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Feyisa BB, Dabu GT. Determinant of under nutrition among under five children in Ambo town during covid 19 pandemic in 2020. A community-based cross-sectional study. BMC Nutr 2023; 9:103. [PMID: 37715228 PMCID: PMC10504691 DOI: 10.1186/s40795-023-00762-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/03/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND About 8 to 44% of all child mortality in Africa is associated with undernutrition. To alleviate this problem, it is necessary to determine the magnitude and determinants of undernutrition during Covid 19 pandemic. However, there is scarce evidence in an urban setting like Ambo town. Therefore, this study assessed the magnitude and factors associated with undernutrition among under-five children in Ambo town, west Ethiopia. METHODS AND PATIENTS A community-based cross-sectional study was conducted in Ambo town from March 01-30, 2020. The child and mother/caregiver socio-demographic characteristics, child illness and health care utilization, and child feeding practice-related data were collected using the standardized tool adopted from similar studies conducted in Ethiopia. Anthropometric measurements of the child were made using a calibrated scale. A systematic sampling technique was employed to select 363 mothers/caregivers of the child as a source of data. Nutritional status indices were generated using ENASMART software. After testing for collinearity, variables with a p-value < 0.25 in binary logistic regression were interred to backward multiple logistic regressions at a level of significance of p < 0.05. RESULTS A total of 363 participants were included in this study providing a 100% response rate and providing the following result. The mean (+ SD) age of children was 28.85 (+ 14.17) months and that of mothers/caregivers was 28.12 + 48 years. This study found 16.00%, 25.30%, and 19.00% of the study participants were underweight, wasted, and stunted respectively. Decisions making on major food purchases, who usually care for the child, the age at which the child starts complimentary food, late introduction of complementary food were positively associated with wasting. Diarrhea, birth weight, child age, age at which the child starts complimentary food, consumption of milk and milk product, and who usually care for the child were significantly associated with being underweight. Consumption of milk and milk products, household food security level, and birth weight were independent determinants of stunting. CONCLUSION This study identified a high prevalence of undernutrition, especially wasting. Childbirth weight, age, diarrhea, feeding practice, household (HH) food security, Decision making on major food purchases, late introduction of complementary food were found to be the potential determinants of undernutrition. Thus there should be an effort to improve the nutritional status of children in the study area by focusing on these factors.
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Affiliation(s)
- Beshadu Bedada Feyisa
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, PO box 19, Ambo, Ethiopia.
| | - Getu Taresa Dabu
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, PO box 19, Ambo, Ethiopia
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Adeyemi O, Ajieroh V, Umunna L, Aminu F, Onabolu A. Stakeholders, Relationships, and Coordination: 2015 Baseline Study of Needed Enablers for Bridging Agriculture-Nutrition Gaps in Nigeria. Food Nutr Bull 2023; 44:S41-S51. [PMID: 36047001 DOI: 10.1177/03795721221119249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Renewed efforts by the Nigerian government to address malnutrition have led to nutrition actions by several sectors, including the agriculture sector. However, the success of these actions depends on the characteristics of the stakeholders involved, including their relationships and coordination. OBJECTIVE This article reports a 2015 study of nutrition-sensitive agricultural stakeholders in Nigeria that assessed what the stakeholders do, where they work and how they are organized to improve nutrition. The study provides a baseline for assessing progress and measuring stakeholder and coordination changes in the Nigerian nutrition-sensitive agriculture landscape. METHODS Semi-structured interviews (n = 17) and focus group discussions (n = 2) were held with federal, state, and local government level stakeholders; reviews of stakeholder program documents were also conducted. RESULTS The study identified 7 groups of nutrition-sensitive agriculture stakeholders and several coordination challenges. Political leadership, advocacy and provision of material and human resource support by nongovernmental organizations, and donor interest and funding have been vital for mobilizing nutrition-sensitive agriculture. Still, although stakeholders frequently highlighted that nutrition was an important consideration in their interventions, nutrition goals and activities and/or indicators to measure outcomes were not regularly communicated. Also, while coordination mechanisms existed, there appeared to be minimal actual cross-sectoral partnerships because of inadequate trust, competition, and conflicts over institutional turf and mandates. CONCLUSIONS Needed enablers for improving nutrition-sensitive agriculture in Nigeria included improved stakeholder nutrition literacy, as well as enhanced stakeholder engagement facilitated by role definition, clarification, and consensus. Exploring different approaches to coordination may also be necessary.
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Affiliation(s)
- Olutayo Adeyemi
- Department of Human Nutrition and Dietetics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Victor Ajieroh
- Bill and Melinda Gates Foundation and formerly of Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria
| | | | | | - Adeyinka Onabolu
- Global Alliance for Improved Nutrition, Abuja, Nigeria
- Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria
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Cervantes G, Thow AM, Gómez-Oliver L, Durán-Arenas L, Pérez-Ferrer C. What Opportunities Exist for Making the Food Supply Nutrition Friendly? A Policy Space Analysis in Mexico. Int J Health Policy Manag 2022; 11:2451-2463. [PMID: 34973055 PMCID: PMC9818101 DOI: 10.34172/ijhpm.2021.164] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 11/27/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND As part of a global policy response for addressing malnutrition, food system actions have been proposed. Within food system interventions, policies directed to supply chains have the potential to increase the availability and affordability of a healthy diet. This qualitative study aimed to identify opportunities to integrate nutrition as a priority into the food supply policy space in Mexico. METHODS Data were collected through analysis of 19 policy documents and 20 semi-structured stakeholder interviews. As an analytical framework, we used policy space analysis and embedded the Advocacy Coalition Framework (ACF) and the steps of the food chain of the conceptual framework of food systems for diets and nutrition. RESULTS Policy issues relevant to nutrition were viewed differently in the economic and agricultural sectors versus the health sector. Overall, the main policy objective related to nutrition within the economic and agricultural sectors was to contribute to food security in terms of food quantity. Nutrition was an objective in itself only in the health sector, with a focus on food quality. Our policy space analysis reveals an opportunity to promote a new integrated vision with the recent creation of an intersectoral group working on the public agenda for a food system transformation. This newer integrative narrative on food systems presents an opportunity to shift the existing food security narrative from quantity towards considerations of diet quality. CONCLUSION The political context and public agenda are favorable to pursue a food system transformation to deliver sustainable healthy diets. Mexico can provide a case study for other low- and middle-income countries (LMICs) for putting nutrition at the center of food policy, despite the ongoing constraints on achieving this.
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Affiliation(s)
- Gloria Cervantes
- Master´s and Doctorate Program in Medical and Health Sciences, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Luis Gómez-Oliver
- Faculty of Economics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Luis Durán-Arenas
- Department of Public Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Carolina Pérez-Ferrer
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
- National Council for Science and Technology (CONACYT), Mexico City, Mexico
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Kognition: Einflüsse von Essen, Trinken und Bewegung. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01539-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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5
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Chew CC, Lim XJ, Low LL, Lau KM, Kari M, Shamsudin UK, Rajan P. The challenges in managing the growth of indigenous children in Perak State, Malaysia: A qualitative study. PLoS One 2022; 17:e0265917. [PMID: 35320328 PMCID: PMC8942260 DOI: 10.1371/journal.pone.0265917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/09/2022] [Indexed: 11/25/2022] Open
Abstract
Indigenous peoples in Peninsular Malaysia, known as Orang Asli, have been associated with the problem of malnutrition. Approximately 40% of their children are underweight. Indigenous peoples' distinct social, cultural, and economic traits, which differ from those of the dominant communities in which they live, may pose significant challenges for health care providers (HCPs) in addressing the malnutrition issue. This study explores challenges encountered by HCPs, with at least six months of experience in monitoring the growth parameters of Orang Asli children residing in Perak State in Peninsular Malaysia. A cross-sectional study was conducted between December 2020 and June 2021, involving three focus group discussions and three in-depth interviews. Thematic analysis was used. A total of 19 participants (6 nurses, 5 nursing managers, 4 medical officers, 2 nutritionists, a family medicine specialist, and a paediatrician) took part in this study. The challenges were summarized into four themes: (I) accessibility to nutrition, (II) accessibility to healthcare services, (II) skills of HCPs, and (IV) challenges of implementing nutrition programs. The inability of the Orang Asli children to access nutritious food was due to poverty, different perceptions of life priorities, and the practice of food taboos among the communities. Inadequate infrastructure and transportation discourage parents from bringing their children to healthcare facilities. The belief in and preference for traditional healing, the practice of semi-nomadic lifestyles, and fear of HCPs and their timid nature were factors that prevented Orang Asli children from accessing healthcare services. HCPs need to equip themselves with cross-cultural communication and interaction skills and adapt their skills to environmental challenges to overcome unexpected encounters in mobile clinics. The non-exposed food items, the risk of food basket sharing with other family members, and community feeding programs' coordination were the challenges to be addressed when implementing nutrition programmes for Orang Asli children. The challenges of HCPs are multifactorial and require a multifaceted approach. There is a need for joint efforts of stakeholders, from communities and non-governmental organisations (NGOs) to the health authorities, to address the challenges of HCPs.
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Affiliation(s)
- Chii-Chii Chew
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
| | - Xin-Jie Lim
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
| | - Lee-Lan Low
- Institute for Health Systems Research, Ministry of Health, Ipoh, Malaysia
| | - Kin-Mun Lau
- Perak State Health Department, Ministry of Health, Ipoh, Ipoh, Malaysia
| | - Maziana Kari
- Perak State Health Department, Ministry of Health, Ipoh, Ipoh, Malaysia
| | | | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
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Torlesse H, Ruducha J, Mann C, Murira Z. Assessment of regional networks on nutrition in South Asia: a multi-methods study. BMC Public Health 2022; 22:174. [PMID: 35078437 PMCID: PMC8790857 DOI: 10.1186/s12889-022-12585-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many national and international organizations are working to improve maternal and child nutrition in countries with high malnutrition prevalence and burdens. While there has been progress in strengthening multi-organizational networks on nutrition at country and global levels, the regional level has received much less attention. We conducted a study to 1) determine the existing relationships and levels of engagement between international organizations working to improve nutrition at the regional level or in at least two countries in South Asia; and 2) examine the experiences and perspectives of international organizations on regional-level communication, coordination or collaboration on nutrition in South Asia. METHODS A mixed methods approach involving organizational network analysis (ONA) and semi-structured interviews was used to develop an understanding of the existing network and relationships between international organizations working on nutrition in South Asia. ONA data from 43 international organizations was analysed using a social network analysis software (UCINET) to systematically quantify and visualize the patterns of relationships between organizations. RESULTS We found a high degree of connectivity between most of the international organizations in South Asia, but there were gaps between the many organizations that knew each other and the work they did together regionally on nutrition. Most organizations worked together only 'rarely' or 'sometimes' on nutrition at the regional level and high-intensity (collaborative) working relationships were uncommon. Organizations of the same type tended to cluster together, and a small number of UN agencies and multilateral organizations were central brokers in the nutrition working relationships. Perceived constraints to the nutrition working relationships included organizations' agenda and mandate, threats to visibility and branding, human and financial resources, history, trust and power relations with other organizations, absence of a regional network for cooperation, and donor expectations. There was high demand to remedy this situation and to put network mechanisms in place to strengthen communication, coordination and collaboration on nutrition. CONCLUSIONS Opportunities are being missed for organizations to work together on nutrition at the regional level in South Asia. The effectiveness of regional nutrition networks in influencing policy or programme decisions and resources for nutrition at country level should be explored.
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Affiliation(s)
- Harriet Torlesse
- UNICEF Regional Office for South Asia, Leknath Marg, Kathmandu, 44600, Nepal
| | - Jenny Ruducha
- Braintree Global Health, 4322 West Point Place, Vancouver, BC, V6R 4M9, Canada.
| | - Carlyn Mann
- Braintree Global Health, 4322 West Point Place, Vancouver, BC, V6R 4M9, Canada
| | - Zivai Murira
- UNICEF Regional Office for South Asia, Leknath Marg, Kathmandu, 44600, Nepal
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Michaud-Létourneau I, Gayard M, Njoroge B, Agabiirwe CN, Luwangula AK, McGough L, Mwangi A, Pelto G, Tumilowicz A, Pelletier DL. Operationalizing Implementation Science in Nutrition: The Implementation Science Initiative in Kenya and Uganda. Curr Dev Nutr 2022; 6:nzab146. [PMID: 35047720 PMCID: PMC8760423 DOI: 10.1093/cdn/nzab146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Implementation science (IS) has the potential to improve the implementation and impact of policies, programs, and interventions. Most of the training, guidance, and experience has focused on implementation research, which is only 1 part of the broader field of IS. In 2018, the Society for Implementation Science in Nutrition borrowed concepts from IS in health to develop a broader and more integrated conceptual framework, adapted to the particular case of nutrition and with language and concepts more familiar to the nutrition community: it is called the IS in Nutrition (ISN) framework. OBJECTIVE The purpose of this research was to generate knowledge concerning challenges and strategies in operationalizing the ISN framework in low- and middle-income country (LMIC) settings. METHODS The ISN framework was operationalized in partnership with country teams in Kenya and Uganda over a 3-y period as part of the Implementation Science Initiative. An action research methodology (developmental evaluation) was used to provide timely feedback to the country teams, facilitate adaptations and adjustments, and generate the data presented in this article concerning challenges and strategies. RESULTS Operationalization of the ISN framework proceeded by first articulating a set of guiding principles as touchstones for the country teams and further articulating 6 components of an IS system to facilitate development of work streams. Challenges and strategies in implementing these 6 components were then documented. The knowledge gained through this experience led to the development of an IS system operational model to assist the application of IS in other LMIC settings. CONCLUSIONS Future investments in IS should prioritize a system- and capacity-building approach in order to realize its full potential and become institutionalized at country level. The operational model can guide others to improve the implementation of IS within a broad range of programs.
