Maternal and Child Nutrition最新文献

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.

This study aimed to assess the coverage of essential nutrition interventions delivered through the health system and explored the relationship between co-coverage and child- and maternal-level factors, household-level factors, and access to healthcare facilities. We used data from the Ethiopia Food and Nutrition Strategy Baseline Survey, a population-based cross-sectional study conducted between July 2021 and October 2022. The survey was conducted in 10 regions and 2 city administrations of Ethiopia. A total of 7931 women of reproductive age (15-49 years) and children aged 0-59 months (mother-child pairs) were included. We assessed coverage for 16 essential nutrition and health interventions. Our findings show that the coverage of essential nutrition interventions is suboptimal. Notably, interventions delivered during pregnancy and in early infancy had the highest coverage compared to those provided in late childhood. We identified missed opportunities to deliver of nutrition interventions in the corresponding health platforms. Despite 41% of women reporting having four or more antenatal care visits during their last pregnancy, only 17% took 90 or more iron/folic acid tablets. We also found pro-rich and pro-urban inequalities in access for almost all interventions. Among children eligible to receive all 16 interventions (12-59 months), 8% had zero exposure to interventions. Child age, household wealth, maternal education, place of residence, and walking time to the nearest health facility were significantly associated with co-coverage. The observed low coverage, coupled with existing inequities and identified opportunity gaps in intervention delivery, emphasizes the need to better leverage the health system to reduce undernutrition.

This cross-sectional study was conducted in the Somali Regional State in Ethiopia. The purpose of the study was to compare haemoglobin (Hb) concentrations from venous and finger-pricked capillary blood using the HemoCue 301 as well as estimating anaemia prevalence. Participants were non-pregnant women of reproductive age (WRA), 18-49 years old (n = 884). Blood was collected by trained laboratory technologists using standard protocols. Venous blood was transferred from the EDTA-coated vacutainer to a HemoCue microcuvette. An automatic safety lancet was used to obtain capillary blood, and a microcuvette was filled with the third drop. Both venous and capillary blood were analysed immediately in the field using the same HemoCue analyser. The mean (±SD) Hb concentration was 11.6 ± 2.2 g/dL for venous blood and 11.4 ± 2.3 g/dL for capillary blood. The mean Hb difference was 0.2 ± 0.8 g/dL (p < 0.0001). After adjustment for altitude, anaemia prevalence was estimated. Both blood collection methods confirmed anaemia prevalence as a severe public health problem; the prevalence was 66.6% from venous and 70.7% from capillary blood. Using venous Hb as the standard, the sensitivity of capillary Hb was 94.9%, and its specificity was 77.5% in identifying anaemia. The differences in anaemia estimates using venous and capillary blood have the potential to impact both public health strategies and programme evaluations.

Saccharomyces cerevisiae yeast-based supplements (SCYS) are frequently used as galactagogues with limited evidence of their efficacy. This study investigates the effect of SCYS on human milk oligosaccharide (HMO) concentration and indicators of milk supply. Sixty-eight breastfeeding women with a healthy singleton infant aged 1-7 months were randomly assigned to consume a SCYS product (5 g/day) or placebo for 4 weeks. The primary outcome was the change in the total HMO concentration. The secondary outcomes included participants' perceptions of milk supply, intervention effectiveness, postnatal distress, infant feeding patterns, infant anthropometry, and adverse effects. Intention-to-treat analysis was performed. Multivariable linear regression analysis showed no significant effect of SCYS on individual or total HMO concentrations. However, 65% of women in the SCYS group, compared to 35% in the placebo group, perceived an increase in milk production (p < 0.05). No significant differences were found for other secondary outcomes. However, mothers in the SCYS group had a small but significant improvement in perception of their milk quantity and quality (p < 0.05). SCYS use was also associated with significantly lower formula use at 6 months postpartum (4% vs. 27%, p < 0.05). While SCYS does not impact HMO concentration, it may improve women's perceptions of milk supply. A larger randomised controlled trial is needed to assess its potential effects on actual milk production and composition and address issues of perceived insufficient milk. Trial Registration: This trial was registered at the Australian New Zealand Clinical Trials Registry (trial registration number: ACTRN12619000704190).

Despite economic growth and poverty reduction, child undernutrition is still widespread in Bangladesh. This study aimed to evaluate both the burden and correlates of undernutrition among children under five in Bangladesh using the Composite Index of Anthropometric Failure (CIAF). Data were obtained from the 2019 Multiple Indicator Cluster Survey (MICS), comprising a weighted sample of 21,885 children collected through a nationally representative cross-sectional survey between January and June 2019. The study applied a two-stage stratified cluster sampling technique. To determine the factors influencing CIAF, a generalized linear mixed model (GLMM) was employed, accounting for clustering effects. The adjusted odds ratio (AOR) was derived, accompanied by its corresponding 95% CI, and a significance threshold of p < 0.05 was used to identify significant predictors of CIAF. The study revealed an overall CIAF prevalence of 37.2% (95% CI: 36.6%-37.9%). The prevalence of combined stunting and underweight was 11.9%, wasting and underweight 4.2%, and concurrent stunting, wasting and underweight 3.3%. Children aged 24-59 months, multiple births, birth size smaller than average, children of mothers with below primary education (AOR: 2.02; 95% CI: 1.59-2.57), received no ANC visits (AOR: 1.23; 95% CI: 1.04-1.46), children delivered at home, and children from lower socio-economic families had significantly higher odds of undernutrition compared with other counterparts (AOR: 1.70; 95% CI: 1.37-2.11). In Bangladesh, more than one-third of under-five children suffer from undernutrition, hindering the potential of millions. Urgent policy action is needed to address undernutrition, particularly among socio-economically disadvantaged children and those in the Sylhet division. Strengthening nutritional programs, maternal education, financial stability and healthcare access is crucial. The study recommends adopting CIAF as a national indicator to measure child undernutrition and guide comprehensive strategies to achieve the Sustainable Development Goals.

