Maternal and Child Nutrition最新文献

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.

Human milk provides essential nutrition for infants, particularly vulnerable preterm and low-birth-weight neonates. This qualitative study explored Iranian mothers' perspectives on human milk bank (HMB) services through semi-structured interviews with 16 participants (9 donors, 7 recipients) across four HMBs. Using inductive content analysis, we identified five key themes: (1) Expanding opportunities for HMB utilization requires integrating milk donation education into prenatal programs and addressing awareness gaps; (2) Familiarizing parents with HMB services through healthcare providers and social media is crucial for engagement; (3) Infrastructure limitations including equipment shortages and insufficient HMB locations hinder service delivery; (4) Donated human milk (DHM) represents both hope for recipients and fulfillment for donors; and (5) Religious beliefs about milk kinship and family support significantly influence participation. Findings reveal that while Iran has developed the Middle East's most extensive HMB network, cultural and religious considerations around milk kinship require sensitive approaches. Donors reported altruistic motivations and emotional rewards, whereas recipients described DHM as critical for infant survival. Key barriers included limited public awareness, equipment deficiencies, and concerns about milk safety. The study highlights the need for culturally adapted education campaigns, standardized equipment, and policy support to expand services. These results provide valuable insights for improving HMB implementation in Muslim-majority contexts while addressing unique regional challenges in neonatal nutrition. The research underscores DHM's potential to reduce infant mortality when combined with appropriate infrastructure and community engagement strategies.

The COVID-19 pandemic caused a crisis that jeopardized food consumption and dietary diversity. This study aimed to: (1) investigate relationship between COVID-19 and women's and children's diets in India; (2) examine how this varies by socioeconomic status and mothers' vegetarianism; and (3) assess whether mobility restrictions during India's national lockdown influenced these dietary changes. The analysis drew on data from India's National Family Health Survey 2015-16 and 2019-21, focusing on 11 states surveyed before and during COVID-19 (N = 567,727 women, 141,905 children). COVID-19 exposure was defined as interviews after 24 March 2020 (national lockdown). Outcomes included child feeding practices and women's food consumption and dietary diversity. The impact of COVID-19 on diets was estimated using a difference-in-difference model; effect of mobility reduction on diets was examined using linear regression. All analyses were adjusted for confounders, interview month, state fixed effects, and sampling weights. Results showed that COVID-19 exposure was linked to significant declines in child feeding practices (-6.9 percentage points [pp] for minimum dietary diversity, -5.0 pp for minimum acceptable diet, and -6.1 pp for fruit consumption) and women's diet (-5.7 pp for dietary diversity and green vegetable consumption). While magnitude of impact varied across socioeconomic sub-strata and mothers' vegetarianism status, the differences were not statistically significant. The diets of women and children were greatly impacted by mobility reduction. COVID-19 has worsened the diets of women and children in India. More research is needed on the impact of relief measures to strengthen food safety nets nationwide.

Growth monitoring and promotion (GMP) programmes have been implemented for decades in almost all countries. Despite this long history of implementation, GMP has been criticised for being ineffective, calling for a rethink of the programme. With a view of contributing evidence towards the redesign of GMP, we conducted a qualitative evaluation of the programme in various contexts of Ethiopia. We conducted focus-group discussions (FGDs; n = 28) and key informant interviews (KIIs; n = 193) with programme managers, service providers and caregivers beneficiaries. Supply-side, service delivery, and barriers hindering effective coverage were identified. Lack of functional weighing scales, budget constraints, limited transportation facilities, overlap of interventions, and the low motivation and performance of health workers were identified as main barriers affecting the quality-of-service delivery. The benefits of participating in GMP were not always clear to beneficiaries. Competing priorities like household chores, long travel distances to health centres, and in some contexts culturally insensitive practices deterred participation. Although GMP can serve as an entry point for mainstreaming nutrition into universal health coverage (UHC), the programme would need to be redesigned and supported by adequate supply, resources (financial and human), planning, and quality service delivery that is contextual and culturally sensitive.

Home fortification products (HFPs), including multiple micronutrient powders and small-quantity lipid-based nutrient supplements, are specialized, nutrient-filled products added to foods with the aim of filling critical nutrient gaps. Despite their potential, there is limited documentation of the use of HFPs in humanitarian settings. The aim of this scoping review was to explore the evidence base and feasibility of implementing HFP programming in humanitarian settings specifically among young children 6-59 months of age and pregnant and lactating women. Electronic databases (PubMed, Embase, and CINAHL) were searched in December 2024, yielding 70 articles after duplicates were eliminated. Two research assistants independently selected articles that met inclusion criteria and analyzed them thematically. A total of eight studies (six quantitative, one qualitative, and one mixed methods) were included. The limited studies examined indicate that the use of HFPs is more feasible when carried out in the context of ongoing humanitarian programming, including general food distribution, growth monitoring, and behaviour change communication. Adherence and acceptability monitoring, along with sensitization and education efforts, also contributed to successful HFP programming. Hindering the use of HFPs were logistical issues, including delays in obtaining the products, sharing of HFPs across household members, and a lack of trust in both implementers and HFPs. HFPs appeared to have mixed results regarding improving health outcomes, such as growth, anaemia, and morbidities, though effects were difficult to isolate. Overall, this review demonstrates that HFPs are feasible to implement and potentially beneficial; however, more studies, including implementation research and effectiveness trials, are needed to better determine whether and how HFP programming should be implemented in humanitarian settings.

UK breastfeeding rates are low, with health inequalities in initiation and continuation. Breastfeeding peer support interventions are recommended in UK and global policy. The Assets-based feeding help Before and After birth (ABA-feed) trial tested the effectiveness of proactive, woman-centred support for infant feeding delivered by trained peer supporters (infant feeding helpers; IFHs) in addition to usual care at 17 UK sites. Using data from an embedded process evaluation, this paper reports the views and experiences of women receiving, and the IFHs and coordinators delivering, ABA-feed. Women (n = 2475) were recruited to the trial antenatally; 1458 were allocated to the intervention. Thirty women from five study sites took part in qualitative interviews between 9 and 23 weeks postnatal. IFHs (n = 72) and coordinators (n = 25) from across all sites participated in individual or group interviews towards the end of the intervention period. Interview transcripts were analysed alongside 1147 free-text responses from an 8-week postnatal follow-up survey using Framework Analysis. The ABA-feed intervention was highly acceptable to women, including younger women, those with less education, from diverse ethnic groups, single mothers, and those who intended to formula feed, as well as to IFHs and coordinators. Both remote and in-person support was acceptable. While women valued proactive daily contact during the first 14 days postpartum, some IFHs found this challenging, and some struggled with supporting women who chose formula feeding or were less engaged. This study highlights the value of flexible, proactive, woman-centred infant feeding support. TRIAL REGISTRATION: ISRCTN17395671.