Maternal and Child Nutrition最新文献

Systematic crises may disrupt well-designed nutrition interventions. Continuing services requires understanding the intervention paths that have been disrupted and adapting as crises permit. Alive & Thrive developed an intervention to integrate nutrition services into urban antenatal care services in Dhaka, which started at the onset of COVID-19 and encountered extraordinary disruption of services. We investigated the disruptions and adaptations that occurred to continue the delivery of services for women and children and elucidated how the intervention team made those adaptations. We examined the intervention components planned and those implemented annotating the disruptions and adaptations. Subsequently, we detailed the intervention paths (capacity building, supportive supervision, demand generation, counselling services, and reporting, data management and performance review). We sorted out processes at the system, organizational, service delivery and individual levels on how the intervention team made the adaptations. Disruptions included decreased client load and demand for services, attrition of providers and intervention staff, key intervention activities becoming unfeasible and clients and providers facing challenges affecting utilization and provision of services. Adaptations included incorporating new guidance for the continuity of services, managing workforce turnover and incorporating remote modalities for all intervention components. The intervention adapted to continue by incorporating hybrid modalities including both original activities that were feasible and adapted activities. Amidst health system crises, the adapted intervention was successfully delivered. This knowledge of how to identify disruptions and adapt interventions during major crises is critical as Bangladesh and other countries face new threats (conflict, climate, economic downturns, inequities and epidemics).

Infant and young child feeding practices (IYCF) are crucial for children's growth and development but often deteriorate during periods of instability. A cross-sectional survey conducted in three oblasts of Ukraine—Kyiv City and Kyiv, Lviv, and Odesa—enroled 724 children 0–23 months of age from 699 households. Using global WHO IYCF Guidelines, 12 indicators of optimal IYCF practices were evaluated. The study found IYCF practices to be relatively stable since 2015, despite the continued escalation of conflict, with an improvement in exclusive breastfeeding (EBF). EBF was reported by 51% of mothers, while breastfeeding was initiated early in 65% of children. Complementary feeding practices were optimal for most children, with 79% having a minimum acceptable diet. Infant formula assistance was independently associated with suboptimal breastfeeding practices in multi-variable models. Children from households that received formula assistance had 67% (adjusted odds ratio [aOR] 0.33, 95% confidence interval [CI] 0.14–0.73) lower odds of being exclusively breastfed, 65% (aOR 0.35, 95% CI 0.20–0.61) lower odds of continued breastfeeding at 12 months, and 3.3 times (95% CI 2.31–4.78) higher odds of being bottlefed. Baby food assistance did not independently predict a minimum acceptable diet. High levels of optimal complementary feeding sustained since 2015 suggest protective factors for child nutrition in Ukraine, such as domestic agriculture and social safety nets. Additionally, maternal education was consistently linked to better IYCF outcomes, highlighting the need for targeted support for less-educated mothers. The negative association of formula assistance with EBF warrants further research alongside reinforcement of guidelines to prevent inappropriate formula targeting.

This study aimed to define complementary feeding trends in Guinea from 2005 to 2018 and complementary feeding risk factors at the individual, household, and community levels. Data from 2005 to 2018 demographic health surveys (DHS) and Multiple Indicator Cluster Surveys were used to describe complementary feeding trends in Guinea. The most recent DHS was used to examine complementary feeding risk factors at the individual, household, and community levels. Complementary feeding indicators including introduction to complementary foods (INTRO), minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) were calculated based on the 2010 World Health Organisation guidance. Multivariate logistic regressions were used to identify significant risk factors (p < 0.05). Since 2005, there has been a marginal increase in MDD and MAD, but a decrease in INTRO and MMF. The 2018 DHS survey revealed various complementary feeding risk factors. At the individual level, travelling 1–60 min to get water was associated with decreased odds of meeting INTRO, while iron supplementation and maternal education were associated with increased odds of meeting MMF and MDD, respectively. Routine vitamin A supplementation, fever in the past 2 weeks, and low birth weight were associated with increased odds of meeting MAD. At the household level, being in a lower wealth quintile was associated with decreased odds of meeting MDD and MAD. National and subnational programmes and policies designed to improve infant and young child diets may consider tailored approaches that address the specific indicators and risk factors associated with poorer diets in this Guinean context.

