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Werner ER, Arnold CD, Caswell BL, Iannotti LL, Maleta KM, Stewart CP. Associations of fish and meat intake with iron and anaemia in Malawian children. Matern Child Nutr 2024; 20:e13622. [PMID: 38217291 PMCID: PMC10981481 DOI: 10.1111/mcn.13622] [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: 08/12/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/15/2024]
Abstract
Animal flesh foods are rich in bioavailable iron but infrequently consumed by young children. We aimed to determine whether flesh food intake was associated with iron and anaemia status among 585 Malawian infants enroled in a 6-month egg-feeding trial. The percentage of days of small fish, large fish and meat consumption were assessed through weekly 7-day animal-source food screeners. Grams of intake were assessed through 24-h recalls conducted at 6-9, 9-12 and 12-15 months of age. Plasma ferritin, soluble transferrin receptor (sTfR) and haemoglobin concentrations were measured at 6-9 and 12-15 months of age. Iron biomarkers were adjusted for inflammation during analysis. At enrolment, each flesh food category was consumed by <5% of children in the past 24 h. Over the next 6 months, small fish, large fish and meat were consumed on 25%, 8% and 6% of days, respectively, with mean usual intakes of <5 g/day. More frequent small fish consumption was associated with lower sTfR (geometric mean ratio [95% CI]: 0.98 mg/L [0.96, 1.00] per 10 percentage point difference) but not ferritin (1.03 µg/L [0.98, 1.07]) or haemoglobin (1.01 g/dL [1.00, 1.01]). Large fish consumption was associated with higher anaemia (prevalence ratio [95% CI]: 1.09 [1.01, 1.19]) and lower iron deficiency (0.96 [0.93, 1.00]) prevalence. Gram intakes of flesh food categories were not associated with any iron or anaemia indicators. Small fish were a primary contributor to flesh food intake in this cohort of Malawian children, although usual portions were small. Fish was associated with modest improvements to iron status, but meat was too infrequent to be associated with anaemia and iron deficiency.
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Affiliation(s)
- E. Rochelle Werner
- Institute for Global NutritionUniversity of California, DavisDavisCaliforniaUSA
- Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - Charles D. Arnold
- Institute for Global NutritionUniversity of California, DavisDavisCaliforniaUSA
| | - Bess L. Caswell
- Institute for Global NutritionUniversity of California, DavisDavisCaliforniaUSA
- U.S. Department of AgricultureWestern Human Nutrition Research CenterDavisCaliforniaUSA
| | - Lora L. Iannotti
- E3 Nutrition LabWashington University in St. LouisSt. LouisMissouriUSA
| | - Kenneth M. Maleta
- School of Global and Public HealthKamuzu University of Health SciencesBlantyreMalawi
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Schwendler TR, Na M, Keller KL, Jensen L, Kodish SR. Observational Methods in Studies of Infant and Young Child Feeding Practices in Low- and Middle-Income Countries: A Twenty-Year Retrospective Review. Nutrients 2024; 16:288. [PMID: 38257180 PMCID: PMC10820610 DOI: 10.3390/nu16020288] [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: 12/05/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
This narrative review describes the observational approaches used to study infant and young child feeding (IYCF) practices in low- and middle-income countries (LMICs) published between 2001 and 2021. Articles were included in this narrative review if they were (1) original peer-reviewed articles published in English in PubMed and Web of Science; (2) published between 1 January 2001, and 31 December 2021; (3) conducted in an LMIC; and (4) employed observations and focused on IYCF practices among children aged 6-59 months. The studies (n = 51) revealed a wide-ranging application of direct meal and full-day observations, as well as indirect spot checks, to study IYCF. The findings revealed that meal observations were typically conducted during a midday meal using precise recording approaches such as video and aimed to understand child-caregiver interactions or specialized nutritious food (SNF) usage. Conversely, full-day observations lasted between 6 and 12 h and often used a field notes-based recording approach. Behaviors occurring outside of mealtime, such as snacking or interhousehold food sharing, were also a primary focus. Finally, spot checks were conducted to indirectly assess SNF compliance during both announced and unannounced visits. This review highlights the adaptability of observations across contexts and their versatility when used as a primary data collection tool to help monitor and evaluate nutrition programs.
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Affiliation(s)
- Teresa R. Schwendler
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Muzi Na
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Kathleen L. Keller
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA
- 202 Rodney A. Erickson Food Science Building, Department of Food Science, The Pennsylvania State University, University Park, PA 16802, USA
| | - Leif Jensen
- Armsby Building, Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University, University Park, PA 16802, USA
| | - Stephen R. Kodish
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA
- 219 Biobehavioral Health Building, Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802, USA
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Rosen F, Settel L, Irvine F, Koselka EPD, Miller JD, Young SL. Associations between food insecurity and child and parental physical, nutritional, psychosocial and economic well-being globally during the first 1000 days: A scoping review. Matern Child Nutr 2024; 20:e13574. [PMID: 37828823 PMCID: PMC10750018 DOI: 10.1111/mcn.13574] [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: 04/24/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
Food insecurity affects billions of individuals annually and contributes to myriad poor health outcomes. Experiences of food insecurity may be particularly harmful during the first 1000 days, but literature on the topic has not been synthesized. We therefore aimed to characterize all available studies examining associations between food insecurity and nutritional, psychosocial, physical and economic well-being among parents and children during this period. We implemented a standardized search strategy across 11 databases. Four researchers screened 10,257 articles, 120 of which met the inclusion criteria. Most studies were conducted in Sub-Saharan Africa (43.3%), followed by North America (20.8%). Studies were primarily quantitative (95.8%), cross-sectional (70.0%) and focused on women (pregnant or post-partum, 48.3%) or women and children (15.8%). Physical health outcomes were the most investigated (n = 87 studies), followed by nutritional (n = 69), psychosocial (n = 35) and economic well-being (n = 2). The most studied associations were between food insecurity and stunting (n = 15), maternal depression (n = 12), child dietary diversity (n = 7) and maternal body mass index (n = 6). The strength of evidence for the observed associations varied across populations as well as within and between examined outcomes. We recommend that future studies recruit more diverse study populations, consider temporality of relationships, use instruments that facilitate cross-site comparisons, measure individual-level food insecurity and outcomes most likely to be impacted by food insecurity, evaluate contextual factors that may modify the effects of food insecurity and employ analytic techniques that permit assessment of causal pathways.
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Affiliation(s)
- Francesca Rosen
- Department of Global Health StudiesNorthwestern UniversityEvanstonIllinoisUSA
| | - Lily Settel
- Department of Global Health StudiesNorthwestern UniversityEvanstonIllinoisUSA
- Department of AnthropologyNorthwestern UniversityEvanstonIllinoisUSA
| | - Faith Irvine
- Department of Global Health StudiesNorthwestern UniversityEvanstonIllinoisUSA
| | | | - Joshua D. Miller
- Department of AnthropologyNorthwestern UniversityEvanstonIllinoisUSA
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Sera L. Young
- Department of AnthropologyNorthwestern UniversityEvanstonIllinoisUSA
- Institute for Policy ResearchNorthwestern UniversityEvanstonIllinoisUSA
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Kianian B, Leidman E, Bilukha O. Infant and young child feeding practices in refugee settings across 203 population-based surveys from 2013-2019. Matern Child Nutr 2024; 20:e13568. [PMID: 37915299 PMCID: PMC10749998 DOI: 10.1111/mcn.13568] [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] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/02/2023] [Accepted: 09/05/2023] [Indexed: 11/03/2023]
Abstract
Infant and young child feeding (IYCF) plays a crucial role in early childhood growth and development. This study summarizes recent IYCF practices in multiple refugee settings and compares them to those in the host countries. We analyzed 203 surveys conducted among refugees residing in 15 countries and 120 unique sites and assessed eight IYCF indicators available from those surveys. A total of 146 surveys were conducted in Eastern and Southern Africa (ESA) and 50 in Western and Central Africa (WCA) regions. The median prevalence across surveys of all four indicators describing intake of breast milk was relatively high: 96.6% for ever breastfed, 81.2% for initiation of breastfeeding within 1 h of birth, 76.9% for exclusive breastfeeding 0-5 months, and 75.0% for continued breastfeeding 12-23 months. The median prevalence of early initiation and exclusive breastfeeding was markedly higher in ESA than in WCA (85.0% vs. 37.5% and 83.5% vs. 56.1%, respectively). Conversely, the overall median prevalence of timely introduction of solid and semisolid foods and flesh food consumption was low: 51.8% and 16.1%, respectively. Flesh food consumption was higher in WCA than in ESA (27.4% vs. 11.6%). The median prevalence of mixed milk feeding at 0-5 months and bottle feeding was very low: 2.4% and 3.8%, respectively. Indicators describing breast milk intake were generally either similar or higher in refugees than in the host country populations, whereas the other indicators were generally higher in the host populations than in refugees. The low prevalence of timely introduction of solids and of flesh food consumption in refugees is concerning and requires substantial improvement.
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Affiliation(s)
- Behzad Kianian
- Emergency Response and Recovery Branch, Division of Global Health Protection, Global Health CenterCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Eva Leidman
- Emergency Response and Recovery Branch, Division of Global Health Protection, Global Health CenterCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Oleg Bilukha
- Emergency Response and Recovery Branch, Division of Global Health Protection, Global Health CenterCenters for Disease Control and PreventionAtlantaGeorgiaUSA
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Waid JL, Wendt AS, Kader A, Sobhan S, Gabrysch S. Impact of a Homestead Food Production Program on Dietary Diversity: Seasonal and Annual Results from the Cluster-Randomized FAARM Trial in Sylhet, Bangladesh. J Nutr 2024; 154:191-201. [PMID: 37871747 DOI: 10.1016/j.tjnut.2023.10.014] [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: 06/13/2023] [Revised: 10/03/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Rice-predominant diets are common in Bangladesh, leading to widespread nutritional deficiencies. The Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized controlled trial in rural Sylhet, Bangladesh evaluated a homestead food production intervention implemented 2015-2018 through Helen Keller International, aiming to improve child growth. OBJECTIVES We estimated the intervention's impact on women's and children's dietary diversity, a secondary trial objective. METHODS We collected dietary diversity throughout the trial (March 2015 to June 2020) at multiple times each year using standard, United Nations-endorsed, self-reported measures for women (10-food group scale) and children (7-food group scale). We included 28,282 observations of 2701 women (out of 2705 enrolled) and 17,445 observations of their 3257 children (aged 6-37 mo) in 96 settlements, 48 of which received the intervention. We estimated the intervention's impact on dietary diversity by year of intervention, overall periods following the start of the intervention, and seasonally, using multilevel regression with the control group as the counterfactual, controlling for seasonality, baseline dietary diversity, and clustering by settlement and repeated measures. RESULTS At baseline, approximately one-third of women and children consumed a minimally diverse diet. Over the entire intervention and postintervention period, women's and children's odds of consuming a minimally diverse diet nearly doubled (odds ratio [OR] 1.8, P < 0.001, for both). This benefit was barely present in the first year, increased in the second, and peaked in the last intervention year (OR 2.4 for women, OR 2.5 for children, both P < 0.001) before settling at around double the odds in postintervention years (P < 0.001). Dietary improvement was observed throughout the year for both women and children with incremental increases in nearly all food groups. CONCLUSIONS The nutrition-sensitive agriculture intervention successfully increased dietary diversity in women and children, and these impacts persisted after the project closed, including during the early COVID 19 lockdown period. This trial was registered at clinicaltrials.gov as NCT02505711.
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Affiliation(s)
- Jillian L Waid
- Research Department 2, Potsdam Institute for Climate Impact Research, Member of the Leibniz Association, Potsdam, Germany; Bangladesh Country Office, Helen Keller International, Dhaka, Bangladesh; Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.
| | - Amanda S Wendt
- Research Department 2, Potsdam Institute for Climate Impact Research, Member of the Leibniz Association, Potsdam, Germany; Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Abdul Kader
- Bangladesh Country Office, Helen Keller International, Dhaka, Bangladesh
| | - Shafinaz Sobhan
- Research Department 2, Potsdam Institute for Climate Impact Research, Member of the Leibniz Association, Potsdam, Germany; Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sabine Gabrysch
- Research Department 2, Potsdam Institute for Climate Impact Research, Member of the Leibniz Association, Potsdam, Germany; Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany; Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Pries AM, Bassetti E, White JM, Mulder A, Threapleton D, Blankenship J. Benchmarking the nutrient composition and labelling practices of finger foods and snacks for older infants and young children across seven Southeast Asian countries. Matern Child Nutr 2023; 19 Suppl 2:e13598. [PMID: 38092380 PMCID: PMC10719055 DOI: 10.1111/mcn.13598] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/13/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023]
Abstract
Ensuring consumption of nutrient-dense, safe and appropriate complementary foods among older infants and young children (IYC) 6-36 months of age is critical for enabling optimal growth and development. The ubiquitous availability of and high demand for commercially packaged snack foods has culminated in a growing trend of snack food products specifically produced and promoted for older IYC. Commercially produced complementary foods (CPCF) that are finger foods/snacks often contain added sugars, excessive sodium content and high total sugar content, making them inappropriate for this young population. This study benchmarked the nutrient composition and labelling practices of CPCF finger foods/snacks available for purchase in seven countries in Southeast Asia. The study adapted a nutrient profiling model from the WHO Regional Office for Europe to determine the proportion of products suitable for promotion for older IYC. Of the total 606 products identified, 8.2% were automatically categorized as not suitable because they were confectionery items. Of the remaining 556 products assessed, over 85% failed to meet all nutrient composition requirements, with the presence of added sugars/sweeteners and excessive sodium and total sugar contents the primary reasons for failure. Products also demonstrated concerning labelling practices, with all of the products (98.6%) displaying an inappropriate claim on the label. These findings reveal major concerns with the nutrient composition and labelling practices of CPCF finger foods/snacks in the SEA region and should serve as an alarm bell for regulatory action. National binding legal measures, such as mandatory standards for composition and labelling are urgently needed.
