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Pradhan MR, Shete MR. Determinants of nutritional status among under-five children receiving Integrated Child Development Services (ICDS) in India. Nutr Health 2023; 29:575-590. [PMID: 35238244 DOI: 10.1177/02601060221085809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Undernutrition is a significant public health problem and the leading risk factor for India's disease burden. Aim: To understand the determinants of nutritional status among under-five children receiving Integrated Child Development Services (ICDS) in India. Methods: The study used the National Family Health Survey-4 (2015-16) data. The analysis was carried out for under-five children who have availed of any ICDS services in the 12 months preceding the survey (n = 1,27,813). Stunting, wasting, and underweight were estimated following the World Health Organization guideline and used as the outcome variables. The binary logistic regression was conducted to examine the association of ICDS utilization and socioeconomic-demographic predictors with under-five children's nutritional status. STATA (V 13) was used for statistical analyses. Results: A sizable proportion of under-five children receiving any ICDS services suffer from undernutrition. The undernutrition prevalence varied considerably by socioeconomic and demographic characteristics. Logistic regression found an insignificant association of ICDS utilization with the nutritional status of under-five children. Children not immunized in ICDS centers were less likely to be stunted (OR: 0.93; P < 0.01), wasted (OR: 0.93; P < 0.01), and underweight (OR: 0.90; P < 0.01) than their counterparts. The child's age and gender, maternal education and nutrition status, wealth index, social group, region, residence, and region were significant determinants of undernutrition among ICDS beneficiaries. Conclusion: The study suggests the need to ensure all available services to children enrolled in the Anganwadi Center (AWC). The program should also emphasize feeding practices and educate parents about improving child health and nutrition.
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Affiliation(s)
- Manas Ranjan Pradhan
- Assistant Professor, Department of Fertility and Social Demography, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, Maharashtra, India
| | - Mahesh Rajendra Shete
- Data Analyst, Max Institute of Healthcare Management, Indian School of Business, Mohali, India
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Wang Z, Chaudhry M, Mistry R, Needham BL, Baylin A, Mancuso P, Singh K, Khandelwal S. A mixed-methods study on the dietary practices of early postpartum women during the summer rainy season in Belgaum, Karnataka, India. Ecol Food Nutr 2022; 61:728-752. [PMID: 36268551 DOI: 10.1080/03670244.2022.2136171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The current mixed-method study uses Food Frequency Questionnaires and 24-hour dietary recalls (n = 41) to assess the food/nutrient intake; and qualitative interviews to identify local perceptions of food among 41 early postpartum women in Belgaum, India. The results show that total energy, protein, and most micronutrient intake were significantly lower than the Recommended Dietary Allowance of India (p < .05 individually); ninety percent of mothers restricted the consumption of some specific fruits, vegetables, and other foods during postpartum due to their perceptions of foods, folk medicines, and health beliefs. Culturally sensitive programs relevant to postpartum diet practices for women should be implemented.
