Maternal and Child Nutrition最新文献

Positive mealtime interactions shape infant eating patterns potentially promoting appetite regulation. This study investigated whether caregivers who "tune-in" to their own internal affect and appetite cues, can also recognise and respond to their infant's appetite cues via responsive feeding (RF). Caregivers (N = 445; mean age: 33.5 ± 4.7 years) with children aged 5-28 m participated in an online survey in August 2023. Caregivers' RF practices, mealtime emotions, eating traits, alexithymia (impaired capacity to identify and express emotions) and their infant's eating traits were administered using validated questionnaires. Recent mealtime experiences were described through an open-ended question. Caregivers who relied on interoceptive cues in eating scored high on recognising infant appetite cues (R² = 0.11, F(1, 396) = 5.40, p < 0.001). Whereas caregivers with alexithymia reported poorer ability to recognise infant appetite cues (R² = 0.12, F(7, 399) = 7.53, p < 0.001) and less positive mealtime emotions (R² = 0.12, F(7, 399) = 7.49, p < 0.001) compared to those without alexithymia. Caregivers' capacity to "tune-in" to their own internal satiation cues inversely mediated the relationship between caregivers' alexithymia and their recognition of infant mealtime appetite cues. Infant eating traits (Food Responsiveness and Satiety Responsiveness) were associated with parental use of food to calm. Overall, RF was associated with mealtime emotions, parental ability to "tune-in" to their own affect (alexithymia) and appetite, and child's appetitive traits. Developing caregiver's awareness and responsiveness to their own and their child's affect and appetite cues may promote RF practices.

Due to the nutrition transition, adolescent diets globally appear to be shifting to increased consumption of fast foods and snacks high in sodium, added sugar, and saturated fat. In urban informal settlements in Kenya, limited evidence suggests adolescents consume 1-2 meals per day, have low dietary diversity, and consume foods from roadside stalls. We characterized the diets of adolescent girls in an urban informal settlement in Kenya and assessed the factors associated with diet quality and decision-making. We used a convergent mixed methods design to simultaneously analyze survey, dietary intake, structured interview, and focus group discussion data. Participants were recruited via a community-based participatory-development organization. We assessed diet quality from 24-h recall using the Global Diet Quality Project's Global Dietary Recommendations score-combining dietary risk factors for non-communicable disease (NCD-risk) with dietary factors protective of non-communicable disease (NCD-protect). We tested associations between diet quality, household hunger, sociodemographic variables, and food behaviors. Focus group discussion (FGD) and interview data were transcribed, translated, and analyzed thematically according to the factors that influenced diet. Adolescent girls predominately consumed food from grains, dark leafy greens, sweet tea or coffee, and deep-fried foods (predominately samosas, mandazi [doughnuts], and fries). Adolescent girls with moderate or severe household hunger had higher diet quality scores-driven by a lower consumption of dietary risk factors for non-communicable disease (NCD risk)-compared to girls with little to no household hunger. This relationship was driven by the consumption of red meat, by girls with less household hunger. In qualitative data, finances were the main decision-making factor with skipping meals as a common coping strategy. Adolescent girls were aware of what foods constitute a healthy diet, but their diet quality and decision-making were driven by household hunger, finances, and food safety.

Despite improvements in children's nutritional status and a commitment to early childhood development (ECD) policy developments in Ethiopia, the risk of poor ECD outcomes remains alarming. This study aimed to identify enablers and barriers to the implementation of ECD assessment and provision of nutrition-focused interventions in community settings. A qualitative case study was employed in Hawassa city and Dore Bafano district of Sidama region from November 2023 to February 2024. Fifteen key informant interviews (KIIs) and five focus group discussions (FGDs) were conducted with purposively selected key informants from the healthcare system and mothers of children under two years old, respectively. Pre-tested interview and discussion guides were used for data collection and a narrative thematic analysis was applied at different levels of the socio-ecological model (SEM). The existing ECD policy and strategy landscape, healthcare system, communication and trust built between the health Extension workers (HEWs) and the community, existence of different mothers groups and the HEWs positive attitudes were identified as enablers; however, gaps in ECD practical knowledge and community awareness, low commitment of HEWs and political leaders at multiple levels, as well as absence of training, facilities and standardized indicators of ECD were identified as barriers for the implementation of ECD assessment and provision of nutrition-interventions in the community settings. ECD assessments and nutrition-focused interventions can be integrated into the existing health extension program, with HEWs playing key roles. This requires raising awareness of ECD policies across all healthcare levels and providing targeted training for HEWs on ECD assessment and its targeted interventions. Building the capacity of all persons associated with health posts, and incorporating ECD indicators into HEWs' services and their supervision checklists will enhance the effectiveness and sustainability of ECD integration in the community, leading to improved child health and development outcomes. Additional research is required to develop a tailored, user-friendly and time-saving ECD assessment tool for use in the community by the HEWs to assess, classify and identify children at risk of developmental delay.