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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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Bassetti E, Blankenship J, White JM, Sweet L, Threapleton D, Pries AM. Benchmarking the nutrient composition and labelling practices of dry or instant cereals for older infants and young children across seven Southeast Asian countries. Matern Child Nutr 2023; 19 Suppl 2:e13603. [PMID: 38092376 PMCID: PMC10719057 DOI: 10.1111/mcn.13603] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/17/2023]
Abstract
In Southeast Asia, the increasing availability of commercially produced complementary foods (CPCF), including dry or instant cereals (CPCF cereals), has been noted, however, concerns exist around their nutrient profile and labelling practices. This 2021 study assessed the nutrient composition, labelling practices, and micronutrient content of CPCF cereals sold in the capital cities of seven Southeast Asian countries: Phnom Penh (Cambodia), Jakarta (Indonesia), Manila (Philippines), Bangkok (Thailand), Vientiane (Lao PDR), Hanoi (Vietnam), and Kuala Lumpur (Malaysia). The study adapted a nutrient profiling model from the WHO Regional Office for Europe to determine the proportion of products suitable for promotion for older infants and young children. Micronutrient content of fortified CPCF cereals was assessed against fortification levels specified in the Codex Alimentarius guideline for formulated complementary foods. Of the 484 products assessed, 184 (38.0%) met all nutrient composition requirements. Around one-third of CPCF cereals contained added sugars and/or sweeteners (37.2%) and high levels of sodium (28.9%). None of the CPCF cereals met all labelling requirements, primarily due to the presence of inappropriate claims on the labels. Most fortified CPCF cereals contained adequate amounts of critical micronutrients, such as calcium, iron, zinc, vitamin A, and vitamin D. However, rates of fortification varied across the seven countries, and almost a third (30.8%) of CPCF cereals were not fortified with any micronutrients. To support the appropriate promotion of CPCF in the region, Southeast Asian countries need to strengthen and enforce national binding legal measures, including national standards for the composition, labelling, and fortification of CPCF cereals.
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Wang Y, Yu D, Yang Z, Zhao L. [Changes of sweet beverage and unhealthy food consumption among infant and young child aged 6-24 months old in China]. Wei Sheng Yan Jiu 2023; 52:919-923. [PMID: 38115655 DOI: 10.19813/j.cnki.weishengyanjiu.2023.06.010] [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] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE To describe the change of sweet beverage and unhealthy food consumption among infant and young child aged 6-23 months in 2013, 2016-2017, China. METHODS Data was from the China Nutrition and Health Surveillance among Children and Lactating Women in 2013, 2016-2017.9983, 20 423 children aged 6-23 months old were involved respectively. The sweet beverage and unhealthy food consumption was analyzed with WHO and UNICEF 2021 updated infant and young child feeding indicators. Data analyses were conducted using the complex weight based on national census from National Bureau of Statistics in 2010. Rao-Scott Chi-square was used test for statistical difference. RESULTS The proportions of sweet beverage consumption among children aged 6-23 months was 20.2%(95%CI 16.0%-24.4%) in 2013; it was 29.6% in large cities, and 14.0% in poor rural areas, but there was no significant difference in different areas. Compared with 2013, the proportions of sweet beverage consumption increased significantly in 2016-2017, reaching 51.7%(95%CI 48.9%-54.4%); it was 54.1% in medium and small cities, and 44.3% in large cities. The proportions of unhealthy food consumption among children aged 6-23 months was 31.2%(95%CI 23.2%-39.3%) in 2013; it was 46.3% in medium and small cities, and 16.3% in poor rural areas. Compared with 2013, the proportions of unhealthy food consumption was 35.6%(95%CI 33.6%-39.3%) in 2016-2017, and no significant difference was observed(Rao-Scott χ~2=0.96, P=0.33); It was 38.6% in medium and small cities, and reached 30% in large cities and poor rural areas. For those 2 indicators at the same survey, no consistent differences were observed between boys and girls and there was significant difference in various months of age(P<0.01). CONCLUSION In China, the proportion of sweet beverage consumption among children aged 6-23 months has increased significantly, and the intake of unhealthy food is relatively stable. Children aged over 12 months and in rural areas need to be concerned about.
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Affiliation(s)
- Yuying Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Dongmei Yu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China Key Laboratory of Trace Element Nutrition of National Health Committee, Beijing 100050, China
| | - Zhenyu Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China Key Laboratory of Trace Element Nutrition of National Health Committee, Beijing 100050, China
| | - Liyun Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China Key Laboratory of Trace Element Nutrition of National Health Committee, Beijing 100050, China
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Hailu FM, Kefene SW, Sorrie MB, Mekuria MS, Guyo TG. Sick child's feeding practices and associated factors among mothers with sick children aged less than 2 years in Gamo zone, southern Ethiopia. Does the participation of fathers contribute to improving nutrition? A facility-based cross-sectional study. Front Public Health 2023; 11:1256499. [PMID: 37965506 PMCID: PMC10641438 DOI: 10.3389/fpubh.2023.1256499] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/02/2023] [Indexed: 11/16/2023] Open
Abstract
Background Children's nutritional status can decline rapidly during or after a common childhood illness unless additional nutritional requirements associated with the illness are considered. Therefore, this study was aimed at assessing a sick child's feeding practices and associated factors among mothers who have sick children under 2 years of age in southern Ethiopia. Methods A facility-based cross-sectional study design was employed from 1 April 2022 to 30 April 2022. Data were collected through the questionnaire, entered into an open data kit (ODK), and exported into Statistical Packages for Social Sciences (SPSS) version 25.0 for analysis. A systematic random sampling technique was used to select study participants. Bivariable and multivariable logistic regression analyses were used to identify factors associated with sick child feeding practices. An adjusted odds ratio (AOR) with 95% confidence intervals (CIs) was used to determine the strength of the association. Statistical significance was declared at a p-value of <0.05. Results The overall magnitude of mothers' good sick child feeding practices was determined to be 45.0% (95% CI: 41.03, 48.97%). Being urban residents, being employed, having antenatal care (ANC) visits, having postnatal care (PNC) visits, counseling about child feeding, and fathers' involvement in sick child feeding increased the likelihood of sick child feeding practices by 4.4, 2.10, 2.31, 3.54, 2.11, and 2.54 times, respectively. Conclusion Sick child feeding practices were associated with having antenatal or postnatal visits, counseling about child feeding, and fathers' involvement in sick child feeding practices. Therefore, strengthening infant and young child feeding practices by showing special concern for the father's involvement is important to improve mothers' sick child feeding practices.
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Affiliation(s)
- Feven Masresha Hailu
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Simegn Wagaye Kefene
- Department of Public Health, Arba Minch College of Health Sciences, Arba Minch, Ethiopia
| | - Muluken Bekele Sorrie
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Misgun Shewangezaw Mekuria
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tamirat Gezahegn Guyo
- Department of Public Health, Arba Minch College of Health Sciences, Arba Minch, Ethiopia
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Tessema M, Hussien S, Ayana G, Teshome B, Hussen A, Kebebe T, Mogese T, Petros A, Fikresilassie G, Wodajo B, Mokenen T, Tollera G, Whiting SJ. Effect of enhanced nutrition services with community-based nutrition services on the diet quality of young children in Ethiopia. Matern Child Nutr 2023; 19:e13525. [PMID: 37139835 PMCID: PMC10483948 DOI: 10.1111/mcn.13525] [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] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
Poor diet quality related to inadequate complementary feeding is a major public health problem in low and middle-income countries including Ethiopia. Low dietary diversity has been linked to negative health outcomes in children. To provide a package of interventions to close nutritional gaps through agriculture, the Sustainable Undernutrition Reduction in Ethiopia (SURE) programme was set up as a multi-sectoral initiative and the results of combined effects of community-based and enhanced nutrition services, compared to community-based alone, on diet diversity and diet quality of complementary feeding of young children are presented. The study used pre- and post-intervention design. Baseline (n = 4980) data were collected from May to July 2016, and follow-up (n = 2419) data from December 2020 to January 2021. From 51 intervention districts having the SURE programme, 36 intervention districts were randomly selected for baseline and 31 for the follow-up survey. The primary outcome was diet quality: minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD). Comparing endline to baseline over the 4.5-year intervention, the use of standard community-based nutrition services of growth monitoring and promotion increased (16%-46%), as did enhanced nutrition services of infant and young child feeding counselling, and agricultural advising (62%-77%). Women involved in home gardening significantly increased (73%-93%); however, household production of food decreased yet consumption of most own-grown foods increased. Importantly, MAD and MDD increased four-fold. The SURE intervention programme was associated with improvements in complementary feeding and diet quality through enhanced nutrition services. This suggests programmes targeted at nutrition-sensitive practices can improve child feeding in young children.
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Affiliation(s)
- Masresha Tessema
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Shimelis Hussien
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Girmaye Ayana
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Beza Teshome
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Alemayehu Hussen
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Tadesse Kebebe
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Tseday Mogese
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Alem Petros
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Getinet Fikresilassie
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Berhanu Wodajo
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Tadesse Mokenen
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Getachew Tollera
- Food Science and Nutrition Research Directorate, Ethiopian Public Health InstituteAddis AbabaEthiopia
| | - Susan J. Whiting
- College of Pharmacy and NutritionUniversity of SaskatchewanSaskatoonSaskatoonCanada
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Flax VL, Bose S, Escobar-DeMarco J, Frongillo EA. Changing maternal, infant and young child nutrition practices through social and behaviour change interventions implemented at scale: Lessons learned from Alive & Thrive. Matern Child Nutr 2023:e13559. [PMID: 37735818 DOI: 10.1111/mcn.13559] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/12/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
Alive & Thrive (A&T) is an initiative designed to advance the implementation of maternal, infant and young child nutrition (MIYCN) social and behaviour change (SBC) at a large scale. The aims of this research were to: (1) describe A&T's SBC implementation processes and their impact based on a review of programme documents and peer-reviewed publications and (2) gather lessons learned from key informant interviews (N = 23) with A&T staff and stakeholders in Bangladesh, Burkina Faso, Ethiopia, India, Nigeria and Vietnam. A&T's SBC approach used interpersonal communication, community mobilization and mass media to address knowledge gaps, strengthen self-efficacy and shift social norms. The initiative used data for design and evaluation and facilitated scale and sustainability through close collaboration with governments and other stakeholders. A&T's approach increased exclusive breastfeeding, minimum meal frequency of children and use of iron and folic acid tablets by pregnant women, but had mixed impacts on early initiation of breastfeeding and maternal and child dietary diversity. Multiple SBC channels and frequent contacts strengthened the impact of SBC on MIYCN practices. Lessons learned included: using existing large-scale platforms for interpersonal communication, improving counselling skills of health workers, delivering timely tailored messages, engaging key influencers to take specific actions, using research to address underlying behavioural concerns and maximize mass media reach and frequency, using simple memorable messages and employing additional channels to reach low media coverage areas. A&T developed and implemented at-scale MIYCN SBC in multiple countries, providing lessons learned about intervention strategies, engagement of influencers and mass media campaign development, which governments and other implementers can adapt and replicate.
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Affiliation(s)
- Valerie L Flax
- RTI International, Research Triangle Park, North Carolina, USA
| | - Sujata Bose
- Alive & Thrive, FHI Solutions, Washington, District of Columbia, USA
| | - Jessica Escobar-DeMarco
- Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, North Carolina, USA
| | - Edward A Frongillo
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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13
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Wang Y, Yu D, Duan Y, Guo Q, Pang X, Xu X, Wang J, Bi Y, Yang Z, Zhao L. [Status of infant and young child feeding in China in 2016-2017]. Wei Sheng Yan Jiu 2023; 52:691-697. [PMID: 37802891 DOI: 10.19813/j.cnki.weishengyanjiu.2023.05.001] [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] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
OBJECTIVE To describe the feeding status and related factors of infant and young child aged 6-23 months in China. METHODS Data was from the China Nutrition and Health Surveillance among 0-17 Years Old Children and Lactating Women in 2016-2017, and 20 423 children aged 6-23 months were involved in 275 surveillance sites from 31 provinces(autonomous regions and municipalities). The introduction of solid, semi-solid or soft foods, minimum dietary diversity, minimum meal frequency were analyzed with WHO and UNICEF 2021 updated infant and young child feeding indicators. Data analyses were conducted using the complex weight based on national census from National Bureau of Statistics in 2010. Rao-Scott Chi-square was used test for statistical difference. RESULTS The percentage of infants 6-8 months of age who consumed solid, semi-solid or soft foods was 83.2%(95%CI 80.5%-85.9%) in 2016-2017. No significant difference were observed between boys and girls; there was significant difference in different areas(Rao-Scott χ~2=30.85, P<0.01), it was 90.3% in medium and small cities, and reached 75.0% even in poor rural areas. The proportions of children aged 6-23 months meeting minimum dietary diversity(MDD) was 60.6%(95%CI 58.1%-63.1%). It was 71.1% in medium and small cities, and 50.5% in poor rural areas. Except for breast milk, the percentage of eggs(34.4%) and legumes(19.0%) consumption was low, the percentage of grains, vitamin A-rich fruits or vegetables consumption was 89.7%(95%CI 88.4%-91.1%). The percentage of consuming egg and/or flesh food was 76.4%(95%CI 74.2%-78.7%). The percentage of zero vegetables or fruits consumption was 9.1%(95%CI 7.8%-10.4%). The proportions of children aged 6-23 months meeting minimum meal frequency(MMF) was 72.4%(95%CI 70.1%-74.7%). It was over 70% in large cities, medium and small cities, general rural areas; and 60.2% in poor rural areas. The proportions of children aged 6-23 months meeting minimum acceptable diet was 43.4%(95%CI 40.7%-46.1%), it was over 50% in urban areas, and less than 40% in rural areas, 30.1% in poor rural areas. No consistent differences were observed between boys and girls for all 3 indicators(MDD, MMF and MAD), and there was significant difference in different areas and various months of age(P<0.01). CONCLUSION There was no gender difference in the feeding status of children aged 6-23 months in China, the complementary feeding was relatively timely, and the minimum dietary diversity and meal frequency of children were relatively ideal, but the minimum acceptable diet of children in poor rural areas was poor.
