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Mgongo M, Ickes SB, Leyaro BJ, Mboya IB, Grounds S, Seiger ER, Hashim TH, Conklin JL, Kimani-Murage EW, Martin SL. Early Infant Feeding Practices among Women Engaged in Paid Work in Africa: A Systematic Scoping Review. Adv Nutr 2024; 15:100179. [PMID: 38246350 PMCID: PMC10877690 DOI: 10.1016/j.advnut.2024.100179] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/05/2024] [Accepted: 01/14/2024] [Indexed: 01/23/2024] Open
Abstract
Around the world, paid work without appropriate structural support is a key barrier to optimal breastfeeding practices. To better protect, promote, and support optimal breastfeeding practices among working women in Africa, this scoping review sought to understand how paid work influences infant feeding practices in the first 6 mo of life and what support women need to manage work and optimal infant feeding practices. We systematically searched PubMed, Scopus, Global Health, and CINAHL Plus, screened 2436 abstracts, and reviewed 322 full-text articles using Covidence for review and charting. We identified 203 articles that met the inclusion criteria. We identified 32 quantitative, 10 qualitative, 3 mixed-methods, and 2 review articles that focused on examining the relationship between work and breastfeeding, and 109 quantitative, 22 qualitative, 21 mixed-methods, and 4 review articles that included work as part of broader breastfeeding research but did not focus on work. Most studies reported a significant negative association between work and exclusive breastfeeding. Three major domains were reported in the qualitative studies: challenges to managing work and infant feeding, receiving support from employers and family members/caregivers, and strategies for feeding infants when the mother is working. Reviewed studies proposed recommendations to increase support for breastfeeding through changes to policies and support within worksites, the health system, and childcare; however, evidence of previously implemented policies or programs is limited. We recommend more consistent definitions and measurement of women's work. Future research is needed on the impact of implementing various strategies and benefits for breastfeeding at workplaces, as well as efforts to support breastfeeding among informal workers.
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Affiliation(s)
- Melina Mgongo
- Institute of Public Health, Department of Community and Global Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania; Better Health for the African Mother and Child, Moshi, Tanzania.
| | - Scott B Ickes
- Department of Biological and Health Sciences, Wheaton College, Wheaton, IL, United States; Kenya Medical Research Institute, Nairobi, Kenya; Program in Nutritional Sciences, and Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States; Department of Kinesiology and Health Sciences, William and Mary, WIlliamsburg, VA, United States
| | - Beatrice J Leyaro
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Innocent B Mboya
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania; Department of Translational Medicine, Lund University, Malmo, Sweden
| | - Samantha Grounds
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Emily R Seiger
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tamara H Hashim
- Institute of Public Health, Department of Community and Global Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Jamie L Conklin
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Ickes SB, Lemein HS, McKay A, Arensen K, Singa B, Kinyua J, Nduati R, Walson J, Denno DM. Mothers' Willingness to Use Workplace Lactation Supports: Evidence from Formally Employed Mothers in Central Kenya. Curr Dev Nutr 2023; 7:102032. [PMID: 38130332 PMCID: PMC10733674 DOI: 10.1016/j.cdnut.2023.102032] [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] [Received: 07/27/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 12/23/2023] Open
Abstract
Background Formally employed mothers are vulnerable to early cessation of exclusive breastfeeding. Kenyan national policy requires employer-provided maternity benefits and workplace lactation supports. Objective The objective of this study was to evaluate willingness to use nationally mandated workplace lactation supports among formally employed women in Kenya. Methods We conducted a cross-sectional survey among 304 mothers of children ages ≤12 mo in Naivasha, Kenya, who were currently formally employed and employed before delivery of the most recent child to assess availability of and willingness to use current and potential future workplace lactation supports. Results The most available reported workplace lactation supports were schedule flexibility to arrive late or leave early (87.8%) or visit a child to nurse during lunch (24.7%), followed by company-funded community-based daycare (7.6%). Few (<4.0%) reported the availability of lactation rooms, on-site daycares, transportation to breastfeed during lunch, refrigerators for expressed milk, or manual or electric breastmilk pumps. If made available, >80% of mothers reported moderate or strong willingness to use flexible schedules to arrive late or leave early, break during lunch, and transportation to visit a child to nurse. A moderate proportion reported strong willingness to use on-site daycares (63.8%), company-funded community-based daycare (56.9%), on-site lactation rooms (60.5%), refrigeration for expressed milk (49.3%), manual (40.5%), and electric pumps (27.6%). Mothers expressed fear of missing production targets and reported more willingness to use on-site compared with off-site daycare to save transportation time but noted concerns about chemical exposures and early arrival times with young infants. Hesitations regarding the use of on-site lactation rooms included concerns about privacy, milk identification and storage, and use and sharing of pumps. Conclusions Flexible schedules were the workplace lactation supports in highest demand among formally employed mothers. Maternal willingness to use lactation rooms, refrigeration, and pumping equipment was moderate to low, suggesting sensitization may help to increase demand as the implementation of Kenyan policies moves forward.
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Affiliation(s)
- Scott B. Ickes
- Department of Biological and Health Sciences, Wheaton College, Wheaton, IL, United States
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
- Departments of Medicine (Allergy and Infectious Disease) and Epidemiology, University of Washington, Washington, DC, United States
- Department of Kinesiology, William and Mary, Williamsburg, VA, United States
| | - Hellen Sankaine Lemein
- Departments of Medicine (Allergy and Infectious Disease) and Epidemiology, University of Washington, Washington, DC, United States
| | - Anna McKay
- Department of Biological and Health Sciences, Wheaton College, Wheaton, IL, United States
| | - Kelly Arensen
- Department of Biological and Health Sciences, Wheaton College, Wheaton, IL, United States
| | - Benson Singa
- Departments of Medicine (Allergy and Infectious Disease) and Epidemiology, University of Washington, Washington, DC, United States
| | - Joyceline Kinyua
- Departments of Medicine (Allergy and Infectious Disease) and Epidemiology, University of Washington, Washington, DC, United States
| | - Ruth Nduati
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Judd Walson
- Departments of Medicine (Allergy and Infectious Disease) and Epidemiology, University of Washington, Washington, DC, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Donna M. Denno
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
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Ickes SB. Incorporating Nutrition Interventions within Antenatal Care Services Can Improve Iron and Folic Acid Supplement Intake among Pregnant Women and Early Breastfeeding Practices. J Nutr 2023; 153:2773-2774. [PMID: 37573012 DOI: 10.1016/j.tjnut.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023] Open
Affiliation(s)
- Scott B Ickes
- Department of Kinesiology, William and Mary, Williamsburg, Virginia.