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Affiliation(s)
- Isabelle Michaud-Létourneau
- The Society for Implementation Science in Nutrition,
NY, USA
- Department of Social and Preventive Medicine, School of Public Health, University of Montréal, Montréal, Québec, Canada
| | - Marion Gayard
- The Society for Implementation Science in Nutrition,
NY, USA
| | | | | | | | | | | | - Gretel Pelto
- The Society for Implementation Science in Nutrition,
NY, USA
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, USA
| | | | - David L Pelletier
- The Society for Implementation Science in Nutrition,
NY, USA
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, USA
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Abstract
All nutrients are essential for brain development, but pre-clinical and clinical studies have revealed sensitive periods of brain development during which key nutrients are critical. An understanding of these nutrient-specific sensitive periods and the accompanying brain regions or processes that are developing can guide effective nutrition interventions as well as the choice of meaningful circuit-specific neurobehavioral tests to best determine outcome. For several nutrients including protein, iron, iodine, and choline, pre-clinical and clinical studies align to identify the same sensitive periods, while for other nutrients, such as long-chain polyunsaturated fatty acids, zinc, and vitamin D, pre-clinical models demonstrate benefit which is not consistently shown in clinical studies. This discordance of pre-clinical and clinical results is potentially due to key differences in the timing, dose, and/or duration of the nutritional intervention as well as the pre-existing nutritional status of the target population. In general, however, the optimal window of success for nutritional intervention to best support brain development is in late fetal and early postnatal life. Lack of essential nutrients during these times can lead to long-lasting dysfunction and significant loss of developmental potential.
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Affiliation(s)
- Sarah E Cusick
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN, USA.
| | - Amanda Barks
- University of Minnesota Medical School, Minneapolis, MN, USA
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Morton SU, Leyshon BJ, Tamilia E, Vyas R, Sisitsky M, Ladha I, Lasekan JB, Kuchan MJ, Grant PE, Ou Y. A Role for Data Science in Precision Nutrition and Early Brain Development. Front Psychiatry 2022; 13:892259. [PMID: 35815018 PMCID: PMC9259898 DOI: 10.3389/fpsyt.2022.892259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Multimodal brain magnetic resonance imaging (MRI) can provide biomarkers of early influences on neurodevelopment such as nutrition, environmental and genetic factors. As the exposure to early influences can be separated from neurodevelopmental outcomes by many months or years, MRI markers can serve as an important intermediate outcome in multivariate analyses of neurodevelopmental determinants. Key to the success of such work are recent advances in data science as well as the growth of relevant data resources. Multimodal MRI assessment of neurodevelopment can be supplemented with other biomarkers of neurodevelopment such as electroencephalograms, magnetoencephalogram, and non-imaging biomarkers. This review focuses on how maternal nutrition impacts infant brain development, with three purposes: (1) to summarize the current knowledge about how nutrition in stages of pregnancy and breastfeeding impact infant brain development; (2) to discuss multimodal MRI and other measures of early neurodevelopment; and (3) to discuss potential opportunities for data science and artificial intelligence to advance precision nutrition. We hope this review can facilitate the collaborative march toward precision nutrition during pregnancy and the first year of life.
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Affiliation(s)
- Sarah U Morton
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | | | - Eleonora Tamilia
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Rutvi Vyas
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States
| | - Michaela Sisitsky
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States
| | - Imran Ladha
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States
| | | | | | - P Ellen Grant
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States.,Department of Radiology, Boston Children's Hospital, Boston, MA, United States
| | - Yangming Ou
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States.,Department of Radiology, Boston Children's Hospital, Boston, MA, United States
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10
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Abstract
AbstractFood systems that deliver healthy diets without exceeding the planet’s resources are essential to achieve the worlds’ ambitious development goals. Healthy diets need to be safe, accessible, and affordable for all, including for disadvantaged and nutritionally vulnerable groups such as of smallholder producers, traders, and consumers in low- and middle-income countries. Globally, food systems are experiencing rapid and drastic changes and are failing to fulfil these multiple duties simultaneously. The international community therefore calls for rigorous food systems transformations and policy solutions to support the achievement of healthy diets for all. Most strategies, however, are essentially supply- and market-oriented. Incorporation of a healthy diet perspective in food system transformation is essential to enable food systems to deliver not only on supplying nutritious foods but also on ensuring that consumers have access can afford and desire healthy, sustainable, and culturally acceptable diets. This paper argues that this should be guided by information on diets, dietary trends, consumer motives, and food environment characteristics. Transformational approaches and policies should also take into account the stage of food system development requiring different strategies to ensure healthier diets for consumers. We review current knowledge on drivers of consumer choices at the individual and food environment level with special emphasis on low- and middle income countries, discuss the converging and conflicting objectives that exist among multiple food-system actors, and argue that failure to strengthen synergies and resolve trade-offs may lead to missed opportunities and benefits, or negative unintended consequences in food system outcomes. The paper proposes a menu of promising consumer- and food-environment- oriented policy options to include in the food systems transformation agenda in order to shift LMIC consumer demand towards healthier diets in low- and middle income countries.
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Exploring the Perspectives of South African Parents and Primary Caregivers Living in Low-Income Communities on What Children Need to Thrive within the First 1000 Days of Life. CHILDREN-BASEL 2021; 8:children8060483. [PMID: 34200273 PMCID: PMC8229791 DOI: 10.3390/children8060483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/24/2021] [Accepted: 06/03/2021] [Indexed: 11/25/2022]
Abstract
The first 1000 days is recognised as a critical period for the development of children. What children need to thrive in this particular phase of development may be different from any other phase. In South Africa, parents’ perception of children’s needs within the first 1000 days of life could be considered as emerging. Therefore, this study aims to explore the perspectives of South African parents and primary caregivers on what children need to thrive within the first 1000 days. An exploratory qualitative study design was used to explore the parents’ understanding of what children need to thrive in the first 1000 days. A purposive sampling approach was employed to select parents and primary caregivers in low-income communities. In all, thirty respondents participated in the study. The data were analysed using thematic analysis. During the analysis, four themes emerged. The themes included (1) the importance of parenting, care and support; (2) children’s need for holistic development; (3) parental roles; and (4) sharing responsibilities. Parents and primary caregivers living in low-income communities understand what children need to thrive within the first thousand days of life. The study could assist policymakers and service providers to design appropriate interventions for parents within these communities.
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The Magnitude of Wasting and Associated Factors among Children Aged 2-5 Years in Southern Ethiopia: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6645996. [PMID: 34041300 PMCID: PMC8121579 DOI: 10.1155/2021/6645996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/25/2021] [Accepted: 04/30/2021] [Indexed: 11/18/2022]
Abstract
Background Malnutrition accounts for almost half of the global under-five child mortality. Worm infections are one of the immediate and commonest causes that affect the nutritional status of children. There is limited data related to the magnitude of wasting and associated factors among children. Therefore, this study was aimed at assessing the magnitude of wasting and associated factors among children aged 2 to 5 years in the Wonago district of Gedeo Zone, southern Ethiopia. Methods Community-based cross-sectional study design was conducted. A total of 3324 children aged 2-5 years were included in the study. A pretested semistructured questionnaire was used for data collection, and anthropometric measurements were computed using the World Health Organization Anthro-nutritional software. The multivariate logistic regression analyses with adjusted odds ratio, 95% confidence interval, and P value less than 0.05 were used to identify the factors significantly associated with wasting. Results A total of 3273 children aged 2-5 years participated with a 98.5% response rate. The magnitude of wasting was 13%. The factors like government-employed fathers [AOR = 1.93; 95% CI (1.08, 3.46)], child's age range between 48 and 59 months [AOR = 1.46; 95% CI (1.01, 2.09)], being a male child [AOR = 1.42; 95% CI (1.07, 1.88)], having diarrheal disease in the past two weeks [AOR = 0.39; 95% CI (0.17, 0.90)], and bathing less than two times per week [AOR = 1.42; 95% CI (1.03, 1.96)] were factors significantly associated with wasting. Conclusion Undernutrition in children is still a problem, and the proportion of wasting was 13%. Government-employed fathers, child's age range between 48 and 59 months, being a male child, having diarrheal disease in the past two weeks, and bathing below two times per week were significantly associated with children's nutritional status warranting close attention by policymakers and stakeholders. For researchers, a further longitudinal study is recommended to get strong evidence.
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Victora CG, Christian P, Vidaletti LP, Gatica-Domínguez G, Menon P, Black RE. Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda. Lancet 2021; 397:1388-1399. [PMID: 33691094 PMCID: PMC7613170 DOI: 10.1016/s0140-6736(21)00394-9] [Citation(s) in RCA: 286] [Impact Index Per Article: 95.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/20/2020] [Accepted: 09/23/2020] [Indexed: 12/26/2022]
Abstract
13 years after the first Lancet Series on maternal and child undernutrition, we reviewed the progress achieved on the basis of global estimates and new analyses of 50 low-income and middle-income countries with national surveys from around 2000 and 2015. The prevalence of childhood stunting has fallen, and linear growth faltering in early life has become less pronounced over time, markedly in middle-income countries but less so in low-income countries. Stunting and wasting remain public health problems in low-income countries, where 4·7% of children are simultaneously affected by both, a condition associated with a 4·8-times increase in mortality. New evidence shows that stunting and wasting might already be present at birth, and that the incidence of both conditions peaks in the first 6 months of life. Global low birthweight prevalence declined slowly at about 1·0% a year. Knowledge has accumulated on the short-term and long-term consequences of child undernutrition and on its adverse effect on adult human capital. Existing data on vitamin A deficiency among children suggest persisting high prevalence in Africa and south Asia. Zinc deficiency affects close to half of all children in the few countries with data. New evidence on the causes of poor growth points towards subclinical inflammation and environmental enteric dysfunction. Among women of reproductive age, the prevalence of low body-mass index has been reduced by half in middle-income countries, but trends in short stature prevalence are less evident. Both conditions are associated with poor outcomes for mothers and their children, whereas data on gestational weight gain are scarce. Data on the micronutrient status of women are conspicuously scarce, which constitutes an unacceptable data gap. Prevalence of anaemia in women remains high and unabated in many countries. Social inequalities are evident for many forms of undernutrition in women and children, suggesting a key role for poverty and low education, and reinforcing the need for multisectoral actions to accelerate progress. Despite little progress in some areas, maternal and child undernutrition remains a major global health concern, particularly as improvements since 2000 might be offset by the COVID-19 pandemic.
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Affiliation(s)
- Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
| | - Parul Christian
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Luis Paulo Vidaletti
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | | | - Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, New Delhi, India
| | - Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Can Nepal achieve nutritional targets by 2030? A trend analysis of childhood undernutrition in Nepal from 2001 to 2016. Public Health Nutr 2021; 24:5453-5462. [PMID: 33472717 DOI: 10.1017/s1368980021000240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study assesses the prevalence of childhood undernutrition from 2001 to 2016 and estimate projections of undernutrition for 2016-2030 in Nepal. DESIGN The study used data from four rounds of a cross-sectional survey of Nepal Demographic and Health Survey (NDHS) conducted in 2001, 2006, 2011 and 2016. Descriptive analyses were conducted to calculate prevalence, binary logistic regression was used to test the significance of trends over time and autoregressive integrated moving average model was used to forecast the prevalence of childhood undernutrition. SETTINGS The children and household member datasets from four NDHS were merged to assess the trends of childhood undernutrition in Nepal. PARTICIPANTS A total of 16 613 children (8399 male and 8214 female) under 5 years of age were selected for anthropometric measurements using a stratified cluster random sampling method. RESULTS Overall results show a decline in prevalence of stunting from 57·2 % to 35·8 % (P < 0·001), underweight from 42·7 % to 27 % (P < 0·001) and wasting from 11·2 % to 9·7 % (P < 0·05) from 2001 to 2016. However, different population subgroups have a higher prevalence of undernutrition than national average. Further, the analyses show that the prevalence of stunting will decline to 14·3 % and wasting to 8·4 % by 2030. CONCLUSION A remarkable decrease in the prevalence of stunting and underweight has been observed over the last 15 years. Nepal is likely to achieve the nutritional targets for stunting but not for wasting by 2030. Given large subpopulation variations, further improvement in undernutrition require more specific, targeted and localised programmes.