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Affiliation(s)
- Yuying Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Dongmei Yu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yifan Duan
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Qiya Guo
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xuehong Pang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiaoli Xu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jie Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Ye Bi
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Zhenyu Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Liyun Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Bhattacharyya DS, Sarker T, Akter N, Shafique S, Nabi MH, Hawlader MDH, Mitra DK. Factors associated with fathers' involvement in infant and young child feeding and nurturing care in the urban slums of Bangladesh: A cross-sectional study. Food Sci Nutr 2023; 11:4020-4029. [PMID: 37457166 PMCID: PMC10345689 DOI: 10.1002/fsn3.3390] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/20/2023] [Accepted: 04/06/2023] [Indexed: 07/18/2023] Open
Abstract
Optimal infant and young child feeding (IYCF) and nurturing care during the first years of children's lives are crucial for ensuring their growth and development. The IYCF and nurturing practices are associated with a multifaceted interplay of context-specific factors where fathers' involvement is necessary. The aim of this study is to explore the current scenario of fathers' involvement in IYCF practices in the urban slums of Bangladesh. A cross-sectional survey among the residents of the Sat Tola slum in Dhaka, the capital of Bangladesh was conducted. To avoid social desirability bias, 361 mothers of children aged <24 months were interviewed regarding fathers' involvement. An operational definition of father's involvement was developed based on 11 criteria and then scoring was applied to classify 'Good Involvement' and associated factors were identified using multivariable logistic regression. Fathers' mean age was around 31 (SD ± 6.09) years and the majority of them (44.32%) completed primary education. Fathers had diversified occupations such as day laborer (32.41%), garment worker (22.71%), and business (14.96%). Factors that were significantly associated with the father's involvement in IYCF practices include educational status (aOR = 3.98, 95% CI = 1.91, 8.26, p < .00) and theiroccupational status (aOR = 0.34, 95% CI = 0.16, 0.70, p = .00). Fathers were more active for their first child (aOR: 1.99, 95% CI = 1.04, 3.79, p = .03). Having child in the age group of 14-20 months (aOR = 2.73, 95% CI = 1.32, 5.64, p = <.01) and wife in the age group of 21-30 years (aOR = 2.34, 95% CI = 1.20, 4.58, p = .01) were significantly associated. The study finding explored that fathers' education and occupation as well as mothers' age and education were significantly associated factors for fathers' involvement in the IYCF practices. Further longitudinal studies are recommended to establish the causal relationship between fathers' involvement with IYCF and their impact on child growth and development.
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Affiliation(s)
- Dipika Shankar Bhattacharyya
- Health System and Population Studies Divisionicddr,bDhakaBangladesh
- Department of Public HealthNorth South UniversityDhakaBangladesh
| | - Tonmoy Sarker
- Department of Public HealthNorth South UniversityDhakaBangladesh
- Infectious Disease Divisionicddr,bDhakaBangladesh
| | - Nargis Akter
- Health System and Population Studies Divisionicddr,bDhakaBangladesh
| | - Sohana Shafique
- Health System and Population Studies Divisionicddr,bDhakaBangladesh
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Khosravi A, Bassetti E, Yuen-Esco K, Sy NY, Kane R, Sweet L, Zehner E, Pries AM. Nutrient Profiles of Commercially Produced Complementary Foods Available in Burkina Faso, Cameroon, Ghana, Nigeria and Senegal. Nutrients 2023; 15:nu15102279. [PMID: 37242162 DOI: 10.3390/nu15102279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
The nutritional quality of commercially produced complementary food (CPCF) varies widely, with CPCF in high-income settings often containing excessive levels of sugar and sodium. Little is known about the nutritional quality of CPCF available in the West Africa region, despite their potential to improve the nutrition of infants and young children (IYC). This study evaluated the nutritional quality of CPCF available in five West African countries using the WHO Europe nutrient profiling model (NPM) and assessed their suitability for IYC based on label information. The proportion that would necessitate a "high sugar" warning was also determined, and the micronutrient (iron, calcium, and zinc) content was assessed against IYC-recommended nutrient intakes. Of the 666 products assessed, only 15.9% were classified as nutritionally suitable for promotion for IYC. The presence of added sugar and excessive sodium levels were the most common reasons for a product to fail the nutrient profiling assessment. Dry/instant cereals contributed the highest percentage of recommended nutrient intake (RNI) per serving. This highlights the need for policies to improve the nutritional quality of CPCF in West Africa, including labeling standards and the use of front-of-pack warning signs to promote product reformulation and clearly communicate nutritional quality to caregivers.
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Affiliation(s)
| | | | | | | | | | - Lara Sweet
- JB Consultancy, Johannesburg 2198, South Africa
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Marchetti F, Preziosi J, Zambri F, Tambascia G, Di Nolfi A, Scardetta P, Splendore F, Colaceci S, Coia M, Caredda E, Masi L, De Luca V, Perra A, Giusti A. Health needs and perception of health care quality among Asylum Seekers and Refugees in an Italian local health authority: A qualitative study. Front Public Health 2023; 11:1125125. [PMID: 37124798 PMCID: PMC10130403 DOI: 10.3389/fpubh.2023.1125125] [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: 12/15/2022] [Accepted: 03/21/2023] [Indexed: 05/02/2023] Open
Abstract
Background Migrants, Asylum Seekers and Refugees (ASRs) represent a vulnerable diversified population with increased risks of developing health problems, and in the hosting countries several barriers often hamper their access to the health services. Gathering information about ASRs' experiences and perceptions of host country health care systems may contribute to improve the quality of health care provided. The aim of this study was to explore the health needs in their bio-psycho-social meaning, and the quality of health care as perceived from the ASRs' perspective. Methods The qualitative descriptive study was conducted as part of the Project "G-START - testing a governance model of receiving and taking care of the Asylum Seekers and Refugees." Through purposeful and snowball sampling, four Focus Groups conducted in English, Italian and French were carried out between July and August 2019, involving 50 ASRs hosted by four reception centers located on the territory pertaining to an Italian Local Health Authority covering a general population of 500.000 people. The analysis of data was categorical, and was performed using N-Vivo software. Results The macro-categories emerged were the ASRs' bio-psycho-social health needs, including mental health, sexual and reproductive health, food and nutrition, knowledge of the health care system, need for inclusion; healthcare services access, including barriers before and after the access and the ability of the local health system to respond to existing and evolving demands; strengths of the healthcare and reception systems, and suggestions for improving them in the future. Discussion and conclusions ASRs present vulnerabilities and specific health needs, and the health care system is not always able to guarantee access or to respond to these needs. Several obstacles have been highlighted, such as linguistic barriers and lack of cultural mediation, bureaucratic and administrative barriers, lack of knowledge of the Italian health care system. An effective reorganization of services driven by a more detailed output analysis of the target population needs, together with the use of cultural mediation, peer to peer education and support, and the training of health professionals are recommended to ensure a more accessible, equitable and effective health care system at local level.
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Affiliation(s)
- Francesca Marchetti
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Jessica Preziosi
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Francesca Zambri
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Gabriella Tambascia
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Annachiara Di Nolfi
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Paola Scardetta
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Flavia Splendore
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Sofia Colaceci
- Saint Camillus International University of Health and Medical Sciences (UniCamillus), Rome, Italy
| | - Maura Coia
- Department of Prevention, Local Health Authority “Roma 5”, Rome, Italy
| | - Emanuele Caredda
- Department of Prevention, Local Health Authority “Roma 5”, Rome, Italy
- General Directorate for Health Prevention, Ministry of Health, Rome, Italy
| | - Loredana Masi
- Maternal and Child Department, Local Health Authority “Roma 5”, Rome, Italy
| | - Vittorio De Luca
- Department of Mental Health and Addiction, Local Health Authority “Roma 5”, Rome, Italy
| | - Alberto Perra
- Department of Prevention, Local Health Authority “Roma 5”, Rome, Italy
| | - Angela Giusti
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
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Muleka N, Maanaso B, Phoku M, Mphasha MH, Makwela M. Infant and Young Child Feeding Knowledge among Caregivers of Children Aged between 0 and 24 Months in Seshego Township, Limpopo Province, South Africa. Healthcare (Basel) 2023; 11:healthcare11071044. [PMID: 37046971 PMCID: PMC10094686 DOI: 10.3390/healthcare11071044] [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: 01/08/2023] [Revised: 03/26/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Appropriate infant and young child feeding (IYCF) involves the initiation of breastfeeding within an hour of delivery, exclusive breastfeeding for 6 months, introduction of complementary feeding at 6 months while continuing breastfeeding for 2 years or beyond. Adequate IYCF knowledge among caregivers is associated with improved practices, lowers risk of kids developing malnutrition, infection, morbidity, and mortality. Early introduction of solid foods, mixed feeding, inadequate breastfeeding, and complementary feeding are all prevalent in South Africa. These are related to caregivers' lack of IYCF knowledge. Hence, this study aims to determine the IYCF knowledge level of caregivers of children under 24 months in the semiurban Seshego Township, South Africa. METHODOLOGY Quantitative and cross-sectional design was applied. A total of 86 caregivers were selected using simple random sampling, which is representative of a target population of 110. Structured questionnaire was utilised to gather data, and analysed through statistical software, using descriptive and inferential statistics. Chi-square test was used to calculate associations at 95% confidence interval, where a p-value of < 0.05 was considered statistically significant. RESULTS Findings show that 67% of participants had good IYCF knowledge (a score of 81 to 100%) and there was a significant relationship between knowledge and education (p = 0.001). Moreover, 40.7% did not know that exclusive breastfeeding should be up to 6 months, and 90% mentioned that breastmilk protects the child against diseases. Most participants (82.6%) know that complementary feeding should be introduced at 6 months with continuation of breastfeeding. CONCLUSIONS Caregivers know that breastfeeding should begin immediately after birth, and that it protects against diseases. Moreover, they know that solid food should be introduced at 6 months. However, there is still a need to strengthen IYCF education, particularly on exclusive breastfeeding. Interventions to improve IYCF knowledge should be intertwined with improving educational and health literacy on breastfeeding and complementary feeding.
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Affiliation(s)
- Ndivhudzannyi Muleka
- Department of Human Nutrition and Dietetics, University of Limpopo, Polokwane 0790, South Africa
| | - Baatseba Maanaso
- Department of Human Nutrition and Dietetics, University of Limpopo, Polokwane 0790, South Africa
| | - Mafiwa Phoku
- Department of Human Nutrition and Dietetics, University of Limpopo, Polokwane 0790, South Africa
| | | | - Maishataba Makwela
- Department of Human Nutrition and Dietetics, University of Limpopo, Polokwane 0790, South Africa
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18
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Rithu S, Vyas N. Assessment of infant and young child feeding practices among mothers of Paniya tribal children aged 0-23 months in Gudalur Block, Nilgiris District. Indian J Public Health 2023; 67:320-323. [PMID: 37459033 DOI: 10.4103/ijph.ijph_1159_22] [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] [Indexed: 07/20/2023] Open
Abstract
Optimal infant and young child feeding practices (IYCFPs), despite being emphasized since 2003, are yet to be met in India. This study assessed these practices and their association with various factors among mothers of children aged 0-23 months in Paniya tribes in Nilgiris, Tamil Nadu. About 89.1% of the infants below six months were timely breastfed and 77.9% of them were exclusively breastfed, respectively. Complementary food was introduced to 25% of infants aged six to eight months. About 27.8% of them received a diverse diet. About 91.7% of them were fed egg and/or flesh food and 37% of them were fed vegetables and fruits. Illiterate mothers and mothers who had a vaginal delivery fed the infant optimally. The adherence to these practices was found to decrease gradually with an increase in the infant's age. The prevalence of IYCFP is higher in the study population compared to the corresponding indicators for the district according to the National Family Health Survey-5.
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Affiliation(s)
- S Rithu
- Postgraduate Student, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Navya Vyas
- Assistant Professor-Senior Scale, Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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19
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Marino JA, Meraz K, Dhaliwal M, Payán DD, Wright T, Hahn-Holbrook J. Impact of the COVID-19 pandemic on infant feeding practices in the United States: Food insecurity, supply shortages and deleterious formula-feeding practices. Matern Child Nutr 2023:e13498. [PMID: 36949019 DOI: 10.1111/mcn.13498] [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] [Grants] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/24/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic increased food insecurity among US households, however, little is known about how infants, who rely primarily on human milk and/or infant formula, were impacted. We conducted an online survey with US caregivers of infants under 2 years of age (N = 319) to assess how the COVID-19 pandemic impacted breastfeeding, formula-feeding and household ability to obtain infant-feeding supplies and lactation support (68% mothers; 66% White; 8% living in poverty). We found that 31% of families who used infant formula indicated that they experienced various challenges in obtaining infant formula, citing the following top three reasons: the formula was sold out (20%), they had to travel to multiple stores (21%) or formula was too expensive (8%). In response, 33% of families who used formula reported resorting to deleterious formula-feeding practices such as diluting formula with extra water (11%) or cereal (10%), preparing smaller bottles (8%) or saving leftover mixed bottles for later (11%). Of the families who fed infants human milk, 53% reported feeding changes directly as a result of the pandemic, for example, 46% increased their provisioning of human milk due to perceived benefits for the infant's immune system (37%), ability to work remotely/stay home (31%), concerns about money (9%) or formula shortages (8%). Fifteen percent of families who fed human milk reported that they did not receive the lactation support they needed and 4.8% stopped breastfeeding. To protect infant food and nutrition security, our results underscore the need for policies to support breastfeeding and ensure equitable and reliable access to infant formula.