The prevalence of common mental disorder (CMD) and anemia is observed to be on the rise over time, adversely affecting the health and overall quality of life among adolescents. Extensive literature corroborates the significant impact of anemia on cognitive development, intelligence and developmental milestones. Nevertheless, the linkage between hemoglobin level and CMD emerging during adolescence remains relatively unexplored. Thus, the objective of this study was to investigate the association between hemoglobin level and CMD as well as the mediating factor among school adolescent girls residing in Central Ethiopia. A cross-sectional study design was conducted among adolescent girls attending schools in Silti Woreda, Central Ethiopia, comprising a total sample size of 516 individuals during the period from October 2–20, 2023. Hemoglobin level was adjusted for altitude, while CMD was evaluated utilising the summation score of a 20-item Self-Reporting Questionnaire. Data were analysed through fitting Structural Equation Model and the maximum likelihood estimation method. Goodness of fit was assessed using the χ2The -test statistic, Comparative Fit Index, Root Mean Square Error of Approximation, Standardised Root Mean Square Residual, Non-Normed Fit Index, Pclose and coefficient of determination (R²). The prevalence of CMD was 22.3% (95% CI: 18.6%–25.8%). Hemoglobin level (UTE = −0.73, CI: −0.93, −0.53) and experience of morbidity symptoms (UTE = 1.05; CI: 0.74, 1.38) were significantly associated with CMD. Furthermore, hemoglobin level is significantly influenced by morbidity frequency symptoms (UDE = −0.63, CI = −0.77, −0.49) and animal source food (ASF) (UDE = 0.09, CI = 0.01, 0.17). Hemoglobin level has been identified as a significant mediator of the experience of morbidity symptoms and ASF on CMD. However, household food insecurity and wealth index had no significant association with CMD. A significant proportion of adolescent girls face CMD, often linked to a lower hemoglobin level. Having a significant association with CMD, the hemoglobin level is found to mediate a significant effect of morbidity symptom experience and ASF on CMD. Hence, addressing early infection prevention, promoting ASF and treating anemia are promptly needed.

This mixed-method study explored the experiences of mothers and fathers combining breastfeeding with returning to paid employment after childbirth. Tasmanian State Service employees participated in an online survey and phone interviews. A total of 130 parents completed the survey, and 42 participated in 60-min phone interviews. The survey had more female respondents (109) than male (21), and only 4 of the 42 interviews were with fathers. The sample consisted mainly of professional women (84%) and men (16%), predominantly Australian-born (88%). Two-thirds of participants worked part-time (62%), taking either unpaid (52%) or paid leave (61%) within the first 12 months after birth. The majority (88%) preferred to breastfeed, with the mean age of the first formula feed being 4.1 months. A narrative analysis of the qualitative data, informed by work–family conflict theory, reveals that transitioning back to paid work while breastfeeding is challenging for both mothers and fathers. Parents face multiple conflicts between paid work, family responsibilities and maintaining breastfeeding. The emotional and physical demands of feeding, expressing, storing and transporting breast milk, combined with often inadequate workplace facilities, policies and gender discrimination, add to parental pressure. Mothers bear the greatest burden, while fathers’ roles and needs are often overlooked in the workplace. The major finding of this study is that breastfeeding is insufficiently recognised as an integral part of the return-to-work process for both parents, generating a form of work–family breastfeeding conflict, where work (part-time or full-time) interferes with family responsibilities and breastfeeding. Family-friendly breastfeeding policies based on equity principles are needed to address workplace gender inequality and discrimination and better support parents in combining work and breastfeeding.

Persistent organic pollutants (POPs) are environmental contaminants that can accumulate in human tissues and pose potential health risks. Despite global efforts to reduce their prevalence, follow-up studies are needed to see if the measures are successful. Since most infants in Norway are breastfed for the first 6 months of life, monitoring POP contamination in breastmilk is important for children's health and development. This study aims to evaluate the current levels of various POPs in women's breastmilk in Innlandet County, Norway. A cross-sectional study was conducted measuring concentrations of 35 different POPs, including polychlorinated biphenyls (PCBs), chlordanes (ChlDs), hexachlorocyclohexanes (HCHs), dichlorodiphenyltrichloroethanes (DDTs), Mirex, and brominated flame retardants in 120 breastmilk samples. The study analysed the impact of maternal age, parity, pre-pregnancy BMI, and infant age on POPs levels and compared the estimated daily intake per body weight of infants to existing health guidelines. The detected percentages for PCBs were 100%, for DDTs 98.3%, and for ChlDs 98.3%. The highest median concentration was found for ΣPCBs (26.9 ng/g lw). Maternal age, parity, and infant age were significant determinants of POP concentrations. Most infants exceeded the health-based guidance values for ΣPCB, and 6.4% percent did so for ΣHCHs. Despite lower POPs concentrations in breastmilk than in earlier studies, many breastfed infants are still exposed to levels exceeding health-based guidance values. Although the study's design had limitations, the study provides updated population-based data on POPs in breastmilk. Continued monitoring and research are necessary to understand and mitigate potential health risks associated with POPs.

Child malnutrition is a major health problem in Sub-Saharan Africa. Complementary foods made from African indigenous and locally available raw materials are often low in protein and nutrients. It is, therefore, important to supply complementary foods that are nutritious and affordable, and with an acceptable consistency and taste. The objective of this study was to develop, on a pilot scale, food-to-food fortified, convenient, canned complementary porridges based on blends of African indigenous crops, i.e., orange fleshed sweet potato (OFSP) flour, and leguminous (i.e., cowpea, and Bambara groundnut) and cereal flours (i.e., teff, finger millet, maize, and amaranth), and milk powder. Plant-based, African complementary foods are often lacking in vitamin A, zinc, iron, and energy. Porridge with OFSP on a 32% dry weight (dw) basis achieved recommended levels of vitamin A (530 µg per 100 g dw). Satisfactory energy (431 Kcal per 100 g dw) was obtained by supplementation of vegetable oil. A nutritious, low-cost porridge (costing 0.15 € per 100 g can) that fulfills consistency constraints was obtained by including supplements of zinc and iron salts as ingredients. The solids content and thus protein/energy could be significantly increased using protein fractionated or germinated cowpea flours without compromising on viscosity. The sensory profile was characterised by more intense vegetable, leguminous, and malty flavours as compared to traditional reference porridges.

