Maternal and Child Nutrition最新文献

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.

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.

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.

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.