to 40 days has an impact on the health of the postpartum, postpartum mother, especially only a little breast milk, dry skin, weakness, dizziness, and even sickness. Community beliefs also influence nutritional care patterns. For infants aged 0–6 months, none of the informants’ toddlers receive exclusive; breastfeeding. Exclusive breastfeeding is not given to children due to the mother’s lack of knowledge about exclusive breastfeeding benefits. The eating habit prioritizes elders’ advice such as parents, in-laws, and religious leaders are still related to myths about health and nutrition in pregnant women and toddlers. The pattern of nutrition parenting performed by mothers for infants >6 months is not under the Indonesian Ministry of Health recommendations. In the Aceh Jaya district, mothers habitually give instant noodles as a substitute for the rice to consume toddlers. However, their mothers also have parenting styles, whereas if the working mothers provide food for toddlers, they are older siblings, grandmothers, or nieces. Inadequate care, such as improper feeding from infancy to toddlerhood, causes toddlers to suffer from illness more often due to disruption of digestion because the baby’s intestines are still vulnerable. CONCLUSION: Parenting affects toddlers who experience stunting in the working area of Pante Kuyun Community Health Center, Aceh Jaya Regency.

An On-Line Cross-Sectional Questionnaire to Assess Knowledge of COVID-19 Pandemic among Citizens Tested for the SARS-CoV-2 Virus in Quito and Ibarra, Ecuador

Several public health measures have been implemented to contain the SARS-CoV-2 outbreak. The adherence to control measures is known to be influenced by people’s knowledge, attitudes and practices with regard to the disease. This study aimed at assessing COVID-19 knowledge in individuals who were tested for the virus. An online cross-sectional survey of 32 items, adapted to the national context, was conducted among 1656 Ecuadorians. The mean knowledge score was 22.5 ± 3 out of 28, with significant differences being observed with regard to educational attainment. People with postgraduate training scored higher than those with college, secondary and elementary instruction. Indeed, multiple linear regression revealed that lower scores were associated significantly with the latter three levels of education. Interviewees were knowledgeable about the symptoms, detection, transmission and prevention of the disease. However, they were less assertive regarding the characteristics of the virus as well as the usefulness of traditional and unproven treatments. These outcomes indicated a lack of knowledge in fundamental aspects of virus biology, which may limit the effectiveness of further prevention campaigns. Conclusively, educational and communicational programs must place emphasis on explaining the basic molecular characteristics of SARS-CoV-2; such information will certainly contribute to improve the public’s adherence to control measures.

Three-year review of a capacity building pilot for a sustainable regional network on food, nutrition and health systems education in India

Background

In Kolkata (India), there are high rates of malnourished children (45.9%) under the age of three, impacting growth, organ development, function, and cognition. Mothers have a major role to play during this crucial development stage, with research showing nutrition knowledge, attitudes and practices (KAP) of mothers are important determinants of childhood malnutrition.

Aims

To document 3 years of capacity building towards a sustainable nutrition education network in Kolkata, India, while assessing the ability to perform data collection in the form of needs assessments, impact assessments and capacity reviews.

Methods

Descriptive review and analysis of engagement and impact from 3 years of work by the NNEdPro Global Centre for Nutrition and Health, initiating locally led nutrition education interventions. Mapping to the Indian National Nutrition Strategy was also performed to review adherence to nationwide priorities surrounding nutrition and determine the wider application potential of the network.

Results

Two simultaneous projects were taken forward by a team of local healthcare professionals and student champions. Project 1—medical college workshops for medical student nutrition education with added focus on underserved populations, Project 2—preparation for a ‘Mobile Teaching Kitchen’ (MTK) in marginalised communities to empower local women as nutrition educators.

Data collection methods used for analysing markers of impact and sustainability were semi-structured interviews of the community members, and KAP questionnaires to assess response to educational sessions.

Conclusion

With local support it is possible to create and sustain fieldwork for an extended period with meaningful outputs and impact. This initiative demonstrates that it is possible to use healthcare professionals, students and volunteers with low-intensity training and a low-cost approach to produce action research with considerable impact and results in rapid, reliable and robust manner.