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Affiliation(s)
- Jessica A Marino
- Department of Psychology, University of California, Merced, California, USA
| | - Kimberly Meraz
- Department of Psychology, University of California, Merced, California, USA
| | - Manuvir Dhaliwal
- Department of Psychology, University of California, Merced, California, USA
| | - Denise D Payán
- Department of Health, Society, and Behavior, University of California, Irvine, California, USA
| | - Tashelle Wright
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Hahn-Holbrook
- Department of Psychology, University of California, Merced, California, USA
- Health Sciences Research Institute, University of California, Merced, USA
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Cunningham K, Pandey Rana P, Rahman MM, Sen Gupta A, Manandhar S, Frongillo EA. Text messages to improve child diets: Formative research findings and protocol of a randomised controlled trial in Nepal. Matern Child Nutr 2023. [PMID: 36864635 DOI: 10.1111/mcn.13490] [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] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Given the role of malnutrition in childhood morbidity and mortality, the prioritisation of maternal and child nutrition programmes has grown significantly in the 21st century. Policies and programmes aim to improve infant and young child feeding, but questions persist about the most effective combination of interventions to achieve desired behaviour change. There is increasing interest in mobile-based interventions globally, but scant evidence exists to guide donors, policymakers and programme implementers on their effectiveness. Formative research was conducted to assess the feasibility and acceptance of text message-based interventions and to guide the final design of the text message intervention. This protocol is for a cluster-randomised controlled trial to test the effectiveness of adding text messaging to other ongoing SBC interventions to promote egg consumption, dietary diversity and other ideal dietary practices, particularly among children 12-23 months of age in Kanchanpur, Nepal. The trial findings will contribute to the emerging body of evidence on the effectiveness of using text messages for behaviour change, specifically for young child dietary outcomes in South Asia. Recent studies have suggested that mobile-based interventions alone may be insufficient but valuable when added to other social and behavioural interventions; this trial will help to provide evidence for or against this emerging theory. This trial was registered at ClinicalTrials.gov on 11 March 2019 (ID: NCT03926689) and has been updated twice.
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Affiliation(s)
- Kenda Cunningham
- Suaahara II, Helen Keller International, New York, New York, USA.,Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, England
| | | | - Mohammad Masudur Rahman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Aman Sen Gupta
- Suaahara II, Helen Keller International, Kathmandu, Nepal
| | - Shraddha Manandhar
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, England
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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21
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Werner ER, Haskell MJ, Arnold CD, Caswell BL, Iannotti LL, Lutter CK, Maleta KM, Stewart CP. The Effects of One Egg Per Day on Vitamin A Status Among Young Malawian Children: A Secondary Analysis of a Randomized Controlled Trial. Curr Dev Nutr 2023; 7:100053. [PMID: 37181936 PMCID: PMC10111603 DOI: 10.1016/j.cdnut.2023.100053] [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: 09/30/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 02/24/2023] Open
Abstract
Background Vitamin A deficiency (VAD) is common in populations with limited dietary diversity and access to vitamin A-rich foods. Objectives This analysis aimed to determine the impact of supplementing children's diets with 1 egg/d on the concentration of plasma retinol and RBP and the prevalence of VAD. Methods Children age 6-9 mo living in the Mangochi district of Malawi were individually randomly assigned to receive 1 egg/d for 6 mo (n = 331) or continue their usual diet (n = 329) in the Mazira trial (clinicaltrials.gov; NCT03385252). This secondary analysis measured plasma retinol by HPLC and RBP, CRP, and α-1-acid glycoprotein (AGP) by ELISA techniques at enrollment and 6 mo follow-up. Retinol and RBP were adjusted for inflammation, and mean concentrations were compared between groups using linear regression models. In addition, prevalence ratios of VAD (retinol <0.7 μmol/L) were compared between groups using log-binomial or modified Poisson regression models. Results After 6 mo of study participation, 489 were assessed for retinol (egg: n = 238; control: n = 251), and 575 (egg: n = 281; control: n = 294) were assessed for RBP. Prevalence of inflammation (CRP >5 mg/L or AGP >1 g/L: 62%) and inflammation-adjusted VAD (7%) at enrollment did not differ between groups. At follow-up, the egg intervention group did not differ from the control in inflammation-adjusted retinol [geometric mean (95% CI); egg: 1.10 μmol/L (1.07, 1.13); control: 1.08 (1.05, 1.12)], RBP [egg: 0.99 μmol/L (0.96, 1.02); control: 0.97 (0.94, 1.00)], or prevalence of VAD [egg: 6%; control: 3%; prevalence ratio: 1.87 (0.83, 4.24)]. Conclusions Provision of 1 egg/d did not impact VAD, plasma retinol, or RBP among young children in rural Malawi, where the prevalence of VAD was low. Curr Dev Nutr 2023;x:xx.This trial was registered at [clinicaltrials.gov] as [NCT03385252].
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Affiliation(s)
- E Rochelle Werner
- Institute for Global Nutrition, University of California, Davis, Davis, CA, United States
| | - Marjorie J Haskell
- Institute for Global Nutrition, University of California, Davis, Davis, CA, United States
| | - Charles D Arnold
- Institute for Global Nutrition, University of California, Davis, Davis, CA, United States
| | - Bess L Caswell
- Institute for Global Nutrition, University of California, Davis, Davis, CA, United States
- Western Human Nutrition Research Center, US Department of Agriculture, Davis, CA, United States
| | - Lora L Iannotti
- E3 Nutrition Lab, Washington University in St Louis, St Louis, MO, United States
| | | | - Kenneth M Maleta
- School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Christine P Stewart
- Institute for Global Nutrition, University of California, Davis, Davis, CA, United States
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22
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Locks LM, Newell KB, Imohe A, Moloney GM, Shaker-Berbari L, Paudyal N, Jefferds MED. The effect of interventions distributing home fortification products on infant and young child feeding (IYCF) practices: A systematic narrative review. Matern Child Nutr 2023:e13488. [PMID: 36842164 DOI: 10.1111/mcn.13488] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/14/2022] [Accepted: 01/26/2023] [Indexed: 02/27/2023]
Abstract
Interventions distributing micronutrient powders (MNPs) and small-quantity lipid-based nutrient supplements (SQ-LNS), or home fortification products (HFPs), have the potential to improve infant and young child feeding (IYCF) practices and children's nutrition. We systematically searched for studies on the effect of interventions distributing HFP on IYCF practices. We identified 12 (8 MNP, 4 SQ-LNS) studies: seven programmes with IYCF behaviour change communications (BCC) and MNP (IYCF-MNP) and one provided MNP without IYCF BCC (MNP only). Three SQ-LNS studies came from randomised trials without an IYCF component (SQ-LNS only) and one from a programme with both IYCF BCC and SfQ-LNS (IYCF-SQ-LNS). Five IYCF-MNP programmes reported positive associations with some IYCF practices-four with minimum dietary diversity, two with minimum meal frequency, four with minimum acceptable diet, and three with the initiation of complementary foods at 6 months. Two reported no association between MNP and IYCF indicators, and one reported a decline in IYCF practices during the intervention, although it also reported significant changes to the IYCF programme during the evaluation period. Two studies from interventions that distributed SQ-LNS (one from a related set of randomised controlled trials and the sole IYCF-SQ-LNS programme) reported a positive association with IYCF practices; one trial reported no change in breast milk intake with the provision of SQ-LNS and one found no association with IYCF practices. SQ-LNS and MNP can address nutrient gaps for young children in low-resource settings; our findings indicate that programmes that combine HFP with IYCF interventions may also contribute to improved IYCF practices in some settings.
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Affiliation(s)
- Lindsey M Locks
- Department of Health Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts, USA.,Department of Global Health, Boston University, Boston, Massachusetts, USA
| | - Katharine B Newell
- Department of Health Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts, USA
| | - Annette Imohe
- United Nation Children's Fund (UNICEF) Headquarters, New York City, New York, USA
| | - Grainne M Moloney
- United Nation Children's Fund (UNICEF) Headquarters, New York City, New York, USA
| | - Linda Shaker-Berbari
- United Nation Children's Fund (UNICEF) Headquarters, New York City, New York, USA
| | - Naveen Paudyal
- United Nation Children's Fund (UNICEF) Nepal Country Office, Kathmandu, Nepal
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23
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Kim SS, Ashok S, Avula R, Mahapatra T, Gokhale P, Walton S, Heidkamp RA, Munos MK. Moderate Accuracy of Survey Responses about Infant and Young Child Feeding Counseling Reported by Mothers with Children Less than 1 Year of Age in India. J Nutr 2023; 153:1220-1230. [PMID: 36796483 DOI: 10.1016/j.tjnut.2023.02.010] [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: 09/19/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Counseling on infant and young child feeding (IYCF) to support optimal breastfeeding and complementary feeding practices is an essential intervention, and accurate coverage data is needed to identify gaps and monitor progress. However, coverage information captured during household surveys has not yet been validated. OBJECTIVES We examined the validity of maternal reports of IYCF counseling received during community-based contacts and factors associated with reporting accuracy. METHODS Direct observations of home visits conducted by community workers in 40 villages in Bihar, India served as the "gold standard" to maternal reports of IYCF counseling received during 2-wk follow-up surveys (n = 444 mothers with children less than 1 y of age, interviews matched to direct observations). Individual-level validity was assessed by calculating sensitivity, specificity, and AUC. Population-level bias was measured using the inflation factor (IF). Multivariable regression models were used to examine factors associated with response accuracy. RESULTS Prevalence of IYCF counseling during home visits was very high (90.1%). Maternal report of any IYCF counseling received in the past 2 wk was moderate (AUC: 0.60; 95% CI: 0.52, 0.67), and population bias was low (IF = 0.90). However, the recall of specific counseling messages varied. Maternal report of any breastfeeding, exclusive breastfeeding, and dietary diversity messages had moderate validity (AUC > 0.60), but other child feeding messages had low individual validity. Child age, maternal age, maternal education, mental stress, and social desirability were associated with reporting accuracy of multiple indicators. CONCLUSIONS Validity of IYCF counseling coverage was moderate for several key indicators. IYCF counseling is an information-based intervention that may be received from various sources, and it may be challenging to achieve higher reporting accuracy over a longer recall period. We consider the modest validity results as positive and suggest that these coverage indicators may be useful for measuring coverage and tracking progress over time.
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Affiliation(s)
- Sunny S Kim
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, USA.
| | | | | | | | - Priya Gokhale
- CARE India Solutions for Sustainable Development, Bihar, India
| | - Shelley Walton
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca A Heidkamp
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Melinda K Munos
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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24
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Ngure FM, Kassim N, Phillips EL, Turner PC. Infant and Young Child Feeding Practices and Mycotoxin Contamination of Complementary Food Ingredients in Kongwa District, Tanzania. Curr Dev Nutr 2023; 7:100030. [PMID: 37180082 PMCID: PMC10111587 DOI: 10.1016/j.cdnut.2023.100030] [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: 08/31/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Background Inadequate infant and young child feeding (IYCF) practices in low income countries contribute to poor child growth and development. Objectives To assess IYCF practices and mycotoxin contamination in complementary food ingredients across 2 seasons in Kongwa District, Tanzania. Methods Early feeding practices in 115 rural households from 25 villages in Kongwa District, Dodoma region, Tanzania, were assessed. The primary caregiver for the index child (6-18 mo of age) was interviewed using a structured dietary questionnaire at recruitment (October/November 2017), and revisited 6 mo later. The questionnaire included questions on typical food consumption in the past 24 h. This study reports 7 of the revised and new IYCF indicators, including minimum dietary diversity (MDD). Aflatoxins (AF) and fumonisins (FUM) were analyzed in complementary food ingredients for pooled household samples to broadly establish patterns of contamination at the village level. Results The MDD was not met for 80% of infants at recruitment (survey 1) as compared with 56% in survey 2 (P < 0.05). Changes in MDD between the 2 surveys were dependent on season but not age. Maize was consumed by >90% of households in both surveys, whereas groundnut was consumed by 44% and 64% of households in surveys 1 and 2, respectively. AF concentrations in maize and groundnuts were found to be higher in survey 1 than in survey 2. Overall, AF exceeded the legal limit in 18% of maize and 61% of groundnut pooled samples in both surveys. Maize was also contaminated with significant FUM concentrations. Conclusions Poor diets were common among children in Kongwa District. Reliance on maize and groundnuts exposes this vulnerable age group to AF (also to FUM in maize). Inadequate diet and exposure to AF and FUM have separately been linked to linear growth retardation. Low diet diversity and mycotoxins contamination are plausible causes for poor growth and development among infants in Central Tanzania. Curr Dev Nutr 20XX;x:xx.
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Affiliation(s)
- Francis M. Ngure
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Neema Kassim
- Department of Food Biotechnology and Nutritional Sciences, School of Life Science and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
| | - Erica L. Phillips
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Paul C. Turner
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD, USA
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25
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Grey K, Kodish SR, Namohunu SA, Losi J, Matean M, Palaniappan U, Northrup-Lyons M, Cherian A, Gwavuya S, McLean J, Erasmus W. Determinants of maternal, infant, and young child nutrition during the 1,000-day window of opportunity in Solomon Islands: A focused ethnographic study. Front Nutr 2023; 9:1082161. [PMID: 36742003 PMCID: PMC9893623 DOI: 10.3389/fnut.2022.1082161] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
Introduction This focused ethnographic study used qualitative, ethnographic, and participatory methods to explore determinants of maternal, infant, and young child nutrition (MIYCN) during the first 1,000 days of life as part of efforts to address the double burden of malnutrition in Solomon Islands. Methods An iterative study design was used to first explore and then confirm findings related to food and nutrition security and social and behavioral determinants of MIYCN in urban and rural settings. The first phase included in-depth interviews, household observations, free lists, and seasonal food availability calendar workshops while the second phase included focus group discussions, pile sorts, participatory community workshops, and repeated household observations. Results and discussion We found that MIYCN is shaped by a complex interaction of factors at the macro- and micro-levels. At the macro-level, globalization of the food system, a shifting economy, and climate change are driving a shift toward a delocalized food system based on imported processed foods. This shift has contributed to a food environment that leaves Solomon Islanders vulnerable to food and nutrition insecurity, which we found to be the primary determinant of MIYCN in this context. At the micro-level, this food environment leads to household- and individual-level food decisions that often do not support adequate MIYCN. Multi-sectoral interventions that address the macro- and micro-level factors shaping this nutrition situation may help to improve MIYCN in Solomon Islands.