Father involvement in child feeding refers to the support fathers provide such as financial, social and physical that influences child feeding habits. While previous research has focused predominantly on mothers, limited attention has been given to fathers' roles in this context. A community-based cross-sectional study employing a concurrent mixed-methods approach was conducted from 1 January to 1 March 2024. A two-stage sampling technique was used to recruit 634 fathers with children aged 6-24 months. Quantitative data were collected using a structured interviewer-administered questionnaire, while qualitative data were obtained through in-depth interviews using a semi-structured guide. Quantitative data were analysed using SPSS version 27, and bivariable and multivariable binary logistic regression analyses were conducted to identify factors associated with father involvement in child feeding. Qualitative data were thematically analysed and triangulated with the quantitative findings. Overall, 54.1% of fathers were involved in child feeding practices (95% CI: 50.04%, 58.2%). Significant predictors of involvement included: fathers with diploma-level education and above (AOR = 3.42, 95% CI: 1.19, 9.83); employment in government or private/nongovernment sectors (AOR = 3.75, 95% CI: 1.10, 12.76; AOR = 3.65, 95% CI: 1.01, 13.19, respectively); spouses with similar employment status (AOR = 3.48 and 2.61, respectively); positive attitudes (AOR = 3.87, 95% CI: 2.23, 6.73); good knowledge (AOR = 2.21, 95% CI: 1.30, 3.75); and positive perceptions of cultural norms (AOR = 2.31, 95% CI: 1.36, 3.94). Qualitative findings reinforced that negative attitudes, unfavourable cultural norms and occupational constraints hinder father involvement. Only about half of fathers were involved in their child's feeding. Key influencing factors included education, employment status, attitudes, knowledge and cultural perceptions. To improve paternal involvement, targeted interventions should be undertaken by stakeholders such as the Ministry of Health, community leaders and family welfare organizations, focusing on behavioural change communication and supportive workplace policies.

During the perinatal period, mothers make decisions on how to feed their infants. Adolescent mothers can have additional challenges in the decision-making process (e.g., lack of autonomy, lack of support from professionals). We conducted a qualitative evidence synthesis to explore adolescent mothers' experiences in making infant feeding decisions, identify their support needs, and understand the role of healthcare professionals in supporting them through this process. Following a systematic search, 51 studies were included. Thematic synthesis was used and identified themes and sub-themes. The four themes are: autonomy and the roles of others; changes in feeding decision making; mothers' self-efficacy in breastfeeding; and experiences of formal support from healthcare professionals. We found that adolescent mothers still have unmet support needs, highlighting the necessity for tailored assistance, including non-judgmental help, follow-up care and easily understandable informational materials to facilitate appropriate infant feeding decision-making.

Adolescent girls and young women in Nepal are vulnerable to poor diets and anaemia, yet the extent of these risks remains overlooked. We assessed changes in dietary diversity, haemoglobin, and anaemia, and identified associated factors among adolescent girls and young women in Nepal. We analysed data from a longitudinal panel study including never-married and not-pregnant participants, enroled at 10-19 years in 2017 (n = 770) and followed up in 2018 (n = 682) and 2019 (n = 618). We used descriptive statistics and mixed-effects regression analyses. The dietary diversity score was on average four out of 10 food groups, haemoglobin remained between 12.7 and 12.8 g/dL throughout the study period, and anaemia prevalence increased from 20.6% (2017) to 24.8% (2019). In adjusted models, we found positive associations between more schooling and dietary diversity and between access to improved toilet and haemoglobin. Living in the terai and hills, and disadvantaged caste/ethnicity were negatively associated with dietary diversity, and haemoglobin, while living in the terai and disadvantaged caste/ethnicity were negatively associated with anaemia. Food insecurity was negatively associated with dietary diversity only. Post-menarche status was associated with lower haemoglobin and higher odds of anaemia. Adolescent nutrition should be prioritised within national health, education, and social protection frameworks. Multi-sectoral interventions particularly in terai and hills, should focus on scaling up micronutrient supplementation, enhancing government-led school meal programme to provide balanced, culturally appropriate meals (including vegetarian protein sources for lacto-vegetarians), improving educational uptake, ensuring access to sanitation facilities, and delivering targeted, sustained interventions around menarche throughout adolescence.

The drivers of malnutrition are complex and multifaceted, requiring multisectoral interventions. The benefits of effective multisectoral approaches to nutrition have been recognised by nutrition policies in Ethiopia, but in practice, multisectoral coordination remains a challenge. This study aimed to identify facilitators and challenges to effective multisectoral coordination by applying the collective impact framework. Key informant interviews (KIIs; n = 63) were conducted among stakeholders representing various sectors and playing various roles in nutrition governance at the national level. Focus-group discussions (FGDs; n = 39) were conducted with stakeholders involved in nutrition programme implementation and governance from local kebele to national level. Addressing malnutrition through a multi-sectoral approach is identified as a unifying and common agenda across sectors. However, the other four conditions of collective impact, namely shared measurement, reinforcing activities, continuous communication, and backbone support, were suboptimal and varied by region and administration level. Limitations in resources, governance and accountability structures impeded the full realisation of effective multisectoral coordination. The application of the collective impact framework helped identify the impediments to a more effective multisectoral coordination in Ethiopia, providing guidance to improve the design and implementation of nutrition programmes for impact at scale.

