Maternal and Child Nutrition最新文献

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.

Poor diet quality may contribute to the multiple forms of malnutrition among children in Ghana. This cross-sectional study (1) described the prevalence and frequency of consumption of fruits, vegetables, sugar-sweetened beverages (SSB), salty snacks and sweet snacks among children 2–5 years in northern Ghana; (2) identified factors associated with consumption; and (3) examined relationships between consumption and nutritional status. Households were recruited from urban and rural clusters in Tolon and Kumbungu districts. Children's (2–5 years; n = 243) dietary data were collected using a questionnaire modelled after the WHO STEPS tool. We assessed children's height, weight, haemoglobin and micronutrient biomarker (n = 125) concentrations. We used multi-variable logistic and linear regression to identify individual, maternal and household factors predicting consumption of the food groups and relationships between consumption and nutritional status. In a typical week, most children consumed vegetables (98%), sweet snacks (81%) and fruits (76%); 50% consumed salty snacks and 46% consumed SSB. Average number of servings consumed weekly, mean (SD), was: 7.9 (7.3) vegetables, 2.9 (2.5) sweet snacks, 2.6 (3.9) SSB, 1.8 (1.7) fruits and 1.2 (1.7) salty snacks. Children in households with higher food insecurity were more likely to report consumption of all food groups (> 0 servings fruits, SSB, salty snacks and sweet snacks; ≥ 7 servings vegetables weekly), but other characteristics did not consistently predict consumption. Few associations were found between consumption and nutritional status. Interventions to increase fruit and vegetable intake to align with guidelines, while avoiding SSB and snack foods, are needed.

The Ghana School Feeding Programme (GFSP) operates a decentralised procurement model, in which school caterers are responsible for: selecting, purchasing, transporting, preparing, delivering and distributing school meals. However, caterers' views and experiences are rarely taken into account. This study aimed to better understand GSFP caterers' lived professional experience to identify context-specific challenges and solutions around their food procurement and provisioning practices. A photovoice study was conducted in March-April 2024 in three regional districts of Greater Accra: Ashaiman, La Nkwantanang and Ningo-Prampram. Schools (n = 60) were randomly selected and school caterers (n = 34) were invited to attend training on the photovoice method and cocreate research questions. The training was attended by 27 caterers and individual follow-up interviews were conducted with 19 or the original participants. Data analysis included emergent themes and a priori codes, based on a school food system framework. A photo exhibition was held to advocate for change among GSFP stakeholders. Key themes discussed included: infrastructure support, food preparation, caterer wellbeing and wholesale and trading. Challenges such as low allocation of funds per student and delayed payments were referenced by all caterers and cut across most food system steps, shifting or interrupting caterers' ability to provide meals. Caterers recommended solutions included: timely payments, increased funding, bulk food purchasing, access to electricity and water and on-site school kitchens to improve GSFP delivery. The GSFP's procurement models merits careful review as current overhead costs placed on small-scale food system actors are unsustainable and jeopardise programme objectives. Acknowledging caterers' daily challenges and addressing concerns can promote caterer wellbeing alongside meal quality for programme beneficiaries.

