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Endawkie A, Asmare L, Alemu HT, Geberu DM, Hagos A, Jejaw M, Abera KM, Tiruneh MG, Demissie KA, Tsega Y, Yeshambel Belay A, Negash WD, Workie AM, Yohannes L, Getnet M, Worku N. Trend and determinants of minimum dietary diversity consumption change among children aged 6-23 months in Ethiopia from 2011 to 2019: A multivariate decomposition analysis. PLoS One 2024; 19:e0308349. [PMID: 39093880 PMCID: PMC11296628 DOI: 10.1371/journal.pone.0308349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 06/21/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Sustainable Development Goals 2 target 2.2 aimed to end all forms of malnutrition by 2030. However, the prevalence of inadequate minimum dietary diversity (MDD) is high in Ethiopia and the evidence of trends and determinants of MDD consumption change among children over time is limited. Therefore, this study aimed to determine trends and determinants of MDD consumption change among children aged 6 to 23 months in Ethiopia from 2011-2019 Demographic and Health Survey (DHS) data. METHOD The study used the data on nationally representative weighted samples of 6,971, 7,467, and 3,154 children aged 6-23 months from the 2011, 2016, and 2019 rounds of the DHS. Trend and Multivariate Decomposition analysis was conducted to determine MDD consumption change from 2011-2016, and 2016-2019 into two components: one that was explained by differences in the level of the determinants (endowment), and the other component was explained by differences in the effect of the covariates on the outcome (coefficient effects). RESULT The trends analysis showed that adequate MDD consumption significantly increased from 2% to 10.41% from 2011 to 2016 but decreased from 10.41% to 7.11% from 2016 to 2019 in Ethiopia. The compositional and behavioral change factors like maternal age, occupational status of parents, sex of the household head, wealth index, residence, and sex of child statistically contributed to changes in MDD consumption from 2011 to 2016, and from 2016 to 2019 at p-value <0.05. CONCLUSION The trend of minimum dietary diversity consumption among children aged 6 to 23 months in Ethiopia increased from 2011-2016 and decreased from 2016-2019 in the last decade. The study revealed that the changes in behavioral response and population composition contributed to MDD consumption change among children in Ethiopia. The finding highlights the urgent need for targeted interventions and policies to address the issue of MDD consumption change among young children due to population structure changes like wealth status, residence, and behavioral response related to employment, household head, and sex of the child in Ethiopia. Therefore, efforts should be geared to reduce poverty and improve maternal employment status, particularly for women, by producing equitable economic opportunities.
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Affiliation(s)
- Abel Endawkie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Lakew Asmare
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Hiwot Tadesse Alemu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Demiss Mulatu Geberu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Asebe Hagos
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Melak Jejaw
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Kaleab Mesfin Abera
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Misganawu Guadie Tiruneh
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Kaleb Assegid Demissie
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yawkal Tsega
- Department of Health Systems Management and Policy, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Adina Yeshambel Belay
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Amare Mesfin Workie
- Department of Nutrition, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Lamrot Yohannes
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mihret Getnet
- Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Nigusu Worku
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Tran LM, Nguyen PH, Young MF, Martorell R, Ramakrishnan U. The relationships between optimal infant feeding practices and child development and attained height at age 2 years and 6-7 years. MATERNAL & CHILD NUTRITION 2024; 20:e13631. [PMID: 38450914 PMCID: PMC11168365 DOI: 10.1111/mcn.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/31/2023] [Accepted: 01/23/2024] [Indexed: 03/08/2024]
Abstract
Limited evidence exists on the long-term effects of early feeding practices on child growth and development. We examined the relationships between infant feeding practices and child height and development at ages 2 and 6-7 years. We studied 885 mother-child dyads from a randomized controlled trial of preconception supplementation in Vietnam. Early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), breastfeeding (BF) duration and minimum dietary diversity (MDD) were assessed using World Health Organization (WHO) guidelines. Child development was assessed by the Bayley Scales of Infant Development-III at 2 years and the Wechsler Intelligence Scale for Children® - IV at 6-7 years. Child height-for-age z-score (HAZ) was calculated from child height and age. Multivariable regression and structural equation models were used in analyses that controlled for confounding. EIBF and EBF at 6 months occurred in 52% and 62% of children, respectively. Mean breastfeeding duration was 18 months and 83% achieved MDD at 1 year. EIBF was associated with motor (β = 0.13, 95% confidence interval [CI]: 0.00, 0.28) and cognitive development at 2 years (β = 0.12, 95% CI: -0.01, 0.26), which in turn were positively associated with cognitive development at 6-7 years. EBF was directly associated with development at 6-7 years (β = 0.21, 95% CI:0.08, 0.34) whereas motor and cognitive development at 2 years explained 41%-75% of the relationship between EIBF and development at 6-7 years. HAZ at 2 years also mediated 70% of the association between MDD at 1 year and HAZ at 6-7 years. BF duration was not associated with child development and HAZ. Early infant feeding practices, especially EIBF and EBF, have important long-term implications for optimizing child linear growth and cognition as they begin school.
