Maternal and Child Nutrition最新文献

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.

There is growing attention to the influence of commercial milk formula (CMF) marketing on health professionals and their professional associations, with ongoing controversies about the conflicts of interest created by the CMF industry and how health professionals and their associations can avoid them. Australian guidelines state that health workers should implement the International Code of Marketing of Breast-milk Substitutes (the Code), and a recent regulatory review considered whether health professional association (HPA) ethical codes and standards require compliance with the Code. However, evidence was lacking. This study aimed to assess the extent to which Australian HPAs' codes and standards require compliance with the Code. Sampled were national associations of regulated health professionals likely to provide health care to mothers and infants. Online searches of websites of these Australian HPAs were conducted in 2021 and repeated in 2024, to identify documents on professional ethics on the Code and breastfeeding. To assess the documents, we developed a simple scoring system and tool using the eight critical elements of the Code and World Health Organisation guidance for health workers. Searches identified 19 within-scope associations. Most (15/19) had no provisions relating to the Code or Guidance in their ethics or standards documents in 2024. Only one comprehensively covered the Code components and just five scored above 50 per cent. Professional association codes of ethics and standards in Australia do not prevent health professionals being influenced by CMF company marketing or ensure breastfeeding is protected, promoted and supported in line with health worker responsibilities under Australian guidelines and the Code. Future research could apply this scoring system in other country settings, and for other HPAs.

Poor dietary quality, particularly inadequate fruit and vegetable (F&V) intake, remains a significant public health challenge globally. This article synthesizes findings from scoping reviews examining diet and F&V intake, and interventions to increase F&V consumption among population groups in five countries: Benin, Fiji, the Philippines, Sri Lanka and Tanzania. Our analysis confirms previous findings of inadequate F&V intake across all five countries, with most adults consuming well below the WHO recommendations of 400 g per day. Across the five countries, the identified scientific evidence is limited due to heterogeneous dietary assessment methods, limited coverage of population groups in national surveys and smaller studies, and limited data from rigorous evaluations of interventions aiming to increase F&V intake. Although all five countries have developed food-based dietary guidelines promoting F&V intake, research on their implementation and effectiveness remains limited. To build evidence for effective programmes and policies to improve both quantity and diversity of F&V intake, we identify three priority areas for future research: standardizing dietary assessment methods for use in surveys and evaluations, understanding context-specific drivers and determinants of F&V intake and strengthening intervention research in low-resource settings.

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.