Maternal and Child Nutrition最新文献

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.

Poor intrauterine growth has long-term implications for child growth and nutritional status. Fetal malnutrition (FM) is a type of poor intrauterine growth defined by the presence of soft tissue wasting at birth and is identified using the Clinical Assessment of Nutritional Status Score (CANSCORE) tool, independent of gestational age. There is limited evidence evaluating FM as a predictor of longitudinal growth and nutritional status in young children. In this longitudinal birth cohort in Leyte, the Philippines, mother–infant dyads were enroled, and infants were followed for 24 months after delivery. Infants were evaluated using CANSCORE within 48 h of birth by a trained midwife, and FM was defined as CANSCORE < 25. Weight and length were measured at birth, 1-, 6-, 12-, 18- and 24-month visits. Weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length (WLZ) z scores were determined using WHO Anthro. Associations between FM and anthropometric z scores were assessed using multivariable linear regression, adjusting for maternal body mass index (BMI), family socioeconomic status (SES) and child's sex. Among N = 246 infants included for analysis, 8 (3%) were classified with FM at birth. Despite limited power, FM was significantly associated with reduced WAZ, LAZ and WLZ at nearly all timepoints in the fully adjusted models. CANSCORE is a user-friendly tool for assessing FM in areas with limited equipment and predicted that newborns with FM were at continued risk for undernutrition and growth stunting until age 24 months. Identification of FM at birth provides opportunities for targeted early nutrition interventions for high-risk infants.

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.

The provision of human milk is a global public health priority underpinned by its extensive benefits to infant and maternal health, and significant positive impacts within economic, societal, and environmental spheres. Informal human milk sharing (IHMS) is a contemporary and increasingly prevalent phenomenon which involves the exchange of human milk outside formal structures such as milk banks. This study aimed to investigate the characteristics, motivations, practices and experiences of donors and recipients who engage in IHMS in Ireland. A national cross-sectional survey included a validated questionnaire and was administered online in Ireland following ethical approval. The study is reported according to STROBE guidelines. Recipients reported significantly higher rates of cesarean sections, birth complications, and traumatic births compared to donors, with postpartum anxiety prevalent in both donors and recipients (51.4%). Recipients primarily sought donor milk due to perceived lactation insufficiency, concerns regarding commercial milk formula, infant related factors and belief in human milk benefits. Donors were motivated by altruism and the desire not to waste their expressed milk. Most donors (84.5%) considered formal milk bank donations but were inhibited by practical barriers, favoring informal sharing via online platforms and direct exchanges. There was minimal discussions with healthcare professionals about IHMS. The increasing significance of IHMS in Ireland is driven by diverse maternal and infant needs, and online communities. Future research should investigate safety outcomes and long-term impacts of IHMS, the lived experiences of donors and recipients, as well as the examination of strategies to enhance engagement with formal milk banks.