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Affiliation(s)
- Lan Mai Tran
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate SchoolEmory UniversityAtlantaGeorgiaUSA
| | - Phuong H. Nguyen
- Nutrition, Diets, and Health Unit, International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
- Thai Nguyen University of Pharmacy and MedicineThai NguyenVietnam
| | - Melissa F. Young
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate SchoolEmory UniversityAtlantaGeorgiaUSA
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate SchoolEmory UniversityAtlantaGeorgiaUSA
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate SchoolEmory UniversityAtlantaGeorgiaUSA
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Tura DC, Belachew T, Tamiru D, Hassen Abate K. Energy, protein and iron densities of dabi teff-field pea-based optimised novel complementary flour and its contribution to daily energy and nutrients demand by 6-23-month-old children. Br J Nutr 2024; 131:1015-1030. [PMID: 37936348 PMCID: PMC10876449 DOI: 10.1017/s0007114523002581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/23/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
Inadequate intake of age-specific energy and nutrients is among the prime immediate causes of child malnutrition. Thus, this study aimed to determine the energy, protein and Fe densities of pre-processed dabi teff-field pea-based optimised novel complementary flour and its contribution to daily energy and nutrients demand by 6-8, 9-11 and 12-23 month-old children. The optimal formula at overall optimisation was identified to be 34·66 % dabi teff, 25 % barley, 15 % oats, 15·34 % field pea, 5 % linseed and 5 % maize with response values of 15·74 % protein, 5·09 % fat, 2·26 % ash, 2·88 % fibre, 73·05 % carbohydrate, 1591·72 kJ/100 g (380·43 kcal/100 g) energy, 32·21 mg/100 g Fe, 77·51 mg/100 g Ca and 2·59 mg/100 g Zn. The energy density of the optimised novel complementary flour was 1·27 kcal/g which fulfilled the Pan American Health Organization/WHO recommendation (≥ 0·8 kcal/g), protein density was 4·14 g/100 kcal and the Fe density was 8·47 mg/100 kcal, which was 2·12 to 10·59 times higher than the recommended value where the optimal had demonstrated to contribute more than 100 % of the daily energy and protein demand and notably more than 200 % of daily Fe demand at moderate bioavailability (0·8-4 mg/100 kcal). These findings showed that the daily recommended dietary allowance for energy, protein and Fe could be attained by the developed dabi teff-field pea-based optimised novel complementary flour and its contribution to the children's daily energy and nutrients demand met the standard, where the product can be used as food-based nutrition intervention to manage protein-energy malnutrition and Fe deficiency anemia in children sustainably.