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Ariff S, Saddiq K, Khalid J, Sikanderali L, Tariq B, Shaheen F, Nawaz G, Habib A, Soofi SB. Determinants of infant and young complementary feeding practices among children 6-23 months of age in urban Pakistan: a multicenter longitudinal study. BMC Nutr 2020; 6:75. [PMID: 33323127 PMCID: PMC7739450 DOI: 10.1186/s40795-020-00401-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Suboptimal feeding practices have a negative impact on children’s health and growth in the first 2 years of life and increase their risk of undernutrition, morbidity, and mortality. The aim of the study was to assess the factors that influence infant and young child feeding practices among urban mothers in a hospital setting at Karachi, Pakistan. Methods A longitudinal multi-center cohort study was conducted in four countries, MULTICENTER BODY COMPOSITION REFERENCE STUDY (MBCRS) to produce normal body composition reference data in healthy infants from 3 months to 24 months of age. Repeated anthropometric (weight, length and head circumference) and body composition measurements using “deuterium dilution method” along with 24-h dietary recall questionnaires were performed on 250 healthy term infants at 3, 6, 9, 12, 18, and 24 months of age. The 24-h dietary recall data from this study was used to assess the breastfeeding and complementary feeding practices in children aged 6–24 months. Results A total of 250 healthy infants were enrolled in the study. A majority of newborns (75.4%) were exclusively breastfed till 3 months of age; however, by 6 months of age, only 30.2% of infants were exclusively breastfed. Only 44.1% of children aged 6–24 months achieved minimum dietary diversity (MDD), 84.7% achieved minimum meal frequency (MMF), and 44.1% achieved a minimum acceptable diet (MAD). 71.4% achieved MDD and MAD and 100% achieved MMF at 24 months. The bivariate analysis found that breastfed children (OR 3.93, 95% CI 2.72–5.68), with employed mothers (OR 1.55, 95% CI 1.06–2.27) who had graduated from secondary school (OR 1.45, 95% CI 1.08–1.94) were more likely to meet minimum dietary diversity. The multivariable analysis showed that only the child’s age was significantly associated with MDD (p value< 0.0001), with the likelihood of meeting MDD increasing as the children aged; 9 months (OR 18.96, 95% CI 6.63–54.19), 12 months (OR 40.25, 95% CI 14.14–114.58), 18 months (OR 90.02, 95% CI 30.84–262.77) and 24 months (OR 82.14, 95% CI 27.23–247.83). Conclusion Our study revealed that Infant and young child feeding practices are significantly associated with maternal education, employment, and the child’s age. Therefore, it is essential that investments be made towards protective breastfeeding and complementary feeding policies and legislations, emphasis on female education and ensuring the availability of affordable nutritious and diverse foods.
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Affiliation(s)
- Shabina Ariff
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Kamran Saddiq
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Javairia Khalid
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Laila Sikanderali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Batha Tariq
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fariha Shaheen
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Gul Nawaz
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Atif Habib
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Bashir Soofi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
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Bhutta ZA, Akseer N, Keats EC, Vaivada T, Baker S, Horton SE, Katz J, Menon P, Piwoz E, Shekar M, Victora C, Black R. How countries can reduce child stunting at scale: lessons from exemplar countries. Am J Clin Nutr 2020; 112:894S-904S. [PMID: 32692800 PMCID: PMC7487427 DOI: 10.1093/ajcn/nqaa153] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Child stunting and linear growth faltering have declined over the past few decades and several countries have made exemplary progress. OBJECTIVES To synthesize findings from mixed methods studies of exemplar countries to provide guidance on how to accelerate reduction in child stunting. METHODS We did a qualitative and quantitative synthesis of findings from existing literature and 5 exemplar country studies (Nepal, Ethiopia, Peru, Kyrgyz Republic, Senegal). Methodology included 4 broad research activities: 1) a series of descriptive analyses of cross-sectional data from demographic and health surveys and multiple indicator cluster surveys; 2) multivariable analysis of quantitative drivers of change in linear growth; 3) interviews and focus groups with national experts and community stakeholders and mothers; and 4) a review of policy and program evolution related to nutrition. RESULTS Several countries have dramatically reduced child stunting prevalence, with or without closing geographical, economic, and other population inequalities. Countries made progress through interventions from within and outside the health sector, and despite significant heterogeneity and differences in context, contributions were comparable from health and nutrition sectors (40% of change) and other sectors (50%), previously called nutrition-specific and -sensitive strategies. Improvements in maternal education, maternal nutrition, maternal and newborn care, and reductions in fertility/reduced interpregnancy intervals were strong contributors to change. A roadmap to reducing child stunting at scale includes several steps related to diagnostics, stakeholder consultations, and implementing direct and indirect nutrition interventions related to the health sector and nonhealth sector . CONCLUSIONS Our results show that child stunting reduction is possible even in diverse and challenging contexts. We propose that our framework of organizing nutrition interventions as direct/indirect and inside/outside the health sector should be considered when mapping causal pathways of child stunting and planning interventions and strategies to accelerate stunting reduction to achieve the 2030 Sustainable Development Goals.
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Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Emily C Keats
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tyler Vaivada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shawn Baker
- United States Agency for International Development, Washington, DC, USA
| | - Susan E Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Joanne Katz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, South Asia Office, New Delhi, India
| | - Ellen Piwoz
- Global Development Division, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Meera Shekar
- Health, Nutrition & Population, World Bank, Washington, DC, USA
| | - Cesar Victora
- Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Robert Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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National Strategy for Framing and Prioritizing Environmental Protection Research and Development Topics. SUSTAINABILITY 2020. [DOI: 10.3390/su12187420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
One of the key methods for implementing the sustainability model in practice includes environmental vision and policy, goal setting, preference areas, and setting environmental research and development (ER&D) priorities. There are different ways to identify and prioritize the R&D of governments or international bodies, yet we have not found a comprehensive study or strategy regarding the framing and prioritization of ER&D at a national level. The aim of the study was to present a methodological approach, principles, and criteria for the prioritization of national ER&D. The study was initiated with a comprehensive literature review, including studies reported by a wide range of entities and countries, followed by the identification of eight principles to select ER&D priorities. Finally, each of the environmental issues was ranked in the frame of every principle, based on a quantitative criterion or criteria, considering global challenges, local needs, and capabilities.
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Abstract
The well-balanced nourishment during "the first 1000 days," the period between conception (day 18) and the age of two years, is quite important for two main reasons. Firstly, the nutritive requirement is high due to the rapid physiological growth and functional development. Then, this period is characterized by extreme susceptibility to external stimuli such as inadequate maternal and infant nutritional status which they can interfere with the different stages of the development process leading to short and long-term consequences for health. Linear growth and brain development are particularly impaired from not sufficient nutrition. In consideration of the irreversible damage of malnutrition, especially on developing brain, an adequate nutrition during the first 1000 days of life is paramount. The aim of this review was to overview the latest scientific evidences on the relationship between nutrition and growth, focusing on nutritional requirements during the first 1000 days, and the impact of inadequate nutrition on brain development and linear growth.
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Affiliation(s)
- Lorena Matonti
- Department of Pediatrics, University of Chieti, Chieti, Italy
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Appiah CA, Mensah FO, Hayford FEA, Awuuh VA, Kpewou DE. Predictors of undernutrition and anemia among children aged 6–24 months in a low-resourced setting of Ghana: a baseline survey. JOURNAL OF HEALTH RESEARCH 2020. [DOI: 10.1108/jhr-05-2019-0095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeThe purpose of this study was to identify the predictors of child undernutrition and anemia among children 6–24 months old in the East Mamprusi district, Northern region, Ghana.Design/methodology/approachThis cross-sectional study recruited 153 children and their mothers. Weight, height and hemoglobin levels of the children were measured. A structured questionnaire based on the World Health Organization's indicators for assessing infant and young child feeding practices was used to collect data on parents' socioeconomic status, household characteristics, hygiene and sanitation practices, mothers' knowledge on feeding practices such as child's meal frequency and dietary diversity and child morbidity within the past two weeks. Predictors of child nutritional status were determined using multinomial logistic regression analysis.FindingsUnderweight in the children was significantly predicted by maternal knowledge on protein foods (AOR = 0.045, p = 0.008), time of initiation of complementary feeding (AOR = 0.222, p = 0.032) and maternal age (AOR = 9.455, p = 0.017). Feeding child from separate bowls (AOR = 0.239, p = 0.005), minimum meal frequency per child's age (AOR = 0.189, p = 0.007) and time of initiation of complementary feeding (AOR = 0.144, p = 0.009) were significant determinants of stunting among the children. Exclusive breast feeding (AOR = 7.975, p = 0.012) and child's past morbidity (AOR = 0.014, p = 0.001) significantly contributed to anemia among the children.Research limitations/implicationsThis is a cross-sectional study and cannot establish causality. The small sample size also limits the generalizability of study findings. However, findings of the study highlight factors which could potentially influence the high rate of child undernutrition in the study setting.Practical implicationsThis study identifies determinants of undernutrition in the East Mamprusi district, an underresourced area in Ghana. This information could inform the development/reformulation of locally sensitive key messages and targeted intervention strategies to curb the high levels of child undernutrition in the East Mamprusi district of Ghana.Originality/valueThis study identifies maternal care practices as key potential drivers of undernutrition in a low-resource setting known for high prevalence of child undernutrition. It suggests insight for large-scale studies on the predictors of child undernutrition in Northern Ghana and other resource-poor settings.
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Shaka MF, Woldie YB, Lola HM, Olkamo KY, Anbasse AT. Determinants of undernutrition among children under-five years old in southern Ethiopia: does pregnancy intention matter? A community-based unmatched case-control study. BMC Pediatr 2020; 20:101. [PMID: 32126986 PMCID: PMC7053136 DOI: 10.1186/s12887-020-2004-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 02/26/2020] [Indexed: 12/02/2022] Open
Abstract
Background Stunting, which describes a small height for one’s age, is an indicator of chronic malnutrition. It develops mainly as a result of prolonged food deprivation or a chronic disease or illness. Unintended pregnancies and unplanned births are among the psychological factors that negatively affect the nutritional status of children. Therefore, this study aimed to determine the effects of unintended pregnancies and other family and child characteristics on the nutritional status of children under 5 years old. Methods A community-based unmatched case-control study was conducted among 302 children (151 cases and 151 controls) 6–59 months old in Wonago town, Gedeo Zone, Southern Ethiopia. The cases were stunted children and the controls were non-stunted children in the study area. The cases were randomly selected from among the stunted children, and the controls were randomly selected from among the non-stunted children. The descriptive characteristics of the respondents were compared using the chi-squared test, and a multivariable logistic regression was used to assess the effects of an unintended pregnancy on stunting, after controlling for the other variables, with a p value of 0.05. Results The result revealed that unintended pregnancy is found to be among predictors of stunting where children from unintended pregnancy were about three times more likely to be stunted [AOR: 2.62, CI: (1.26, 5.45)]. The other predictors identified in this study were educational status of the father, wealth index of the household and daily meal frequency. From the finding, children from illiterate fathers [AOR: 3.43, CI: (1.04, 11.29)], children from poorer household economic status [AOR: 2.32, CI: (1.20, 4.49)] and children whom their daily meal frequency is below the recommended number of feeding [AOR: 4.50, CI: (1.31, 15.49)] were found to be more stunted. Conclusions Based on the results of this study, the children born from unintended pregnancies exhibited a significantly higher risk of stunting. Therefore, preventing unintended pregnancy could play a great role in decreasing the risk of stunting in children.