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Affiliation(s)
- Kelsey Grey
- Nourish Global Nutrition, Vancouver, BC, Canada,*Correspondence: Kelsey Grey,
| | - Stephen R. Kodish
- Chandlee Lab, Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, United States,Chandlee Lab, Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, United States
| | | | - Jill Losi
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | | | | | | | | | | | - Judy McLean
- Nourish Global Nutrition, Vancouver, BC, Canada
| | - Wendy Erasmus
- United Nations Children’s Fund (UNICEF) Pacific, Suva, Fiji
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26
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Pereira-Kotze C, Horwood C, Haskins L, Kingston G, Luthuli S, Doherty T. Exploring women's exposure to marketing of commercial formula products: a qualitative marketing study from two sites in South Africa. Glob Health Action 2022; 15:2074663. [PMID: 35946213 PMCID: PMC9377257 DOI: 10.1080/16549716.2022.2074663] [Citation(s) in RCA: 1] [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: 12/03/2022] Open
Abstract
Background Regulating the marketing of commercial formula products is a long-term commitment required to protect breastfeeding. Marketing strategies of formula manufacturers, retailers and distributors evolve at a rapid rate. Objective The aim of this research was to describe exposure of pregnant women and mothers of young children in South Africa to marketing of commercial formula products, compared to international recommendations and national legislation. Methods Using mobile phone marketing diaries twenty participants in Cape Town and Johannesburg documented the formula marketing they were exposed to for one week. Ten mothers were interviewed to explore their perceptions towards marketing exposure in more depth. Results Women reported limited infant formula advertising, but an abundance of strategies used to market growing-up formula and powdered drinks for children over 36 months. Strategies included product packaging, in-store displays, online distribution channels and educational material about product ranges. Online strategies were reported, namely social media marketing (sponsored adverts and support groups), websites and mobile phone applications providing infant and young child feeding information and price discounts, print and TV advertisements, and competitions. Products for children over 36 months are cross-promoted with products prohibited to be advertised by national legislation. Conclusions South African women are being exposed to covert marketing of infant, follow-up, and growing-up formula. Explicit marketing of products for children over 36 months of age allows formula companies to provide messages about branding and use of commercial formula products to mothers. National legislation should be updated and effectively implemented to address changing marketing strategies.
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Affiliation(s)
| | - Christiane Horwood
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Lyn Haskins
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Silondile Luthuli
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Tanya Doherty
- School of Public Health, University of the Western Cape, Cape Town, South Africa.,Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Angeles-Agdeppa I, Goyena EA, Maniego MLV. The Philippines' snapshot situation of pregnancy-related and child feeding practices during the COVID-19 pandemic. Nutr Health 2022; 28:751-759. [PMID: 35603828 PMCID: PMC9130869 DOI: 10.1177/02601060221103004] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: Maternal, infant and young child health and nutrition are affected during the COVID-19 pandemic. Aim: This study aimed to present the snapshot situation of maternal health practices of pregnant women including infant and young child feeding (IYCF) practices of children under two during the COVID-19 pandemic. Methods: A rapid nutrition assessment survey (RNAS) was conducted through phone interview in nine selected areas from November 3 to December 3, 2020. A multi-stage sampling design was employed in the selection of areas with low, medium, and high risk categories across the islands of Luzon, Visayas, and Mindanao in the Philippines. A total of 792 mother-child pairs, and 148 pregnant women were covered. Results: Majority (84.5%) of pregnant women availed pre-natal check-ups, 82.4% of them had micronutrient supplements, of which 20.5% took IFA tablets. Almost 60.0% of children under two were currently breastfed during the pandemic, with 60.8% of infants less than 6 months receiving breastmilk exclusively. Appropriate complementary feeding practices based on this study were not drastically affected by the COVID-19 pandemic. However, access to pregnancy-related information, along with breastfeeding and complementary feeding messages and advice were disrupted during the community lockdown. Conclusion: Although maternal and child feeding practices were unchanged, innovative delivery of community health and nutrition services such as tele-visits by midwives, and community health workers are some of the ways to move forward in improving the health and nutrition of women and children in the wake of the pandemic and during subsequent waves.
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Affiliation(s)
| | - Eva A Goyena
- Eva A Goyena, Department of Science and
Technology, Food and Nutrition Research Institute, Bicutan, Taguig City, Metro
Manila, Philippines.
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28
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Ibrahim C, Bookari K, Sacre Y, Hanna-Wakim L, Hoteit M. Breastfeeding Practices, Infant Formula Use, Complementary Feeding and Childhood Malnutrition: An Updated Overview of the Eastern Mediterranean Landscape. Nutrients 2022; 14:4201. [PMID: 36235853 DOI: 10.3390/nu14194201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND With increasing global rates of overweight, obesity and non-communicable diseases (NCDs) along with undernutrition and micronutrient deficiencies, the Eastern Mediterranean Region (EMR) is no exception. This review focuses on specific nutrition parameters among under five years children, namely ever breastfed, exclusive breastfeeding, mixed milk feeding, continued breastfeeding, bottle feeding, introduction of solid, semi-solid, or soft foods and malnutrition. METHODOLOGY PubMed, Google Scholar, United Nations International Children's Emergency Fund (UNICEF) databases, World Health Organization (WHO) databases, the World Bank databases and the Global Nutrition Report databases were explored between 10 January and 6 June 2022, to review the nutrition situation among under five years children in the EMR. RESULTS The regional average prevalence of ever breastfed, exclusive breastfeeding, mixed milk feeding, continued breastfeeding, bottle feeding, introduction of solid, semi-solid, or soft foods was estimated at 84.3%, 30.9%, 42.9%, 41.5%, 32.1% and 69.3%, respectively. Iran, Iraq, Libya and Palestine have seen a decline over time in the prevalence of exclusive breastfeeding. Lebanon, Egypt, Kuwait and Saudi Arabia reported early introduction of infant formula. Moreover, Lebanon, Pakistan, Saudi Arabia and United Arab Emirates were seen to introduce food early to the child, at between 4-6 months of age. The estimated weighted regional averages for stunting, wasting and underweight were 20.3%, 8.9% and 13.1%, respectively. Of concern is the increasing prevalence of stunting in Libya. As for overweight and obesity, the average prevalence was reported to be 8.9% and 3%, respectively. Lebanon, Libya, Kuwait and Palestine showed an increased trend throughout this time. CONCLUSIONS In this review, the suboptimal infant and young child feeding patterns and the twofold incidence of malnutrition in the EMR are highlighted and we urge the prioritizing of measures to improve children's nutrition.
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McClintic EE, Ellis A, Ogutu EA, Caruso BA, Ventura SG, Arriola KRJ, Kowalski AJ, Linabarger M, Wodnik BK, Muga R, Freeman MC, Girard AW. Application of the Capabilities, Opportunities, Motivations, and Behavior (COM-B) Change Model to Formative Research for Child Nutrition in Western Kenya. Curr Dev Nutr 2022; 6:nzac104. [PMID: 35898312 PMCID: PMC9314706 DOI: 10.1093/cdn/nzac104] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023] Open
Abstract
Background Interventions aimed at improving dietary intake and feeding practices have alone proven insufficient for combatting stunting resulting from poor nutrition and repeated infections. Objectives To support the development of an integrated water, sanitation, and hygiene (WASH) and nutrition, social, and behavior change strategy aimed at reducing stunting, formative research was conducted in 2 program sites in western Kenya. Methods Twenty-nine key informant interviews were conducted with community leaders, health workers, and project staff, and 24 focus group discussions with caregivers of children under 2 y on topics related to feeding, sanitation, and hygiene behaviors. Three frameworks informed the study design and analysis of our formative research: the Capabilities, Opportunities, and Motivations model for behavior change, which identifies what needs to change in order for behavior change interventions to be effective; the Grandmother Project's Change Through Culture Approach, which values the important role of influential household and community members in producing household health; and Starr and Fornoff's approach to Theory of Change development. Results Caregivers exhibited sufficient psychological capabilities (knowledge and skills) for many of the key maternal and infant nutrition behaviors. However, reflective motivation to perform optimal behaviors was undermined by limitations in physical and social opportunities, including limited time and competing priorities for mothers, limited accessibility and availability of diverse foods, low self-efficacy for exclusive breastfeeding, and fears of negative consequences related to specific foods and recommended practices. Conclusions Interventions that aim to improve maternal and child diets should address the underlying social, cultural, and environmental determinants that contribute to motivations and opportunities to perform recommended practices.
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Affiliation(s)
- Emilie Ewart McClintic
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anna Ellis
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Emily A Ogutu
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bethany A Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sandra Gomez Ventura
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kimberly R Jacob Arriola
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alysse J Kowalski
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA USA
| | - Molly Linabarger
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Breanna K Wodnik
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Amy Webb Girard
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA USA
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30
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Scott S, Gupta S, Menon P, Raghunathan K, Thai G, Quisumbing A, Prasad V, Hegde A, Choudhury A, Khetan M, Nichols C, Kumar N. A Quasi-Experimental Evaluation of a Nutrition Behavior Change Intervention Delivered Through Women's Self-Help Groups in Rural India: Impacts on Maternal and Young Child Diets, Anthropometry, and Intermediate Outcomes. Curr Dev Nutr 2022; 6:nzac079. [PMID: 35694241 PMCID: PMC9177383 DOI: 10.1093/cdn/nzac079] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/21/2022] [Accepted: 04/07/2022] [Indexed: 11/14/2022] Open
Abstract
Background Women's self-help groups (SHGs) have become one of the largest institutional platforms serving the poor. Nutrition behavior change communication (BCC) interventions delivered through SHGs can improve maternal and child nutrition outcomes. Objectives The objective was to understand the effects of a nutrition BCC intervention delivered through SHGs in rural India on intermediate outcomes and nutrition outcomes. Methods We compared 16 matched blocks where communities were supported to form SHGs and improve livelihoods; 8 blocks received a 3-y nutrition intensive (NI) intervention with nutrition BCC, and agriculture- and rights-based information, facilitated by a trained female volunteer; another 8 blocks received standard activities (STD) to support savings/livelihoods. Repeated cross-sectional surveys of mother-child pairs were conducted in 2017-2018 (n = 1609 pairs) and 2019-2020 (n = 1841 pairs). We matched treatment groups over time and applied difference-in-difference regression models to estimate impacts on intermediate outcomes (knowledge, income, agriculture/livelihoods, rights, empowerment) and nutrition outcomes (child feeding, woman's diet, woman and child anthropometry). Analyses were repeated on households with ≥1 SHG member. Results Forty percent of women were SHG members and 50% were from households with ≥1 SHG member. Only 10% of women in NI blocks had heard of intervention content at endline. Knowledge improved in both NI and STD groups. There was a positive NI impact on knowledge of timely introduction of animal-sourced foods to children (P < 0.05) but not on other intermediate outcomes. No impacts were observed for anthropometry or diet indicators except child animal-source food consumption (P < 0.01). In households with ≥1 SHG member, there was a positive NI impact on child unhealthy food consumption (P < 0.05). Conclusions Limited impacts could be due to limited exposure or skills of volunteers, and a concurrent national nutrition campaign. Our findings add to a growing literature on SHG-based BCC interventions and the conditions necessary for their success.
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Affiliation(s)
- Samuel Scott
- Poverty Health and Nutrition Division, International Food Policy Research Institute, New Delhi, India
| | - Shivani Gupta
- Poverty Health and Nutrition Division, International Food Policy Research Institute, New Delhi, India
| | - Purnima Menon
- Poverty Health and Nutrition Division, International Food Policy Research Institute, New Delhi, India
| | - Kalyani Raghunathan
- Poverty Health and Nutrition Division, International Food Policy Research Institute, New Delhi, India
| | - Giang Thai
- Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Agnes Quisumbing
- Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | | | - Aditi Hegde
- Public Health Resource Society (PHRS), New Delhi, India
| | - Avijit Choudhury
- Professional Assistance for Development Action (PRADAN), New Delhi, India
| | - Madhu Khetan
- Professional Assistance for Development Action (PRADAN), New Delhi, India
| | - Carly Nichols
- Geographical and Sustainability Studies Department, University of Iowa, Iowa City, IA, USA
| | - Neha Kumar
- Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
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Tariqujjaman M, Hasan MM, Mahfuz M, Hossain M, Ahmed T. Association between Mother's Education and Infant and Young Child Feeding Practices in South Asia. Nutrients 2022; 14:1514. [PMID: 35406127 DOI: 10.3390/nu14071514] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 12/15/2022] Open
Abstract
The association between mother’s education and the World Health Organization’s (WHO’s) eight Infant and Young Child Feeding (IYCF) core indicators has yet to be explored in South Asia (SA). This study aimed to explore the association between mother’s education and the WHO’s eight IYCF core indicators in SA. We analyzed data from the most recent nationally representative Demographic and Health Surveys of six South Asian Countries (SACs)—Afghanistan, Bangladesh, India, Maldives, Nepal, and Pakistan. We found significantly higher odds (adjusted odds ratio, AOR, 1.13 to 1.47) among mothers who completed secondary or higher education than among mothers with education levels below secondary for the following seven IYCF indicators: early initiation of breastfeeding (EIBF), exclusive breastfeeding under 6 months (EBF), the introduction of solid, semisolid or soft foods (ISSSF), minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD), and consumption of iron-rich or iron-fortified foods (CIRF); the exception was for the indicator of continued breastfeeding at one year. Country-specific analyses revealed significantly higher odds in EIBF (AOR 1.14; 95% CI: 1.11, 1.18) and EBF (AOR 1.27; 95% CI: 1.19, 1.34) among mothers with secondary or higher education levels in India. In contrast, the odds were lower for EIBF in Bangladesh and for EBF in Pakistan among mothers with secondary or higher education levels. For country-specific analyses for complementary feeding indicators such as ISSSF, MDD, MMF, MAD, and CIRF, significantly higher odds (AOR, 1.15 to 2.34) were also observed among mothers with secondary or higher education levels. These findings demonstrate a strong positive association between mother’s education and IYCF indicators. Strengthening national policies to educate women at least to the secondary level in SACs might be a cost-effective intervention for improving IYCF practices.
