Maternal and Child Nutrition最新文献

Despite improvements in children's nutritional status and a commitment to early childhood development (ECD) policy developments in Ethiopia, the risk of poor ECD outcomes remains alarming. This study aimed to identify enablers and barriers to the implementation of ECD assessment and provision of nutrition-focused interventions in community settings. A qualitative case study was employed in Hawassa city and Dore Bafano district of Sidama region from November 2023 to February 2024. Fifteen key informant interviews (KIIs) and five focus group discussions (FGDs) were conducted with purposively selected key informants from the healthcare system and mothers of children under two years old, respectively. Pre-tested interview and discussion guides were used for data collection and a narrative thematic analysis was applied at different levels of the socio-ecological model (SEM). The existing ECD policy and strategy landscape, healthcare system, communication and trust built between the health Extension workers (HEWs) and the community, existence of different mothers groups and the HEWs positive attitudes were identified as enablers; however, gaps in ECD practical knowledge and community awareness, low commitment of HEWs and political leaders at multiple levels, as well as absence of training, facilities and standardized indicators of ECD were identified as barriers for the implementation of ECD assessment and provision of nutrition-interventions in the community settings. ECD assessments and nutrition-focused interventions can be integrated into the existing health extension program, with HEWs playing key roles. This requires raising awareness of ECD policies across all healthcare levels and providing targeted training for HEWs on ECD assessment and its targeted interventions. Building the capacity of all persons associated with health posts, and incorporating ECD indicators into HEWs' services and their supervision checklists will enhance the effectiveness and sustainability of ECD integration in the community, leading to improved child health and development outcomes. Additional research is required to develop a tailored, user-friendly and time-saving ECD assessment tool for use in the community by the HEWs to assess, classify and identify children at risk of developmental delay.

In 2025, the 'Prevalence of minimum dietary diversity' among infants and young children (IYC) aged 6-23 months and females aged 15-49 years was adopted as an additional Sustainable Development Goal 2: Zero Hunger indicator. Previous studies, mainly in high-income countries, have reported that children's diets bear weak to moderate resemblance of their mothers' diets. Therefore, this study assessed i) the rank correlation between Minimum Dietary Diversity for Women (MDD-W) and MDD-IYC prevalence at country-level and ii) the associations and concordance of nutritious and unhealthy food group consumption among mother-child dyads using nationally representative survey data from 11 low- and middle-income countries. MDD-W was significantly higher than MDD-IYC in each survey, but the indicators nonetheless rank correlated very strongly across countries. Discordance favoured mothers for pulses, nuts and seeds; flesh foods; vitamin A-rich fruits and vegetables (F&V); other F&V; and fried and salty foods, while the opposite was observed for dairy products, eggs, and sweet drinks. Higher maternal dietary diversity was strongly associated with higher diversity in nutritious food group consumption among children in each country. Lastly, mothers consuming five or more out of 10 nutritious food groups-in other words, achieving MDD-W-best discriminated whether children achieved MDD-IYC or not. In conclusion, MDD-IYC and MDD-W data provide complementary insights for targeted and context-specific food and nutrition policies and programmes, such as behavioural change and nutrition education interventions and food environment regulations, needed to improve dietary diversity and moderation of unhealthy food groups among both IYC and females of childbearing age.

Many countries rely on national household surveys to monitor coverage of nutrition interventions. Following a multi-year consultative effort, 14 new and revised nutrition coverage indicators were included in the Round 8 Demographic and Health Survey (DHS-8) core questionnaire. These indicators were better aligned with international recommendations and generate actionable data for policy and programmatic decision making at national, subnational, and global levels. This analysis highlights their potential applications. We included six sub-Saharan African countries who collected and released DHS-8 datasets between January 2021 and June 2024 (Burkina Faso, Côte d'Ivoire, Ghana, Kenya, Mozambique, and Tanzania). We present weighted averages for all nutrition coverage indicators from pregnancy through young childhood by country and estimate inequities in coverage. Coverage of nutrition interventions provided during pregnancy, birth, and postnatal care was higher than during infancy and young childhood, with wide variation between and within countries. For the new indicators on prenatal counseling about breastfeeding and maternal diet, Ghana had the highest coverage (88% and 92%, respectively) and Mozambique the lowest (48% and 51%). Postnatal counseling about infant and young child feeding practices was universally lower, ranging from 12% in Mozambique to 50% in Ghana. Subnational region, wealth quartile, and maternal education were consistent drivers of inequity. The greatest differences in coverage were by subnational region, as high as 71 percentage points for coverage of height and weight measurement of young children in Kenya. The expanded DHS-8 nutrition indicators fill critical information gaps about coverage and inequalities in care.