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Affiliation(s)
- Mohammed Feyisso Shaka
- Department of Reproductive Health, Dilla University College of Health Sciences and Medicine, Dilla, Ethiopia.
| | - Yetayal Birhanu Woldie
- Department of Psychiatry, Dilla University College of Health Sciences and Medicine, Dilla, Ethiopia
| | - Hirbaye Mokona Lola
- Department of Psychiatry, Dilla University College of Health Sciences and Medicine, Dilla, Ethiopia
| | - Kalkidan Yohannes Olkamo
- Department of Psychiatry, Dilla University College of Health Sciences and Medicine, Dilla, Ethiopia
| | - Adane Tesfaye Anbasse
- Department of Reproductive Health, Dilla University College of Health Sciences and Medicine, Dilla, Ethiopia
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Ryckman T, Robinson M, Pedersen C, Bhattacharya J, Bendavid E. Impact of Feed the Future initiative on nutrition in children aged less than 5 years in sub-Saharan Africa: difference-in-differences analysis. BMJ 2019; 367:l6540. [PMID: 31826875 PMCID: PMC7190055 DOI: 10.1136/bmj.l6540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the impact of the US government's Feed the Future initiative on nutrition outcomes in children younger than 5 years in sub-Saharan Africa. DESIGN Difference-in-differences quasi-experimental approach. SETTING Households in 33 low and lower middle income countries in sub-Saharan Africa. POPULATION 883 309 children aged less than 5 years with weight, height, and age recorded in 118 surveys conducted in 33 countries between 2000 and 2017: 388 052 children were from Feed the Future countries and 495 257 were from non-Feed the Future countries. MAIN OUTCOME MEASURES A difference-in-differences approach was used to compare outcomes among children in intervention countries after implementation of the initiative with children before its introduction and children in non-intervention countries, controlling for relevant covariates, time invariant national differences, and time trends. The primary outcome was stunting (height for age >2 standard deviations below a reference median), a key indicator of undernutrition in children. Secondary outcomes were wasting (low weight for height) and underweight (low weight for age). RESULTS Across all years and countries, 38.3% of children in the study sample were stunted, 8.9% showed wasting, and 21.3% were underweight. In the first six years of Feed the Future's implementation, children in 12 countries with the initiative exhibited a 3.9 percentage point (95% confidence interval 2.4 to 5.5) greater decline in stunting, a 1.1 percentage point (0.1 to 2.1) greater decline in wasting, and a 2.8 percentage point (1.6 to 4.0) greater decline in underweight levels compared with children in 21 countries without the initiative and compared with trends in undernutrition before Feed the Future was launched. These decreases translate to around two million fewer stunted and underweight children aged less than 5 years and around a half million fewer children with wasting. For context, about 22 million children were stunted, 11 million children were underweight, and four million children were wasted in the Feed the Future countries at baseline. CONCLUSIONS Feed the Future's activities were closely linked to notable improvements in stunting and underweight levels and moderate improvements in wasting in children younger than 5 years. These findings highlight the effectiveness of this large, country tailored initiative focused on agriculture and food security and have important implications for the future of this and other nutrition interventions worldwide.
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Affiliation(s)
- Theresa Ryckman
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Jay Bhattacharya
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
| | - Eran Bendavid
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Mahmud I, Kabir M, Haque R, Garrett TJ. Decoding the Metabolome and Lipidome of Child Malnutrition by Mass Spectrometric Techniques: Present Status and Future Perspectives. Anal Chem 2019; 91:14784-14791. [PMID: 31682425 DOI: 10.1021/acs.analchem.9b03338] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Child malnutrition (CM) is a global public health problem. It contributes to poor health in one in four children under five years worldwide and causes serious health problems in children, including stunted, wasted, and overweight growth. These serious public health issues lead to a higher chance of living in poverty in adulthood. Malnutrition is related with reduced economic productivity and increases the serious national and international burden. Currently, there is no meaningful therapeutic intervention of CM, and the use of different therapeutic foods has shown poor outcomes among supplemented malnourished children. The role of metabolites and lipids has been extensively recognized as early determinants of child health, but their contribution in CM and its pathobiology are poorly understood. This perspective provides a most recent update on these aspects. After briefly introducing the disciplines of metabolomics and lipidomics, we describe a mass spectrometry-based metabolic workflow for analysis of both metabolites and lipids and summarize several recent applications of metabolomics and lipidomics in CM. Finally, we discuss the future directions of the field toward the development of meaningful interventions for CM through metabolomics and lipidomics advances.
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Affiliation(s)
- Iqbal Mahmud
- Department of Pathology, Immunology, and Laboratory Medicine , University of Florida, College of Medicine , Gainesville , Florida 32608 , United States.,Southeast Center for Integrated Metabolomics (SECIM), Clinical and Translational Science Institute , University of Florida , Gainesville , Florida 32608 , United States
| | - Mamun Kabir
- Emerging Infections and Parasitology Laboratory, Infectious Disease Division , International Centre for Diarrheal Disease Research , Dhaka 1213 , Bangladesh
| | - Rashidul Haque
- Emerging Infections and Parasitology Laboratory, Infectious Disease Division , International Centre for Diarrheal Disease Research , Dhaka 1213 , Bangladesh
| | - Timothy J Garrett
- Department of Pathology, Immunology, and Laboratory Medicine , University of Florida, College of Medicine , Gainesville , Florida 32608 , United States.,Southeast Center for Integrated Metabolomics (SECIM), Clinical and Translational Science Institute , University of Florida , Gainesville , Florida 32608 , United States
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Salasibew MM, Moss C, Ayana G, Kuche D, Eshetu S, Dangour AD. The fidelity and dose of message delivery on infant and young child feeding practice and nutrition sensitive agriculture in Ethiopia: a qualitative study from the Sustainable Undernutrition Reduction in Ethiopia (SURE) programme. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2019; 38:29. [PMID: 31639070 PMCID: PMC6805331 DOI: 10.1186/s41043-019-0187-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 09/23/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND In Ethiopia, 38% of children under 5 years of age are stunted (low height for age). A novel government-led intervention called the Sustainable Undernutrition Reduction in Ethiopia (SURE) aims to tackle the burden of stunting by improving complementary feeding and dietary diversity among young children. The SURE programme design applies a transtheoretical model of behaviour change, whereby exposure to recommended infant and young child feeding (IYCF) and nutrition-sensitive agriculture messages is a first stage to adopting key behaviours. This qualitative study explored the fidelity and dose of the IYCF and nutrition-sensitive agriculture messages delivered by extension workers. METHODS A qualitative study was conducted across four regions in Ethiopia (Oromiya, Amhara, SNNP and Tigray) between April and October 2017. Across the four regions, 81 key informant interviews, 90 FGDs and 81 observations were conducted with 180 extension workers, 18 development agents and 54 mother-father pairs. Digitally recorded audio files were transcribed verbatim, and the data were analysed based on a framework analysis approach using NVivo (version 12) by coding and categorising texts into major themes and sub-themes. RESULTS SURE target households had the intended exposure to messages about exclusive breastfeeding, timing of initiation of complementary feeding, food groups, diversified food consumption, irrigation, rearing small animals and vegetables. Few households reported receiving messages on the content or frequency of complementary feeding of a child beyond 6 months of age. Frequency of household visits and hence exposure to SURE messages was also variable. Agricultural messages delivered during household visits focussed on improving standard agricultural practices and rarely covered the importance of nutrition-sensitive agriculture to improve household or child nutrition. CONCLUSION Despite variability observed in the breadth and depth of messages delivered, large-scale behaviour change communication programmes can achieve moderate to good message exposure among target groups. Qualitative data provide an in-depth insight into fidelity and may supplement our understanding of programme roll-out and implementation. Further research is required to understand longer-term message saturation including frequency and reach.
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Affiliation(s)
| | - Cami Moss
- London School of Hygiene and Tropical Medicine, London, UK
| | - Girmay Ayana
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Desalegn Kuche
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Solomon Eshetu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Alan D Dangour
- London School of Hygiene and Tropical Medicine, London, UK
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Harris J. Advocacy coalitions and the transfer of nutrition policy to Zambia. Health Policy Plan 2019; 34:207-215. [PMID: 31006019 PMCID: PMC6528744 DOI: 10.1093/heapol/czz024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2019] [Indexed: 11/13/2022] Open
Abstract
Stunted growth in children and multisectoral action to address it are dominant ideas in the international nutrition community today, and this study finds that these ideas are increasingly evident over time in nutrition policy in Zambia, with stunting largely displacing other framings of nutrition. This study is based on key informant interviews (70 interviews with 61 interviewees), policy document review, and social network mapping, with iterative data collection and analysis taking place over 6 years (2011-2016). Analysis was based on two established political science theories: policy transfer theory and the Advocacy Coalition Framework. Policy changes in Zambia are shown to result from the international community's nutrition agenda, transferred to national policy through the normative promotion of certain ways of understanding the issue of malnutrition, largely propagated through advocacy, technical assistance and funding. With its focus on multisectoral action to reduce stunting, the recent nutrition policy narrative impinges directly on an existing food security narrative as it attempts to alter agriculture policy away from maize reliance. The nutrition policy sub-system in Zambia is therefore split between an international coalition promoting action on child stunting, and a national coalition focused on food security and hunger, with implications for both sides on progressing a coherent policy agenda. This study finds that it is possible to understand policy processes for nutrition more fully than has so far been achieved in much nutrition literature through the application of multiple political science theories. These theories allow the generalization of findings from this case study to assess their relevance in other contexts: the study ultimately is about the transfer of policy being explained by the presence of advocacy coalitions and their different beliefs, resources and power, and these concepts can be investigated wherever the nutrition system reaches down from international to national level.
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Affiliation(s)
- Jody Harris
- Institute of Development Studies, Library Road, University of Sussex, Brighton, UK
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Abstract
Background: The problem of stunting occurs in developing countries including Indonesia. In Indonesia the prevalence of child stunting is 30.8%, still above the world prevalence, which is 22.2%. The prevalence of stunting in sub-Saharan Africa is 34.5%, in Ethiopia is 52.4%, and the prevalence of stunting in Congo is 40%. While WHO stipulates that nutrition problems should not exceed 20%. Stunting could inhibit linear growth, development and degenerative diseases later in adulthood.Objective: This review discussed the risk factors of child stunting in developing countries.Discusion: One of the causes of increased stunting in children was due to inadequate nutritional intake in a long period. Stunting was often not realized by parents and only visible after the age of 2 due to low stature. Based on the results of the literature review the likelihood of stunting in developing country were: 16.43 times morelikely due to low birth length, 3.27 times higher due to maternal education, 2.45 times higher if the children were living in rural area, 4.5 times higher due to low birth weight, no risk Antenatal Care increase the risk 3.4 times, 6.38 times higher due to no immunization, and no exclusive breastfeeding increase the risk of stunting 4.0 times.Conclusion: The risk factor for child stunting in developing countries are exclusive breastfeeding, socioeconomic, low birth weight, length of birth, low maternal education, infectious disease.ABSTRAKLatar Belakang: Masalah stunting (stunting) yang terjadi di Negara Berkembang seperti Indonesia masih tinggi yaitu 30,8% masih di atas dunia yaitu 22,2%. Stunting di sub sahara Afrika 34,5%, di Ethiopia 52,4%, prevalensi stunting di Congo 40%. Word Health Organization sudah menentukan bahwa terjadinya masalah gizi suatu negara sebaiknya kurang dari 20%. Stunting memiliki risiko gangguan pertumbuhan, perkembangan dan penyakit degeneratif pada usia dewasa nanti.Tujuan: Review ini bertujuan untuk mengidentifikasi faktor risikos apa saja yang dapat menentukan terjadinya stunting anak di Negara berkembang.Ulasan: Berdasarkan dari beberapa hasil penelitian menyebutkan bahwa salah satu penyebab stunting pada anak adalah karena tidak terpenuhinya gizi yang baik pada kurun waktu yang panjang dan sering kali tidak disadari oleh orang tuanya sehingga setelah anak usia di atas 2 tahun baru terlihat bahwa anaknya mengalami stunting. Berdasarkan hasil literatur review menunjukkan bahwa faktor risiko terjadinya stunting adalah panjang lahir berisiko 16,43 kali, pendidikan ibu yang rendah berisiko 3,27 kali, serta anak yang tinggal di desa berisiko 2,45 kali, BBLR berisiko 4,5 kali, tidak ANC berisiko 3,4 kali, tidak imunisasi berisiko 6,38 kali, dan tidak ASI Eksklusif berisiko 4,0 kali adalah merupakan faktor risiko stunting anak di negara berkembang.Kesimpulan: Hasil sintesis ini secara konsisten yang menjadi faktor risikos terjadinya stunting pada anak di negara berkembang adalah tidak diberikan ASI eksklusif, sosial ekonomi, berat bayi lahir rendah, panjang lahir, pendidikan ibu rendah, penyakit infeksi.