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Affiliation(s)
- Zeyuan Wang
- Nutritional Science, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Monica Chaudhry
- Department of Public Health Nutrition, Public Health Foundation of India (PHFI), Delhi, India
| | - Ritesh Mistry
- Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Belinda L Needham
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Ana Baylin
- Nutritional Science, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.,Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Peter Mancuso
- Nutritional Science, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kalpana Singh
- Department of Public Health Nutrition, Public Health Foundation of India (PHFI), Delhi, India
| | - Shweta Khandelwal
- Department of Public Health Nutrition, Public Health Foundation of India (PHFI), Delhi, India
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le Roux M, Nel M, Walsh C. Determinants of Stunting at 6 Weeks in the Northern Cape Province, South Africa. Front Public Health 2020; 8:166. [PMID: 32582600 PMCID: PMC7289919 DOI: 10.3389/fpubh.2020.00166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 04/17/2020] [Indexed: 11/13/2022] Open
Abstract
The first 1,000 days from conception to 24 months is a critical period for healthy growth and development. In South Africa, stunting (weight-for-length below −2SD from the WHO reference mean) is a major public health issue with significant health consequences. We determined associations between demographic, health, and anthropometric indicators of mothers and their infants. A cross-sectional study was conducted in the Northern Cape. All mothers with 5- to 7-week-old babies visiting PHC facilities were invited to participate. A questionnaire was completed in a structured interview with each mother. Age and length of the baby at 6 weeks were used to determine stunting, while the weight and height of the mother were measured for body mass index (BMI). Eight hundred questionnaires were completed in 92 facilities. The median age of mothers was 26 years (IQR 20–30 years) and 44.9% were married. Only 40.1% had completed school or tertiary education and almost 40% relied on a government grant as the main source of income. Two-thirds (64.9%) had not planned the pregnancy and 17% were on antiretroviral therapy (ART). More than a quarter (26.1%) smoked cigarettes or used snuff during pregnancy, while 9.4% drank alcohol. At 6 weeks, 31% of boys and 14% of girls had a length-for-age below the WHO reference values, while 25.4% of mothers were classified as obese and 24.6% as overweight. More than 70% had a waist circumference above 80 cm. Significantly more mothers with stunted babies weighed less [−6 kg; −1 kg] and were shorter [−4 cm; −1 cm] than mothers with babies who were not stunted. Compared to babies who were not stunted, significantly more babies of mothers who lived in informal housing [−19.7%; −3.2%], relied on a grant [−19.7%; −3.2%], smoked/ snuffed [7.6%; 23.5%], and used alcohol during pregnancy [0.3%; 11.5%] were stunted. The following factors significantly increased the risk of having a stunted baby at 6 weeks: living in informal housing vs. formal housing (RR: 0.68, 95% CI [0.5; 0.9]); smoking or using snuff during pregnancy (RR: 1.74, 95% CI [1.3; 2.3]); using alcohol during pregnancy (RR: 1.5, 95% CI [1.1; 2.2]); both smoking and using alcohol during pregnancy (RR: 1.97, 95% CI [1.4; 2.9]). We confirmed the coexistence of under- and over-nutrition among mothers and their babies, possibly indicating that stunting in childhood may predispose to overweight and obesity in adulthood in a vicious cycle that affects generation after generation. Interventions aimed at poverty alleviation and encouraging healthy lifestyles with an emphasis on healthy eating, smoking cessation and abstaining from alcohol before pregnancy are urgently required.
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Affiliation(s)
- Maretha le Roux
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein, South Africa
| | - Mariette Nel
- Department of Biostatistics, University of the Free State, Bloemfontein, South Africa
| | - Corinna Walsh
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein, South Africa
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Lentz EC, Narayanan S, De A. Last and least: Findings on intrahousehold undernutrition from participatory research in South Asia. Soc Sci Med 2019; 232:316-323. [DOI: 10.1016/j.socscimed.2019.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 05/11/2019] [Accepted: 05/16/2019] [Indexed: 01/17/2023]
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Gillespie S, Menon P, Heidkamp R, Piwoz E, Rawat R, Munos M, Black R, Hayashi C, Kumar Saha K, Requejo J. Measuring the coverage of nutrition interventions along the continuum of care: time to act at scale. BMJ Glob Health 2019; 4:e001290. [PMID: 31297250 PMCID: PMC6590959 DOI: 10.1136/bmjgh-2018-001290] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/11/2019] [Accepted: 01/19/2019] [Indexed: 11/21/2022] Open
Abstract
The global community is committed to addressing malnutrition. And yet, coverage data for high-impact interventions along the continuum of care remain scarce due to several measurement and data collection challenges. In this analysis paper, we identify 24 nutrition interventions that should be tracked by all countries, and determine if their coverage is currently measured by major household nutrition and health surveys. We then present three case studies, using published literature and empirical data from large-scale initiatives, to illustrate the kind of data collection innovations that are feasible. We find that data are not routinely collected in a standardised way across countries for most of the core set of interventions. Case studies—of growth monitoring and screening for acute malnutrition, infant and young child feeding counselling, and nutrition monitoring in India—highlight both challenges and potential solutions. Advancing the nutrition intervention coverage measurement agenda is essential for sustained progress in driving down rates of malnutrition. It will require (1) global consensus on a core set of validated coverage indicators on proven, high-impact nutrition-specific interventions; (2) the inclusion of coverage measurement and indicator guidance in WHO intervention recommendations; (3) the incorporation of these indicators into data collection mechanisms and relevant intervention delivery platforms; and (4) an agenda for continuous measurement improvement.