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Hromi-Fiedler AJ, Pérez-Escamilla R, Segura-Pérez S, Garg A, Bégin F. Assessing the Nurturing Care Content of UNICEF's Community Infant and Young Child Feeding Counselling Package: Gaps, Best Practices, and Lessons Learned. Curr Dev Nutr 2022; 6:nzac018. [PMID: 35368736 PMCID: PMC8967086 DOI: 10.1093/cdn/nzac018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background The United Nations Children's Fund (UNICEF) Community Infant and Young Child Feeding Counselling Package (C-IYCF CP) is used globally for infant and young child feeding (IYCF) counseling. With the C-IYCF CP last updated 8 y ago, mapping existing nurturing care content, identifying gaps, and documenting current country-level changes offers a unique opportunity to guide recommendations to strengthen the nurturing care content of this package. Objectives The primary study aims were to: 1) identify and map existing nurturing care content within UNICEF's C-IYCF CP, 2) identify gaps related to nurturing care or feeding elements within the C-IYCF CP, 3) identify country-level nurturing care adaptations to the C-IYCF CP, and 4) identify best practices and lessons learned from country adaptations that can be recommended for inclusion in the C-IYCF CP. Methods The assessment included 4 phases: 1) conduct an iterative process to identify and map nurturing care elements within the C-IYCF CP using a codebook explicitly developed for this assessment; 2) identify gaps in the C-IYCF CP; 3) apply the codebook to IYCF packages from 11 countries, revise, then finalize the codebook; and 4) identify and interview key informants from 4 countries whose IYCF packages had the most comprehensive nurturing care content plus 1 country where health care professionals make routine mother-child home visits. Results The C-IYCF CP contained limited nurturing care content, especially around safety/security and early learning. All 5 countries interviewed had systematically identified and included priority nurturing care content in each package, yet content level varied. Two countries were also incorporating information technology into the training and delivery of the C-IYCF CP. Conclusions Existing country-level best practices can address nurturing care elements missing from UNICEF's C-IYCF CP. Sharing these practices can allow countries to make context-driven, evidence-informed decisions on the nurturing care content to prioritize.
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Affiliation(s)
- Amber J Hromi-Fiedler
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Mistry SK, Hossain MB, Irfan NM, Saha M, Saberin S, Shamim AA, Arora A. Trends in Complementary Feeding Indicators and Intake from Specific Food Groups among Children Aged 6-23 Months in Bangladesh. Int J Environ Res Public Health 2022; 19:550. [PMID: 35010809 DOI: 10.3390/ijerph19010550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/12/2021] [Accepted: 12/23/2021] [Indexed: 12/04/2022]
Abstract
The present study aims to comprehensively analyse trends in complementary feeding indicators (Introduction of solid, semi-solid, and soft foods at 6–8 months (INTRO), Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF) and Minimum Acceptable Diet (MAD)) among children aged 6–23 months in Bangladesh. The study used data from four rounds (2007, 2011, 2014, and 2017–2018) of nationally representative Bangladesh Demographic and Health Surveys (BDHSs). The Cochran–Armitage test was performed to capture the trends in complementary feeding practices and intake from specific food groups. BDHSs are periodically conducted cross-sectional surveys in all seven administrative divisions of Bangladesh. The present analysis was performed among 8116 children (1563 in 2007, 2137 in 2011, 2249 in 2014, and 2167 in 2017–2018) aged 6–23 months. Overall, a decreasing trend was observed in all the complementary feeding indicators except INTRO from 2007 to 2014, but a substantial increase in MDD, MMF and MAD was noted in 2017–2018. A statistically significant reduction in consumption from different food groups such as legumes and nuts (p < 0.001), dairy products (p = 0.001), vitamin-A-rich fruits or vegetables (p < 0.001), and other fruits and vegetables (p < 0.001) was also observed. However, a positive trend was noted in the consumption of grains/roots/tubers (p = 0.027), and meat/fish/egg (p < 0.001). After experiencing a significant decreasing trend during 2007–2014, the recent BDHS indicates improvements in all complementary feeding indicators among young children in Bangladesh, which calls for integrated, multisectoral, and multicomponent interventions to sustain this progress.
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Roba AA, Tola A, Dugassa D, Tefera M, Gure T, Worku T, Ayele AT, Dasa TT, Workie HM, Asfaw MM, Asfaw A, Mesfin F, Regassa LD, Dessie Y, Abera F, Yeshitila M, Girma M, Gezahagn M, Tezera F, Assefa N, Roba KT. Antenatal care utilization and nutrition counseling are strongly associated with infant and young child feeding knowledge among rural/semi-urban women in Harari region, Eastern Ethiopia. Front Pediatr 2022; 10:1013051. [PMID: 36245728 PMCID: PMC9557120 DOI: 10.3389/fped.2022.1013051] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/12/2022] [Indexed: 11/15/2022] Open
Abstract
There is a gap in evidence linking antenatal care (ANC) utilization, nutrition counseling, and knowledge of pregnant women about infant and young child feeding (IYCF), particularly in low-income settings. Therefore, this study aimed to identify the association between ANC follow-up and nutrition counseling with IYCF knowledge. A cross-sectional study was conducted among 390 pregnant women in the rural kebeles of the Harari region from January to June 2019. Data were collected using face-to-face interviews on tablet computers. Bivariate and multivariate logistic regression were employed. An adjusted odds ratio (with 95% CI) was used to determine the strength of association between IYCF knowledge with ANC follow-up and nutrition counseling by adjusting for educational status, occupation, gravida, and distance to the nearest health center. Overall, 54.4% [95% CI 49.2, 59.2] of currently pregnant women were knowledgeable about IYCF of which only 20% started ANC follow-up and 24.4% received nutrition counseling. Out of 288 multigravida women, only 51.4% had ANC follow-up during their last pregnancy. In the adjusted model, ANC follow-up during the current pregnancy (AOR 1.85, 95% CI 1.07-3.22), those who received nutrition counseling (AOR 1.92, 95% CI 1.09-3.38), literate in education (AOR 1.71, 95% CI 1.07-2.73), multigravida (AOR 1.96, 95% CI 1.12-3.43), and far from the nearest health center (AOR 0.95, 95% CI 0.93-0.97) were significantly associated with the mothers IYCF knowledge. Thus, health care providers should encourage mothers to attend ANC during pregnancy and provide nutrition counseling about the IYCF.
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Affiliation(s)
- Aklilu Abrham Roba
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Assefa Tola
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Desta Dugassa
- Haramaya Institute of Technology, Haramaya University, Dire Dawa, Ethiopia
| | - Maleda Tefera
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Tadese Gure
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Teshager Worku
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | | | | | | | | | - Abiyot Asfaw
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Firehiwot Mesfin
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | | | - Yadeta Dessie
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Fitsum Abera
- College of Agriculture, Haramaya University, Dire Dawa, Ethiopia
| | - Meron Yeshitila
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Meskerem Girma
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Muluken Gezahagn
- College of Agriculture, Haramaya University, Dire Dawa, Ethiopia
| | - Feven Tezera
- College of Agriculture, Haramaya University, Dire Dawa, Ethiopia
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Kedir Teji Roba
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
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Al-Awwad NJ, Ayoub J, Barham R, Sarhan W, Al-Holy M, Abughoush M, Al-Hourani H, Olaimat A, Al-Jawaldeh A. Review of the Nutrition Situation in Jordan: Trends and Way Forward. Nutrients 2021; 14:135. [PMID: 35011008 PMCID: PMC8746685 DOI: 10.3390/nu14010135] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 01/22/2023] Open
Abstract
Jordan is witnessing an escalating pace of nutrition transition, which may be associated with an increased burden of malnutrition and related non-communicable diseases. This review analyzes the nutrition situation in Jordan by exploring specific nutrition indicators, namely infant and young child feeding, low birthweight, micronutrient deficiencies, anthropometric indicators, and food consumption patterns. Results showed that although most children were ever breastfed and early initiation of breastfeeding had a two-fold increasing trend, rates of exclusive breastfeeding below 6 months of age and continued breastfeeding until two years of age were low. Complementary feeding indicators, particularly minimum diet diversity and minimum acceptable diet standards, were suboptimal. An overall low burden of stunting, wasting, and underweight among children under 5 years and remarkable progress in optimizing iodine status among school-aged children were reported. Conversely, the burden of low birthweight and overweight/obesity exacerbated, coexisting with anemia, vitamin A deficiency, and vitamin D deficiency. Overall, fruit and vegetable consumption were inadequate. The consumption of soft drinks and salt on the other hand was higher than recommended. This review acknowledges the double burden of malnutrition in Jordan and recommends the prioritization and evaluation of interventions towards improving the population's nutritional status and achieving nutrition targets.
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Affiliation(s)
- Narmeen Jamal Al-Awwad
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan; (N.J.A.-A.); (M.A.-H.); (M.A.); (H.A.-H.); (A.O.)
| | - Jennifer Ayoub
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon;
| | - Rawhieh Barham
- Nutrition Department, Ministry of Health, Amman 11118, Jordan;
| | - Wafaa Sarhan
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Murad Al-Holy
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan; (N.J.A.-A.); (M.A.-H.); (M.A.); (H.A.-H.); (A.O.)
| | - Mahmoud Abughoush
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan; (N.J.A.-A.); (M.A.-H.); (M.A.); (H.A.-H.); (A.O.)
- Science of Nutrition and Dietetics Program, College of Pharmacy, Al Ain University, Abu Dhabi 64141, United Arab Emirates
| | - Huda Al-Hourani
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan; (N.J.A.-A.); (M.A.-H.); (M.A.); (H.A.-H.); (A.O.)
| | - Amin Olaimat
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan; (N.J.A.-A.); (M.A.-H.); (M.A.); (H.A.-H.); (A.O.)
| | - Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo 7608, Egypt
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Miller JD, Workman CL, Panchang SV, Sneegas G, Adams EA, Young SL, Thompson AL. Water Security and Nutrition: Current Knowledge and Research Opportunities. Adv Nutr 2021; 12:2525-2539. [PMID: 34265039 PMCID: PMC8634318 DOI: 10.1093/advances/nmab075] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 02/05/2021] [Revised: 04/22/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
Water is an essential nutrient that has primarily been considered in terms of its physiological necessity. But reliable access to water in sufficient quantities and quality is also critical for many nutrition-related behaviors and activities, including growing and cooking diverse foods. Given growing challenges to water availability and safety, including climate change, pollution, and infrastructure degradation, a broader conceptualization of water and its diverse uses is needed to sustainably achieve global nutrition targets. Therefore, we review empirical and qualitative evidence describing the linkages between water security (the reliable availability, accessibility, and quality of water for all household uses) and nutrition. Primary linkages include water security for drinking, food production and preparation, infant and young child feeding, and limiting exposure to pathogens and environmental toxins. We then identify knowledge gaps within each linkage and propose a research agenda for studying water security and nutrition going forward, including the concurrent quantification of both food and water availability, accessibility, use, and stability. By making explicit the connections between water security and nutritional well-being, we aim to promote greater collaboration between the nutrition and water, sanitation, and hygiene sectors. Interdisciplinary policies and programs that holistically address the water-nutrition nexus, versus those that focus on water and nutrition independently, are likely to significantly advance our ability to ensure equitable access to healthy foods and safe water for all.
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Affiliation(s)
- Joshua D Miller
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cassandra L Workman
- Department of Anthropology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Sarita V Panchang
- Social Research and Evaluation Center, Louisiana State University, Baton Rouge, LA, USA
| | - Gretchen Sneegas
- Department of Geography, Texas A&M University, College Station, TX, USA
| | - Ellis A Adams
- Keough School of Global Affairs, University of Notre Dame, Notre Dame, IN, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Amanda L Thompson
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Knight F, Woldt M, Sethuraman K, Bergeron G, Ferguson E. Household-level consumption data can be redistributed for individual-level Optifood diet modeling: analysis from four countries. Ann N Y Acad Sci 2021; 1509:145-160. [PMID: 34850396 PMCID: PMC9299870 DOI: 10.1111/nyas.14709] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 12/05/2022]
Abstract
A barrier to using Optifood linear programming (LP), which identifies nutrient gaps and supports population‐specific food‐based recommendation (FBR) development, is the requirement for dietary intake data. We investigated whether Household Consumption and Expenditure Surveys (HCESs) could be used instead of individual‐level 24‐h recalls (24HRs). The 24HR data from 12‐ to 23‐month‐old breastfeeding children in rural Kenya, Uganda, Guatemala, and Bangladesh were paired with HCES food consumption data from similar areas (n = 8) and time periods. HCES food intakes (g/week) were estimated using adult male equivalents, adjusted for breastfeeding. Paired HCES‐ and 24HR‐defined LP inputs and outputs were compared using percentage agreement. Mean overall percentage agreements were 42%, 63%, and 80%, for food, food subgroup, and food‐group model parameters, respectively. HCES food lists were on average 1.3 times longer than 24HR. Similar nutrient gaps (77–100% agreement), food sources of nutrients (71–100% agreement), and FBRs (80–100% agreement) were identified. The results suggest that HCES data can be used in Optifood analyses for 12‐ to 23‐month‐old children, despite recognized challenges of using it to estimate dietary intakes of young children compared with older age groups. Further analyses, however, are required for different age groups and locations to confirm expectations that it would perform equally well.