Dietary diversity has been widely used as a proxy indicator for micronutrient adequacy. In low- and middle-income countries (LMICs), including Rwanda, women are at high risk of inadequate micronutrient intake resulting from poorly diversified diets. This study was conducted to examine the factors associated with women's dietary diversity, with emphasis on homestead production diversity and market access in the Northern Province of Rwanda. A cross-sectional design was used, involving 606 women aged 18–49 years. Linear regression analyses were performed to examine the association between various factors and women's dietary diversity. Results show that 84% of the sample households raised at least one livestock species. Seventy-one percent of the households had no agricultural land. Eighty percent of those without land had a homestead garden on which they grew food crops, mainly vegetables and fruit trees. The average crop species was 2.3. On average, women consumed 3 out of 9 food groups. The homestead production diversity score was positively associated with women's dietary diversity score (β = 0.16, p < 0.001). Women's dietary diversity score was negatively associated with distance from the household to the nearest market (β = −0.08, p = 0.027) and household food insecurity (β = −0.06, p < 0.001). Maternal education (p < 0.001), household wealth index (p < 0.05), and ownership of more than 2.5 acres compared to being without land (p < 0.05) were associated with women's dietary diversity score. The dietary diversity of women could be enhanced through interventions that promote the diversity of livestock and crop species produced through homestead production. Potential interventions to explore may include integrated farming systems that combine small livestock and crop production utilising improved livestock breeds and high-quality seeds and planting materials of high-yielding varieties of fruits and vegetables, along with rainwater harvesting to facilitate small-scale irrigation. The impact of such interventions on women's dietary diversity can be further reinforced by parallel programmes aimed at improving women's education and the socioeconomic status of households.

Breastfeeding is a critical public health strategy for optimal child development and maternal health across the life course. The 2021 Global Burden of Diseases, Injuries and Risk Factors Study reveals that, despite reductions in mortality and disability-adjusted life years (DALYs) attributed to suboptimal breastfeeding practices—namely, non-exclusive breastfeeding during the first 6 months or early discontinuation within the first 2 years—low- and middle-income countries (LMICs) continue to bear a staggering 50-fold higher burden compared to high-income nations. This inequity signals a pressing global health priority. Hence, we propose to address these challenges by first, expanding the Baby-Friendly Hospital Initiative (BFHI) reach through community-driven efforts such as the Baby-Friendly Community Initiative (BFCI) to enhance breastfeeding support in both clinical and community settings; second, embedding breastfeeding counselling within national health and social protection programmes to fill in gaps in culturally competent care, drawing on large scale breastfeeding peer counselling programme experiences like the one being implemented by the US Supplemental Nutrition Program for Women, Infants and Children (WIC); third, improving maternity leave policies and workplace accommodations for breastfeeding women and fourth, stringent regulation of exploitative commercial milk formula (CMF) marketing to combat misinformation and reduce health inequities. Governments must implement strong, evidence-driven policies—such as strict monitoring and regulation of product labelling and digital media marketing—to establish safeguards against the powerful influence of the CMF industry. Collectively, these strategies will enhance breastfeeding outcomes, reduce health disparities and drive progress across countries towards meeting the UN Sustainable Development Goals.

Acute malnutrition in children under 5 years is persistent in Eastern Africa's arid and semiarid lands. This study aimed to identify the drivers of acute malnutrition in Turkana and Samburu counties, Kenya. This was a population-based longitudinal mixed-methods observational study. Qualitative and quantitative data were collected at Wave 1, but only quantitative data were collected during follow-up. Participants were a representative sample of children and their primary caregivers from households with children under 3 years at Wave 1. Anthropometric measurements of all children under 5 years in the sampled households were taken at Wave 1 (May to July 2021), and one child under 3 years was randomly selected for follow-up about every 4 months over 2 years for six data collection waves. The study also collected data on sociodemographics; child feeding practices and morbidity; household water and food insecurity; shocks; coping strategies, social safety nets and economic safeguards; water, sanitation and hygiene; women's decision-making and food consumption. Qualitative data were collected through community dialogues, focus group discussions, in-depth interviews, photovoice and key informant interviews with mothers and fathers with children under 5 years, community leaders, county officials and staff of nongovernmental organisations. Data collection is complete and analysis is ongoing. The analysis includes thematic analysis of qualitative data and descriptive and multi-variable regression analyses of quantitative data.