Commercial milk formula (CMF) marketing adversely influences breastfeeding practices globally. Thailand enacted the Control of Marketing Promotion of Infant and Young Child Food Act ('Thai Code') in 2017 to restrict the marketing of CMF for infants aged 0-12 months. This qualitative study aimed to explore mothers' experiences and perspectives of CMF marketing and its regulation by the Thai Code through semistructured interviews with 15 mothers across Thailand between July 2023 and March 2024. Our findings revealed that while traditional advertising and healthcare-setting promotions decreased, CMF marketing strategies evolved toward social media platforms, particularly TikTok and Facebook, and through building relationships with mothers for CMF products for young children. Participants reported varying perceptions toward CMF marketing, with those of lower socioeconomic status appearing to be more susceptible to marketing claims, for example, CMF boosts cognitive development and is equivalent to breast milk. While participants reported receiving strong breastfeeding support from healthcare facilities, subtle CMF promotional practices persisted in private settings through free sample distribution and invitations to join company-sponsored digital platforms. Despite general awareness that some form of CMF marketing regulation exists, participants had limited knowledge of the Thai Code's specific provisions. Therefore, enhanced monitoring of digital marketing and private healthcare settings, alongside improved public communication about the Thai Code, could strengthen its implementation, particularly in lower income settings in which mothers may be more vulnerable to marketing claims.

This study characterizes the sample size and precision for infant and young child feeding (IYCF) indicators evaluated in surveys conducted in refugee settings, characterized by sample sizes enabling timely information to inform humanitarian response. We analyzed surveys provided by the United Nations High Commissioner for Refugees conducted from 2013 to 2019. For eight IYCF indicators recommended in the current global guidance, we assessed achieved sample sizes and precision by evaluating the half-width of 95% confidence intervals (HWCIs) by survey design. Among cluster surveys, we characterized the intraclass correlation coefficients (ICCs) and design effects. Final analysis included 203 surveys from refugee settings in 15 countries. Ever breastfed and bottle feeding indicators were the most precise (median HWCI: 3.1% and 3.6%) due to inclusion of all children 0-23 months resulting in relatively large sample sizes and estimates of prevalence close to 100% and 0%, respectively. Exclusive breastfeeding under 6 months and the introduction of solid foods (6-8 months) had the lowest precision (median HWCI estimates: 12.6% and 18.2%). In cluster surveys, early initiation of breastfeeding and flesh food consumption stood out with markedly higher design effects (median estimates: 2.63 and 2.17) driven by relatively larger sample sizes and high ICCs (median estimates: 0.31 and 0.27); all other indicators had median design effects < 1.3. Evidence on expected variation in precision and heterogeneity by indicator can help design surveys with samples that allow for the rapid collection of data sufficient to inform emergency responses. High caution is needed when interpreting estimates of exclusive breastfeeding and introduction of solid foods in past surveys given lower precision.

The World Health Organization recommend that babies are breastfed up to 2 years old and beyond. Breastfeeding beyond infancy continues to provide physical and mental health benefits for mothers and supports nutrition, immunity and development for children. However, there is a dearth of research exploring the experiences of women who breastfeed beyond 2 years, particularly in countries such as the United Kingdom, where only a small percentage of mothers breastfeed past 1 year. This qualitative study explored the experiences of 12 women in the United Kingdom who breastfed or were breastfeeding a child over 2 years old. Semi-structured interviews were conducted and analysed using thematic analysis, identifying the benefits and challenges of their experiences. Breastfeeding was central to women's parenting style and nurturing of their child, and its impact extended far beyond nutrition. Breastfeeding helped with bonding and soothing and was viewed as central to a gentle parenting philosophy. However, women reported facing barriers such as stigma, especially around breastfeeding an older child in public, disapproval from family and friends, and poor information from healthcare professionals. Despite these challenges, mothers reported a desire to set an example to others and to normalise breastfeeding an older child. When trying to stop breastfeeding, there was a conflict between mothers wanting to be led by their child and a desire to regain their bodily autonomy. These findings reiterate the importance of supporting women to breastfeed for as long as they want to and ensuring that breastfeeding support encompasses infants and children of all ages.

In Brazil, the Kangaroo Care Method (KCM) is a public policy that proposes systematic and humanized care for preterm low birth weight infants (LBWI), and one of its pillars is breastfeeding promotion. Therefore, this study aims to compare complementary feeding of LBWI in terms of age of introduction and the type of food offered according to the type of care received-KCM or Conventional Care (CC). A prospective cohort study was conducted from September 2019 to August 2021 at a Brazilian university hospital. A total of 65 LBWI born at the institution weighing 1800 g or less were included. Data were collected during the first week of hospitalization and at 4 and 6 months of corrected age. The median age at food introduction was estimated by survival analysis using the Kaplan-Meier method. The log-rank test was used to compare the median age at the time of food introduction according to the type of care. Longer exclusive breastfeeding (KCM = 30 days; CC = 0.001, p = 0.002) and continued breastfeeding were observed in KCM preterm infants (KCM = 172 days; CC = 0.001, p = 0.002). The median age at introduction of infant formula (KCM = 38 days; CC = 35 days), water (KCM = 65 days; CC = 46 days), salted porridge (KCM = 139 days; CC = 136 days) and fruits (KCM = 134 days; CC = 136 days) was similar between both types of care received. No ultra-processed foods were consumed. In conclusion, despite encouraging exclusive and continuous breastfeeding, there was no significant difference in the time of introduction of foods according to the type of care received.

