Maternal and Child Nutrition最新文献

The World Health Organization's 2023 recommendations for managing moderate wasting provide criteria for prioritizing children to receive specially formulated foods (SFF) rather than counseling alone. However, the practical programmatic impact of such prioritization is unclear. This secondary analysis aimed to describe the caseload and treatment outcomes among moderately wasted 6- to 59-month-old Malian children, categorized into higher-priority (HP) and lower-priority (LP) groups. All children admitted with a MUAC ≥ 115 to < 125 mm without nutritional edema received SFF (500 kcal/day) until they achieved a MUAC ≥ 125 mm for 2 consecutive visits. HP criteria were < 2 years old, WAZ < −3 SD, or MUAC 115–119 mm; LP criteria were ≥ 2 years, WAZ ≥ −3 SD, or MUAC ≥ 120 mm. We reported the caseload per priority criterion and compared treatment outcomes, including recovery and anthropometric changes, between LP and HP children. Of the 35 685 children included in the analysis, 95% met at least one priority criterion. The proportion of children recovered was similar between LP and HP children, regardless of the criterion used. MUAC-for-age z-score and WAZ weekly changes showed similar trajectories. Furthermore, although classified as LP, children > 2 years exhibited lower WAZ throughout treatment compared to children < 2 years. Most moderately wasted children (MUAC < 125 mm) met at least one priority criterion, raising concerns about the feasibility and rationale of the prioritization approach. The similar recovery rates in higher- and lower-priority groups after both received SFF highlight the need for research to assess the impact of different interventions.

Children's early years food environment can influence dietary habits. We evaluated Yes to Veg! a 4-week nursery-based programme on pre-school children's vegetable exposure, consumption and agency. A quasi-experimental study in 11 nurseries (6 intervention/5 controls) located in socio-economically deprived areas of Glasgow, Scotland. Yes to Veg! delivered locally grown fresh vegetables once-per-week for children's daily nursery activities. Control nurseries received standard healthy eating recommendations. Parental pre- and post-questionnaires measured child vegetable exposure (vegetables tried from a 27-item list), consumption frequency (1 = once-per-week to 5 = everyday) and variety consumed (0 = none/1 = 1-4/2 = 5-9/3 = 10+ kinds). Qualitative comments reported by parents, nursery staff and from researcher observations were extracted for qualitative themes. From 257 parent-child dyads recruited, 57 (n = 34 intervention/n = 23 control, child mean age 51 months) completed both questionnaires. Vegetables tried [Mean(SD)] did not change between intervention [total score pre 16.7(4.5) vs 16.8(5.6) post, difference 0.19(0.6), p = 0.765] and control group [total score pre 16.4(5.3) vs 16.0(5.6) post, difference −0.39(0.57), p = 0.503]. Median pre- and post-consumption frequency in both groups was 4 (most days); the variety of vegetables consumed was higher in intervention (5-9 items) vs control (1-4 items) and these measurements didn't change between pre- and post. Vegetable agency increased in the intervention; parents said children talked more about vegetables at home (91% vs 65% control) and were willing to try vegetables at home (41% vs 34% control); emerging qualitative themes included children's engagement with vegetables, sensory interaction and programme acceptance. Yes to Veg! facilitated exposure, engagement and familiarisation to vegetables, was well implemented and received, but did not change consumption.

The 2025 call of the World Alliance for Breastfeeding Action (WABA) is to prioritise breastfeeding through creating sustainable support systems. This is based on the strong foundations of breastfeeding and the unique properties of human milk to nourish, protect and provide optimal physical, emotional and cognitive growth for the infant. Empowering women to establish and maintain lactation is critical for the short- and long-term health of mothers and infants; reducing infant and maternal morbidity; reducing healthcare costs; and building healthy societies. Studies have demonstrated this can be done effectively and sustainably using peer educators to provide support, knowledge and self-efficacy to establish and maintain breastfeeding. However, rates of breastfeeding remain far below global targets. Safe and sustainable support options are needed for mothers who struggle with an insufficient milk supply, despite lactation support. These options include wet nursing and safe human milk sharing. When these are not possible/feasible, donor milk from human milk banks should be considered. Creating support systems requires investing in financial and human resources to protect, promote and support breastfeeding through revisiting these sustainable approaches.

Digital technologies are increasingly used to promote and support breastfeeding, particularly where access to skilled lactation counseling is limited. This Perspective argues that such tools should complement, not replace, in-person care and should be integrated into maternal and child health systems in low- and middle-income countries. Drawing on lessons from large-scale digital health initiatives, it highlights the importance of equity, government ownership, and sustainability. The paper also emphasizes the need for pandemic and emergency preparedness in digital strategies to ensure continuity of breastfeeding support when face-to-face services are disrupted. It concludes with key priorities for policymakers and implementers to design, evaluate, and scale digital breastfeeding interventions responsibly and equitably.