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Affiliation(s)
- Diriba Chewaka Tura
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
- Department of Human Nutrition, Wollega University, Nekemte, Ethiopia
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Dessalegn Tamiru
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Kalkidan Hassen Abate
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
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Hackl LS, Du-Skabrin L, Ok A, Kumwenda C, Sin N, Mwelwa-Zgambo L, Dhakal R, Thandie Hamaimbo B, Reynolds EC, Adams KP, Arnold CD, Stewart CP, Milner EM, Pedersen S, Yourkavitch J. Estimating minimum dietary diversity for children aged 6-23 months: a comparison of agreement and cost of two recall methods in Cambodia and Zambia. Public Health Nutr 2024; 27:e79. [PMID: 38250809 DOI: 10.1017/s1368980024000107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To compare the agreement and cost of two recall methods for estimating children's minimum dietary diversity (MDD). DESIGN We assessed child's dietary intake on two consecutive days: an observation on day one, followed by two recall methods (list-based recall and multiple-pass recall) administered in random order by different enumerators at two different times on day two. We compared the estimated MDD prevalence using survey-weighted linear probability models following a two one-sided test equivalence testing approach. We also estimated the cost-effectiveness of the two methods. SETTING Cambodia (Kampong Thom, Siem Reap, Battambang, and Pursat provinces) and Zambia (Chipata, Katete, Lundazi, Nyimba, and Petauke districts). PARTICIPANTS Children aged 6-23 months: 636 in Cambodia and 608 in Zambia. RESULTS MDD estimations from both recall methods were equivalent to the observation in Cambodia but not in Zambia. Both methods were equivalent to the observation in capturing most food groups. Both methods were highly sensitive although the multiple-pass method accurately classified a higher proportion of children meeting MDD than the list-based method in both countries. Both methods were highly specific in Cambodia but moderately so in Zambia. Cost-effectiveness was better for the list-based recall method in both countries. CONCLUSION The two recall methods estimated MDD and most other infant and young child feeding indicators equivalently in Cambodia but not in Zambia, compared to the observation. The list-based method produced slightly more accurate estimates of MDD at the population level, took less time to administer and was less costly to implement.
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Affiliation(s)
- Laura S Hackl
- USAID Advancing Nutrition, Arlington, Virginia, USA
- John Snow Research and Training, Inc., 2733 Crystal Drive, 4th floor, Arlington, Virginia22202, USA
| | - Lidan Du-Skabrin
- USAID Advancing Nutrition, Arlington, Virginia, USA
- John Snow Research and Training, Inc., 2733 Crystal Drive, 4th floor, Arlington, Virginia22202, USA
| | - Amry Ok
- SBK Research and Development, Phnom Penh, Cambodia
| | - Chiza Kumwenda
- School of Agricultural Sciences, Department of Food Science and Nutrition University of Zambia, Lusaka, Zambia
| | - Navy Sin
- SBK Research and Development, Phnom Penh, Cambodia
| | - Lukonde Mwelwa-Zgambo
- School of Agricultural Sciences, Department of Food Science and Nutrition University of Zambia, Lusaka, Zambia
| | - Ramji Dhakal
- SBK Research and Development, Phnom Penh, Cambodia
| | - Bubala Thandie Hamaimbo
- School of Agricultural Sciences, Department of Food Science and Nutrition University of Zambia, Lusaka, Zambia
| | - Elise C Reynolds
- USAID Advancing Nutrition, Arlington, Virginia, USA
- Institute for Global Nutrition, University of California, Davis, CA, USA
| | - Katherine P Adams
- USAID Advancing Nutrition, Arlington, Virginia, USA
- Institute for Global Nutrition, University of California, Davis, CA, USA
| | - Charles D Arnold
- USAID Advancing Nutrition, Arlington, Virginia, USA
- Institute for Global Nutrition, University of California, Davis, CA, USA
| | - Christine P Stewart