Severe acute malnutrition (SAM) affects 12.2 million children globally. Integrating a water, sanitation and hygiene (WASH) kit in outpatient SAM treatment can improve recovery rates by preventing WASH-related diseases and complications, but its cost at scale remains unknown. This study estimates the cost of integrating a WASH kit, composed of chlorine-based water treatment, safe water storage with a lid, soap, and a hygiene promotion component into Senegal's national protocol for treating uncomplicated SAM. This costing study was nested within the TISA randomised controlled trial, which evaluated the addition of a WASH component to standard SAM treatment for children aged 6–59 months. Cost data were collected from 660 participants enroled between December 2020 and December 2021. We took a societal perspective and used a micro-costing approach to estimate direct medical, non-medical and indirect costs. The WASH component led to a 2021 international $105.32 additional cost per child treated, with the WASH kit, transportation and management representing $33.03. Sensitisation to hygiene and water treatment cost $13.46 at health posts and $29.63 for two at-home visits. No additional out-of-pocket expenses were incurred by households, but $1.58 in opportunity costs (income loss) was observed. Human resources were the main cost driver for the WASH component, exceeding the human resources for standard SAM treatment. The total societal cost per child treated was $338.77, ranging from $238.09 to $517.29 in sensitivity analysis, with the SAM treatment representing 69% ($233.40) of this total cost. The main expense for this component was Ready-to-Use-Therapeutic Food (RUTF) ($154.39). The absence of additional costs for households induced by the WASH component is encouraging, as it suggests that it would not represent an obstacle to integration into the national protocol. We produced a robust and comprehensive cost estimate for integrating a WASH kit and hygiene promotion into Senegal's SAM treatment protocol. This increased the treatment cost by 45% which was lower than estimates from a previous study. Results inform budget planning and support future cost-effectiveness analyses of integrating WASH interventions into SAM protocols.

Food provision in early years settings (EYS) presents an opportunity to support healthy eating amongst young children. This study aimed to record and nutritionally analyse setting lunches provided for, consumed and wasted by 3- to 4-year-old children attending EYS in Sheffield, England, including a comparison to packed lunches. Lunch choices were recorded for participating children, along with weights of foods served and any leftovers. A total of 142 setting lunches were recorded, eaten by 46 children attending four of eight recruited EYS. Lunches included vegetables (83.8%) more often than fruit (59.2%), and on average provided sufficient energy, carbohydrate, fibre, protein, vitamins A and C, calcium, iodine and zinc, but insufficient iron. Free sugars and saturated fat, but not sodium, were higher than recommended. Children left 22% of food served on their plate, and consumption of energy, carbohydrate, fibre, vitamin A, iron, iodine and zinc was lower than recommended. Food and nutrient contents were also compared to 185 packed lunches eaten by 67 children from eight settings. Setting lunches contained less food (median 288 g) than packed lunches (median 321 g, p < 0.001) and were more likely to meet guidelines for free sugars (p < 0.001), saturated fat (p < 0.001), vitamin A (p = 0.034), vitamin C (p < 0.001) and sodium (p < 0.001) but less frequently provided sufficient fibre (p = 0.025), calcium (p < 0.001), iron (p < 0.001) and zinc (p < 0.001). Setting lunches were more nutritionally balanced than packed lunches. However, to maximise EYS potential contribution to children's diets, settings must have access to support to both provide sufficiently nutrient-dense meals and encourage children to eat them.

Psycho-social stimulation interventions, recommended in the WHO guidelines for severe acute malnutrition (SAM), have been demonstrated to improve neurodevelopment and growth. However, interventions which have proven effective in clinical trials are resource-intensive and may be challenging in many contexts. This study aimed to explore facilitators, barriers and the existing provision of psycho-social stimulation interventions. We undertook a survey targeting practitioners across the globe who are involved in SAM care and/or programme management. We then undertook 12 semi-structured key informant interviews with practitioners from diverse professional contexts. We transcribed and coded interviews using a deductive approach based on the Consolidated Framework for Implementation Science Research (CFIR). We gained 42 responses from 18 countries for our survey with 29 respondents including psycho-social stimulation interventions in their SAM programmes. Our 12 key informant interviews described several barriers (financial, physical, and human resource limitations, prioritisation of life-saving care, and staff beliefs) as well as some potential facilitators (inclusion in guidelines, enjoyment for staff and parents, and emerging evidence of benefits in terms of short and long-term outcomes). This multi-country mixed methods study revealed that there are very heterogeneous patterns around the implementation of psycho-social interventions in children with SAM. Our study has demonstrated the perceived challenges by professionals involved in SAM care of the feasibility of implementing interventions from research trials. Pragmatic studies are needed which also include an assessment of implementation to enhance an understanding of what might drive uptake. Limitations of our study include a potential respondent bias and small sample size.