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Belay E, Handebo S, Derso T, Tariku A, Sisay M. Prevalence and determinants of pre-adolescent (5-14 years) acute and chronic undernutrition in Lay Armachiho District, Ethiopia. Int J Equity Health 2019; 18:137. [PMID: 31477149 PMCID: PMC6721279 DOI: 10.1186/s12939-019-1041-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/23/2019] [Indexed: 12/25/2022] Open
Abstract
Background In Ethiopia it is documented that 16% of all grade repetitions in primary school and 33.9% childhood deaths are associated with undernutrition. School aged children are often omitted from public health research. Thus, the present study was carried out to find out the prevalence and determinants of pre-adolescent (5–14 years) acute and chronic undernutrition in Lay Armachiho District. Methods In this community based cross-sectional study, anthropometrics, individual and household characteristics data were collected from December, 2016 to January, 2017. A total of 848 school aged children (5–14 years) were included in the study. Z-scores for height-for-age (HAZ) and body-mass-index-for-age (BAZ) were calculated to illustrate stunting (chronic undernutrition) and thinness (acute undernutrition), respectively with Anthro Plus software version 1.0.4 using the WHO 2007 growth reference standard. Finally, backward stepwise multivariable logistic regression analysis was carried out to identify factors associated with stunting and thinness, individually. Results The overall prevalence of stunting and thinness was 35.5 and 9.9%, respectively. The multivariable analysis showed that child age 10–14 years [AOR = 1.58, 95% CI: 1.17, 2.12] and lack of availability of a latrine at home [AOR = 1.60; 95% CI: 1.17, 2.20)] were associated with increased likelihood of stunting. Nevertheless, child’s hand washing practice before eating [AOR = 0.67; 95% CI: 0.49, 0.91] was protective against stunting. Children who consumed diversified foods [AOR = 0.64; 95% CI 0.39, 0.97] were protected from thinness. Conclusion In Lay Armachiho district, one-third and one in every ten of school aged children were stunted and thin, respectively. Children age 10–14 years, lack of availability of a latrine at home and hand washing practices before eating were associated with stunting, while only dietary diversity was associated with thinness. Ensuring consistent hand washing practices before eating and ensuring availability of latrine should be improved in the region, which can assist in effectively tackling undernutrition. Finally, dietary diversification should be enhanced to rectify burden of acute undernutrition.
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Affiliation(s)
- Eleni Belay
- Medical Ward, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Simegnew Handebo
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Terefe Derso
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Tariku
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mekonnen Sisay
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Villalobos Dintrans P, Bossert TJ, Sherry J, Kruk ME. A synthesis of implementation science frameworks and application to global health gaps. Glob Health Res Policy 2019; 4:25. [PMID: 31485483 PMCID: PMC6712702 DOI: 10.1186/s41256-019-0115-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/01/2019] [Indexed: 11/25/2022] Open
Abstract
Background Implementation science has been growing as discipline in the past decades, producing an increasing number of models in the area. On the other hand, most frameworks are intended to guide the implementation of programs, focusing on identifying elements and stages that increase their success. This article aims to structure this discussion, proposing a simplified tool that synthesizes common elements of other frameworks, and highlight the usefulness to use implementation science not only in identifying successful implementation strategies but as a tool to assess gaps in global health initiatives. Methods The study was carried out through a combined methodology that included an initial search of implementation science frameworks, experts’ opinions, and the use of references in frameworks to elaborate a list of articles to be reviewed. A total of 52 articles were analyzed, identifying their definitions of implementation science and the elements of different frameworks. Results The analysis of articles allowed identifying the main goals and definitions of implementation science. In a second stage, frameworks were classified into “time-based”, “component-based” and “mixed”, and common elements of each type of model were used to propose a synthetic framework with six elements: Diagnosis, Intervention provider/ system, Intervention, Recipient, Environment, and Evaluation. Finally, this simplified framework was used to identify gaps in global health was using The Lancet Global Health Series. Potential areas of intervention arise for five different global health issues: malaria, non-communicable diseases, maternal and child health, HIV/AIDS, and tuberculosis. Prioritization strategies differ for the different health issues, and the proposed framework can help identify and classify all these different proposals. Conclusions There is a huge variety of definitions and models in implementation science. The analysis showed the usefulness of applying an implementation science approach to identify and prioritize gaps in implementation strategies in global health. Electronic supplementary material The online version of this article (10.1186/s41256-019-0115-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Jim Sherry
- 3University Research Co., LLC, Chevy Chase, USA
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Abu BA, Oldewage‐Theron W, Aryeetey RN. Risks of excess iodine intake in Ghana: current situation, challenges, and lessons for the future. Ann N Y Acad Sci 2019; 1446:117-138. [PMID: 30489642 PMCID: PMC6618322 DOI: 10.1111/nyas.13988] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/05/2018] [Accepted: 10/19/2018] [Indexed: 12/21/2022]
Abstract
In Ghana, iodine deficiency was first reported in 1994 among 33% of the population. A nationwide Universal Salt Iodization (USI) program plus other complementary interventions were subsequently implemented as a response. Our paper reviews the current risks of excess iodine status in Ghana and identifies policy and research gaps. A mixed methods review of 12 policies and institutional reports and 13 peer-reviewed articles was complemented with consultations with 23 key informants (salt producers and distributors, food processors, regulatory agency officials, and healthcare providers) purposively sampled between May and August 2017. The findings show a strong policy environment indicated by regulations on food and salt fortification (Act 851), including the USI regulation. However, currently, only a third of Ghanaian households use adequately iodized salt. Recent evidence shows that voluntarily fortified processed foods (including condiments) supply a considerable amount of iodine to the food system. Limited biological impact data suggest possible household exposure to excessive dietary iodine (>15 parts per million). Currently, there is no systematic tracking of iodine content from fortified foods and other sources. Cross-sectoral actions are needed to understand this situation better. Key research gap is the lack of comprehensive data on iodine content and intake from other sources in Ghana.
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Affiliation(s)
- Brenda A.Z. Abu
- Rochester Institute of TechnologyCollege of Health Sciences and Technology, Wegmans School of Health and NutritionRochesterNew York
- Department of Nutritional SciencesTexas Tech University, College of Human SciencesLubbockTexas
| | - Wilna Oldewage‐Theron
- Department of Nutritional SciencesTexas Tech University, College of Human SciencesLubbockTexas
| | - Richmond N.O. Aryeetey
- Department of Population, Family and Reproductive HealthUniversity of Ghana, School of Public HealthLegonAccraGhana
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Mishra NR, Mohanty SK, Mittra D, Shah M, Meitei WB. Projecting stunting and wasting under alternative scenarios in Odisha, India, 2015-2030: a Lives Saved Tool (LiST)-based approach. BMJ Open 2019; 9:e028681. [PMID: 31142537 PMCID: PMC6549738 DOI: 10.1136/bmjopen-2018-028681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Although nutrition-specific interventions are designed based on maternal, household and community-level correlates, no attempt has been made to project stunting and wasting and identify intervention priorities in India. The objective of this paper is to model the stunting and wasting in the state of Odisha, India by scaling up maternal and child health interventions under alternative scenarios. DESIGN This study primarily used data from National Family Health Survey 4, 2015-2016. MEASURES The LiST (Lives Saved Tool) software is used to model the nutritional outcomes and prioritise interventions. The projections were carried out under four alternative scenarios: scenario 1-if the coverage indicators continued based on past trends; scenario 2-scaled up to the level of the richest quintile; scenario 3-scaled up to that of Tamil Nadu; and scenario 4-scaled up to an aspirational coverage level. RESULTS In 2015, out of 3.52 million under-5 children in Odisha, around 1.20 million were stunted. By 2030, the numbers of stunted children will be 1.11 million under scenario 1, 1.07 million under scenario 2, 1.09 million under scenario 3 and 0.89 million under scenario 4. The projected stunting level will be 25% under scenario 4 and around 31% under all other scenarios. By 2030, the level of wasting will remain unchanged at 20% under the first three scenarios and 4.3% under scenario 4. Appropriate complementary feeding would avert about half of the total stunting cases under all four scenarios, followed by zinc supplementation. Water connection at home, washing hands with soap and improved sanitation are other effective interventions. CONCLUSION Sustaining the maternal and child health interventions, promoting evidence-based stunting and wasting reduction interventions, and a multisectoral approach can achieve the World Health Assembly targets and Sustainable Development Goals of undernutrition in Odisha.
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Affiliation(s)
| | - Sanjay K Mohanty
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Devjit Mittra
- Azim Premji Philanthrophic Initiatives, Bhubaneswar, Odisha, India
| | - Mansi Shah
- Azim Premji Philanthropic Initiatives, Bengaluru, Karnataka, India
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Evaluating consistency of recall of maternal and newborn care complications and intervention coverage using PMA panel data in SNNPR, Ethiopia. PLoS One 2019; 14:e0216612. [PMID: 31071142 PMCID: PMC6508703 DOI: 10.1371/journal.pone.0216612] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/24/2019] [Indexed: 11/30/2022] Open
Abstract
Background There is recognition that effective interventions are available to prevent neonatal and maternal deaths but providing reliable and valid coverage estimates remains a challenge. Household surveys rely on recall of self-reported events that may span up to 5 years, raising concerns of recall bias. Objective This study assessed the reliability of maternal recall of pregnancy, delivery, and postpartum events over a six-month period and identified relevant individual characteristics associated with inconsistent reporting. Methodology A longitudinal household survey was conducted with 321 pregnant women in 44 enumeration areas in Southern Nationals, Nationalities and People’s Region in Ethiopia. Women who were six or more months pregnant were enrolled and interviewed at seven days, six weeks, and six months post-partum using an identical set of questions regarding maternal and neonatal health and receipt of select neonatal care interventions. We compared responses given at 7 days to those reported at 6 weeks and 6 months and conducted sensitivity, specificity, area under receiving operative curve, and Kappa analyses of selected indicators. Results We find that reporting complications is higher at the first interview after birth than at either the six-week or six-month interview. The specificity of the majority of complications is high, however sensitivity is generally much lower. The sensitivity of reporting any complication during pregnancy, delivery, or post-partum ranged from 54.5% to 67.6% at the 6-week interview and from 39.2% to 63.2% at the 6-month interview. Though sensitivity of receipt of neonatal interventions was high, specificity and kappa demonstrate low consistency. Conclusion As with childbirth, it may be that during the first seven days women note symptoms with higher scrutiny, but if these do not later develop into serious health issues, they may be forgotten over time. Maternal complications and care are likely to be under-reported by women if interviewed for distant events.
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Anjorin O, Okpala O, Adeyemi O. Coordinating Nigeria's micronutrient deficiency control programs is necessary to prevent deficiencies and toxicity risks. Ann N Y Acad Sci 2019; 1446:153-169. [PMID: 30942488 DOI: 10.1111/nyas.14055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/15/2019] [Accepted: 02/22/2019] [Indexed: 12/16/2022]
Abstract
Nigeria has an alarming prevalence of micronutrient deficiencies that has persisted over decades. National Micronutrient Deficiency Control (MNDC) guidelines describe several interventions to address the issue. This study identified and described currently implemented interventions, assessed coverage and coordination of the interventions, and considered the risk of overdosage and gaps. Methods included reviews of policy and program documents, key informant interviews, market, and pharmacy visits. The study found that an array of MNDC interventions were being implemented, including public health supplementation, mandatory fortification, point-of-use fortification, biofortification, promotion of dietary diversity, voluntary fortification, and ad hoc individual supplement use. Insufficient coordination existed for government, private, and civil society interventions within the health sector and between health and other sectors. Dosages of micronutrients supplied by different interventions were set independently of each other and target populations overlapped. Inadequate implementation of various interventions appeared to reduce the risk of excessive micronutrient intakes, but increased the risk of deficiencies. The risk of excessive intakes will likely increase with improved implementation and scale-up. There is a need to develop effective coordination structures for MNDC in Nigeria that will critically examine the landscape, decide modalities for different interventions, and ensure that both deficiencies and risk of excessive intakes are minimized.
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Affiliation(s)
- Olufolakemi Anjorin
- Department of Human Nutrition, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Oluchi Okpala
- Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Olutayo Adeyemi
- Department of Human Nutrition, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
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Awuuh VA, Appiah CA, Mensah FO. Impact of nutrition education intervention on nutritional status of undernourished children (6-24 months) in East Mamprusi district of Ghana. ACTA ACUST UNITED AC 2019. [DOI: 10.1108/nfs-05-2018-0134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to determine the impact of nutrition education intervention on nutritional status of undernourished children aged 6-24 months in the East Mamprusi district of Ghana.
Design/methodology/approach
This was a pre-post interventional study. In all, 153 undernourished children of age 6-24 months and their mothers were recruited from five communities. Underweight, stunting, wasting, mid upper arm circumference (MUAC) and haemoglobin (Hb) levels were determined at baseline and after intervention. Nutrition education was given to the mothers for three months based on the nutrition problems identified at baseline assessment.