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Ickes SB, Lemein H, Arensen K, Kinyua J, Denno DM, Sanders HK, Walson JL, Martin SL, Nduati R, Palmquist AEL. Perinatal care and breastfeeding education during the COVID-19 pandemic: Perspectives from Kenyan mothers and healthcare workers. Matern Child Nutr 2023; 19:e13500. [PMID: 37208841 PMCID: PMC10483952 DOI: 10.1111/mcn.13500] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/07/2023] [Accepted: 02/15/2023] [Indexed: 05/21/2023]
Abstract
The impact of the COVID-19 pandemic on breastfeeding (BF) practices in low- and middle-income countries (LMICs) is not well understood. Modifications in BF guidelines and delivery platforms for breastfeeding education during the COVID-19 pandemic are hypothesised to have affected BF practices. We aimed to understand the experiences with perinatal care, BF education and practice among Kenyan mothers who delivered infants during the COVID-19 pandemic. We conducted in-depth key informant interviews with 45 mothers who delivered infants between March 2020 and December 2021, and 26 health care workers (HCW) from four health facilities in Naivasha, Kenya. While mothers noted that HCWs provided quality care and BF counselling, individual BF counselling was cited to be less frequent than before the pandemic due to altered conditions in health facilities and COVID-19 safety protocols. Mothers stated that some HCW messages emphasised the immunologic importance of BF. However, knowledge among mothers about the safety of BF in the context of COVID-19 was limited, with few participants reporting specific counselling or educational materials on topics such as COVID-19 transmission through human milk and the safety of nursing during a COVID-19 infection. Mothers described COVID-19-related income loss and lack of support from family and friends as the major challenge to practising exclusive breastfeeding (EBF) as they wished or planned. COVID-19 restrictions limited or prevented mothers' access to familial support at facilities and at home, causing them stress and fatigue. In some cases, mothers reported job loss, time spent seeking new means of employment and food insecurity as causes for milk insufficiency, which contributed to mixed feeding before 6 months. The COVID-19 pandemic created changes to the perinatal experience for mothers. While messages about the importance of practising EBF were provided, altered HCW education delivery methods, reduced social support and food insecurity limit EBF practices for mothers in this context.
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Affiliation(s)
- Scott B. Ickes
- Department of Biological and Health SciencesWheaton CollegeWheatonIllinoisUSA
- Department of Health Systems and Population HealthUniversity of WashingtonSeattleWashingtonUSA
- Kenya Medical Research InstituteNairobiKenya
| | | | - Kelly Arensen
- Department of Biological and Health SciencesWheaton CollegeWheatonIllinoisUSA
| | | | - Donna M. Denno
- Department of Health Systems and Population HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
| | - Hannah K. Sanders
- Department of Biological and Health SciencesWheaton CollegeWheatonIllinoisUSA
| | - Judd L. Walson
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
- Departments of Medicine (Allergy and Infectious Disease) and EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Stephanie L. Martin
- Department of Nutrition, Chapel Hill Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Ruth Nduati
- Department of Pediatrics and Child HealthUniversity of NairobiNairobiKenya
| | - Aunchalee E. L. Palmquist
- Department of Maternal and Child Health, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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Ickes SB, Adams JN, Sanders HK, Kinyua J, Lemein HS, Denno DM, Myhre JA, Ithondeka A, Farquhar C, Singa B, Walson JL, Nduati R. Access to Workplace Supports is Positively Associated with Exclusive Breastfeeding among Formally Employed Mothers in Kenya. J Nutr 2023; 152:2888-2897. [PMID: 36040327 PMCID: PMC9839982 DOI: 10.1093/jn/nxac160] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/13/2022] [Accepted: 07/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Mothers in low-income settings who work in agricultural employment are challenged to meet breastfeeding (BF) recommendations. Recent legislation in Kenya mandates maternity leave and workplace supports, yet the relation of these benefits with BF practices is poorly understood. OBJECTIVES We evaluated the associations with workplace-provided BF supports and BF practices among formally employed mothers in Kenya. The availability of supports was hypothesized to be associated with a higher prevalence and greater odds of exclusive breastfeeding (EBF). METHODS We conducted repeated cross-sectional surveys among formally employed mothers at 1-4 d and 6, 14, and 36 wk (to estimate 24 wk) postpartum in Naivasha, Kenya. We used logistic regression adjusted for maternal age, education, physical burden of work, HIV status, and income to evaluate associations between workplace supports and EBF practices. RESULTS Among formally employed mothers (n = 564), those who used onsite workplace childcare were more likely to practice EBF than those who used community- or home-based childcare at both 6 wk (95.7% compared with 82.4%, P = 0.030) and 14 wk (60.6% compared with 22.2%, P < 0.001; adjusted OR: 5.11; 95% CI: 2.3, 11.7). Likewise, at 14 wk among mothers who currently used daycare centers, a higher proportion of mothers who visited daycare centers at or near workplaces practiced EBF (70.0%) than of those not visiting daycare centers (34.7%, P = 0.005). EBF prevalence was higher among mothers with access to workplace private lactation spaces than among mothers without such spaces (84.6% compared with 55.6%, P = 0.037), and among mothers who lived in workplace housing than those without onsite housing (adjusted OR: 2.06, 95% CI: 1.25, 3.41). CONCLUSIONS Formally employed mothers in Kenya who have access to and use workplace-provided BF supports were more likely to practice EBF than mothers who lacked these supports. As the Kenya Health Act is implemented, lactation rooms, onsite housing and daycare, and transportation to visit children can all support BF and EBF among employed mothers.