Pregnancy and lactation increase maternal nutritional requirements. This study evaluated the trajectories of maternal dietary energy, macro- and micronutrient intake from the third trimester of pregnancy to 8.5 months postpartum, associated factors, and micronutrient intake adequacy. Longitudinal study with mother-infant pairs recruited in a hospital in Rio de Janeiro, Brazil, during the third trimester of pregnancy. At least one 24-h recall was answered in the third trimester of pregnancy (n = 369) and three visits postpartum [M1: 1.0-3.49 (n = 196), M2: 3.5-5.99 (n = 145), and M3: 6.0-8.5 months (n = 108)]. The dietary nutritional composition was calculated using the Brazilian Food Composition Table, and the adequacy percentage was determined based on the dietary reference intakes (estimated average requirement or adequate intake). The usual intake was determined using the Multiple Source Method, which involves fitting z-scores with Generalised Mixed-Effect Models. Carbohydrate and fibre dietary intake decreased 1.84 and 0.41 g, monthly, from the third trimester of pregnancy to 8.5 months postpartum. Total fat intake increased 0.89 g per month. Vitamin B2, B9, C, calcium, phosphorus and magnesium intake decreased over time, while vitamin E, selenium, and sodium increased. Prepregnancy body mass index, age, education, and income were significantly associated with changes in macro- and micronutrients over time. Intake adequacy was lowest at the third trimester of pregnancy for vitamin D (29.7%), B6 (53.2%) and iron (60.1%). Vitamins A and C at 8.5 months showed a significant reduction in adequacy compared to the third trimester of pregnancy. Nutritional education strategies should target pregnant women and their families during pregnancy and the postpartum period. They are essential for promoting adequate nutrition and preventing nutrient deficiencies and/or excesses that can adversely affect maternal and infant health.

Commercial milk formula (CMF) marketing adversely influences breastfeeding practices globally. Thailand enacted the Control of Marketing Promotion of Infant and Young Child Food Act ('Thai Code') in 2017 to restrict the marketing of CMF for infants aged 0-12 months. This qualitative study aimed to explore mothers' experiences and perspectives of CMF marketing and its regulation by the Thai Code through semistructured interviews with 15 mothers across Thailand between July 2023 and March 2024. Our findings revealed that while traditional advertising and healthcare-setting promotions decreased, CMF marketing strategies evolved toward social media platforms, particularly TikTok and Facebook, and through building relationships with mothers for CMF products for young children. Participants reported varying perceptions toward CMF marketing, with those of lower socioeconomic status appearing to be more susceptible to marketing claims, for example, CMF boosts cognitive development and is equivalent to breast milk. While participants reported receiving strong breastfeeding support from healthcare facilities, subtle CMF promotional practices persisted in private settings through free sample distribution and invitations to join company-sponsored digital platforms. Despite general awareness that some form of CMF marketing regulation exists, participants had limited knowledge of the Thai Code's specific provisions. Therefore, enhanced monitoring of digital marketing and private healthcare settings, alongside improved public communication about the Thai Code, could strengthen its implementation, particularly in lower income settings in which mothers may be more vulnerable to marketing claims.

Many countries rely on national household surveys to monitor coverage of nutrition interventions. Following a multi-year consultative effort, 14 new and revised nutrition coverage indicators were included in the Round 8 Demographic and Health Survey (DHS-8) core questionnaire. These indicators were better aligned with international recommendations and generate actionable data for policy and programmatic decision making at national, subnational, and global levels. This analysis highlights their potential applications. We included six sub-Saharan African countries who collected and released DHS-8 datasets between January 2021 and June 2024 (Burkina Faso, Côte d'Ivoire, Ghana, Kenya, Mozambique, and Tanzania). We present weighted averages for all nutrition coverage indicators from pregnancy through young childhood by country and estimate inequities in coverage. Coverage of nutrition interventions provided during pregnancy, birth, and postnatal care was higher than during infancy and young childhood, with wide variation between and within countries. For the new indicators on prenatal counseling about breastfeeding and maternal diet, Ghana had the highest coverage (88% and 92%, respectively) and Mozambique the lowest (48% and 51%). Postnatal counseling about infant and young child feeding practices was universally lower, ranging from 12% in Mozambique to 50% in Ghana. Subnational region, wealth quartile, and maternal education were consistent drivers of inequity. The greatest differences in coverage were by subnational region, as high as 71 percentage points for coverage of height and weight measurement of young children in Kenya. The expanded DHS-8 nutrition indicators fill critical information gaps about coverage and inequalities in care.