Reliable anthropometric data are essential for tracking child malnutrition, yet such data are prone to measurement errors, particularly in large-scale surveys conducted in resource-limited settings. This study assesses the quality of anthropometric data in the Bangladesh Demographic and Health Surveys (BDHS) from 2014, 2018, and 2022, focusing on how different data filtering approaches affect malnutrition estimates. We analyzed data from children aged 6–59 months using the BDHS children's recode files. Data quality was assessed using WHO-defined thresholds for biologically implausible values and SMART plausibility criteria, which exclude values beyond ±3.1 standard deviations from the sample mean. Additional checks included z-score distribution properties, digit preference scores (DPS), and demographic consistency measures. Prevalence of stunting, underweight, and wasting was calculated before and after data filtering, with subgroup analyses by age, household wealth, and family size. SMART flagging excluded about 12% of records per round—substantially more than WHO thresholds. Stunting and underweight estimates remained broadly stable over time, while wasting prevalence dropped by 1.5–2.5 percentage points post-flagging, reflecting sensitivity of prevalence to filtering thresholds. Children aged 6–23 months were more frequently flagged. A steady decline in digit preference scores suggested improved measurement consistency, though variability persisted by socioeconomic group. Overall, BDHS anthropometric data showed stable internal patterns across survey rounds rather than conclusive reliability. These findings are presented as scenario analyses comparing WHO and SMART filters, illustrating how methodological choices influence malnutrition estimates. Strengthening field protocols—particularly for weight-for-height among younger children—could further enhance data precision and comparability.

Few studies have explored associations between indexes incorporating both breastfeeding and complementary feeding and future risk of overweight/obesity. The aim of this study was to explore associations between a previously developed Infant Diet Score (IDS; higher score reflecting better alignment with breastfeeding and complementary feeding guidelines in the first year of life), and the risk of overweight and/or obesity in childhood. Nutrition and anthropometric data for all children born in Iceland in January 2009 to June 2015 were gathered from national health records. Logistic regression models were used to test associations between IDS and BMI-for-age z-scores (WHO standards). Among children for which the IDS could be calculated, anthropometric data was available for 6,335 children at 2.5 years (thereof 7% with overweight/obesity), 2,486 at 4 years (4% with overweight/obesity), 8,946 at 6 years (19% with overweight and 8% obesity) and 5,626 at 9 years (23% with overweight and 15% obesity). Compared to children in the highest IDS quintile, those in quintiles 1 and 2 had higher odds of obesity at 6 years (aOR: 1.42; 95% CI: 1.05–1.93 and aOR: 1.58; 95% CI: 1.18–2.14) and 9 years (aOR: 1.37; 95% CI: 1.02–1.85 and aOR: 1.46; 95% CI: 1.10–1.94). The same applied for IDS quintile 3 in partly, but not fully adjusted models. Associations were inconsistent at 2.5 years and not observed at 4 years. In this national cohort, lower alignment with infant nutrition guidelines was associated with higher risk of obesity at school age.

Relapse to acute malnutrition after recovery from severe acute malnutrition (SAM) is common. However, most programmatic resources are devoted to the acute phase of recovery, and fewer interventions are available for children recently discharged from outpatient nutritional programs. We evaluated the feasibility of training caregivers to screen for relapse using mid-upper arm circumference (MUAC) tapes for reducing time to detection of relapse among children recently recovered from SAM in Burkina Faso. Caregiver-child dyads were enrolled and randomized in a 1:1 fashion to either caregiver MUAC screening or local standard of care (SOC), which consists of monthly clinic-based follow-up visits for 3 months following discharge. In the MUAC screening group, caregivers were trained on how to use a standard MUAC tape and asked to screen their child weekly with a provided MUAC tape for the 6-month duration of the study. The primary outcome was time to relapse detection, defined as MUAC < 12.5 cm and/or weight-for-height Z-score < −2. Secondary outcomes included hospitalization and/or death over the 6-month study period. Of 200 caregiver-child dyads enrolled in the trial, 99 were randomized to the MUAC screening group and 101 to the SOC group. By 6 months after enrollment, the hazard of relapse detection was lower in the MUAC screening group compared to the SOC group (hazard ratio, HR, 0.65, 95% confidence interval, CI, 0.38–1.12). Fewer hospitalizations and/or deaths occurred in the MUAC screening group compared to the SOC group (MUAC: 3%; SOC: 14%, risk ratio 0.23, 95% CI, 0.07–0.79). Training caregivers to screen for relapse after recovery from SAM was feasible and may lead to modestly reduced time to detection of relapse, suggesting a full-scale trial is warranted.

Trial Registration: This study was prospectively registered on clinicaltrials.gov (NCT05932992, registered June 27, 2023).