- USAID Advancing Nutrition, Arlington, Virginia, USA
- Institute for Global Nutrition, University of California, Davis, CA, USA
| | | | - Sarah Pedersen
- USAID Bureau for Resilience and Food Security, Washington, DC, USA
| | - Jennifer Yourkavitch
- USAID Advancing Nutrition, Arlington, Virginia, USA
- Results for Development, Washington, DC, USA
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Mekonen EG, Zegeye AF, Workneh BS. Complementary feeding practices and associated factors among mothers of children aged 6 to 23 months in Sub-saharan African countries: a multilevel analysis of the recent demographic and health survey. BMC Public Health 2024; 24:115. [PMID: 38191351 PMCID: PMC10775555 DOI: 10.1186/s12889-023-17629-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/31/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION Malnutrition is a public health problem in sub-Saharan Africa with an increased morbidity and mortality rate than in other parts of the world. Poor complementary feeding practices are one of the major causes of malnutrition during the first two years of life. Therefore, this study aimed to determine the prevalence and associated factors of appropriate complementary feeding practices among mothers of children aged 6 to 23 months in sub-Saharan African countries. METHODS A multilevel mixed-effect analysis was carried out using recent demographic health survey data from 19 sub-Saharan African countries, which were conducted between 2015 and 2020. A total weighted sample of 60,266 mothers of children aged 6 to 23 months were included in the study. The demographic health survey employs a stratified two-stage sampling technique. Data extracted from the recent DHS data sets were cleaned, recorded, and analyzed using STATA/SE version 14.0 statistical software. Multilevel mixed-effects logistic regression was used to determine the factors associated with complementary feeding practice. Variables with a p-value less than 0.05 and adjusted odds ratio (AOR) with a 95% confidence interval (CI) were reported as statistically significant variables associated with appropriate complementary feeding practices. RESULTS The prevalence of appropriate complementary feeding practices among mothers of children aged 6 to 23 months in sub-Saharan African countries was 13.02% (95% CI: 12.75-13.29%). Maternal educational level [AOR = 0.69, 95% CI (0.64, 0.74)] and [AOR = 0.52, 95% CI (0.47, 0.57)], marital status of the mother [AOR = 0.85, 95% CI (0.74, 0.96)], sex of household head [AOR = 1.78, 95% CI (1.09, 1.27)], total children ever born [AOR = 1.52, 95% CI (1.18, 1.96)], [AOR = 1.43, 95% CI (1.14, 1.81)], and [AOR = 1.31, 95% CI (1.04, 1.64)], media exposure [AOR = 0.74, 95% CI (0.69, 0.79)], ANC visits attended during pregnancy [AOR = 0.73, 95% CI (0.63, 0.80)] and [AOR = 0.67, 95% CI (0.62, 0.74)], place of delivery [AOR = 0.92, 95% CI (0.85, 0.98)], currently breastfeeding [AOR = 1.12, 95% CI (1.01, 1.23)], PNC checkup [AOR = 0.75, 95% CI (0.70, 0.80)], the current age of the child [AOR = 0.26, 95% CI (0.24, 0.28)] and [AOR = 0.14, 95% CI (0.13, 0.16)], birth order [AOR = 1.31, 95% CI (1.09, 1.58)], number of under 5 children in the household [AOR = 0.76, 95% CI (0.59, 0.97)], community illiteracy [AOR = 1.09, 95% CI (1.02, 1.18)], and country category [AOR = 1.62, 95% CI (1.18, 2.22)] were significantly associated with appropriate complementary feeding practices. CONCLUSION The prevalence of appropriate complementary feeding practices among mothers of children aged 6 to 23 months in sub-Saharan Africa was relatively low. Higher maternal educational level, female household head, having media exposure, attending more ANC visits, health facility delivery, currently breastfeeding, having PNC follow-up, low community illiteracy, and living in the West Africa region increase the odds of appropriate complementary feeding practices. Women empowerment, increasing maternal health services accessibility, promoting breastfeeding behavior, increasing media exposure of the household, and improving the proportion of health facility delivery are strongly recommended.