Findings
There were improvements in underweight, wasting, MUAC and Hb levels among the children after the nutrition education intervention. The level of improvement at post-intervention differed significantly for underweight (−2.4 ± 0.4, −2.2 ± 0.4; p = 0. 001), wasting (−2.2 ± 0.6, −1.9 ± 0.6; p = 0. 001), MUAC (12.3 ± 0.5, 12.9 ± 0.6; p = 0. 001) and Hb level (10.0 ± 1.4, 10.5 ± 1.4; p = 0. 001) of the children compared to pre-intervention (−1.4 ± 1.8, −1.3 ± 1.7; p = 0.314).
Practical implications
There was significant improvement in the nutritional status of the undernourished children after the nutrition education intervention. Community nutritionists and stakeholders involved in nutrition and health issues concerning infants and young children should consider nutrition education, as it could be an inexpensive and effective strategy in combating childhood undernutrition in resource-poor settings.
Originality/value
Findings of this study provide evidence, suggesting nutrition education as a potential strategy to curb the high rates of child undernutrition in resource-poor communities in Ghana. This study provides insight for larger studies on the effectiveness of nutrition education in curbing child malnutrition in deprived communities in Ghana.
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Abstract
We discuss efforts in improving the value of nutrition research. We organised the paper in five research stages: Stage 1: research priority setting; Stage 2: research design, conduct and analysis; Stage 3: research regulation and management; Stage 4: research accessibility and Stage 5: research reporting and publishing. Along the stages of the research cycle, varied initiatives exist to improve the quality and added value of nutrition research. However, efforts are focused on single stages of the research cycle without vision of the research system as a whole. Although research on nutrition research has been limited, it has potential to improve the quality of nutrition research and develop new tools and instruments for this purpose. A comprehensive assessment of the magnitude of research waste in nutrition and consensus on priority actions is needed. The nutrition research community at large needs to have open discussions on the usefulness of these tools and lead suitable efforts to enhance nutrition research across the stages of the research cycle. Capacity building is essential and considerations of nutrition research quality are vital to be integrated in training efforts of nutrition researchers.
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Motani P, Van de Walle A, Aryeetey R, Verstraeten R. Lessons learned from Evidence-Informed Decision-Making in Nutrition & Health (EVIDENT) in Africa: a project evaluation. Health Res Policy Syst 2019; 17:12. [PMID: 30704528 PMCID: PMC6357392 DOI: 10.1186/s12961-019-0413-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 01/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Evidence-informed Decision-making in Nutrition and Health (EVIDENT) is an international partnership that seeks to identify information needs in nutrition and health in Africa and build local capacity in knowledge management to help translate the best available evidence into context-appropriate recommendations aligned to the priorities of decision-makers. This study evaluates the extent to which EVIDENT achieved its intended activities, documents the lessons learned and draws on these lessons learned to inform future activities of EVIDENT, as well as in evidence-informed decision-making (EIDM) in nutrition overall. Methods Purposive and snowball sampling were used to identify participants that were either directly or indirectly involved with EVIDENT. An analytical framework of five key elements was developed to guide data collection from EVIDENT’s documentation, in-depth interviews (n = 20), online surveys (n = 26) and a participatory discussion. Interviews were transcribed verbatim and coded in NVivo 11, using deductive thematic content analysis and a phenomenological approach. Online surveys were analysed using Stata 14. Data were triangulated to address both objectives under each element of the analytical framework. Results EVIDENT succeeded in establishing a collaborative partnership, within which it delivered four short courses in EIDM. This capacity complemented case study activities in four partner African countries where EIDM processes were implemented and assessed. Identified barriers to these processes included little experience in EIDM, difficulties in engaging stakeholders, challenging local environments (e.g. donor influence, bureaucracy, inaccessibility to scientific research, poor internet connectivity), and limited time and funding. However, EVIDENT activities were driven by a local need for EIDM, a sheer interest and commitment to the cause, and the opportunity for the Global North and South to work together and build relationships. Future activities of EVIDENT, and EIDM in nutrition overall, should focus on sustained capacity-building in EIDM processes, leadership and functional skills across the Global South, investment in stakeholder engagement, context-specific EIDM, enhanced communication and linking, and strengthening relationships with existing stakeholder organisations. Conclusions In its first 3 years, EVIDENT developed and strengthened partnership, capacity and visibility on EIDM in Africa. Innovative and long-term capacity-building, dedicated leadership, further stakeholder engagement and sustainable financing, are needed for future activities of EVIDENT and EIDM in nutrition. Electronic supplementary material The online version of this article (10.1186/s12961-019-0413-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pankti Motani
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Independent Researcher, Antwerp, Belgium
| | - Anais Van de Walle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Richmond Aryeetey
- Department of Population, Family and Reproductive Health, University of Ghana, Accra, Ghana.
| | - Roosmarijn Verstraeten
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Independent Researcher, Antwerp, Belgium
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Rodríguez-González GL, Castro-Rodríguez DC, Zambrano E. Pregnancy and Lactation: A Window of Opportunity to Improve Individual Health. Methods Mol Biol 2018; 1735:115-144. [PMID: 29380310 DOI: 10.1007/978-1-4939-7614-0_7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Human and animal studies indicate that obesity during pregnancy adversely impacts both maternal health and offspring phenotype predisposing them to chronic diseases later in life including obesity, dyslipidemia, type 2 diabetes mellitus, and hypertension. Effective interventions during human pregnancy and/or lactation are needed to improve both maternal and offspring health. This review addresses the relationship between adverse perinatal insults and its negative impact on offspring development and presents some maternal intervention studies such as diet modification, probiotic consumption, or maternal exercise, to prevent or alleviate the negative outcomes in both the mother and her child.
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Affiliation(s)
- Guadalupe L Rodríguez-González
- Reproductive Biology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Diana C Castro-Rodríguez
- Reproductive Biology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Elena Zambrano
- Reproductive Biology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Abstract
Current debates about precision medicine take different perspectives on its relevance and value in global health. The term has not yet been applied to disaster medicine or humanitarian health, but it may hold significant value. An interpretation of the term for global public health and disaster medicine is presented here for application to vulnerable populations. Embracing the term may drive more efficient use and targeting of limited resources while encouraging innovation and adopting the new approaches advocated in current humanitarian discourse. PatelRB. Precision health in disaster medicine and global public health. Prehosp Disaster Med. 2018;33(6):565-566.
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Visser J, McLachlan MH, Maayan N, Garner P. Community-based supplementary feeding for food insecure, vulnerable and malnourished populations - an overview of systematic reviews. Cochrane Database Syst Rev 2018; 11:CD010578. [PMID: 30480324 PMCID: PMC6517209 DOI: 10.1002/14651858.cd010578.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Supplementary feeding may help food insecure and vulnerable people by optimising the nutritional value and adequacy of the diet, improving quality of life and improving various health parameters of disadvantaged families. In low- and middle-income countries (LMIC), the problems supplementary feeding aims to address are entangled with poverty and deprivation, the programmes are expensive and delivery is complicated. OBJECTIVES 1. To summarise the evidence from systematic reviews of supplementary feeding for food insecure, vulnerable and malnourished populations, including children under five years of age, school-aged children, pregnant and lactating women, people with HIV or tuberculosis (or both), and older populations.2. To describe and explore the effects of supplementary feeding given to people in these groups, and to describe the range of outcomes between reviews and range of effects in the different groups. METHODS In January 2017, we searched the Cochrane Database of Systematic Reviews, MEDLINE, Embase and nine other databases. We included systematic reviews evaluating community-based supplementary feeding, and concerning food insecure, vulnerable and malnourished populations. Two review authors independently undertook selection of systematic reviews, data extraction and 'Risk of bias' assessment. We assessed review quality using the AMSTAR tool, and used GRADEpro 'Summary of findings' tables from each review to indicate the certainty of the evidence for the main comparisons. We summarised review findings in the text and reported the data for each outcome in additional tables. We also used forest plots to display results graphically. MAIN RESULTS This overview included eight systematic reviews (with last search dates between May 2006 and February 2016). Seven were Cochrane Reviews evaluating interventions in pregnant women; children (aged from birth to five years) from LMIC; disadvantaged infants and young children (aged three months to five years); children with moderate acute malnutrition (MAM); disadvantaged school children; adults and children who were HIV positive or with active tuberculosis (with or without HIV). One was a non-Cochrane systematic review in older people with Alzheimer's disease. These reviews included 95 trials relevant to this overview, with the majority (74%) of participants from LMIC.The number of included participants varied between 91 and 7940 adults, and 271 and more than 12,595 children. Trials included a wide array of nutritional interventions that varied in duration, frequency and format, with micronutrients often reported as cointerventions. Follow-up ranged from six weeks to two years; three trials investigated outcomes at four to 17 years of age. All reviews were rated as high quality (AMSTAR score between eight and 11). The GRADE certainty ratings ranged from very low to moderate for individual comparisons, with the evidence often comprising only one or two small trials, thereby resulting in many underpowered analyses (too small to detect small but important differences). The main outcome categories reported across reviews were death, anthropometry (adults and children) and other markers of nutritional status, disease-related outcomes, neurocognitive development and psychosocial outcomes, and adverse events.Mortality data were limited and underpowered in meta-analysis in all populations (children with MAM, in children with HIV, and in adults with tuberculosis) with the exception of balanced energy and protein supplementation in pregnancy, which may have reduced the risk of stillbirth (risk ratio (RR) 0.60, 95% confidence interval (CI) 0.39 to 0.94; 5 trials, 3408 women). Supplementation in pregnancy also improved infant birth weight (mean difference (MD) 40.96 g, 95% CI 4.66 to 77.26; 11 trials, 5385 participants) and reduced risk of infants born small-for-gestational age (RR 0.79, 95% CI 0.69 to 0.90; 7 trials, 4408 participants). These effects did not translate into demonstrable long-term benefits for children in terms of growth and neurocognitive development in the one to two trials reporting on longer-term outcomes. In one study (505 participants), high-protein supplementation was associated with increased risk of small-for-gestational age babies.Effects on growth in children were mixed. In children under five years of age from LMIC, one review found that supplementary feeding had a little or no effect on child growth; however, a more recent review in a similar population found that those who received food supplementation gained an average of 0.12 kg more in weight (MD 0.12 kg, 95% CI 0.05 to 0.18; 9 trials, 1057 participants) and 0.27 cm more in height (MD 0.27 cm, 95% CI 0.07 to 0.48; 9 trials, 1463 participants) than those who were not supplemented. Supplementary food was generally more effective for younger children (younger than two years of age) and for those who were poorer or less well-nourished. In children with MAM, the provision of specially formulated food improved their weight, weight-for-height z scores and other key outcomes such as recovery rate (by 29%), as well as reducing the number of participants dropping out (by 70%). In LMIC, school meals seemed to lead to small benefits for children, including improvements in weight z scores, especially in children from lower-income countries, height z scores, cognition or intelligence quotient tests, and maths and spelling performance.Supplementary feeding in adults who were HIV positive increased the daily energy and protein intake compared to nutritional counselling alone. Supplementation led to an initial improvement in weight gain or body mass index but did not seem to confer long-term benefit.In adults with tuberculosis, one small trial found a significant benefit on treatment completion and sputum conversion rate. There were also significant but modest benefits in terms of weight gain (up to 2.60 kg) during active tuberculosis.The one study included in the Alzheimer's disease review found that three months of daily oral nutritional supplements improved nutritional outcomes in the intervention group.There was little or no evidence regarding people's quality of life, adherence to treatment, attendance at clinic or the costs of supplementary feeding programmes. AUTHORS' CONCLUSIONS Considering the current evidence base included, supplementary food effects are modest at best, with inconsistent and limited mortality evidence. The trials reflected in the reviews mostly reported on short-term outcomes and across the whole of the supplementation trial literature it appears important outcomes, such as quality of life and cost of programmes, are not systematically reported or summarised.