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Affiliation(s)
- S B Ickes
- Department of Biological and Health Sciences, Wheaton College, IL, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine (Allergy and Infectious Disease), University of Washington, Seattle, WA, USA
| | - J N Adams
- Department of Biological and Health Sciences, Wheaton College, IL, USA
| | - H K Sanders
- Department of Biological and Health Sciences, Wheaton College, IL, USA
| | - J Kinyua
- Department of Medicine (Allergy and Infectious Disease), University of Washington, Seattle, WA, USA
| | - H S Lemein
- Department of Medicine (Allergy and Infectious Disease), University of Washington, Seattle, WA, USA
| | - D M Denno
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Deparment of Pediatrics, University of Washington, Seattle, WA, USA
- Childhood Acute Illnesses Network (CHAIN), Nairobi, Kenya
| | - J A Myhre
- Naivasha Sub-County Referral Hospital, Naivasha, Kenya
- Serge, East Africa, Bundibugyo, Uganda
| | - A Ithondeka
- Naivasha Sub-County Referral Hospital, Naivasha, Kenya
| | - C Farquhar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine (Allergy and Infectious Disease), University of Washington, Seattle, WA, USA
| | - B Singa
- Kenya Medical Research Institute, Nairobi, Kenya
| | - J L Walson
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine (Allergy and Infectious Disease), University of Washington, Seattle, WA, USA
- Deparment of Pediatrics, University of Washington, Seattle, WA, USA
- Childhood Acute Illnesses Network (CHAIN), Nairobi, Kenya
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - R Nduati
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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Ickes SB, Craig C, Heidkamp R. Design Factors for Food Supplementation and Nutrition Education Interventions That Limit Conclusions about Effectiveness for Wasting Prevention: A Scoping Review of Peer-Reviewed Literature. Adv Nutr 2021; 13:328-341. [PMID: 34666351 PMCID: PMC8803494 DOI: 10.1093/advances/nmab107] [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] [Received: 01/01/2021] [Revised: 05/04/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
We conducted a scoping review to characterize the evidence base for the effectiveness of food supplementation (FS), nutrition education (NE), or FS/NE interventions to prevent wasting among children aged 6 to 59 mo. We aimed to identify gaps in peer-reviewed literature and to develop recommendations for strengthening study designs. We identified 56 unique studies (FS = 21, NE = 19, FS/NE = 16) for which we assessed intervention design factors, implementation context, evaluation methods, and wasting impact. Compared with studies focused on stunting, fewer wasting-focused studies reported weight-for-height z score (WHZ). Midupper arm circumference (MUAC) was more commonly reported in wasting-focused studies (71.4%) than those focused on stunting (36.8%) or wasting and stunting (30.4%). FS studies measured anthropometry (mean, 95% CI) more frequently at every 11.3 (7.8, 14.8) wk than NE interventions at 36.3 (8.8, 62.1) wk (P = 0.036), but not FS/NE interventions at 25.8 (5.6, 49.1) wk (P = 0.138). NE interventions tended to be of longer duration than FS or FS/NE interventions. Only 6 studies followed and measured children after the intervention period ended. Across all studies, 45% reported a significant effect on wasting; these included FS, NE, and FS/NE interventions. The lack of comparability across studies limits conclusions about the effectiveness of specific types of interventions. To build a more unified evidence base for wasting prevention we recommend that future studies 1) report on a consistent set of metrics, including MUAC; 2) attempt to measure change in wasting incidence using more frequent measures; 3) measure wasting prevalence among the general population; 4) follow children postintervention to assess relapse; 5) measure food insecurity and diet quality; and 6) use harmonized protocols across multiple settings. Such efforts to improve study comparability will strengthen the evidence base, may help unite divergent professional communities, and ultimately accelerate progress toward eliminating child undernutrition.
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Affiliation(s)
| | | | - Rebecca Heidkamp
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ickes SB, Sanders H, Denno DM, Myhre JA, Kinyua J, Singa B, Lemein HS, Iannotti LL, Farquhar C, Walson JL, Nduati R. Exclusive breastfeeding among working mothers in Kenya: Perspectives from women, families and employers. Matern Child Nutr 2021; 17:e13194. [PMID: 33949782 PMCID: PMC8476403 DOI: 10.1111/mcn.13194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/22/2021] [Accepted: 03/26/2021] [Indexed: 12/01/2022]
Abstract
Exclusive breastfeeding (EBF) for the first 6 months of life improves survival, growth and development. In Kenya, recent legislation and policies advocate for maternity leave and workplace support for breastfeeding and breast milk expression. We conducted a qualitative study to describe factors influencing EBF for 6 months among mothers employed in commercial agriculture and tourism. We interviewed employed mothers (n = 42), alternate caregivers and employed mothers' husbands (n = 20), healthcare providers (n = 21), daycare directors (n = 22) and commercial flower farm and hotel managers (n = 16) in Naivasha, Kenya. Despite recognizing the recommended duration for EBF, employed mothers describe the early cessation of EBF in preparation for their return to work. Managers reported supporting mothers through flexible work hours and duties. Yet, few workplaces have lactation spaces, and most considered adjusting schedules more feasible than breastfeeding during work. Managers and healthcare providers believed milk expression could prolong EBF but thought mothers lack experience with pumping. The most frequently suggested interventions for improving EBF duration were to expand schedule flexibility (100% of groups), provide on-site daycare (80% of groups) and workplace lactation rooms (60% of groups), improve milk expression education and increase maternity leave length (60% of groups). Returning to work corresponds with numerous challenges including lack of proximate or on-site childcare and low support for and experience with milk expression. These factors currently make EBF for 6 months unattainable for most mothers in these industries. Interventions and supports to improve breastfeeding upon return to work are recommended to strengthen employed mothers' opportunity for EBF.
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Affiliation(s)
- Scott B. Ickes
- Department of Applied Health ScienceWheaton CollegeWheatonIllinoisUSA
- Department of Health ServicesUniversity of WashingtonSeattleWashingtonUSA
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Kenya Medical Research InstituteNairobiKenya
| | - Hannah Sanders
- Department of Applied Health ScienceWheaton CollegeWheatonIllinoisUSA
| | - Donna M. Denno
- Department of Health ServicesUniversity of WashingtonSeattleWashingtonUSA
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
- Childhood Acute Illnesses Network (CHAIN)NairobiKenya
| | - Jennifer A. Myhre
- Naivasha Sub‐County Referral Hospital, Serge East AfricaNaivashaKenya
| | | | | | | | - Lora L. Iannotti
- Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
| | - Carey Farquhar
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Departments of Medicine (Allergy and Infectious Disease) and EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Judd L. Walson
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
- Childhood Acute Illnesses Network (CHAIN)NairobiKenya
- Departments of Medicine (Allergy and Infectious Disease) and EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Ruth Nduati
- Department of Pediatrics and Child HealthUniversity of NairobiNairobiKenya
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Ickes SB. Corrigendum to: Formal maternal employment is associated with lower odds of exclusive breastfeeding by 14-weeks postpartum: a cross-sectional survey in Naivasha, Kenya. Am J Clin Nutr 2021;113(3):562-73. Am J Clin Nutr 2021; 113:1060. [PMID: 33822863 PMCID: PMC8023810 DOI: 10.1093/ajcn/nqab055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S B Ickes
- Address correspondence to SI (e-mail: )
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Ickes SB, Oddo VM, Sanders HK, Nduati R, Denno DM, Myhre JA, Kinyua J, Iannotti LL, Singa B, Farquhar C, Walson JL. Formal maternal employment is associated with lower odds of exclusive breastfeeding by 14 weeks postpartum: a cross-sectional survey in Naivasha, Kenya. Am J Clin Nutr 2021; 113:562-573. [PMID: 33515015 PMCID: PMC7948888 DOI: 10.1093/ajcn/nqaa351] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/28/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In many low- and middle-income countries, improvements in exclusive breastfeeding (EBF) have stalled, delaying reductions in child mortality. Maternal employment is a potential barrier to EBF. OBJECTIVES We evaluated associations between maternal employment and breastfeeding (BF) status. We compared formally and non-formally employed mothers in Naivasha, Kenya, where commercial floriculture and hospitality industries employ many women. METHODS We conducted a cross-sectional survey among mothers (n = 1186) from September 2018 to October 2019 at 4 postpartum time points: at hospital discharge (n = 296) and at 6 wk (n = 298), 14 wk (n = 295), and 36 wk (to estimate BF at 24 wk; n = 297) postpartum. Mothers reported their BF status and reasons for EBF cessation. We used multivariable logistic regression models to test the association between formal maternal employment and 3 outcomes: early BF initiation (within 1 h of birth), EBF at each time point, and continued BF at 9 mo. Models were informed by a directed acyclic graph: a causal diagram used to characterize the relationship among variables that influence the independent (employment) and dependent (BF status) variables. RESULTS EBF did not differ by employment status at hospital discharge or at 6 wk postpartum. However, formally employed mothers were less likely than those not formally employed to report EBF at 14 wk (59.0% compared with 95.4%, respectively; AOR: 0.19; 95% CI: 0.10, 0.34) and at 24 wk (19.0% compared with 49.6%, respectively; AOR: 0.25; 95% CI: 0.14, 0.44). The prevalence of continued BF at 36 wk did not differ by group (98.1% for formally employed compared with 98.5% for non-formally employed women; AOR: 0.80; 95% CI: 0.10, 6.08). The primary reasons reported for early EBF cessation were returning to work (46.5%), introducing other foods based on the child's age (33.5%), or perceived milk insufficiency (13.7%). CONCLUSIONS As more women engage in formal employment in low- and middle-income countries, additional supports to help prolong the period of EBF may be beneficial for formally employed mothers and their children.