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Affiliation(s)
- Enyew Getaneh Mekonen
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belayneh Shetie Workneh
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Tura DC, Belachew T, Tamiru D, Abate KH. Optimization of a formula to develop iron-dense novel composite complementary flour with a reduced phytate/minerals molar ratio from dabi teff-field pea-based blends using a D-optimal mixture design. Front Nutr 2023; 10:1244571. [PMID: 37885442 PMCID: PMC10598669 DOI: 10.3389/fnut.2023.1244571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/11/2023] [Indexed: 10/28/2023] Open
Abstract
Iron deficiency anemia is one of the major public health problems in children associated with the inadequate intake of bioavailable iron. Thus, this research was aimed at incorporating dabi teff, an underutilized/forgotten crop, into other pre-processed local food crops, viz., germinated maize, roasted barley, roasted field pea, dehulled oats, and linseed, to develop optimized iron-dense novel composite complementary flour with a reduced phytate/minerals molar ratio. Nutrisurvey software was employed to define ranges, and they were constrained at 20-35% dabi teff, 0-30% field pea, and 5-20% maize, while the remaining were kept constant at 25% barley, 15% oats, and 5% linseed. Eleven experimental runs were generated from the six mixture components using Stat-Ease Design Expert® software version 11, D-optimal. Inductively coupled plasma-optical emission spectrometry was used to determine micronutrients. 'Scheffe' regression was used to fit and test the model's adequacy, and numerical multi-response optimization was performed using the Design Expert® to identify the optimal points. Dabi teff had a significantly higher (p < 0.05) iron content at 86.5 mg/100 g, iron density at 24.53 mg/100 kcal, and calcium content at 123.59 mg/100 g. The new formulations had a significantly higher iron content (3.31-4.36 times), iron density (3.25-4.27 times), and calcium content (1.49-1.58 times), as compared to the control flour, and fulfilled FAO/WHO recommendations. The optimal formula was identified at 34.66% dabi teff, 25% barley, 15% oats, 15.34% field pea, 5% linseed, and 5% maize flour ratios, with response values at the overall optimization as 32.21 mg/100 g iron, 77.51 mg/100 g calcium, 2.59 mg/100 g zinc, 0.233 phytate/iron molar ratio (Ph:Fe), 0.067 phytate/calcium molar ratio (Ph:Ca), 3.43 phytate/zinc molar ratio (Ph:Zn), and 6.63 phytate by calcium to zinc molar ratio (Ph*Ca:Zn). Furthermore, it contained iron at a level that is 2.01 times higher than the standard and 4.44 times higher than the control, as well as an iron density of 8.47 mg/100 kcal, which was 4.39 times higher than that of the control. These findings showed that the optimized dabi teff-field pea based iron-dense novel composite complementary flour with enhanced bioavailability can be developed and used as a sustainable food-based strategy to combat iron deficiency anemia among children in less developed countries, such as Ethiopia.
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Affiliation(s)
- Diriba Chewaka Tura
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
- Department of Human Nutrition, Wollega University, Nekemte, Ethiopia
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Dessalegn Tamiru
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Kalkidan Hassen Abate
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
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Jannat K, Agho KE, Parvez SM, Rahman M, Thomson R, Amin MB, Merom D. The Effects of Yogurt Supplementation and Nutritional Education on Malnourished Infants: A Pilot RCT in Dhaka's Slums. Nutrients 2023; 15:2986. [PMID: 37447313 DOI: 10.3390/nu15132986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Our objective was to quantify the effects of yogurt supplementation and nutrition education over three months on the linear growth of infants at risk of stunting. We conducted a three-arm pilot randomized controlled trial: (1) nutrition education for mothers; (2) nutrition education plus a daily yogurt supplement (50 g) for the index child; and (3) usual care (control). Dyads of children aged 4-6 months and at risk of stunting [length-for-age z-score (LAZ) ≤ -1 SD and >-2 SD] and their mothers with ≤10 years of education were eligible for the study. Participants were recruited from five slum areas in Dhaka, Bangladesh. Intention-to-treat (N = 162) and complete-case analyses (N = 127) showed no between-group statistically significant differences in LAZ or weight-for-age (WAZ). However, the yogurt group showed greater change in linear growth compared to the control (LAZ: mean difference 0.20, 95% CI: -0.06, 0.47, p-value 0.13), which was also slightly greater than the education-only group. Children in the yogurt plus group were five times (95% CI: 0.80, 31.80, p-value 0.09) more likely to meet the minimum dietary diversity (MDD) score compared to the control. A 3-month follow-up of this pilot study did not demonstrate that yogurt was beneficial to linear growth. However, there were encouraging trends that merit replication of the intervention with larger samples and longer follow-ups.