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Affiliation(s)
- Stuart Gillespie
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Rebecca Heidkamp
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ellen Piwoz
- Global Development Program, Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Rahul Rawat
- Global Development Program, Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Melinda Munos
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert Black
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chika Hayashi
- Monitoring and Statistics, Unicef USA, New York, New York, USA
| | - Kuntal Kumar Saha
- Nutrition for Health and Development, Organisation mondiale de la Sante, Geneva, Switzerland
| | - Jennifer Requejo
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Haghparast-Bidgoli H, Skordis J, Harris-Fry H, Krishnan S, O'Hearn M, Kumar A, Pradhan R, Mishra NK, Upadhyay A, Pradhan S, Ojha AK, Cunningham S, Rath S, Palmer T, Koniz-Booher P, Kadiyala S. Protocol for the cost-consequence and equity impact analyses of a cluster randomised controlled trial comparing three variants of a nutrition-sensitive agricultural extension intervention to improve maternal and child dietary diversity and nutritional status in rural Odisha, India (UPAVAN trial). Trials 2019; 20:287. [PMID: 31133067 PMCID: PMC6537168 DOI: 10.1186/s13063-019-3388-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 05/02/2019] [Indexed: 11/18/2022] Open
Abstract
Background Undernutrition causes around 3.1 million child deaths annually, around 45% of all child deaths. India has one of the highest proportions of maternal and child undernutrition globally. To accelerate reductions in undernutrition, nutrition-specific interventions need to be coupled with nutrition-sensitive programmes that tackle the underlying causes of undernutrition. This paper describes the planned economic evaluation of the UPAVAN trial, a four-arm, cluster randomised controlled trial that tests the nutritional and agricultural impacts of an innovative agriculture extension platform of women’s groups viewing videos on nutrition-sensitive agriculture practices, coupled with a nutrition-specific behaviour-change intervention of videos on nutrition, and a participatory learning and action approach. Methods The economic evaluation of the UPAVAN interventions will be conducted from a societal perspective, taking into account all costs incurred by the implementing agency (programme costs), community and health care providers, and participants and their households, and all measurable outcomes associated with the interventions. All direct and indirect costs, including time costs and donated goods, will be estimated. The economic evaluation will take the form of a cost-consequence analysis, comparing incremental costs and incremental changes in the outcomes of the interventions, compared with the status quo. Robustness of the results will be assessed through a series of sensitivity analyses. In addition, an analysis of the equity impact of the interventions will be conducted. Discussion Evidence on the cost and cost-effectiveness of nutrition-sensitive agriculture interventions is scarce. This limits understanding of the costs of rolling out or scaling up programs. The findings of this economic evaluation will provide useful information for different multisectoral stakeholders involved in the planning and implementation of nutrition-sensitive agriculture programmes. Trial registration ISRCTN65922679. Registered on 21 December 2016 Electronic supplementary material The online version of this article (10.1186/s13063-019-3388-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Jolene Skordis
- University College London, Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Helen Harris-Fry
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT,, UK
| | - Sneha Krishnan
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT,, UK
| | - Meghan O'Hearn
- Tufts University, Friedman School of Nutrition Science and Policy, 150 Harrison Avenue, Boston, MA, 02111, USA
| | - Abhinav Kumar
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016, India
| | - Ronali Pradhan
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016, India
| | - Naba Kishore Mishra
- VARRAT (Voluntary Association for Rural Reconstruction and Appropriate Technology), Boulakani Baradang, Mahakalpara Kendrapad, Odisha, 754224, India