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Affiliation(s)
- Frances Knight
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.,United Nations World Food Programme, Rome, Italy
| | - Monica Woldt
- Helen Keller International, Washington, District of Columbia.,Formerly with the Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia.,USAID Advancing Nutrition, Arlington, Virginia
| | - Kavita Sethuraman
- Formerly with the Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia
| | - Gilles Bergeron
- Formerly with the Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia.,New York Academy of Sciences, New York, New York
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Wang Y, Si X, Yu D, Yang Z, Zhao L. [Status of infant and young child feeding using World Health Organization 2021 indicators in China]. Wei Sheng Yan Jiu 2021; 50:882-886. [PMID: 34949311 DOI: 10.19813/j.cnki.weishengyanjiu.2021.06.002] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe the feeding status of infant and young child aged 6-23 months in China. METHODS Data was from the China Nutrition and Health Surveillance among 0-5 Years Old Children and Lactating Women in 2013.Stratified multistage cluster sampling method was used, and 9983 children aged 6-23 months were involved. We analyzed the infant and young child feeding practices with World Health Organization(WHO) 2021 updated indicators. Data analyses were conducted using the complex weight based on national census from National Bureau of Statistics in 2010.We used Rao-Scott Chi-square test for statistical difference. RESULTS The proportions of children aged 6-23 months meeting minimum dietary diversity(MDD) was 34.5%(95% CI 28.8%-40.2%); it was over 50% in large cities, and only 20.4% in poor rural areas. The proportions of children aged 6-23 months meeting minimum meal frequency(MMF) was 69.2%(95% CI 64.7%-73.7%); it was about 80% in large cities, medium and small cities, and only 45.3% in poor rural areas. The proportions of children aged 6-23 months meeting minimum acceptable diet(MAD)was 23.7%(95% CI 19.2%-28.2%), it was 44.2% in large cities, and less than 10% in poor rural areas. No consistent differences were observed between boys and girls for all 3 dietary indicators(MDD, MMF and MAD), and there was significant difference in different areas and various months of age(P<0.05). CONCLUSION The minimum dietary diversity and minimum acceptable diet among children aged 6-23 month were not optimal in China, especially in poor rural areas.
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Affiliation(s)
- Yuying Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiang Si
- Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Dongmei Yu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Zhenyu Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Liyun Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Bansal SC, Odedra R, Talati K, Morgaonkar VA, Shinde M, Nimbalkar SM. Infant and young child feeding (IYCF) practices and their determinants in two Urban districts of India. J Family Med Prim Care 2021; 10:3137-3143. [PMID: 34660459 PMCID: PMC8483104 DOI: 10.4103/jfmpc.jfmpc_184_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/25/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: It is essential to maintain optimal nutrition during the early years of life when the growth rate is maximum. Aims and Objectives: Our study investigated the prevalence of various feeding practices. We also explored their association with different sociodemographic, biomedical variables, and childhood morbidity. Methodology: This was a cross-sectional community-based study. Data were collected through a questionnaire-based survey of mothers of school-going children aged 2–6 years in the districts of Anand and Vadodara, Gujarat. Results: A total of 367 mothers participated in the study. About 78% of the mothers did early initiation of breastfeeding within 1 h of birth, and 68% gave colostrum to the newborn. Around 30% of the mothers practiced bottle feeding, and 25% gave prelacteal feeds. Most mothers received good family support for breastfeeding (93.73%). On univariate analysis, we found the following associations of feeding practices—breastfeeding initiation with the gender of the baby (P value—0.006) and type of delivery (P value < 0.001); the duration of exclusive breastfeeding with the time difference between two deliveries (P value—0.027) and maternal age (P value—0.004); prelacteal feeds with the type of delivery (P value—0.034); feeding difficulty with the time difference between two deliveries (P value < 0.001) and breastfeeding at night with maternal education (P value—0.002). The time of the initiation of breastfeeding was associated with cough and cold episodes. No other association was found between breastfeeding variables and health indicators. Conclusion: Maternal age, maternal education, the time difference between two deliveries, the type of delivery, and gender of the baby were significantly associated with different Infant and Young Child Feeding (IYCF) practices. Identifying these factors might help in the development of strategies for optimizing feeding practices.
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Affiliation(s)
- Satvik C Bansal
- Department of Pediatrics, Gajra Raja Medical College, Gwalior, Madhay Pradesh, India
| | - Rahul Odedra
- Medical Officer, Department of Paediatrics, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat, India
| | - Kandarp Talati
- Department of Interdisciplinary Research, Foundation for Diffusion of Innovations, Vadodara, Gujarat, India
| | | | - Mayur Shinde
- Central Research Services, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Somashekhar M Nimbalkar
- Professor and Head, Department of Paediatrics, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat, India
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Shaker‐Berbari L, Qahoush Tyler V, Akik C, Jamaluddine Z, Ghattas H. Predictors of complementary feeding practices among children aged 6-23 months in five countries in the Middle East and North Africa region. Matern Child Nutr 2021; 17:e13223. [PMID: 34137179 PMCID: PMC8476411 DOI: 10.1111/mcn.13223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 01/13/2023]
Abstract
Ensuring diets of children aged 6-23 months meet recommended guidance is crucial for growth and development and for the prevention of malnutrition including stunting, wasting and micronutrient deficiencies. Despite some improvement, indicators related to undernutrition and overnutrition fall short of global targets in the Middle East and North Africa (MENA) region that consist of low- and middle-income countries witnessing political and social changes and a nutrition transition. This research aims at reviewing the situation related to the diets of children aged 6-23 months in five selected countries in the MENA region, examining factors affecting complementary feeding and providing recommendations for guiding effective strategies to improve it. The study triangulated data on complementary feeding status and predictors from semistructured interviews with 30 key informants, and multivariable analysis of household surveys in Egypt, Jordan, Lebanon, State of Palestine and Sudan including data on refugees in Lebanon and Jordan. There remain considerable gaps in complementary feeding differing noticeably among geographic areas. Findings from qualitative and quantitative analyses showed that maternal factors, including maternal education and age, household level factors such as paternal education and wealth, community-level factors (culture and geographic location), and utilization of health services, were associated with minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD) at varied levels in the five countries. Interventions to improve complementary feeding practices should include actions tailored to the needs of the population at multiple levels including at the caregiver's level, household, service use, community and policy level.
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Affiliation(s)
- Linda Shaker‐Berbari
- United Nations Children's Fund (UNICEF) Regional Office for Middle East and East Africa RegionAmmanJordan
| | - Vilma Qahoush Tyler
- United Nations Children's Fund (UNICEF) Regional Office for Middle East and East Africa RegionAmmanJordan
| | - Chaza Akik
- Center for Research on Population and Health, Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
| | - Zeina Jamaluddine
- Center for Research on Population and Health, Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
- London School of Hygiene and Tropical MedicineLondonUK
| | - Hala Ghattas
- Center for Research on Population and Health, Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
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Donkor WES, Adu-Afarwuah S, Wegmüller R, Bentil H, Petry N, Rohner F, Wirth JP. Complementary Feeding Indicators in Relation to Micronutrient Status of Ghanaian Children Aged 6-23 Months: Results from a National Survey. Life (Basel) 2021; 11:969. [PMID: 34575118 PMCID: PMC8468967 DOI: 10.3390/life11090969] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Optimal complementary feeding is critical for adequate growth and development in infants and young children. The associations between complementary feeding and growth have been studied well, but less is known about the relationship between complementary feeding and micronutrient status. METHODS Using data from a national cross-sectional survey conducted in Ghana in 2017, we examined how multiple WHO-recommended complementary feeding indicators relate to anemia and the micronutrient status of children aged 6-23 months. RESULTS In total, 42%, 38%, and 14% of the children met the criteria for minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), respectively. In addition, 71% and 52% of the children consumed iron-rich foods and vitamin A-rich foods, respectively. The prevalence of anemia, iron deficiency (ID), iron deficiency anemia (IDA) and vitamin A deficiency (VAD) was 46%, 45%, 27%, and 10%, respectively. Inverse associations between MMF and socio-economic status were found, and MMF was associated with an increased risk of ID (55%; p < 0.013) and IDA (38%; p < 0.002). CONCLUSION The pathways connecting complementary feeding and micronutrient status are complex. Findings related to MMF should be further investigated to ensure that complementary feeding programs account for the potential practice of frequent feeding with nutrient-poor foods.
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Affiliation(s)
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon P.O. Box LG 25, Ghana; (S.A.-A.); (H.B.)
| | - Rita Wegmüller
- GroundWork, 7306 Fläsch, Switzerland; (R.W.); (N.P.); (F.R.); (J.P.W.)
| | - Helena Bentil
- Department of Nutrition and Food Science, University of Ghana, Legon P.O. Box LG 25, Ghana; (S.A.-A.); (H.B.)
| | - Nicolai Petry
- GroundWork, 7306 Fläsch, Switzerland; (R.W.); (N.P.); (F.R.); (J.P.W.)
| | - Fabian Rohner
- GroundWork, 7306 Fläsch, Switzerland; (R.W.); (N.P.); (F.R.); (J.P.W.)
| | - James P. Wirth
- GroundWork, 7306 Fläsch, Switzerland; (R.W.); (N.P.); (F.R.); (J.P.W.)
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Dhami MV, Ogbo FA, Diallo TMO, Olusanya BO, Goson PC, Agho KE, On Behalf Of The Global Maternal And Child Health Research Collaboration GloMACH. Infant and Young Child Feeding Practices among Adolescent Mothers and Associated Factors in India. Nutrients 2021; 13:2376. [PMID: 34371886 DOI: 10.3390/nu13072376] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
Adequate infant and young child feeding (IYCF) improve child survival and growth. Globally, about 18 million babies are born to mothers aged 18 years or less and have a higher likelihood of adverse birth outcomes in India due to insufficient knowledge of child growth. This paper examined factors associated with IYCF practices among adolescent Indian mothers. This cross-sectional study extracted data on 5148 children aged 0–23 months from the 2015–2016 India National Family Health Survey. Survey logistic regression was used to assess factors associated with IYCF among adolescent mothers. Prevalence of exclusive breastfeeding, early initiation of breastfeeding, timely introduction of complementary feeding, minimum dietary diversity, minimum meal frequency, and minimum acceptable diet rates were: 58.7%, 43.8%, 43.3%, 16.6%, 27.4% and 6.8%, respectively. Maternal education, mode of delivery, frequency of antenatal care (ANC) clinic visits, geographical region, child’s age, and household wealth were the main factors associated with breastfeeding practices while maternal education, maternal marital status, child’s age, frequency of ANC clinic visits, geographical region, and household wealth were factors associated with complementary feeding practices. IYCF practices among adolescent mothers are suboptimal except for breastfeeding. Health and nutritional support interventions should address the factors for these indicators among adolescent mothers in India.
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Cunningham K, Nagle D, Gupta P, Adhikari RP, Singh S. Associations between parents' exposure to a multisectoral programme and infant and young child feeding practices in Nepal. Matern Child Nutr 2021; 17 Suppl 1:e13143. [PMID: 34241957 PMCID: PMC8269143 DOI: 10.1111/mcn.13143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/07/2020] [Accepted: 01/04/2021] [Indexed: 12/28/2022]
Abstract
In Nepal, an at-scale, multisectoral programme-Suaahara (2011-2023)-aims to improve nutrition behaviours. Suaahara II (2016-2023) transitioned from a mother/child dyad focus to explicitly targeting all family members. Evidence is scant, however, regarding how exposure by men to social and behaviour change interventions relates to nutrition outcomes. This study uses a 2019 cross-sectional monitoring dataset to test associations between maternal and male household head exposure to Suaahara II interventions (interacting with a frontline worker, participating in a community event or listening to the Bhanchhin Aama radio programme) and adoption of three infant and young child feeding practices: minimum dietary diversity, minimum acceptable diet and sick child feeding, in households with a child under 2 years (n = 1827). Maternal exposure to Suaahara II had a positive association with minimum dietary diversity (OR: 1.71, 95% CI [1.27, 2.28], P < 0.001), minimum acceptable diet (OR: 1.60, 95% CI [1.19, 2.14], P = 0.002) and increased feeding to a sick child (OR: 2.11, 95% CI [1.41, 3.17], P < 0.001). Male household head exposure was only associated with increased feeding to a sick child (OR: 2.21, 95% CI [1.27, 3.84], P = 0.005). Among households with an exposed mother, having an exposed male household head nearly tripled the odds of appropriate sick child feeding (OR: 2.90, 95% CI [1.57, 5.34], P = 0.001) but was not significantly associated with the other two outcomes. These findings suggest that the relationships between exposure to nutrition programmes and outcomes are complex and further research is needed to understand variation by family member, behavioural outcome and context.
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Affiliation(s)
- Kenda Cunningham
- Helen Keller InternationalNew YorkNew YorkUSA
- Department of Population Health, Faculty of Epidemiology, London School of Hygiene and Tropical MedicineLondonEngland
| | - Devin Nagle
- Heilbrunn Department of Population and Family Health, Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Poonam Gupta
- Department of International Health, Johns Hopkins Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
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Schott W, Richardson B, Baker E, D'Agostino A, Namaste S, Vosti SA. Comparing costs and cost-efficiency of platforms for micronutrient powder (MNP) delivery to children in rural Uganda. Ann N Y Acad Sci 2021; 1502:28-39. [PMID: 34169531 PMCID: PMC8596512 DOI: 10.1111/nyas.14621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/07/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
Micronutrient powder (MNP) can reduce iron deficiency in young children, which has been well established in efficacy trials. However, the cost of different delivery platforms has not been determined. We calculated the cost and cost-efficiency of distributed MNP through community-based mechanisms and in health facilities in a primarily rural district in Uganda. An endline survey (n = 1072) identified reach and adherence. During the 9-month pilot, 37,458 (community platform) and 12,390 (facility platform) packets of MNP were distributed. Each packet consisted of 30 MNP sachets. In 2016, total costs were $277,082 (community platform, $0.24/sachet) and $221,568 (facility platform, $0.59/sachet). The cost per child reached was lower in the community platform ($53.24) than the facility platform ($65.97). The cost per child adhering to a protocol was $58.08 (community platform) and $72.69 (facility platform). The estimated cost of scaling up the community platform pilot to the district level over 3 years to cover approximately 17,890 children was $1.23 million (scale-up integrated into a partner agency program) to $1.62 million (government scale-up scenario). Unlike previous estimates, these included opportunity costs. Community-based MNP delivery costs were greater, yet more cost-efficient per child reached and adhering to protocol than facility-based delivery. However, total costs for untargeted MNP delivery under program settings are potentially prohibitive.