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Affiliation(s)
- S B Ickes
- Address correspondence to SBI (e-mail: )
| | - V M Oddo
- University of Washington Department of Health Services, Seattle, WA, USA,University of Illinois Chicago, Department of Kinesiology and Nutrition, Chicago, IL, USA
| | - H K Sanders
- Wheaton College Department of Applied Health Science, Wheaton, IL, USA
| | - R Nduati
- University of Nairobi Department of Pediatrics and Child Health, Nairobi, Kenya
| | - D M Denno
- University of Washington Department of Health Services, Seattle, WA, USA,University of Washington Department of Global Health, Seattle, WA, USA,University of Washington Department of Pediatrics, Seattle, WA, USA,Childhood Acute Illnesses Network (CHAIN), Nairobi, Kenya
| | - J A Myhre
- Naivasha Sub-County Referral Hospital and Serge East Africa, Naivasha, Kenya
| | - J Kinyua
- Kenya Medical Research Institute, Nairobi, Kenya
| | - L L Iannotti
- Washington University in St. Louis Brown School, St. Louis, MO, USA
| | - B Singa
- Kenya Medical Research Institute, Nairobi, Kenya
| | - C Farquhar
- University of Washington Department of Global Health, Seattle, WA, USA,University of Washington Department of Medicine (Allergy and Infectious Disease), Seattle, WA, USA,University of Washington Department of Epidemiology, Seattle, WA, USA
| | - J L Walson
- University of Washington Department of Global Health, Seattle, WA, USA,University of Washington Department of Pediatrics, Seattle, WA, USA,Childhood Acute Illnesses Network (CHAIN), Nairobi, Kenya,University of Washington Department of Medicine (Allergy and Infectious Disease), Seattle, WA, USA,University of Washington Department of Epidemiology, Seattle, WA, USA
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Ickes SB, Craig C, Heidkamp RA. How do nutrition professionals working in low-income countries perceive and prioritize actions to prevent wasting? A mixed-methods study. Matern Child Nutr 2020; 16:e13035. [PMID: 32510856 PMCID: PMC7507008 DOI: 10.1111/mcn.13035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/26/2020] [Accepted: 04/22/2020] [Indexed: 11/27/2022]
Abstract
Despite a shared commitment to achieving global nutrition targets, development and emergency‐humanitarian actors tend to prioritize different nutrition outcomes and actions. New approaches are needed to bridge the divide between these communities and to strengthen the overall evidence base for prevention of wasting. To better understand how these different groups perceive and prioritize actions for wasting prevention, key informant interviews (n = 21) were conducted, and an online survey was fielded among nutrition professionals working in low‐income countries (n = 107). Additionally, nutrition policy and strategy documents for select global and country institutions (n = 12) were analysed to identify interventions and approaches for addressing different forms of undernutrition. The findings of this study suggest that at both global and country levels, development actors tend to prioritize stunting prevention, and emergency‐humanitarian actors tend to prioritize treatment of acute malnutrition. It was less common for wasting prevention to be mentioned as an explicit priority. Many interventions were perceived by respondents to influence both stunting and wasting despite limited published evidence of effectiveness on wasting for water, sanitation and hygiene, growth monitoring and promotion, breastfeeding promotion and micronutrient supplementation. To help unify the nutrition community around prevention of wasting, the discourse about priority interventions should shift from ‘stunting versus wasting’ and ‘prevention versus treatment’ to a life‐course framing around child survival, growth and development. Respondents identified a need for more programme and research funding that prioritizes both wasting and stunting as outcomes. They also suggest leveraging existing national coordination bodies that bring development and emergency‐humanitarian partners together.
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Affiliation(s)
- Scott B Ickes
- Department of Applied Health Science, Wheaton College, Wheaton, Illinois, USA.,Departments of Global Health and Health Services, University of Washington School of Public Health, Seattle, Washington, USA
| | | | - Rebecca A Heidkamp
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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11
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Ickes SB. Supportive Evidence for Program Impact Pathways: Food-Assisted Maternal and Child Health and Nutrition Programs Can Produce Sustained Dietary Improvements. J Nutr 2020; 150:661-662. [PMID: 32171007 PMCID: PMC8045987 DOI: 10.1093/jn/nxaa056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/13/2020] [Accepted: 02/18/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Scott B Ickes
- Wheaton College Department of Applied Health Sciences, University of Washington Departments of Global Health and Health Services, Kenya Medical Research Institute, Wheaton, IL, USA,Address correspondence to SBI (e-mail: )
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12
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Nahar B, Hossain M, Ickes SB, Naila NN, Mahfuz M, Hossain D, Denno DM, Walson J, Ahmed T. Development and validation of a tool to assess appetite of children in low income settings. Appetite 2019; 134:182-192. [PMID: 30583008 DOI: 10.1016/j.appet.2018.12.032] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 12/20/2018] [Indexed: 11/26/2022]
Abstract
Reliable and validated tools for measuring appetite of children in South Asia are not available. This study aimed to develop and validate a tool for assessing appetite level of under-five children. Based on literature review and findings from focus group discussions (FGDs), an initial 27-item interview-based tool, the "Early Childhood Appetite and Satiety Tool (ECAST)" was developed in Bangladesh. Fourteen FGDs were carried out in rural and urban settings and constructs for inclusion were derived from the themes and coding of FGDs and appetite assessment tools used in Western contexts. For structural validation, the ECAST-27-was administered on 150 mothers/primary caregivers of children aged 6-59 months, living in urban and rural areas. To validate the association with other variables, the ECAST was administered on mothers of children aged 12-24 months in the community (N = 50), and two groups of wasted, hospitalized children (Weight-for-length, Z score <-2SD) [group1: twenty acutely ill children aged 6-59 months; group 2: twenty children in nutritional rehabilitation aged 18-24 months]. Reliability of ECAST was estimated using Cronbach's alpha and Pearson's correlation coefficient. Kaiser-Meyer-Olkin = 0.73 and the Bartlett's test of sphericity, χ2(253) = 755.791, p < 0.001 indicated that the raw data were suitable. Given the convergence of the Scree plot, Kaiser's criterion and dropping of cross loading items, a 16-item ECAST was produced with three sub scales: Appetite cue; Food responsiveness and Emotion and preference, which were internally valid and had good test-retest reliability (Cronbach's alpha 0.6 and test-retest reliability 0.797). Total ECAST scores of wasted children with good appetite were significantly higher from those with poor appetite (p = 0.004 and 0.001 for two wasted groups respectively). Results suggest that ECAST may provide a useful measure to assess the appetite level of under-five children.
