Maternal and Child Nutrition最新文献

The effect of community-based multi-input interventions that promote health, nutrition, and development on childhood infections, and the pathways that explain these effects remain unclear. We conducted a secondary analysis of a factorial-designed clustered randomized controlled trial (N = 1489) conducted in rural Pakistan to estimate the effects of responsive stimulation and enhanced nutrition (responsive feeding and multiple micronutrient powders (MNPs)) interventions on diarrhoea, fever, and acute respiratory infection (ARI) among children under 2 years using Poisson regression models. We used a counterfactual framework and weighting-based approach to conduct mediation analyses through diet and care-related factors. The responsive stimulation intervention reduced diarrhoea between 12 and 24 months of age (rate ratio (RR): 0.87; 95% CI: 0.77, 0.97), fever from 6 to 24 months (RR: 0.80; 95% CI: 0.73, 0.88), and ARI from 6 to 24 months (RR: 0.91; 95% CI: 0.83, 0.99). In contrast, enhanced nutrition increased rates of fever from 6 to 24 months (RR: 1.34; 95% CI: 1.22, 1.48). Reductions in maternal depressive symptoms partially mediated the positive effects of responsive stimulation on diarrhoea, fever, and ARI between 6 and 24 months (54.7%, 15.6%, and 49.1% mediated, respectively) and also provided positive indirect effects for the enhanced nutrition intervention on these outcomes. Improvements in meal frequency contributed to reductions in child diarrhoea for both interventions. Responsive stimulation and enhanced nutrition had contrasting effects on childhood infections, but both interventions improved diet and care-related mediators that contributed positive indirect effects. The provision of iron-containing MNPs may explain the overall negative effect of the enhanced nutrition package on fever. Trial Registration: Clinicaltrials.gov identifier: NCT007159636.

Anaemia among mothers and their children is a widespread public health challenge with profound consequences for individuals and societies. While anaemia has been studied separately in women and children, there remains a literature gap examining anaemia in mother-child dyads, limiting insights on interventions that may simultaneously address anaemia in both groups. Our study examines trends and drivers of anaemia among mother-child dyads (mothers aged 15-49 years and their children aged 6-59 months; N = 408,342) in India using nationally-representative data from 2006 to 2021 and estimates the potential future reduction in anaemia among mother-child dyads based on changes in selected drivers. We employed descriptive statistics, multivariable logistic regression and population attributable fraction (PAF) analysis. The co-occurrence of anaemia among mothers-child dyads changed very slightly, from 35% in 2006% to 33% in 2016 and to 37% in 2021. Subnational analyses revealed varying trends by states, with Delhi showing the highest increase (17%-32%) and Sikkim the largest decrease (29%-16%) between 2006 and 2021. Maternal education, regular consumption of nonvegetarian food and green leafy vegetables, consumption of iron folic acid supplements, utilization of government health services, and improved sanitation at both household and community levels were associated with lower likelihood of anaemia among mother-child dyads. The cumulative PAF suggested that addressing these factors collectively could reduce anaemia prevalence among mother-child dyads by 18% to 28% (under different scenarios) by 2030. The study underscores the need for comprehensive, multi-sectoral interventions targeting both maternal and child health to effectively combat anaemia in mother-child dyads.

The relationships between severe malnutrition (SM), rehabilitation weight gain, and cardiometabolic risk in adult survivors have not been fully elucidated. We utilised a previously collected data set to explore these associations in a cohort of adults who were hospitalised for SM as children from 1963 to 1995. We studied 278 adult SM survivors: 60% male; median age (IQR) 26.5(11.3) years; mean BMI 23.6(5.2) kg/m²). Children's minimum weight-for-age z scores after hospitalisation (minWAZ) were analysed against adiposity as adults in sex-disaggregated regression models. Higher minWAZ was associated with greater adult waist circumference (mean difference:1.8 cm, 95%CI 0.7, 2.9, p = 0.001), fat mass (difference:2.4 kg, 95%CI 0.17,1.06, p = 0.007) and android fat mass (difference:0.19 kg, 95%CI 0.09, 0.29, p < 0.001) in bivariate analyses. Approximately 13% of the effect of minWAZ on adult fat mass was mediated by rehabilitation weight gain in g/kg/day (Sobel's p = 0.053). In male and not female adult survivors, rehabilitation weight gain > 12.9 g/kg/day was associated with greater adult fat mass (difference:5 kg, 95%CI 2, 9, p = 0.006) and android fat (difference:0.5 kg, 95%CI 0.1, 0.8, p = 0.006). Female sex was the strongest predictor of adult fat mass (difference:12.7 kg, 95%CI 9.6, 15.7, p < 0.001) and android fat mass (difference:0.9 kg, 95%CI 0.6, 1.2 p < 0.001) and adult age the strongest predictor of adult waist circumference (difference:0.67 cm, 95%CI 0.39, 0.94, p < 0.001). Faster rehabilitation weight gain as an independent, causal risk factor for adiposity in male SM survivors requires further exploration and more modest weight gain targets may contribute to reducing their risk of adult cardiometabolic disease.