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Affiliation(s)
- Whitney Schott
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania.,A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Belinda Richardson
- International Agricultural Development, Department of Plant Sciences, University of California, Davis, Davis, California
| | - Emily Baker
- International Agricultural Development, Department of Plant Sciences, University of California, Davis, Davis, California
| | - Alexis D'Agostino
- County of Santa Clara Public Health Department, San Jose, California
| | | | - Stephen A Vosti
- Department of Agricultural and Resource Economics, University of California-Davis, Davis, California
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Gatica-Domínguez G, Neves PAR, Barros AJD, Victora CG. Complementary Feeding Practices in 80 Low- and Middle-Income Countries: Prevalence of and Socioeconomic Inequalities in Dietary Diversity, Meal Frequency, and Dietary Adequacy. J Nutr 2021; 151:1956-1964. [PMID: 33847352 PMCID: PMC8245881 DOI: 10.1093/jn/nxab088] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [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: 12/23/2020] [Revised: 02/02/2021] [Accepted: 03/09/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Adequate complementary feeding practices in early childhood contribute to better food preferences and health outcomes throughout the life course. OBJECTIVES The aim of this study was to describe patterns and socioeconomic inequalities in complementary feeding practices among children aged 6-23 mo in 80 low- and middle-income countries. METHODS We analyzed national surveys carried out since 2010. Complementary feeding indicators for children aged 6-23 mo included minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). Between- and within-country inequalities were documented using relative (wealth deciles), gross domestic product (GDP) per capita, and absolute (estimated household income) socioeconomic indicators. Statistical analyses included calculation of the slope index of inequality, Pearson correlation and linear regression, and scatter diagrams. RESULTS Only 21.3%, 56.2%, and 10.1% of the 80 countries showed prevalence levels >50% for MDD, MMF, and MAD, respectively. Western & Central Africa showed the lowest prevalence for all indicators, whereas the highest for MDD and MAD was Latin America & Caribbean, and for MMF it was East Asia & the Pacific. Log GDP per capita was positively associated with MDD (R2 = 48.5%), MMF (28.2%), and MAD (41.4%). Pro-rich within-country inequalities were observed in most countries for the 3 indicators; pro-poor inequalities were observed in 2 countries for MMF, and in none for the other 2 indicators. Breast milk was the only type of food with a pro-poor distribution, whereas animal-source foods (dairy products, flesh foods, and eggs) showed the most pronounced pro-rich inequality. Dietary diversity improved sharply when absolute annual household incomes exceeded ∼US$20,000. All 3 dietary indicators improved by age and no consistent differences were observed between boys and girls. CONCLUSIONS Monitoring complementary feeding indicators across the world and implementing policies and programs to reduce wealth-related inequalities are essential to achieve optimal child nutrition.
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Affiliation(s)
| | - Paulo A R Neves
- International Center for Equity in Health, Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Aluísio J D Barros
- International Center for Equity in Health, Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Cesar G Victora
- International Center for Equity in Health, Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
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46
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Dhami MV, Ogbo FA, Akombi-Inyang BJ, Torome R, Agho KE. Understanding the Enablers and Barriers to Appropriate Infants and Young Child Feeding Practices in India: A Systematic Review. Nutrients 2021; 13:825. [PMID: 33801545 PMCID: PMC7998710 DOI: 10.3390/nu13030825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/30/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022] Open
Abstract
Despite efforts to promote infant and young child feeding (IYCF) practices, there is no collective review of evidence on IYCF enablers and barriers in India. This review was conducted using 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Six computerized bibliographic databases, Scopus, PubMed, PsycINFO, CINAHL, Embase, and Ovid MEDLINE, were searched for published studies on factors associated with IYCF practices in India from 1 January 1993, to 30 April 2020. IYCF practices examined were early initiation of breastfeeding, exclusive breastfeeding, continued breastfeeding at one year, introduction to solid semi-solid or soft foods, minimum dietary diversity, minimum meal frequency, minimum acceptable diet, continued breastfeeding at two years, predominant breastfeeding, and bottle feeding. In total, 6968 articles were retrieved, and 46 studies met the inclusion criteria. The common enablers of IYCF were higher maternal socioeconomic status (SES) and more frequent antenatal care visits (ANC) (≥3). Common barriers to IYCF practices were low SES and less frequent ANC. The review showed that the factors associated with IYCF practices in India are largely modifiable and multi-factorial. Improving IYCF practices would require the adoption of both facilities- and community-based policy interventions at the subnational and national levels in India.
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Affiliation(s)
- Mansi Vijaybhai Dhami
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW 2571, Australia; (F.A.O.); (K.E.A.)
| | - Felix Akpojene Ogbo
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW 2571, Australia; (F.A.O.); (K.E.A.)
- Barmera Medical Clinic (Lake Bonney Private Medical Clinic), Barmera, SA 5345, Australia;
| | - Blessing Jaka Akombi-Inyang
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia;
- School of Social Sciences, Western Sydney University, Penrith, NSW 2571, Australia
| | - Raphael Torome
- Barmera Medical Clinic (Lake Bonney Private Medical Clinic), Barmera, SA 5345, Australia;
| | - Kingsley Emwinyore Agho
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW 2571, Australia; (F.A.O.); (K.E.A.)
- School of Health Sciences, Western Sydney University, Penrith, NSW 2571, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban 4041, South Africa
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Ching C, Zambrano P, Nguyen TT, Tharaney M, Zafimanjaka MG, Mathisen R. Old Tricks, New Opportunities: How Companies Violate the International Code of Marketing of Breast-Milk Substitutes and Undermine Maternal and Child Health during the COVID-19 Pandemic. Int J Environ Res Public Health 2021; 18:2381. [PMID: 33804481 PMCID: PMC7967752 DOI: 10.3390/ijerph18052381] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [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: 01/05/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022]
Abstract
Breastfeeding is critical to maternal and child health and survival, and the benefits persist until later in life. Inappropriate marketing of breastmilk substitutes (BMS), feeding bottles, and teats threatens the enabling environment of breastfeeding, and exacerbates child mortality, morbidity, and malnutrition, especially in the context of COVID-19. These tactics also violate the International Code of Marketing of Breast-Milk Substitutes. This study identified marketing tactics of BMS companies since the start of the COVID-19 pandemic by reviewing promotional materials and activities from 9 companies in 14 countries, and the official Code reporting data from the Philippines. Eight qualitative themes emerged that indicate companies are capitalizing on fear related to COVID-19 by using health claims and misinformation about breastfeeding. Other promotional tactics such as donations and services were used to harness the public sentiment of hope and solidarity. Past studies show that these tactics are not new, but the pandemic has provided a new entry point, helped along by the unprecedented boom in digital marketing. There was a sharp increase of reported violations in the Philippines since the pandemic: 291 during the first months of the outbreak compared with 70 in all of 2019, corroborating the thematic findings. A lack of public awareness about the harm of donations and inadequate Code implementation and enforcement have exacerbated these problems. Proposed immediate action includes using monitoring findings to inform World Health Assembly (WHA) actions, targeted enforcement, and addressing misinformation about breastfeeding in the context of COVID-19. Longer-term action includes holding social media platforms accountable, raising public awareness on the Code, and mobilizing community monitoring.
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Affiliation(s)
- Constance Ching
- Alive & Thrive Southeast Asia/FHI 360, Washington, DC 20009, USA
| | - Paul Zambrano
- Alive & Thrive Southeast Asia/FHI 360, Manila 1101, Philippines;
| | - Tuan T. Nguyen
- Alive & Thrive Southeast Asia/FHI 360, Hanoi 10000, Vietnam; (T.T.N.); (R.M.)
| | | | | | - Roger Mathisen
- Alive & Thrive Southeast Asia/FHI 360, Hanoi 10000, Vietnam; (T.T.N.); (R.M.)
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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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Satapathy DM, Karmee N, Sahoo SK, Patro SK, Pandit D. Effect of feeding practices on nutritional status of infant and young children residing in urban slums of berhampur: A decision tree approach. Indian J Public Health 2021; 65:147-151. [PMID: 34135183 DOI: 10.4103/ijph.ijph_1272_20] [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: 11/04/2022] Open
Abstract
Background Appropriate infant and young child feeding (IYCF) practices in the early years of life will ensure optimal growth and development of the child. However, many children are not fed in the recommended way. Objectives To assess the risk of malnutrition as a result of various feeding practice patterns among the children with the application of the decision tree algorithm. Methods It was a community-based cross-sectional study conducted in the urban slums of Berhampur Municipal Corporation in Ganjam District, Odisha, India, from January to December 2019. Among a sample of 360 children of 6-23 months, nutritional status and feeding practices were determined. Data were analyzed using R version 3.6.1 developed by R Foundation for Statistical Computing, Vienna, Austria. The effect of IYCF practices on nutritional status was explained with the decision tree method with the use of a Chi-squared automatic interaction detection algorithm. Results The prevalence of children with early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), minimum meal frequency (MMF), and minimum dietary diversity (MDD) was 62.2%, 59.7%, 41.9%, and 19.4%, respectively. The prevalence of wasting, stunting, and underweight among the participants was 36.4%, 31.1%, and 35.3%, respectively. The significant factors which classified and predicted wasting were EBF, EIBF, and MDD, for stunting factors were EBF, MMF, and MDD and for underweight, significant factors were EBF, EIBF, and MDD. Conclusion With the decision tree approach, the probability of malnutrition in relation to various feeding practices patterns can be easily explained to the mothers and health workers as compared to interpreting odds ratio and strict adherence to IYCF guidelines can also be ensured.
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Affiliation(s)
- Durga Madhab Satapathy
- Professor and HOD, Department of Community Medicine, MKCG Medical College, Berhampur, Odisha, India
| | - Nivedita Karmee
- Associate Professor, Department of Community Medicine, MKCG Medical College, Berhampur, Odisha, India
| | - Sanjaya Kumar Sahoo
- Assistant Professor, Department of Community Medicine, MKCG Medical College, Berhampur, Odisha, India
| | - Sithun Kumar Patro
- Senior Resident, Department of Community Medicine, MKCG Medical College, Berhampur, Odisha, India
| | - Debasish Pandit
- Senior Resident, Department of Community Medicine, MKCG Medical College, Berhampur, Odisha, India
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50
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Stark CM, Garner CD, Garg A, Bégin F. Building Capacity of Health Professionals in Low- and Middle-Income Countries Through Online Continuing Professional Development in Nutrition. J Contin Educ Health Prof 2021; 41:63-69. [PMID: 33560042 PMCID: PMC7919702 DOI: 10.1097/ceh.0000000000000334] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
ABSTRACT Continuing professional development (CPD) in low- and middle-income countries (LMICs) can build capacity of health professionals in infant and young child feeding (IYCF). However, travel to in-person workshops can be time-consuming and expensive. Thus, we developed a free online course to provide training in IYCF to health professionals globally; the course received overwhelmingly high numbers of registrations. Our aim was to conduct a program evaluation to assess course satisfaction, learning, and application using surveys administered postcourse and 9 months later. Response rates were 99% (n = 835) and 55% (n = 312), respectively. Among those who only partially completed the course, reasons for noncompletion were assessed (response rate 29%, n = 72). Data within a 1-year period were analyzed. Respondents worked in multiple settings and organizations worldwide. Nearly all (99%) reported postcourse that they learned "a lot" or "some" from all topics, and over 70% applied "a lot" of or "some" information 9 months later. In open-ended questions, respondents reported improved knowledge, skills, and competence to conduct their work; they also desired more similar training courses. Many who did not complete the course reported "not enough time" as the main reason (74%), and most (94%) wanted to continue it. The positive response to the course suggests there is an unmet need for CPD for health professionals in LMICs. Our evaluation found that online training was feasible, acceptable, and increased professionals' knowledge and application of IYCF concepts in nutrition programming. Increased use of online CPD offers the potential for global capacity-building in other health-related topics.
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Affiliation(s)
- Christina M. Stark
- Ms. Stark: Senior Extension Associate, Division of Nutritional Sciences, Cornell University, Ithaca, NY; Dr. Garner: Clinical Assistant Professor, Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX; Dr. Garg: Nutrition Specialist, United Nations Children's Fund (UNICEF) Headquarters, New York, NY; and Dr. Bégin: Senior Advisor, Nutrition, United Nations Children's Fund (UNICEF) Headquarters, New York, NY
| | - Christine D. Garner
- Ms. Stark: Senior Extension Associate, Division of Nutritional Sciences, Cornell University, Ithaca, NY; Dr. Garner: Clinical Assistant Professor, Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX; Dr. Garg: Nutrition Specialist, United Nations Children's Fund (UNICEF) Headquarters, New York, NY; and Dr. Bégin: Senior Advisor, Nutrition, United Nations Children's Fund (UNICEF) Headquarters, New York, NY
| | - Aashima Garg
- Ms. Stark: Senior Extension Associate, Division of Nutritional Sciences, Cornell University, Ithaca, NY; Dr. Garner: Clinical Assistant Professor, Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX; Dr. Garg: Nutrition Specialist, United Nations Children's Fund (UNICEF) Headquarters, New York, NY; and Dr. Bégin: Senior Advisor, Nutrition, United Nations Children's Fund (UNICEF) Headquarters, New York, NY
| | - France Bégin
- Ms. Stark: Senior Extension Associate, Division of Nutritional Sciences, Cornell University, Ithaca, NY; Dr. Garner: Clinical Assistant Professor, Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX; Dr. Garg: Nutrition Specialist, United Nations Children's Fund (UNICEF) Headquarters, New York, NY; and Dr. Bégin: Senior Advisor, Nutrition, United Nations Children's Fund (UNICEF) Headquarters, New York, NY
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