| | - Avinash Upadhyay
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016, India
| | - Shibananth Pradhan
- VARRAT (Voluntary Association for Rural Reconstruction and Appropriate Technology), Boulakani Baradang, Mahakalpara Kendrapad, Odisha, 754224, India
| | - Amit Kumar Ojha
- Ekjut, 556 B-Ward No 17-Potka, Chakradharpur, Jharkhand, 833102, India
| | - Sarah Cunningham
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115,, USA
| | - Shibanand Rath
- Ekjut, 556 B-Ward No 17-Potka, Chakradharpur, Jharkhand, 833102, India
| | - Tom Palmer
- University College London, Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Peggy Koniz-Booher
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally, JSI Research and Training Institute, Inc., 1616 Fort Myer Drive 16th Floor, Arlington, VA, 22209, USA
| | - Suneetha Kadiyala
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT,, UK
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Gausman J, Kim R, Subramanian SV. Stunting trajectories from post-infancy to adolescence in Ethiopia, India, Peru, and Vietnam. Matern Child Nutr 2019; 15:e12835. [PMID: 31042809 DOI: 10.1111/mcn.12835] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/08/2019] [Accepted: 04/23/2019] [Indexed: 11/28/2022]
Abstract
Many interventions focus on preventing stunting in the first 1,000 days of life. We take a broader perspective on childhood growth to assess the proportions of children who suffer persistent stunting, recover, and falter and become newly stunted between birth and adolescence. We use longitudinal data collected on 7,128 children in Ethiopia, India, Peru, and Vietnam. Data were collected in five survey waves between the ages of 1 to 15 years. We use descriptive and graphical approaches to compare the trajectories of children first stunted by age 1, first stunted by age 5, and those remained not stunted until age 5. On average, 29.6% of children were first stunted by age 1, 12.9% of children were first stunted by the age 5, and 68.7% of children were not stunted at either age 1 or age 5. A larger percentage of children stunted by age 1 remained stunted at age 15 (40.7%) compared with those who were first stunted by age 5 (32.3%); 33.7% of children first stunted by age 1 and 31.1% of children first stunted by age 5 go on to recover, but then falter during later childhood. 13.1% of children who were not stunted at age 1 or age 5 become newly stunted between the ages of 8 and 15. Our results show that children both become stunted and recover from stunting into adolescence. More attention should be paid to interventions to support healthy growth throughout childhood.
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Affiliation(s)
- Jewel Gausman
- Women and Health Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rockli Kim
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Kadiyala S, Prost A, Harris-Fry H, O’Hearn M, Pradhan R, Pradhan S, Mishra NK, Rath S, Nair N, Rath S, Tripathy P, Krishnan S, Koniz-Booher P, Danton H, Elbourne D, Sturgess J, Beaumont E, Haghparast-Bidgoli H, Skordis-Worrall J, Mohanty S, Upadhay A, Allen E. Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN) trial comparing three variants of a nutrition-sensitive agricultural extension intervention to improve maternal and child nutritional outcomes in rural Odisha, India: study protocol for a cluster randomised controlled trial. Trials 2018; 19:176. [PMID: 29523173 PMCID: PMC5845188 DOI: 10.1186/s13063-018-2521-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 02/02/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Maternal and child undernutrition have adverse consequences for pregnancy outcomes and child morbidity and mortality, and they are associated with low educational attainment, economic productivity as an adult, and human wellbeing. 