Distance from health facilities is an important predictor of treatment seeking and health outcomes. We aimed to describe the relationship between distance from care with admission characteristics and treatment outcomes among children admitted to malnutrition treatment. Data was collected as part of an observational study on the effectiveness of a simplified malnutrition treatment program in the Nara district of Mali. Treatment was provided at 37 health centers and 51 community health sites. Linear and logistics mixed models were fitted to estimate associations between distance from treatment with admission anthropometrics and programmatic outcomes. A total of 49,074 children with mid-upper arm circumference (MUAC) < 125 mm or edema were admitted to treatment between December 2018 and December 2023. Most (60%) lived within the village/town where treatment was provided (0 km) while 7%, 27% and 7% lived 1-5 km, 6-15 km and > 15 km from the treatment site, respectively. Up to 91% recovered attaining twice a MUAC ≥ 125 mm. Distance from treatment was consistently associated with lower anthropometrics at admission with 0.63, 1.38 and 2.18 mm lower MUAC among children living 1-5, 6-15, and > 15 km distance from the treatment site, respectively (p < 0.001), compared to 0 km. This suggests later treatment seeking among those living further from treatment. Living > 15 km from treatment site was associated with 49% increased risk of defaulting, 20% decreased risk of referral to inpatient care and 18% increased risk of missing a visit when compared to 0 km, and when adjusting for admission anthropometry. Poorer admission status and worse treatment outcomes are observed among children living farther from treatment sites, emphasizing the need to further decentralize malnutrition treatment.

Children successfully treated through community-based management of acute malnutrition (CMAM) frequently relapse to acute malnutrition (AM) following recovery and discharge. This prospective cohort study examined associations between relapse and household water, sanitation and hygiene (WASH) conditions, as well as animal ownership, in Mali, South Sudan and Somalia. Between April 2021 and June 2022, 1115 children were enrolled, with 964 children followed for 6 months, 242 in Mali, 488 in South Sudan and 234 in Somalia. Relapse to AM occurred in 32%, 63% and 21% of children in Mali, South Sudan and Somalia, respectively. In Mali, relapse risk was higher in households using multiple drinking water sources (aRR 1.71, 95% CI: 1.21-2.43, p = 0.003) or lacking soap (aRR 1.71, 95% CI: 1.03-2.82, p = 0.037). In South Sudan, inadequate drinking water sources, open defecation and the presence of animal faeces in the compound were associated with an increased risk of relapse (aRR 1.20, 95% CI: 1.04-1.38, p = 0.010; aRR 1.16, 95% CI: 1.03-1.30, p = 0.016; aRR 1.13, 95% CI: 1.02-1.26, p = 0.019, respectively). Sheep ownership in Mali (aRR 0.57, 95% CI: 0.40-0.81, p = 0.002) and cattle ownership in South Sudan (aRR 0.78, 95% CI: 0.71-0.85, p = < 0.001) were protective. No significant WASH or animal-related factors were associated with relapse in Somalia. As nearly all household drinking water samples were contaminated across settings and time points, no association could be detected between measured water quality and relapse. While many WASH indicators were not associated with relapse, some inadequate WASH conditions were identified as risk factors for relapse, although heterogeneous across contexts. These findings may help to identify at-risk children during treatment and inform strategies to reduce relapse post-recovery.

Undernutrition and infections during pregnancy result in low birth weight (LBW) and maternal anaemia. Social behaviour change communication (SBCC) can promote recommended health practices, potentially improving maternal and neonatal outcomes. This cluster-randomized controlled trial assessed the effects of video-based health education on adherence to iron-folic acid (IFA) supplementation, pregnancy outcomes, and anaemia status among pregnant women in rural Dirashe District, South Ethiopia. Pregnant women in their first trimester across 16 villages were cluster-randomized into either the intervention or control arms. The control arm received standard antenatal care counselling, while the intervention arm received biweekly video-based nutrition and health education at home until delivery. The primary outcomes included adherence to IFA supplementation, birth outcomes, including neonatal length and weight, and maternal haemoglobin concentrations (Hb) throughout pregnancy. Among 596 enroled pregnant women, 519 provided data until delivery. The intervention significantly improved adherence to IFA supplementation, with a mean difference (95% Confidence Interval) of 25.98 (15.60, 36.36) in IFA disappearance rate and a mean percent difference of 14.80% (3.42, 63.99) in self-reported adherence. The intervention significantly improved birth weight, with a mean difference of 204.9 g (38.7, 371.2). Maternal Hb near delivery improved statistically with a mean difference of 0.22 g/dL (0.15, 0.42), with lower anaemia (Hb < 11.0 g/dL) prevalence, with a mean percent difference of -0.08% (-0.12, -0.04). However, no significant effect on birth length or LBW was observed. Video-based SBCC improved IFA adherence, birth weight, and reduced anaemia near delivery. It is a promising approach for community health education in resource-limited settings. REGISTRATION: The study was registered as a clinical trial with the US National Institute of Health (www//.ClinicalTrials.gov; NCT04414527).