Commercially processed complementary foods (CPCFs) are consumed in Kenya, but little is known about caregiver perceptions and reasons for their consumption. We explored caregiver perceptions, motivations and reasons for purchasing CPCFs. This cross-sectional mixed-methods study was conducted in Nairobi among caregivers of children aged 6-23 months. A four-stage sampling strategy was used to select study sites non-slum (Westlands) and slum (Mathare) areas, retail outlets and study participants. Eighty-one caregivers (40 in Mathare, 41 in Westlands) were recruited for the quantitative survey, from this sample 16 participants were recruited for qualitative in-depth interviews. Questions about the place of purchase, types of foods purchased, reasons for purchase, sources of information on infant and young child feeding and CPCFs, and perceptions on health and nutrition claims were asked. Nearly all caregivers (96.3%) reported giving their children CPCFs. Close to half of caregivers offered CPCFs as a snack (46.9%) while 21% offered them as a main meal. CPCFs were perceived to be healthy (73.1%), nutritious (71.8%) and easy to prepare (70.7%) and child preference (55.6%), price (54.3%), taste (51.9%), nutritional quality (55.6%) and food safety (62.9%) were considered important factors when purchasing them. Nutrition and health claims on product packaging were documented, and these appeared to influence caregiver perceptions about CPCFs. Participants perceived CPCFs as good and healthy for children and rich in nutrients essential for growth and development. This is in line with nutrition claims on these products. CPCFs are highly regarded by caregivers and are consumed in slum and non-slum settings in Nairobi. Given that misleading health and nutrition claims are used to market them, CPCFs may negatively impact child health if their marketing and consumption are not regulated.

This study aims to examine intra-household gender dynamics in response to a nutrition intervention (maternal Behaviour Change Communication (BCC), paternal BCC, and food vouchers) aimed at improving IYCF practices using qualitative methods. Participants were drawn from a subset of households enrolled in a larger cluster - randomized controlled trial (RCT) conducted in rural Ethiopia. A total of 40 participants (20 mother-father pairs) from intervention and control households were interviewed separately to explore intra-dyadic beliefs and household decision-making. Furthermore, this study explores plausible mechanisms behind the main RCT finding that greater father involvement, while increasing knowledge, did not consistently improve infant and young child feeding (IYCF) outcomes. We find that BCC mothers had the tendency to adopt more gender-equal beliefs, particularly regarding men's roles in childcare and household chores, whereas fathers were slower to shift their views. This may have led to increased discordance in gender norms within BCC households. By contrast, control couples often retained traditional views, but showed more intra-couple alignment. Unexpectedly, control fathers were sometimes more progressive than control mothers, potentially due to higher education levels. We also find increased paternal engagement occasionally introduced conflicting priorities, as fathers asserted authority over household spending - sometimes at the expense of child-focused nutrition. These findings underscore the complexity of engaging fathers in nutrition interventions and point to the need for strategies that address underlying gender norms and decision-making dynamics within households.

Undernutrition increases the risk of morbidity and mortality, making it essential to identify and address its key determinants. This systematic review and meta-analysis examines the impact of selected child-related, household and hygiene, and sanitation factors on the nutritional status of infants and young children aged 0-59 months in Sub-Saharan Africa. We conducted a comprehensive search of online databases using defined Medical Subject Headings and keyword search terms. Nutritional status was assessed using the WHO child growth Standards Z-scores for stunting, underweight and wasting. A meta-analysis was performed to estimate pooled associations, and heterogeneity was assessed using the Cochrane Q and I² statistic. Sensitivity analyses were conducted, and publication bias was evaluated. Out of 1, 992 articles identified, 49 studies met the inclusion criteria. Our findings indicated that diarrhoea was associated with 77% increased risk of overall undernutrition (odds ratio (OR) = 1.77; confidence interval [Cl] = 1.52, 2.06), and 92% increased risk of wasting (OR = 1.92; 95% Cl = 1.48, 2.48). Low birthweight was linked to a two-fold increased risk of stunting (OR = 2.35; 95% Cl = 1.84, 3.00), while low maternal education was associated with a higher risk of underweight (OR = 1.55; 95% Cl = 1.17, 2.04). These findings highlight the need for targeted interventions to reduce childhood undernutrition in the region.