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Affiliation(s)
- Janicke Visser
- Stellenbosch UniversityDivision of Human NutritionFrancie van Zijl DriveCape TownWestern CapeSouth Africa7505
| | - Milla H McLachlan
- Stellenbosch UniversityDivision of Human NutritionFrancie van Zijl DriveCape TownWestern CapeSouth Africa7505
| | - Nicola Maayan
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Paul Garner
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolMerseysideUKL3 5QA
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Bump JB. Undernutrition, obesity and governance: a unified framework for upholding the right to food. BMJ Glob Health 2018; 3:e000886. [PMID: 30364379 PMCID: PMC6195135 DOI: 10.1136/bmjgh-2018-000886] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/13/2018] [Accepted: 06/16/2018] [Indexed: 11/10/2022] Open
Abstract
This paper addresses the need for conceptual and analytic clarity on nutrition governance, an essential underpinning of more effective approaches for undernutrition, the 'single greatest constraint to global development' and obesity, which already accounts for 4% of the world's disease burden and is growing rapidly. The governance of nutrition, which is essential to designing and implementing policies to realise the right to food, is among the most important and most defining duties of society. But research and action on nutrition governance are hampered by the absence of conceptual rigour, even as the continuing very high burden of undernutrition and the rapid rise in obesity highlight the need for such structures. The breadth of nutrition itself suggests that governance is both needed and sure to be complicated. This analysis explores the reasons attention has come to governance in development policy making, and why it has focused on nutrition governance in particular. It then assesses how the concept of nutrition governance has been used, finding that it has become increasingly prominent in scholarship on poor nutritional outcomes, but remains weakly specified and is invoked by different authors to mean different things. Undernutrition analysts have stressed coordination problems and structural issues related to the general functioning of government. Those studying obesity have emphasised international trade policies, regulatory issues and corporate behaviour. This paper argues that the lack of a clear, operational definition of governance is a serious obstacle to conceptualising and solving major problems in nutrition. To address this need, it develops a unified definition of nutrition governance consisting of three principles: accountability, participation and responsiveness. These are justified with reference to the social contract that defines modern nations and identifies citizens as the ultimate source of national power and legitimacy. A unified framework is then employed to explore solutions to nutrition governance problems.
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Affiliation(s)
- Jesse B Bump
- Department of Global Health and Population, Takemi Program in International Health, and FXB Center for Health and Human Rights, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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Kumera G, Gedle D, Alebel A, Feyera F, Eshetie S. Undernutrition and its association with socio-demographic, anemia and intestinal parasitic infection among pregnant women attending antenatal care at the University of Gondar Hospital, Northwest Ethiopia. Matern Health Neonatol Perinatol 2018; 4:18. [PMID: 30214818 PMCID: PMC6134711 DOI: 10.1186/s40748-018-0087-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background Under nutrition is a worldwide public health problem affecting the well-being of millions of pregnant women in the developing world. Only limited research has been conducted on the prevalence and determinants of maternal nutritional status in Ethiopia. Particularly, data on the nutritional status of pregnant women are lacking. The aim of this study was to assess the prevalence and determinants of undernutrition among pregnant women attending antenatal care at the University of Gondar Hospital, Northwest Ethiopia. Methods An institution based cross-sectional study was conducted in January and February 2016. Randomly selected 409 pregnant women were included in the study. Nutritional status was estimated using mid-upper-arm circumference. Data on potential determinants of undernutrition were gathered using a structured questionnaire. The blood sample was collected to analyze hemoglobin. The stool sample was collected to identify intestinal parasitic infections. Statistical analysis was done using logistic regression. P-value < 0.05 at 95% confidence interval was considered as statistically significant. Results The prevalence of undernutrition among pregnant women was 16.2% (95% CI: 12.4-20.1%). Using a logistic regression model, factors significantly associated with the undernutrition were living in rural areas (AOR = 2.26), low educational status [no formal education (AOR = 2.91), primary education (AOR = 2.69)], history of too many births (AOR = 2.55), anemia (AOR = 2.01), and intestinal parasitic infection (AOR = 2.73). Conclusion The study findings provide evidence for the public health significance of under nutrition among pregnant women in the study area. The problem must be combated through rural livelihood promotion, socioeconomic empowerment of women, sustained nutrition education and expansion of family-planning services in the area.
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Affiliation(s)
- Gemechu Kumera
- 1Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Dereje Gedle
- 1Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Animut Alebel
- 2Department of Nursing, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Fetuma Feyera
- 2Department of Nursing, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Setegn Eshetie
- 3School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Abera L, Dejene T, Laelago T. Magnitude of stunting and its determinants in children aged 6-59 months among rural residents of Damot Gale district; southern Ethiopia. BMC Res Notes 2018; 11:557. [PMID: 30075824 PMCID: PMC6076418 DOI: 10.1186/s13104-018-3666-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/01/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The objective of this study is assessing magnitude of stunting and its predictors among children aged 6-59 months in Damot Gale district, South Ethiopia. Community based cross sectional study was done at Damot Gale district. About 398 children aged 6-59 months were included in the study. Kebele (small administrative unit) and household were chosen by two-phase cluster sample design. Structured questionnaire was used to gather the data. Anthropometric measurement was also used to get the data. SPSS version 20 was used to analysis the data. RESULTS About 41.7% of children were stunted. Children aged 36-47 months [AOR 6.22; 95% CI (1.81-21.36)], and 48-59 months [AOR 7.27; 95% CI (1.22-43.19)], sex of the child [AOR 20.79; 95% CI (7.50-57.65)], birth order [AOR 6.42; 95% CI (1.68-24.48)], mother education [AOR 0.06; 95% CI (0.02-0.14)], having toilet facility [AOR 0.059; 95% CI (0.02-0.18)], washing hand by soap [AOR 16.21; 95% CI (5.11-51.4)] and ANC [AOR 0.045; 95% CI (0.01-0.13)] were associated with stunting.
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Affiliation(s)
| | - Tariku Dejene
- Department of Population Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tariku Laelago
- Department of Health Information Technology, Hossana College of Health Science, P.O. Box 159, Hossana, Ethiopia
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Georgieff MK, Ramel SE, Cusick SE. Nutritional influences on brain development. Acta Paediatr 2018; 107:1310-1321. [PMID: 29468731 PMCID: PMC6045434 DOI: 10.1111/apa.14287] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/12/2018] [Accepted: 02/16/2018] [Indexed: 12/19/2022]
Abstract
There is increasing evidence from preclinical and human studies that nutrition in the late foetal and early neonatal period has a significant impact on neurodevelopment across the lifespan. Certain nutrients have particularly large effects in this time period, and their deficits cause greater long-term risk. The mechanisms by which nutrients influence early brain growth and the sensitive periods for when certain nutrients should be provided are being elucidated. Assessments of nutritional status that index brain growth and predict long-term development are important to assess the efficacy of early life nutritional therapies. CONCLUSION Optimizing nutrition during foetal and early postnatal life is a golden opportunity to impact neurodevelopment and brain function across the lifespan.
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Affiliation(s)
- Michael K. Georgieff
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Sara E. Ramel
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Sarah E. Cusick
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
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Agovino M, Cerciello M, Gatto A. Policy efficiency in the field of food sustainability. The adjusted food agriculture and nutrition index. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2018; 218:220-233. [PMID: 29680754 DOI: 10.1016/j.jenvman.2018.04.058] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 03/29/2018] [Accepted: 04/12/2018] [Indexed: 06/08/2023]
Abstract
This work introduces a revised version of the Food Sustainability Index, proposed by the Economist Intelligence Unit and the Barilla Center for Food and Nutrition in 2016. Our Adjusted Food Sustainability Index features two important advantages: 1) it employs the Mazziotta-Pareto method to compute weights, hence granting an objective aggregation criterion and 2) it does not take policy variables into account, thus focusing on the status quo. The policy variables are aggregated into the Policy Index, measuring the quality of the food sustainability policies. We compute the two indices for 25 countries worldwide, then we use the Data Envelopment Analysis to evaluate policy efficiency. Our results show that country-level variation in policy efficiency is wide and policies affect food sustainability significantly, especially when they target nutritional challenges.
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Affiliation(s)
- Massimiliano Agovino
- Department of Economic & Legal Studies, University of Naples Parthenope, Room 510, Palazzo Pacanowski, Via Generale Parisi, 13 80132, Napoli, Italy.
| | - Massimiliano Cerciello
- Department of Economic & Legal Studies, University of Naples Parthenope, Room 510, Palazzo Pacanowski, Via Generale Parisi, 13 80132, Napoli, Italy.
| | - Andrea Gatto
- Department of Economic & Legal Studies, University of Naples Parthenope, Room 510, Palazzo Pacanowski, Via Generale Parisi, 13 80132, Napoli, Italy.
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Ruducha J, Mann C, Singh NS, Gemebo TD, Tessema NS, Baschieri A, Friberg I, Zerfu TA, Yassin M, Franca GA, Berman P. How Ethiopia achieved Millennium Development Goal 4 through multisectoral interventions: a Countdown to 2015 case study. LANCET GLOBAL HEALTH 2018; 5:e1142-e1151. [PMID: 29025635 PMCID: PMC5640803 DOI: 10.1016/s2214-109x(17)30331-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/26/2017] [Accepted: 08/08/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND 3 years before the 2015 deadline, Ethiopia achieved Millennium Development Goal 4. The under-5 mortality decreased 69%, from 205 deaths per 1000 livebirths in 1990 to 64 deaths per 1000 livebirths in 2013. To understand the underlying factors that contributed to the success in achieving MDG4, Ethiopia was selected as a Countdown to 2015 case study. METHODS We used a set of complementary methods to analyse progress in child health in Ethiopia between 1990 and 2014. We used Demographic Health Surveys to analyse trends in coverage and equity of key reproductive, maternal health, and child health indicators. Standardised tools developed by the Countdown Health Systems and Policies working group were used to understand the timing and content of health and non-health policies. We assessed longitudinal trends in health-system investment through a financial analysis of National Health Accounts, and we used the Lives Saved Tool (LiST) to assess the contribution of interventions towards reducing under-5 mortality. FINDINGS The annual rate of reduction in under-5 mortality increased from 3·3% in 1990-2005 to 7·8% in 2005-13. The prevalence of stunting decreased from 60% in 2000 to 40% in 2014. Overall levels of coverage of reproductive, maternal health, and child health indicators remained low, with disparities between the lowest and highest wealth quintiles despite improvement in coverage for essential health interventions. Coverage of child immunisation increased the most (21% of children in 2000 vs 80% of children in 2014), followed by coverage of satisfied demand for family planning by women of reproductive age (19% vs 63%). Provision of antenatal care increased from 10% of women in 2000 to 32% of women in 2014, but only 15% of women delivered with a skilled birth attendant by 2014. A large upturn occurred after 2005, bolstered by a rapid increase in health funding that facilitated the accelerated expansion of health infrastructure and workforce through an innovative community-based delivery system. The LiST model could explain almost 50% of the observed reduction in child mortality between 2000 and 2011; and changes in nutritional status were responsible for about 50% of the 469 000 lives saved between 2000 and 2011. These developments occurred within a multisectoral policy platform, integrating child survival and stunting goals within macro-level policies and programmes for reducing poverty and improving agricultural productivity, food security, water supply, and sanitation. INTERPRETATION The reduction of under-5 mortality in Ethiopia was the result of combined activities in health, nutrition, and non-health sectors. However, Ethiopia still has high neonatal and maternal morbidity and mortality from preventable causes and an unfinished agenda in reducing inequalities, improving coverage of effective interventions, and strengthening multisectoral partnerships for further progress. FUNDING Bill & Melinda Gates Foundation and Government of Canada.
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Affiliation(s)
| | - Carlyn Mann
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Neha S Singh
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Tsegaye D Gemebo
- School of Public Health, Woliata Sodo University, Woliata Sodo, SNNPR, Ethiopia
| | | | - Angela Baschieri
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Taddese A Zerfu
- Maternal and Child Health Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Mohammed Yassin
- Amhara Regional Health Bureau, South Wollo and Dessie City, Ethiopia
| | | | - Peter Berman
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
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Du Plessis LM, McLachlan MH, Drimie SE. What does an enabling environment for infant and young child nutrition look like at implementation level? Perspectives from a multi-stakeholder process in the Breede Valley Sub-District, Western Cape, South Africa. BMC Public Health 2018; 18:240. [PMID: 29433498 PMCID: PMC5809892 DOI: 10.1186/s12889-018-5165-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 02/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breede Valley is a sub-district of the Cape Winelands district, Western Cape Province, South Africa. The administrative capital of the district is situated in the semi-rural town Worcester. Findings of a baseline survey in Worcester revealed poor infant feeding practices and childhood under- and overnutrition, with particular concern over high levels of stunting and low dietary diversity. Maternal overweight and obesity was high. These characteristics made the site suitable to study multi-sectoral arrangements for infant and young child nutrition (IYCN). The purpose of this study was to explore elements of an enabling environment with key stakeholders aimed at improving IYCN at implementation level. METHODS Focus group discussions and interviews were conducted with representatives from two vulnerable communities; local and district government; higher education institutions; business; and the media in the Breede Valley. Audio recordings were transcribed and data were analysed with the Atlas.TI software programme. RESULTS The participants viewed knowledge and evidence about the first 1000 days of life as important to address IYCN. The impact of early, optimal nutrition on health and intellectual development resonated with them. The IYCN narrative in the Breede Valley could therefore be framed around nutrition's development impact in a well-structured advocacy campaign. Participants felt that capacity and resources were constrained by many competing agendas spreading public resources thinly, leaving limited scope for promotion and prevention activities. "People" were viewed as a resource, and building partnerships and relationships, could bridge some shortfalls in capacity. Conversations about politics and governance elicited strong opinions about what should be done through direct intervention, policy formulation and legislation. A lead government agency could not be identified for taking the IYCN agenda forward, due to its complexity. Participants proposed it should be referred to a local, informal, inter-governmental body where directors and senior managers meet to address issues of cross-cutting importance. CONCLUSION The study illustrated that knowledge and evidence; politics and governance; and capacity and resources, elements of the international definition of an enabling environment, also apply at implementation level. In addition, our findings indicated that a people-centred approach is critical in shaping the enabling environment at this level.