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Affiliation(s)
- Baitun Nahar
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Muttaquina Hossain
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Scott B Ickes
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Applied Health Sciences, Wheaton College, Wheaton, IL, USA
| | - Nurun Nahar Naila
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Daluwar Hossain
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Donna M Denno
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA; Childhood Acute Illness and Nutrition Network, Seattle, WA, USA
| | - Judd Walson
- Department of Global Health, University of Washington, Seattle, WA, USA; James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka, 1212, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Department of Global Health, University of Washington, Seattle, WA, USA; James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka, 1212, Bangladesh
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13
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Oddo VM, Ickes SB. Reply to T Bhurosy and V Ansu. Am J Clin Nutr 2018; 108:1354-1355. [PMID: 30321263 DOI: 10.1093/ajcn/nqy231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Vanessa M Oddo
- University of Washington Department of Health Services and Program in Nutritional Sciences, WA, University of Washington Department of Global Health, WA (SBI)
| | - Scott B Ickes
- University of Washington Department of Health Services and Program in Nutritional Sciences, WA, University of Washington Department of Global Health, WA (SBI)
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14
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Ickes SB, Hossain M, Ritter G, Lazarus M, Reynolds K, Nahar B, Ahmed T, Walson J, Denno DM. Systematic Review of Tools and Methods to Measure Appetite in Undernourished Children in the Context of Low- and Middle-Income Countries. Adv Nutr 2018; 9:789-812. [PMID: 30462177 PMCID: PMC6247147 DOI: 10.1093/advances/nmy042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Indexed: 12/30/2022] Open
Abstract
Child undernutrition has multifactorial causes, ranging from food insecurity to etiologies refractory to conventional nutritional approaches, such as infections, environmental enteric dysfunction, and other conditions that lead to systemic inflammation. Poor appetite may be an important symptom of these causes and may be a useful marker of an undernourished child's ability to recover. We conducted a systematic review to characterize the methods and tools to measure appetite among children <5 y old in low- and middle-income countries. A systematic search of 8 databases identified 23 eligible studies published since 1995. Thirteen described methods based on direct feeding observation or quantification of nutrient intake from caregiver report, 16 described tools that assessed caregiver perceptions of appetite, and 6 reported assessments in both categories. Four studies that gauged caregiver perceptions assessed multiple appetite domains, whereas 12 assessed 1 domain-often with a single question. Only 6 studies reported validation processes, the most common of which compared an observed test meal with daily energy intake. No studies reported the use of a method or tool that was validated in multiple cultural or linguistic contexts. Although dietary intake measures and observed feeding tests have shown validity in some contexts, they are resource intensive. Subjective caregiver questionnaires may offer a more efficient appetite evaluation method, but they have been evaluated less consistently. A rigorously developed and validated tool to rapidly assess child appetite is needed and could be best addressed by a questionnaire that leverages the multiple domains of appetite. The application of interventions that target causes of undernutrition that are not amenable to food-based interventions in clinical or research contexts could be facilitated by an efficient appetite screening tool to identify appetite-related causes of undernutrition and to monitor children's response to such interventions.
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Affiliation(s)
- Scott B Ickes
- Departments of Health Services,Global Health,Program in Nutritional Sciences, University of Washington, Seattle, WA,Wheaton College Department of Applied Health Sciences, Wheaton, IL
| | - Muttaquina Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b)
| | - Gaelen Ritter
- Program in Nutritional Sciences, University of Washington, Seattle, WA
| | - Monica Lazarus
- Program in Nutritional Sciences, University of Washington, Seattle, WA
| | | | - Baitun Nahar
- Nutrition and Clinical Services Division, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b)
| | - Tahmeed Ahmed
- Global Health,Nutrition and Clinical Services Division, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b)
| | - Judd Walson
- Pediatrics,Global Health,Medicine,Epidemiology,Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Donna M Denno
- Departments of Health Services,Pediatrics,Global Health,Childhood Acute Illness and Nutrition Network, Nairobi, Kenya,Address correspondence to DMD (e-mail: )
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15
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Oddo VM, Ickes SB. Maternal employment in low- and middle-income countries is associated with improved infant and young child feeding. Am J Clin Nutr 2018; 107:335-344. [PMID: 29566201 PMCID: PMC6248412 DOI: 10.1093/ajcn/nqy001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/26/2017] [Indexed: 11/14/2022] Open
Abstract
Background Women's employment improves household income, and can increase resources available for food expenditure. However, employed women face time constraints that may influence caregiving and infant and young child feeding (IYCF) practices. As economic and social trends shift to include more women in the labor force in low- and middle-income countries (LMICs), a current understanding of the association between maternal employment and IYCF is needed. Objective We investigated the association between maternal employment and IYCF. Design Using cross-sectional samples from 50 Demographic and Health Surveys, we investigated the association between maternal employment and 3 indicators of IYCF: exclusive breastfeeding (EBF) among children aged <6 mo (n = 47,340) and minimum diet diversity (MDD) and minimum meal frequency (MMF) (n = 137,208) among children aged 6-23 mo. Mothers were categorized as formally employed, informally employed, or nonemployed. We used meta-analysis to pool associations across all countries and by region. Results According to pooled estimates, neither formal [pooled odds ratio (POR) = 0.91; 95% CI: 0.81, 1.03] nor informal employment (POR = 1.05; 95% CI: 0.95, 1.16), compared to nonemployment, was associated with EBF. Children of both formally and informally employed women, compared to children of nonemployed women, had higher odds of meeting MDD (formal POR = 1.47; 95% CI: 1.35, 1.60; informal POR = 1.11; 95% CI: 1.03, 1.20) and MMF (formal POR = 1.18; 95% CI: 1.10, 1.26; informal POR = 1.15; 95% CI: 1.06, 1.24). Sensitivity analyses indicated that compared to nonemployed mothers, the odds of continued breastfeeding at 1 y were lower among formally employed mothers (POR = 0.82; 95% CI: 0.73, 0.98) and higher among informally employed mothers (POR = 1.19; 95% CI: 1.01, 1.40). Conclusion Efforts to promote formalized employment among mothers may be an effective method for improving diet diversity and feeding frequency in LMICs. Formally employed mothers may benefit from support for breastfeeding to enable continued breastfeeding through infancy. This trial was registered at clinicaltrials.gov as NCT03209999.