'Nutrition-sensitive' agriculture programs could tackle the underlying causes of undernutrition. METHODS/DESIGN This study is a four-arm cluster randomised controlled trial in Odisha, India. Interventions are as follows: (1) an agricultural extension platform of women's groups viewing and discussing videos on nutrition-sensitive agriculture (NSA) practices, and follow-up visits to women at home to encourage the adoption of new practices shown in the videos; (2) women's groups viewing and discussing videos on NSA and nutrition-specific practices, with follow-up visits; and (3) women's groups viewing and discussing videos on NSA and nutrition-specific practices combined with a cycle of Participatory Learning and Action meetings, with follow-up visits. All arms, including the control, receive basic nutrition training from government community frontline workers. Primary outcomes, assessed at baseline and 32 months after the start of the interventions, are (1) percentage of children aged 6-23 months consuming ≥ 4 out of 7 food groups per day and (2) mean body mass index (BMI) (kg/m2) of non-pregnant, non-postpartum (gave birth > 42 days ago) mothers or female primary caregivers of children aged 0-23 months. Secondary outcomes are percentage of mothers consuming ≥ 5 out of 10 food groups per day and percentage of children's weight-for-height z-score < -2 standard deviations (SD). The unit of randomisation is a cluster, defined as one or more villages with a combined minimum population of 800 residents. There are 37 clusters per arm, and outcomes will be assessed in an average of 32 eligible households per cluster. For randomisation, clusters are stratified by distance to nearest town (< 10 km or ≥ 10 km), and low (< 30%), medium (30-70%), or high (> 70%) proportion of Scheduled Tribe or Scheduled Caste (disadvantaged) households. A process evaluation will assess the quality of implementation and mechanisms behind the intervention effects. A cost-consequence analysis will compare incremental costs and outcomes of the interventions. DISCUSSION This trial will contribute evidence on the impacts of NSA extension through participatory, low-cost, video-based approaches on maternal and child nutrition and on whether integration with nutrition-specific goals and enhanced participatory approaches can increase these impacts. TRIAL REGISTRATION ISRCTN , ISRCTN65922679 . Registered on 21 December 2016.
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Affiliation(s)
- Suneetha Kadiyala
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Audrey Prost
- University College London, Institute for Global Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Helen Harris-Fry
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Meghan O’Hearn
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016 India
| | - Ronali Pradhan
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016 India
| | - Shibananth Pradhan
- VARRAT (Voluntary Association for Rural Reconstruction and Appropriate Technology), Boulakani Baradang, Mahakalpara Kendrapad, Keonjhar, 754224 Odisha India
| | - Naba Kishore Mishra
- VARRAT (Voluntary Association for Rural Reconstruction and Appropriate Technology), Boulakani Baradang, Mahakalpara Kendrapad, Keonjhar, 754224 Odisha India
| | - Suchitra Rath
- Ekjut, 556 B, Ward No. 17, Potka, Chakradharpur, 833102 Jharkhand India
| | - Nirmala Nair
- Ekjut, 556 B, Ward No. 17, Potka, Chakradharpur, 833102 Jharkhand India
| | - Shibanand Rath
- Ekjut, 556 B, Ward No. 17, Potka, Chakradharpur, 833102 Jharkhand India
| | | | - Sneha Krishnan
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Peggy Koniz-Booher
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally, JSI Research & Training Institute, Inc., 1616 Fort Myer Drive, 16th Floor, Arlington, 22209 VA USA
| | - Heather Danton
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally, JSI Research & Training Institute, Inc., 1616 Fort Myer Drive, 16th Floor, Arlington, 22209 VA USA
| | - Diana Elbourne
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Joanna Sturgess
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Emma Beaumont
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | | | - Jolene Skordis-Worrall
- University College London, Institute for Global Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Satyanarayan Mohanty
- Development Corner Consulting Pvt. Ltd. (DCOR), 131(P), Punjabi Chhak, Satyanagar, Near Hotel Sungreen, Bhubaneshwar, 751007 India
| | - Avinash Upadhay
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016 India
| | - Elizabeth Allen
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Affiliation(s)
- Rasmi Avula
- International Food Policy Research Institute (IFPRI), New Delhi, India
| | - Neha Raykar
- Public Health Foundation of India (PHFI), New Delhi, India
| | - Purnima Menon
- International Food Policy Research Institute (IFPRI), New Delhi, India