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Affiliation(s)
- Kaniz Jannat
- Centre for Research in Mathematics and Data Science, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Kingsley Emwinyore Agho
- Centre for Research in Mathematics and Data Science, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Sarker Masud Parvez
- Environmental Interventions Unit, Laboratory of Food Safety and One Health, Infectious Disease Division, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Mahbubur Rahman
- Environmental Interventions Unit, Laboratory of Food Safety and One Health, Infectious Disease Division, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Russell Thomson
- Centre for Research in Mathematics and Data Science, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Mohammed Badrul Amin
- Environmental Interventions Unit, Laboratory of Food Safety and One Health, Infectious Disease Division, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Dafna Merom
- Centre for Research in Mathematics and Data Science, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
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Kassie GA, Gebrekidan AY, Enaro EY, Asgedom YS. Minimum acceptable dietary intake among children aged 6-23 months in Ethiopia: A systematic review and meta-analysis. PLoS One 2023; 18:e0287247. [PMID: 37384754 PMCID: PMC10310018 DOI: 10.1371/journal.pone.0287247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/01/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND In the absence of minimum acceptable diet, children aged 6-23 months are vulnerable to malnutrition. Not feeding at least the minimum acceptable diet is a major global problem, particularly in developing countries. Even though many studies have been conducted in Ethiopia there are inconsistencies. Therefore, this review aimed to estimate the pooled prevalence of a minimum acceptable diet in Ethiopia. METHODS Published articles from various electronic databases, such as PubMed/MEDLINE, EMBASE, Google Scholar, and Science Direct were systematically searched. All cross-sectional studies conducted on the minimum acceptable diet of children aged 6-24 months and published up to October 30/2021 were included in this review. Data were extracted using an Excel spreadsheet and analyzed using STATA version 14.1. The random-effects model was used to estimate the pooled prevalence, and a subgroup analysis was performed to identify the possible source of heterogeneity. Begg's and Egger's tests were used to identify possible publication bias. RESULTS Nine cross-sectional studies involving 4,223 participants were included. Significant heterogeneity was observed across the studies (I2 = 99.4%). The pooled prevalence of minimum acceptable diet in Ethiopia was found to be 25.69% (95% CI: 11.96, 39.41). CONCLUSION This review revealed that the minimum acceptable dietary intake among children aged 6-23 months in Ethiopia was relatively low; only 1 in 4 of children met the minimum acceptable diet. This indicates that the government should promote child feeding practices according to guidelines to increase the proportion of children with a minimum acceptable diet.
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Affiliation(s)
- Gizachew Ambaw Kassie
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amanuel Yosef Gebrekidan
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Eskinder Yilma Enaro
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Yordanos Sisay Asgedom
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Ngure FM, Kassim N, Phillips EL, Turner PC. Infant and Young Child Feeding Practices and Mycotoxin Contamination of Complementary Food Ingredients in Kongwa District, Tanzania. Curr Dev Nutr 2023; 7:100030. [PMID: 37180082 PMCID: PMC10111587 DOI: 10.1016/j.cdnut.2023.100030] [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: 08/31/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Background Inadequate infant and young child feeding (IYCF) practices in low income countries contribute to poor child growth and development. Objectives To assess IYCF practices and mycotoxin contamination in complementary food ingredients across 2 seasons in Kongwa District, Tanzania. Methods Early feeding practices in 115 rural households from 25 villages in Kongwa District, Dodoma region, Tanzania, were assessed. The primary caregiver for the index child (6-18 mo of age) was interviewed using a structured dietary questionnaire at recruitment (October/November 2017), and revisited 6 mo later. The questionnaire included questions on typical food consumption in the past 24 h. This study reports 7 of the revised and new IYCF indicators, including minimum dietary diversity (MDD). Aflatoxins (AF) and fumonisins (FUM) were analyzed in complementary food ingredients for pooled household samples to broadly establish patterns of contamination at the village level. Results The MDD was not met for 80% of infants at recruitment (survey 1) as compared with 56% in survey 2 (P < 0.05). Changes in MDD between the 2 surveys were dependent on season but not age. Maize was consumed by >90% of households in both surveys, whereas groundnut was consumed by 44% and 64% of households in surveys 1 and 2, respectively. AF concentrations in maize and groundnuts were found to be higher in survey 1 than in survey 2. Overall, AF exceeded the legal limit in 18% of maize and 61% of groundnut pooled samples in both surveys. Maize was also contaminated with significant FUM concentrations. Conclusions Poor diets were common among children in Kongwa District. Reliance on maize and groundnuts exposes this vulnerable age group to AF (also to FUM in maize). Inadequate diet and exposure to AF and FUM have separately been linked to linear growth retardation. Low diet diversity and mycotoxins contamination are plausible causes for poor growth and development among infants in Central Tanzania. Curr Dev Nutr 20XX;x:xx.