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Affiliation(s)
- Vanessa M Oddo
- Departments of Health Services and Program in Nutritional Sciences,Address correspondence to VMO (e-mail: )
| | - Scott B Ickes
- Departments of Health Services and Program in Nutritional Sciences,Global Health, University of Washington, Seattle, WA
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16
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Ickes SB, Wu M, Mandel MP, Roberts AC. Associations between social support, psychological well-being, decision making, empowerment, infant and young child feeding, and nutritional status in Ugandan children ages 0 to 24 months. Matern Child Nutr 2017; 14. [PMID: 28782300 DOI: 10.1111/mcn.12483] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 05/15/2017] [Accepted: 06/04/2017] [Indexed: 01/21/2023]
Abstract
Maternal capabilities-qualities of mothers that enable them to leverage skills and resources into child health-hold potential influence over mother's adoption of child caring practices, including infant and young child feeding. We developed a survey (n = 195) that assessed the associations of 4 dimensions of maternal capabilities (social support, psychological health, decision making, and empowerment) with mothers' infant and young child feeding practices and children's nutritional status in Uganda. Maternal responses were converted to categorical subscales and an overall index. Scale reliability coefficients were moderate to strong (α range = 0.49 to 0.80). Mothers with higher social support scores were more likely to feed children according to the minimum meal frequency (odds ratio [OR] [95% confidence interval (CI)] = 1.38 [1.10, 1.73]), dietary diversity (OR [95% CI] = 1.56 [1.15, 2.11]), iron rich foods, (OR [95% CI] = 1.47 [1.14, 1.89]), and minimally acceptable diet (OR [95% CI] = 1.55 [1.10, 2.21]) indicators. Empowerment was associated with a greater likelihood of feeding a minimally diverse and acceptable diet. The maternal capabilities index was significantly associated with feeding the minimum number of times per day (OR [95% CI] = 1.29 [1.03, 1.63]), dietary diversity (OR [95% CI] = 1.44 [1.06, 1.94]), and minimally acceptable diet (OR [95% CI] = 1.43 [1.01, 2.01]). Mothers with higher psychological satisfaction were more likely to have a stunted child (OR [95% CI] = 1.31 [1.06, 1.63]). No other associations between the capabilities scales and child growth were significant. Strengthening social support for mothers and expanding overall maternal capabilities hold potential for addressing important underlying determinants of child feeding in the Ugandan context.
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Affiliation(s)
- Scott B Ickes
- Departments of Health Services and Global Health, and Program in Nutritional Sciences, University of Washington, Seattle, Washington, USA.,Department of Kinesiology and Health Sciences, The College of William and Mary, Williamsburg, Virginia, USA
| | - Michael Wu
- Master Program of Global Health and Development, Taipei Medical University, Taipei, Taiwan
| | - Maia P Mandel
- Department of Kinesiology and Health Sciences, The College of William and Mary, Williamsburg, Virginia, USA
| | - Alison C Roberts
- Department of Kinesiology and Health Sciences, The College of William and Mary, Williamsburg, Virginia, USA
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17
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Ickes SB, Adair LS, Brahe CA, Thirumurthy H, Charles B, Myhre JA, Bentley ME, Ammerman AS. Impact of lipid-based nutrient supplementation (LNS) on children's diet adequacy in Western Uganda. Matern Child Nutr 2016; 11 Suppl 4:163-78. [PMID: 25597415 DOI: 10.1111/mcn.12164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Lipid-based nutrient supplements (LNS) can help treat undernutrition; however, the dietary adequacy of children supplemented with LNS, and household utilisation patterns are not well understood. We assessed diet adequacy and the quality of complementary foods by conducting a diet assessment of 128 Ugandan children, ages 6-59 months, who participated in a 10-week programme for children with moderate acute malnutrition (MAM, defined as weight-for-age z-score < -2). Caregivers were given a weekly ration of 650 kcal day(-1) (126 g day(-1) ) of a peanut/soy LNS. Two 24-h dietary recalls were administered per child. LNS was offered to 86% of targeted children at least once. Among non-breastfed children, over 90% met their estimated average requirement (EAR) cut-points for all examined nutrients. Over 90% of breastfed children met EAR cut-points for nutrient density for most nutrients, except for zinc where 11.7% met cut-points. A lower proportion of both breastfed and non-breastfed children met adjusted EARs for the specific nutritional needs of MAM. Fewer than 20% of breastfed children met EAR nutrient-density guidelines for MAM for zinc, vitamin C, vitamin A and folate. Underweight status, the presence of a father in the child's home, and higher programme attendance were all associated with greater odds of feeding LNS to targeted children. Children in this community-based supplemental feeding programme who received a locally produced LNS exhibited substantial micronutrient deficiencies given the special dietary needs of this population. These results can help inform programme strategies to improve LNS targeting, and highlight potential nutrient inadequacies for consumers of LNS in community-based settings.
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Affiliation(s)
- Scott B Ickes
- Department of Kinesiology and Health Sciences, College of William and Mary, Williamsburg, Virginia, USA
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Catherine A Brahe
- Department of Kinesiology and Health Sciences, College of William and Mary, Williamsburg, Virginia, USA
| | - Harsha Thirumurthy
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Baguma Charles
- Makerere University School of Public Health, Kampala, Uganda
| | | | - Margaret E Bentley
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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18
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Ickes SB, Heymsfield GA, Wright TW, Baguma C. "Generally the young mom suffers much:" Socio-cultural influences of maternal capabilities and nutrition care in Uganda. Matern Child Nutr 2016; 13. [PMID: 27650794 DOI: 10.1111/mcn.12365] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/11/2016] [Accepted: 07/13/2016] [Indexed: 11/28/2022]
Abstract
We conducted 40 in-depth interviews and eight focus groups among mothers and fathers (n = 91) of diverse ages in western Uganda to define the relevant domains of maternal capabilities and their relationship to infant and young child feeding practices. This study was directed by a developing theory of maternal capabilities that posits that the impact of health-directed interventions may be limited by unmeasured and poorly understood maternal characteristics. Ugandan caregivers defined three major life events that constrain women's capabilities for childcare: early pregnancy, close child spacing, and polygamous marriage. Women describe major constraints in their decision-making capabilities generally and specifically to procuring food for young children. Future nutrition programs may improve their impact through activities that model household decision-making scenarios, and that strengthen women's social support networks. Findings suggest that efforts to transform gender norms may be one additional way to improve nutrition outcomes in communities with a generally low status of women relative to men. The willingness of younger fathers to challenge traditional gender norms suggests an opportunity in this context for continued work to strengthen resources for children's nutritional care. SIGNIFICANCE Maternal factors such as autonomy are associated with child feeding practices and nutritional status, with varying degrees depending on the definition of maternal-level constructs and context. This study describes the events and processes that constrain maternal capabilities-intrapersonal factors that shape mother's abilities to leverage resources to provide care to children-as they relate to nutrition and hygiene practices. We report community beliefs and understandings about which capabilities have meaning for child nutrition and hygiene, and develop a conceptual framework to describe how these capabilities are formed and describe implications for future nutrition programs in East Africa and similar settings.