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Manikam L, Prasad A, Dharmaratnam A, Moen C, Robinson A, Light A, Ahmed S, Lingam R, Lakhanpaul M. Systematic review of infant and young child complementary feeding practices in South Asian families: the India perspective. Public Health Nutr 2018; 21:637-54. [PMID: 29166956 DOI: 10.1017/S136898001700297X] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Suboptimal nutrition among children remains a problem among South Asian (SA) families. Appropriate complementary feeding (CF) practices can greatly reduce this risk. Thus, we undertook a systematic review of studies assessing CF (timing, dietary diversity, meal frequency and influencing factors) in children aged <2 years in India. DESIGN Searches between January 2000 and June 2016 in MEDLINE, EMBASE, Global Health, Web of Science, OVID Maternity & Infant Care, CINAHL, Cochrane Library, BanglaJOL, POPLINE and WHO Global Health Library. Eligibility criteria: primary research on CF practices in SA children aged 0-2 years and/or their families. Search terms: 'children', 'feeding' and 'Asians' and derivatives. Two researchers undertook study selection, data extraction and quality appraisal (EPPI-Centre Weight of Evidence). RESULTS From 45 712 abstracts screened, sixty-four cross-sectional, seven cohort, one qualitative and one case-control studies were included. Despite adopting the WHO Infant and Young Child Feeding guidelines, suboptimal CF practices were found in all studies. In twenty-nine of fifty-nine studies, CF was introduced between 6 and 9 months, with eight studies finding minimum dietary diversity was achieved in 6-33 %, and ten of seventeen studies noting minimum meal frequency in only 25-50 % of the study populations. Influencing factors included cultural influences, poor knowledge on appropriate CF practices and parental educational status. CONCLUSIONS This is the first systematic review to evaluate CF practices in SA in India. Campaigns to change health and nutrition behaviour and revision of nationwide child health nutrition programmes are needed to meet the substantial unmet needs of these children.
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Abstract
The latest available data indicate that 38% of South Asia's children aged 0–59 months are stunted. Such high prevalence combined with the region's large child population explain why South Asia bears about 40% of the global burden of stunting. Recent analyses indicate that the poor diets of children in the first years of life, the poor nutrition of women before and during pregnancy and the prevailing poor sanitation practices in households and communities are important drivers of stunting, most likely because of underlying conditions of women's status, food insecurity, poverty, and social inequalities. With this evidence in mind, UNICEF Regional Office for South Asia convened the Regional Conference: Stop Stunting: Improving Child Feeding, Women's Nutrition, and Household Sanitation in South Asia (New Delhi, November 10–12, 2014). The Conference provided a knowledge‐for‐action platform with three objectives: (1) share state‐of‐the‐art research findings on the causes of child stunting and its consequences for child growth and development and the sustainable growth and development of nations; (2) discuss better practices and the cost and benefits of scaling up programmes to improve child feeding, women's nutrition, and household sanitation in South Asia; and (3) identify implications for sectoral and cross‐sectoral policy, programme, advocacy and research to accelerate progress in reducing child stunting in South Asia. This overview paper summarizes the rationale for the focus on improving child feeding, women's nutrition, and household sanitation as priority areas for investment to prevent child stunting in South Asia. It builds on the invited papers presented at or developed as a follow on to the Stop Stunting Conference.
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Affiliation(s)
- Víctor M Aguayo
- Regional Nutrition Advisor for South Asia, United Nations Children's Fund (UNICEF), Regional Office for South Asia, Kathmandu, Nepal
| | - Purnima Menon
- Senior Research Fellow, International Food Policy Research Institute (IFPRI), New Delhi, India
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