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Affiliation(s)
- Francis M. Ngure
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Neema Kassim
- Department of Food Biotechnology and Nutritional Sciences, School of Life Science and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
| | - Erica L. Phillips
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Paul C. Turner
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD, USA
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Animal-source foods as a suitable complementary food for improved physical growth in 6 to 24-month-old children in low- and middle-income countries: a systematic review and meta-analysis of randomised controlled trials. Br J Nutr 2022; 128:2453-2463. [PMID: 35109944 DOI: 10.1017/s0007114522000290] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Although animal-source foods are suitable complementary food for child growth in low- and middle-income countries (LMICs), their efficacy is still under discussion. This systematic review and meta-analysis was done to investigate the suitability of animal-source foods intake on child physical growth in LMICs. A systematic literature search was done using electronic databases and scanning the reference list of included studies, previous meta-analysis and systematic reviews. Paper selection was based on the PICO (ST) criteria. Papers were selected if based on 6 to 24-month-old children, if they were randomised controlled trials evaluating the effect of complementary animal-based food supplementation of any natural origin, if reporting at least a measure of body size and published after 2000. The PRISMA guidelines for reporting systematic review was followed in the paper selection. Fourteen papers were included in the systematic review and eight were considered for the meta-analysis. Animal-based food supplementation resulted in a higher length-for-age LAZ and weight-for-age (WAZ) Z-scores compared with the control group with random effect size of 0·15 (95 % CI 0·02, 0·27) and 0·20 (95 % CI 0·03, 0·36), respectively. Results were confirmed after influence analyses, and publication bias resulted as negligible. An increased effect on LAZ and WAZ was observed when the food supplementation was based on egg with effect size of 0·31 (95 % CI = -0·03, 0·64) and 0·36 (95 % CI = -0·03, 0·75), respectively. Animal-source foods are a suitable complementary food to improve growth in 6 to 24-month-old children in LMICs.
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Bhati D, Tripathy A, Mishra PS, Srivastava S. Contribution of socio-economic and demographic factors to the trend of adequate dietary diversity intake among children (6-23 months): evidence from a cross-sectional survey in India. BMC Nutr 2022; 8:153. [PMID: 36575545 PMCID: PMC9793661 DOI: 10.1186/s40795-022-00655-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The present study aims to estimate the factors contributing to the change adequate diversified dietary intake (ADDI) from 2005-06 to 2015-16 among children aged 6-23 months in India. METHODS A cross-sectional study was conducted using a large representative survey data. Data from the National Family Health Survey 2005-06 and 2015-16 was used. The effective sample size for the present study was 14,422 and 74,132 children aged 6-23 months in 2005-06 and 2015-16, respectively. The outcome variable was minimum adequate dietary diversity intake. Binary logistic regression was used to evaluate the factors associated with ADDI. Additionally, the Fairlie method of decomposition was used, which allows quantifying the total contribution of factors explaining the decadal change in the probability of ADDI among children aged 6-23 months in India. RESULTS There was a significant increase in ADDI from 2005-06 to 2015-16 (6.2%; p < 0.001). Additionally, compared to the 2005-06 years, children were more likely to have ADDI [AOR; 1.29, CI: 1.22-1.35] in 2015-16. Mother's education explained nearly one-fourth of the ADDI change among children. Further, the regional level contribution of 62.3% showed that the gap was widening across regions between the year 2005-06 and 2015-16 in ADDI among children. The child's age explained 5.2% with a positive sign that means it widened the gaps. Whereas the household wealth quintile negatively contributed and explained by -5.2%, that means between the years the gaps has reduced in ADDI among children aged 6-23 months. CONCLUSION Our findings indicate that increasing awareness of the use of mass media and improving the education levels of mothers would be beneficial for adequate dietary diversity intake among children aged 6-23 months. Investments should support interventions to improve overall infant and young children feeding practices in India.