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Affiliation(s)
- Scott B Ickes
- Department of Health Services and Program in Nutritional Sciences, University of Washington, Seattle, Washington, USA.,Department of Kinesiology and Health Sciences, The College of William and Mary, Williamsburg, Virginia, USA
| | - Grace A Heymsfield
- Department of Nutritional Sciences, The University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Timothy W Wright
- Department of Kinesiology and Health Sciences, The College of William and Mary, Williamsburg, Virginia, USA
| | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
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Ickes SB, Hurst TE, Flax VL. Maternal Literacy, Facility Birth, and Education Are Positively Associated with Better Infant and Young Child Feeding Practices and Nutritional Status among Ugandan Children. J Nutr 2015; 145:2578-86. [PMID: 26377762 PMCID: PMC4620722 DOI: 10.3945/jn.115.214346] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/24/2015] [Accepted: 08/19/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Understanding maternal factors that influence child feeding is necessary to inform intervention planning in settings in which mothers experience substantial social vulnerabilities. OBJECTIVE The purpose of this study was to assess maternal sociodemographic factors that may constrain women's caring capabilities and subsequent child nutrition in Uganda. METHODS We analyzed data from the 2006 and 2011 Uganda Demographic and Health Surveys to model the associations between maternal sociodemographic factors, child feeding practices, and anthropometry with multivariate logistic regression models. RESULTS The proportion of children fed according to recommended guidelines declined in Uganda from 2006 to 2011. Mothers who lacked literacy skills were less likely to achieve recommended complementary feeding indicators; however, literacy was not associated with breastfeeding practices. Mothers in the upper 60% wealth percentile were more likely to meet minimum meal frequency, diversity, and adequacy indicators. Mothers who gave birth at health facilities (2006 OR: 0.49; 95% CI: 0.26, 0.91; P < 0.05) and who were in the upper 60% wealth percentile (2011 OR: 0.43; 95% CI: 0.21, 0.69) were less likely to exclusively breastfeed until 6 mo. There were no significant associations between age at first pregnancy, maternal education, and infant and young child feeding practices. Women with a formal education had children with lower stunting and underweight probabilities in both time periods (OR range: 0.43-0.74). Women who delivered in childbirth facilities were less likely to have a child with low weight-for-age, length-for-age, or weight-for-length z scores (OR range: 0.59-0.82). Marital status, the age at first child birth, not accepting domestic violence, freedom to travel away from home, and involvement in household and reproductive decisions were not associated with child anthropometry in either time period. CONCLUSIONS Mothers with low literacy skills, who deliver their children at home, and who lack formal education are particularly at risk of poor child feeding and represent a group that may benefit from enhanced interventions that address their particular vulnerabilities. Factors that contribute to improved maternal feeding capabilities but may impair breastfeeding practices need to be better understood.
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Affiliation(s)
- Scott B Ickes
- Department of Kinesiology and Health Sciences, College of William and Mary, Williamsburg, VA; and
| | - Taylor E Hurst
- Department of Kinesiology and Health Sciences, College of William and Mary, Williamsburg, VA; and
| | - Valerie L Flax
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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20
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Ickes SB, Trichler RB, Parks BC. Building a Stronger System for Tracking Nutrition-Sensitive Spending: A Methodology and Estimate of Global Spending for Nutrition-Sensitive Foreign Aid. Food Nutr Bull 2015; 36:520-33. [PMID: 26503329 DOI: 10.1177/0379572115611785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/15/2022]
Abstract
BACKGROUND There is growing awareness that the necessary solutions for improving nutrition outcomes are multisectorial. As such, investments are increasingly directed toward "nutrition-sensitive" approaches that not only address an underlying or basic determinant of nutrition but also seek to achieve an explicit nutrition goal or outcome. Understanding how and where official development assistance (ODA) for nutrition is invested remains an important but complex challenge, as development projects components vary in their application to nutrition outcomes. Currently, no systematic method exists for tracking nutrition-sensitive ODA. OBJECTIVE To develop a methodology for classifying and tracking nutrition-sensitive ODA and to produce estimates of the amount of nutrition-sensitive aid received by countries with a high burden of undernutrition. METHODS We analyzed all financial flows reported to the Organization for Economic Co-Operation and Development's Development Assistance Committee Creditor Reporting Service in 2010 to estimate these investments. We assessed the relationships between national stunting prevalence, stunting burden, under-5 mortality, and the amount of nutrition-specific and nutrition-sensitive ODA. RESULTS We estimate that, in 2010, a total of $379·4 million (M) US dollars (USD) was committed to nutrition-specific projects and programs of which 25 designated beneficiaries (countries and regions) accounted for nearly 85% ($320 M). A total of $1.79 billion (B) was committed to nutrition-sensitive spending, of which the top 25 countries/regions accounted for $1.4 B (82%). Nine categories of development activities accounted for 75% of nutrition-sensitive spending, led by Reproductive Health Care (30·4%), Food Aid/Food Security Programs (14·1%), Emergency Food Aid (13·2%), and Basic Health Care (5·0%). Multivariate linear regression models indicate that the amount of nutrition-sensitive (P = .001) and total nutrition ODA was significantly predicted by stunting prevalence (P = .001). The size of the total population of stunted children significantly predicted the amount of nutrition-specific ODA (P < .001). CONCLUSION The recipient profile of nutrition-specific and nutrition-sensitive ODA is related but distinct. Nutrition indicators are associated with the level of nutrition-related ODA commitments to recipient countries. A reliable estimate of nutrition spending is critical for effective planning by both donors and recipients and key for success, as the global development community recommits to a new round of goals to address the interrelated causes of undernutrition in low-income countries.