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Affiliation(s)
- L M Du Plessis
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, CAPE TOWN, 8000, South Africa.
| | - M H McLachlan
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, CAPE TOWN, 8000, South Africa
| | - S E Drimie
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, CAPE TOWN, 8000, South Africa
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Baker P, Hawkes C, Wingrove K, Demaio AR, Parkhurst J, Thow AM, Walls H. What drives political commitment for nutrition? A review and framework synthesis to inform the United Nations Decade of Action on Nutrition. BMJ Glob Health 2018; 3:e000485. [PMID: 29527338 PMCID: PMC5841521 DOI: 10.1136/bmjgh-2017-000485] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Generating country-level political commitment will be critical to driving forward action throughout the United Nations Decade of Action on Nutrition (2016-2025). In this review of the empirical nutrition policy literature, we ask: what factors generate, sustain and constrain political commitment for nutrition, how and under what circumstances? Our aim is to inform strategic 'commitment-building' actions. METHOD We adopted a framework synthesis method and realist review protocol. An initial framework was derived from relevant theory and then populated with empirical evidence to test and modify it. Five steps were undertaken: initial theoretical framework development; search for relevant empirical literature; study selection and quality appraisal; data extraction, analysis and synthesis and framework modification. RESULTS 75 studies were included. We identified 18 factors that drive commitment, organised into five categories: actors; institutions; political and societal contexts; knowledge, evidence and framing; and, capacities and resources. Irrespective of country-context, effective nutrition actor networks, strong leadership, civil society mobilisation, supportive political administrations, societal change and focusing events, cohesive and resonant framing, and robust data systems and available evidence were commitment drivers. Low-income and middle-income country studies also frequently reported international actors, empowered institutions, vertical coordination and capacities and resources. In upper-middle-income and high-income country studies, private sector interference frequently undermined commitment. CONCLUSION Political commitment is not something that simply exists or emerges accidentally; it can be created and strengthened over time through strategic action. Successfully generating commitment will likely require a core set of actions with some context-dependent adaptations. Ultimately, it will necessitate strategic actions by cohesive, resourced and strongly led nutrition actor networks that are responsive to the multifactorial, multilevel and dynamic political systems in which they operate and attempt to influence. Accelerating the formation and effectiveness of such networks over the Nutrition Decade should be a core task for all actors involved.
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Affiliation(s)
- Phillip Baker
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Corinna Hawkes
- Centre for Food Policy, City University London, London, UK
| | - Kate Wingrove
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Alessandro Rhyl Demaio
- Department of Nutrition for Health and Development, World Health Organisation, Geneva, Switzerland
| | - Justin Parkhurst
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Anne Marie Thow
- Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
| | - Helen Walls
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Leverhulme Centre for Integrated Research on Agriculture and Health, London, UK
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Gizaw Z, Woldu W, Bitew BD. Acute malnutrition among children aged 6-59 months of the nomadic population in Hadaleala district, Afar region, northeast Ethiopia. Ital J Pediatr 2018; 44:21. [PMID: 29415750 PMCID: PMC5803907 DOI: 10.1186/s13052-018-0457-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/16/2018] [Indexed: 01/12/2023] Open
Abstract
Background Acute malnutrition to be a major health burden in the world, particularly in the developing world. Acute malnutrition is associated with more than one third of the global disease burden for children. Malnourished children are physically, emotionally and intellectually less productive and suffer more from chronic illnesses and disabilities. The nature, magnitude and determinants of acute malnutrition are determined among the general populations; however, there is a lack of evidence in the nomadic communities. Methods A cross-sectional study was conducted to assess the magnitude and factors associated with acute malnutrition among children aged 6–59 months in Hadaleala district, Afar Region. A total of 591 under-five children were included in this study, and subjects were recruited by the multistage cluster sampling technique. Data were collected by a pre-tested questionnaire and a simple anthropometric index so called mid-upper arm circumference (MUAC). The multivariable binary logistic regression analysis was used to identify factors associated with acute malnutrition on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p < 0.05. Results The prevalence of acute malnutrition was 11.8% (95% CI = 9.3, 14.8%). The highest prevalence (50%) of acute malnutrition occurred among children aged between 12.0–23.0 months. Childhood acute malnutrition was associated with the presence of two (AOR = 2.49, p < 0.05) and three (AOR = 12.87, p < 0.001) children in each household, unprotected drinking water sources (AOR = 3.78, p < 0.05), absence of the latrine (AOR = 5.24, p < 0.05), hand washing with soap (AOR = 0.21, p < 0.05), childhood diarrheal disease (AOR = 2.72, p < 0.05), and child vaccination (AOR = 0.15, p < 0.001). Conclusion The prevalence of acute malnutrition among children aged 6-59 months was was higher than the national prevalence. The number of children in each household, drinking water sources, latrine availability, hand washing practice before food preparation and child feeding, childhood diarrheal disease, and child vaccination were identified as factors affecting the childhood acute malnutrition in the nomadic community. Protecting drinking water sources from possible contaminants, improving hand washing practices, utilization of latrine, preventing diarrheal diseases and vaccinating children integrated with the access of nutrition education is important to improve nutrition of children of the nomadic people.
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Affiliation(s)
- Zemichael Gizaw
- Department of Environmental and Occupational Health and Safety, University of Gondar, Gondar, Ethiopia.
| | - Wondwoson Woldu
- Hadaleala District Health Office, Hadaleala District, Afar Regional State, Ethiopia
| | - Bikes Destaw Bitew
- Department of Environmental and Occupational Health and Safety, University of Gondar, Gondar, Ethiopia
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Aglago EK, Landais E, Zotor F, Nicolas G, Gunter MJ, Amuna P, Slimani N. Optimising design and cost-effective implementation of future pan-African dietary studies: a review of existing economic integration and nutritional indicators for scenario-based profiling and clustering of countries. Proc Nutr Soc 2018; 77:84-93. [PMID: 29241474 DOI: 10.1017/s0029665117004141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Most of the African countries are undergoing a complex nutrition and epidemiologic transition associated with a rapid increase in the prevalence of diverse non-communicable diseases. Despite this alarming situation, the still limited and fragmented resources available in Africa impede the implementation of effective action plans to tackle the current and projected diet-disease burden. In order to address these common needs and challenges, the African Union is increasingly supporting continental approaches and strategies as reflected in the launching of the Agenda 2063 and the African regional nutrition strategy 2015-2025, among others. To assure the successful implementation of pan-African nutritional and health initiatives, cost-effective approaches considering similarities/disparities in economy, regional integration, development and nutritional aspects between countries are needed. In the absence of pre-existing models, we reviewed regional economic integration and nutritional indicators (n 13) available in international organisations databases or governmental agencies websites, for fifty-two African countries. These indicators were used to map the countries according to common languages (e.g. Arabic, English, French, Portuguese), development status (e.g. human development index), malnutrition status (e.g. obesity) and diet (e.g. staples predominantly based on either cereals or tubers). The review of the indicators showed that there exist similarities between African countries that can be exploited to benefit the continent with cross-national experiences in order to avoid duplication of efforts in the implementation of future pan-African health studies. In addition, including present and future nutrition surveillance programmes in Africa into national statistical systems might be cost-effective and sustainable in the longer term.
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Affiliation(s)
- Elom K Aglago
- International Agency for Research on Cancer (IARC/WHO),Lyon,France
| | - Edwige Landais
- UMR 204 'Nutripass' IRD,University of Montpellier,SupAgro,Montpellier,France
| | - Francis Zotor
- University of Health and Allied Sciences,Ho,Volta Region,Ghana
| | | | - Marc J Gunter
- International Agency for Research on Cancer (IARC/WHO),Lyon,France
| | - Paul Amuna
- Research Section,Primary Health Care Corporation,Doha,Qatar
| | - Nadia Slimani
- International Agency for Research on Cancer (IARC/WHO),Lyon,France
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Vaillancourt A, Tatham P, Wu Y, Haavisto I. Humanitarian health project supply chain costs. SUPPLY CHAIN FORUM 2017. [DOI: 10.1080/16258312.2017.1394775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Alain Vaillancourt
- Business Administration, Jönköping International Business School, Jönköping, Sweden
| | - Peter Tatham
- International Business and Asian Studies, Griffith University, Gold Coast, Australia
| | - Yong Wu
- International Business and Asian Studies, Griffith University, Gold Coast, Australia
| | - Ira Haavisto
- Supply Chain Management and Social Responsibility, Hanken School of Economics, Helsinki, Finland
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Pelletier D, Gervais S, Hafeez-Ur-Rehman H, Sanou D, Tumwine J. Boundary-spanning actors in complex adaptive governance systems: The case of multisectoral nutrition. Int J Health Plann Manage 2017; 33:e293-e319. [PMID: 29024002 PMCID: PMC5900925 DOI: 10.1002/hpm.2468] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 11/05/2022] Open
Abstract
A growing literature highlights complexity of policy implementation and governance in global health and argues that the processes and outcomes of policies could be improved by explicitly taking this complexity into account. Yet there is a paucity of studies exploring how this can be achieved in everyday practice. This study documents the strategies, tactics, and challenges of boundary‐spanning actors working in 4 Sub‐Saharan Africa countries who supported the implementation of multisectoral nutrition as part of the African Nutrition Security Partnership in Burkina Faso, Mali, Ethiopia, and Uganda. Three action researchers were posted to these countries during the final 2 years of the project to help the government and its partners implement multisectoral nutrition and document the lessons. Prospective data were collected through participant observation, end‐line semistructured interviews, and document analysis. All 4 countries made significant progress despite a wide range of challenges at the individual, organizational, and system levels. The boundary‐spanning actors and their collaborators deployed a wide range of strategies but faced significant challenges in playing these unconventional roles. The study concludes that, under the right conditions, intentional boundary spanning can be a feasible and acceptable practice within a multisectoral, complex adaptive system in low‐ and middle‐income countries.
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Affiliation(s)
- David Pelletier
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Suzanne Gervais
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | | | - Dia Sanou
- Subregional Office for Eastern Africa, FAO, Addis Ababa, South Africa
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50
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Chalashika P, Essex C, Mellor D, Swift JA, Langley-Evans S. Birthweight, HIV exposure and infant feeding as predictors of malnutrition in Botswanan infants. J Hum Nutr Diet 2017; 30:779-790. [PMID: 28960594 DOI: 10.1111/jhn.12517] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND A better understanding of the nutritional status of infants who are HIV-Exposed-Uninfected (HEU) and HIV-Unexposed-Uninfected (HUU) during their first 1000 days is key to improving population health, particularly in sub-Saharan Africa. METHODS A cross-sectional study compared the nutritional status, feeding practices and determinants of nutritional status of HEU and HUU infants residing in representative selected districts in Botswana during their first 1000 days of life. Four hundred and thirteen infants (37.3% HIV-exposed), aged 6-24 months, attending routine child health clinics, were recruited. Anthropometric, 24-h dietary intake and socio-demographic data was collected. Anthropometric Z-scores were calculated using 2006 World Health Organization growth standards. Modelling of the determinants of malnutrition was undertaken using logistic regression. RESULTS Overall, the prevalences of stunting, wasting and being underweight were 10.4%, 11.9% and 10.2%, respectively. HEU infants were more likely to be underweight (15.6% versus 6.9%), (P < 0.01) and stunted (15.6% versus 7.3%), (P < 0.05) but not wasted (P = 0.14) than HUU infants. HEU infants tended to be formula fed (82.5%), whereas HUU infants tended to breastfeed (94%) for the first 6 months (P < 0.001). Significant predictors of nutritional status were HIV exposure, birthweight, birth length, APGAR (appearance, pulse, grimace, activity and respiration) score and mother/caregiver's education with little influence of socio-economic status. CONCLUSIONS HEU infants aged 6-24 months had worse nutritional status compared to HUU infants. Low birthweight was the main predictor of undernutrition in this population. Optimisation of infant nutritional status should focus on improving birthweight. In addition, specific interventions should target HEU infants aiming to eliminate growth disparity between HEU and HUU infants.
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Affiliation(s)
- P Chalashika
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Loughborough, UK
| | - C Essex
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Loughborough, UK
| | - D Mellor
- School of Life Sciences, Coventry University, Coventry, UK
| | - J A Swift
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Loughborough, UK
| | - S Langley-Evans
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Loughborough, UK
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