Micronutrient deficiencies affect two-thirds of reproductive-age women globally, with pregnant women in low- and middle-income countries at higher risk due to greater nutritional needs and limited diets. Multiple micronutrient supplements (MMS) have shown greater benefits than iron-folic acid (IFA) during pregnancy, but WHO currently limits recommendations to humanitarian or research settings. This study synthesises experiences of implementation research designed to support and document the transition from IFA to MMS for pregnant women in Bangladesh, Burkina Faso, Madagascar and Tanzania, providing insights for scaling up MMS programming globally. This qualitative study used key informant interviews and reviews of key policies, proposals, and project materials. Purposive sampling identified 16 key informants involved in the project design, implementation, or funding at country, regional, or global levels. Semi-structured questionnaires guided discussions on themes including project planning, policy environment, community engagement, logistics, and monitoring. Qualitative descriptive analysis of interview transcripts and documents identified key themes and insights. Findings revealed context-specific successes and challenges in transitioning to MMS, highlighting the unique opportunity to strengthen antenatal care (ANC) systems. Key informants emphasised the importance of context specific situational analysis and tailored interventions, strong policy support, community engagement, robust supply chains, sustainable financing, effective monitoring systems, and collaboration among stakeholders. The experiences from this project contribute to the evidence base on MMS implementation. They demonstrate that the transition from IFA to MMS should be leveraged to enhance services and advocate for a health systems-wide approach, moving beyond isolated interventions, to foster more impactful and integrated improvements within ANC.

Experiencing food insecurity in early childhood is associated with adverse health and nutrition outcomes. About 66% of Brazilian households with children are food insecure; however, interventions targeting early childhood have fallen short in addressing food insecurity due to a lack of funding and multisectoral coordination combined with the COVID-19 pandemic. Therefore, protecting children from food insecurity is a complex task in Brazil and requires innovative approaches. We hypothesize that applying a Nurturing Care Framework (NCF) lens and systems thinking tools can indicate pragmatic pathways to reduce early childhood food insecurity. To examine this hypothesis, we used a participatory group model-building approach to integrate the knowledge of twelve Brazilian experts working in different sectors into a qualitative causal loop diagram (CLD) underlying the dynamics of food insecurity in early childhood. By analyzing the CLD, we aimed (1) to assess whether the Brazilian food insecurity system includes the NCF components and identify how these systems affect young children, and (2) to qualitatively explore feedback loops, pivotal variables (i.e., variables with the most immediate causes and/or immediate causal consequences), and leverage points (i.e., specific variables to intervene to produce a change in the overall system) to reduce food insecurity in early childhood. The integrated CLD outlines a structure with 28 variables assigned across the NCF components. A deeper qualitative analysis of the direct and indirect links identified how food insecurity is experienced by young children. This included a description of two feedback loops reinforcing childhood food insecurity, such as Financial Hardships and Emotional Distress Spiral. Food quality emerged as the pivotal variable with the most proximate causes and/or consequences related to early childhood food insecurity. Positive parenting practices and participation in daycare emerged as direct links to address early childhood food insecurity. Expanding access to nurturing care through national and local policies can enhance the resilience of the systems underlying early childhood food insecurity to disruptions such as the COVID-19 pandemic.

Maternal diet quality and perinatal depression significantly impact maternal and child health, yet their relationship remains underexplored in low-resource settings. This cross-sectional study examined the association between overall diet quality and risk of depression during the third trimester among 296 pregnant women receiving antenatal care at Dhulikhel Hospital, Nepal (August 2023–January 2024). Depression risk was assessed using the Edinburgh Postnatal Depression Scale (EPDS), with scores ≥ 12 indicating elevated symptoms. Diet quality was measured using an adapted Nepali version of the 23-item PrimeScreen questionnaire, generating a Prime Diet Quality Score (PDQS) ranging from 0 to 46. Multivariable logistic regression models were used to estimate the association between PDQS and depression risk, adjusting for age, education, ethnicity, occupation, parity, gestational week, physical activity, and pre-pregnancy BMI. The mean PDQS was 24.7 (SD = 3.1), and 22.3% of participants screened positive for depression. Each 1-point increase in PDQS was associated with 16% lower odds of depression (adjusted OR: 0.84; 95% CI: 0.70–0.90; p = 0.002). These findings suggest that higher overall diet quality is associated with a reduced likelihood of third trimester depression. Further longitudinal studies are warranted to assess causality and inform targeted nutritional interventions. If supported by further studies, incorporating brief dietary assessments like PrimeScreen into antenatal care may potentially offer a feasible strategy to identify women with suboptimal diet quality and co-occurring depressive symptoms in low- and middle-income countries.

Tajikistan faces significant food insecurity and multiple forms of malnutrition in its population, with women particularly at risk. Social norms related to gender and intrahousehold hierarchy are pervasive. Yet, how gender impacts dietary intake in Tajikistan remains to be studied. Understanding this mechanism is critical to develop adequate strategies for effective, equitable progress in mitigating malnutrition and food insecurity. An explanatory sequential mixed-methods study was conducted to assess the extent and identify the drivers of gender-based and intrahousehold differences in dietary diversity in Khatlon Province, Tajikistan. Predictors of dietary diversity were statistically assessed using quantitative survey data from 1704 adults who participated in the 2023 USAID/IFPRI Population-Based Survey. Qualitative data from 12 focus group discussions, 19 individual interviews, and 21 Photovoice interviews were analyzed using reflexive thematic analysis to further ascertain and understand these drivers. Gender was identified as a predictor of dietary diversity in both quantitative and qualitative findings. Women reported lower dietary diversity than men, even within in the same household. Gender norms contribute to unequal food distribution and opportunities to consume food away from the household. Expressing social values such as respect during mealtimes and perceptions of dietary needs prioritize men and children over women in consuming foods deemed more nutritious (e.g., meat). This study highlights the importance of considering household dynamics and gender roles in equitably addressing food and nutrition insecurity and malnutrition. Mitigating malnutrition in Tajikistan will necessitate gender equity-focused social behavior change interventions targeting women and men across different generations.