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Affiliation(s)
- Scott B Ickes
- Department of Kinesiology and Health Sciences, The College of William and Mary, Williamsburg, VA, USA Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | | | - Bradley C Parks
- AidData at The College of William and Mary, Williamsburg, VA, USA
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21
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Jones AD, Mbuya MNN, Ickes SB, Heidkamp RA, Smith LE, Chasekwa B, Menon P, Zongrone AA, Stoltzfus RJ. Reply to correspondence: is the strength of association between indicators of dietary quality and the nutritional status of children being underestimated? Matern Child Nutr 2014; 10:161-2. [PMID: 24341554 DOI: 10.1111/mcn.12107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Andrew D Jones
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Jones AD, Ickes SB, Smith LE, Mbuya MNN, Chasekwa B, Heidkamp RA, Menon P, Zongrone AA, Stoltzfus RJ. World Health Organization infant and young child feeding indicators and their associations with child anthropometry: a synthesis of recent findings. Matern Child Nutr 2013; 10:1-17. [PMID: 23945347 DOI: 10.1111/mcn.12070] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As the World Health Organization (WHO) infant and young child feeding (IYCF) indicators are increasingly adopted, a comparison of country-specific analyses of the indicators' associations with child growth is needed to examine the consistency of these relationships across contexts and to assess the strengths and potential limitations of the indicators. This study aims to determine cross-country patterns of associations of each of these indicators with child stunting, wasting, height-for-age z-score (HAZ) and weight-for-height z-score (WHZ). Eight studies using recent Demographic and Health Surveys data from a total of nine countries in sub-Saharan Africa (nine), Asia (three) and the Caribbean (one) were identified. The WHO indicators showed mixed associations with child anthropometric indicators across countries. Breastfeeding indicators demonstrated negative associations with HAZ, while indicators of diet diversity and overall diet quality were positively associated with HAZ in Bangladesh, Ethiopia, India and Zambia (P < 0.05). These same complementary feeding indicators did not show consistent relationships with child stunting. Exclusive breastfeeding under 6 months of age was associated with greater WHZ in Bangladesh and Zambia (P < 0.05), although CF indicators did not show strong associations with WHZ or wasting. The lack of sensitivity and specificity of many of the IYCF indicators may contribute to the inconsistent associations observed. The WHO indicators are clearly valuable tools for broadly assessing the quality of child diets and for monitoring population trends in IYCF practices over time. However, additional measures of dietary quality and quantity may be necessary to understand how specific IYCF behaviours relate to child growth faltering.
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Affiliation(s)
- Andrew D Jones
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
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Jones AD, Ickes SB, Smith LE, Mduduzi MNN, Chasekwa B, Heidkamp RA, Menon P, Zongrone AA, Stoltzfus RJ. World Health Organization infant and young child feeding indicators and their associations with child growth: a synthesis of recent findings. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.618.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Scott B Ickes
- Department of Kinesiology and Health SciencesCollege of William and MaryWilliamsburgVA
| | - Laura E Smith
- Division of Nutritional SciencesCornell UniversityIthacaNY
| | - Mdu NN Mduduzi
- Division of Nutritional SciencesCornell UniversityIthacaNY
- Zvitambo ProjectHarareZimbabwe
| | | | - Rebecca A Heidkamp
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Purnima Menon
- Poverty, Health and Nutrition DivisionsInternational Food Policy Research InstituteNew DelhiIndia
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Leone LA, Beth D, Ickes SB, Macguire K, Nelson E, Smith RA, Tate DF, Ammerman AS. Attitudes Toward Fruit and Vegetable Consumption and Farmers' Market Usage Among Low-Income North Carolinians. J Hunger Environ Nutr 2012; 7:64-76. [PMID: 24098314 DOI: 10.1080/19320248.2012.651386] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [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: 10/28/2022]
Abstract
Low fruit and vegetable (F&V) consumption is associated with higher rates of obesity and chronic disease among low-income individuals. Understanding attitudes towards F&V consumption and addressing policy and environmental changes could help improve diet and reduce disease risk. A survey of North Carolinians receiving government assistance was used to describe benefits, barriers, and facilitators of eating F&V and shopping at farmers' markets in this population. A total of 341 eligible individuals from 14 counties completed the survey. The most commonly cited barriers to eating F&V were cost (26.4%) and not having time to prepare F&V (7.3%). Facilitators included access to affordable locally grown F&V (13.5%) and knowledge to quickly and easily prepare F&V (13.2%). Among people who did not use farmers' markets, common barriers to shopping there were not being able to use food assistance program benefits (35.3%) and not knowing of a farmers' market in their area (28.8%); common facilitators included transportation (24.8%) and having more information about farmers' market hours (22.9%). In addition to breaking down structural/environmental barriers to farmers' market usage, there is a need to disseminate promotional information about farmers' markets, including hours, location, and accepted forms of payment.
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Affiliation(s)
- Lucia A Leone
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Jilcott SB, Ickes SB, Ammerman AS, Myhre JA. Iterative Design, Implementation and Evaluation of a Supplemental Feeding Program for Underweight Children Ages 6–59 Months in Western Uganda. Matern Child Health J 2009; 14:299-306. [DOI: 10.1007/s10995-009-0456-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 01/27/2009] [Indexed: 10/21/2022]
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Gaskins ND, Sloane PD, Mitchell CM, Ammerman A, Ickes SB, Williams CS. Poor nutritional habits: a modifiable predecessor of chronic illness? A North Carolina Family Medicine Research Network (NC-FM-RN) study. J Am Board Fam Med 2007; 20:124-34. [PMID: 17341748 DOI: 10.3122/jabfm.2007.02.060151] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To examine associations between personal nutritional patterns and various indicators of health, disease risk, and chronic illness in a diverse, representative sample of adult patients from primary care settings. METHODS As part of a survey of adult patients conducted in the waiting rooms of 4 primary care practices in North Carolina (recruitment rate 74.8%), a 7-item nutrition screen was administered to 1788 study participants. Other questionnaire items addressed disease and functional status, race/ethnicity, health habits, and demographic factors. RESULTS Respondents included 292 African Americans (17.3%), 1004 non-Hispanic whites (59.4%), 255 Hispanics (15.1%), and 126 American Indians (7.4%); mean age 47.5 years. Thirty percent reported eating 3 or more fast food meals weekly, 29% drank 3 or more high-sugar beverages weekly, 22% ate 3 or more high-fat snacks weekly, 36% ate 3 or more desserts weekly, 11% reported eating "a lot" of margarine, butter, or meat fat; 62% ate 2 or fewer fruits or vegetables daily; and 42% reported consuming protein less than 3 times a week. Scores on a summary measure were worse for pre-diabetics than for diabetics, for young adults compared with older persons, and for persons reporting good/excellent health versus fair/poor health. CONCLUSIONS People at high risk for developing chronic illnesses later in life reported poorer diets in comparison with people who are already ill. This probably represents increased nutritional awareness and motivation among people with chronic diseases. Because primary care patients have a high prevalence of chronic disease risk factors, the primary care office setting may constitute a particularly appropriate location for nutrition education.
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Affiliation(s)
- Nicole D Gaskins
- School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
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Kambis K, Fulco CS, Friedlander AL, McQuaid DB, Jackson CW, Ickes SB, Muza SR, Rock PB, Cymerman A. Antioxidant Supplementation Alters Mood State at Altitude. Med Sci Sports Exerc 2004. [DOI: 10.1249/00005768-200405001-00516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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