Neural tube defects (NTDs) are severe birth defects linked to insufficient maternal folate status during early pregnancy. Red blood cell (RBC) folate concentration is the recommended biomarker for predicting NTD risk, with a threshold of 748 nmol/L using the US Centers for Disease Control and Prevention (CDC) microbiological assay. However, in large surveys, serum folate concentration is often measured instead of RBC folate. This study aimed to (1) identify the serum folate concentration that corresponds to the RBC folate threshold for NTD risk using data from Ethiopian women of reproductive age (WRA); (2) evaluate the performance of the serum threshold for population-level NTD risk assessment; and (3) compare the serum folate cutoff determined with the Ethiopian data versus the cutoff derived from a Southern Indian population. Biomarker data from 1570 Ethiopian nonpregnant, non-lactating WRA who participated in the 2015 Ethiopian National Micronutrient Survey were analyzed. Serum and RBC folate concentrations were measured using the CDC microbiological assay. Serum folate cutoffs were identified using unadjusted and adjusted regression models and receiver operating characteristics (ROC) analysis. Adjusted models included the following covariates: age, body mass index (BMI), serum vitamin B₁₂ concentration, presence of inflammation, region, and site of residence. Three serum folate cutoffs were identified: 15.3 nmol/L (unadjusted model), 15.2 nmol/L (adjusted model), and 17.9 nmol/L (ROC analysis). Regression-based cutoffs balanced sensitivity (~76%) and specificity (~62%), while the ROC-derived cutoff improved sensitivity (~83%) but reduced specificity (~50%). Ethiopian cutoffs showed fair discriminatory performance (~AUC:0.7) while the Indian cutoff (~AUC:0.6) showed poorer performance. Because of suboptimal NTD risk prediction using serum folate, future surveys should use RBC folate when possible. In situations where it is not possible to measure RBC folate, population-specific serum folate cutoffs should be determined.

We evaluated the association between the inflammatory potential of the maternal diet during pregnancy and levels of inflammatory biomarkers measured in cord blood and maternal serum at birth. Dietary inflammatory potential was calculated using the energy-adjusted dietary inflammatory index (E-DII) in the French EDEN and ELFE birth cohorts. Biomarkers of inflammation (interleukin [IL]-1β, IL-6, IL-10, tumor necrosis factor α [TNF-α]) were measured from cord blood (EDEN [n = 758]; ELFE [n = 899]) and maternal serum (in ELFE only; [n = 911]) collected at birth. Additionally, leptin was also measured from cord blood in EDEN (n = 1202) and C-reactive protein was measured from cord blood in ELFE (n = 895). Linear regression models, adjusted for confounders, were used to investigate the association between tertiles of the E-DII score and each log-transformed biomarker. There were no significant associations between the E-DII score and maternal or cord blood biomarkers in either cohort. The energy-adjusted dietary inflammatory index score during pregnancy was not associated with concentrations of inflammatory biomarkers in either maternal serum or cord blood at birth.

The assets-based feeding help before and after birth (ABA-feed) intervention aims to improve breastfeeding rates by offering proactive peer support to first-time mothers, regardless of feeding intention. Based on behaviour change theory and an assets-based approach, the intervention involved training existing peer supporters to become infant feeding helpers (IFHs). A train-the-trainer model was used, with coordinators delivering four 2-h training sessions to IFHs. Training covered a study overview, IFH role, role-play scenarios and signposting to local assets. Due to COVID-19, training was delivered online. Post-training questionnaires were completed by 22/30 (73.3%) coordinators and 119/193 (61.7%) IFHs, and qualitative interviews were conducted with 24 coordinators and 72 IFHs. Researchers observed training at five sites, assessing fidelity, engagement and delivery quality. Questionnaire data were analysed descriptively, and qualitative data were analysed using framework analysis. Findings indicated that coordinators valued the train-the-trainer model, particularly information on formula feeding and antenatal discussions. IFHs found training engaging and felt prepared, though some were apprehensive about formula feeding support. While online training was convenient, challenges included monitoring discussions and role-play in breakout rooms. Most participants favoured a hybrid approach, with in-person sessions for interactive activities. Observations showed high training fidelity, participant engagement and confidence in delivering intervention components. The ABA-feed training was acceptable to coordinators and IFHs and was delivered with fidelity. Future training should adopt a hybrid approach, incorporating diverse resources and prioritising in-person interactive components such as role-play. Trial Registration: ISRCTN17395671.