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Affiliation(s)
| | - Abhipsa Tripathy
- grid.412779.e0000 0001 2334 6133PG Department of Statistics, Utkal University, Vani Vihar, Odisha Bhubaneswar, 751004 India
| | - Prem Shankar Mishra
- grid.464840.a0000 0004 0500 9573Population Research Centre, Institute for Social and Economic Change, Bengaluru, 560072 Karnataka India
| | - Shobhit Srivastava
- grid.419349.20000 0001 0613 2600 Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, 400088 Maharashtra India
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Koyratty N, Mbuya MNN, Jones AD, Schuster RC, Kordas K, Li CS, Tavengwa NV, Majo FD, Chasekwa B, Ntozini R, Humphrey JH, Smith LE. Implementation and maintenance of infant dietary diversity in Zimbabwe: contribution of food and water insecurity. BMC Nutr 2022; 8:136. [PMCID: PMC9673371 DOI: 10.1186/s40795-022-00622-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Inadequate food and water resources negatively affect child health and the efficiency of nutrition interventions.
Methods
We used data from the SHINE trial to investigate the associations of food insecurity (FI) and water insecurity (WI) on mothers’ implementation and maintenance of minimum infant dietary diversity (MIDD). We conducted factor analysis to identify and score dimensions of FI (poor access, household shocks, low availability & quality), and WI (poor access, poor quality and low reliability). MIDD implementation (n = 636) was adequate if infants aged 12 months (M12) ate ≥ four food groups. MIDD maintenance (n = 624) was categorized into four mutually exclusive groups: A (unmet MIDD at both M12 and M18), B (unmet MIDD at M12 only), C (unmet MIDD at M18 only), and D (met MIDD at both M12 and M18). We used multivariable-adjusted binary logistic and multinomial regressions to determine likelihood of MIDD implementation, and of belonging to MIDD maintenance groups A-C (poor maintenance groups), compared to group D, respectively.
Results
Low food availability & quality were negatively associated with implementation (OR = 0.81; 0.69, 0.97), and maintenance (ORB = 1.29; 1.07, 1.56). Poor water quality was positively associated with implementation (OR = 1.25; 1.08, 1.44), but inconsistently associated with maintenance, with higher odds of infants being in group C (OR = 1.39; 1.08, 1.79), and lower odds of being in group B (OR = 0.80; 0.66, 0.96).
Conclusion
Food security should be prioritized for adequate implementation and maintenance of infant diets during complementary feeding. The inconsistent findings with water quality indicate the need for further research on WI and infant feeding.
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Nurokhmah S, Middleton L, Hendarto A. Prevalence and Predictors of Complementary Feeding Practices Among Children Aged 6-23 Months in Indonesia. J Prev Med Public Health 2022; 55:549-558. [PMID: 36475320 DOI: 10.3961/jpmph.22.199] [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: 05/05/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Poor complementary feeding practices have consistently contributed to the burden of child undernutrition in Indonesia. This study aimed to estimate the prevalence and predictors of the time of the introduction of solid, semi-solid, and soft foods (ISSSF), minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). METHODS We analyzed 4804 last-born infants aged 6-23 months from the 2017 Indonesia Demographic and Health Survey, which employed multistage cluster random sampling. The outcomes were calculated based on the 2021 World Health Organization/United Nations Children's Fund guidelines. The predictors of the 4 complementary feeding indicators were assessed using multivariate Poisson regression with robust variance adjusting for potential confounders and study design. RESULTS The prevalence of ISSSF, MDD, MMF, and MAD was 86.1%, 54.3%, 71.8%, and 37.6%, respectively, with younger children less likely to meet 3 out of the 4 outcomes. Parental education, the presence of a birth attendant, and maternal media consumption were among the predictors of MDD and MAD. Children from families with higher income were more likely to meet MDD than those from low-income households (adjusted prevalence ratio [aPR], 1.16; 95% confidence interval [CI], 1.05 to 1.28). Living in an urban area was positively associated with MMF (aPR, 1.09; 95% CI, 1.04 to 1.15) and MAD (aPR, 1.12; 95% CI 1.02 to 1.24). In eastern regions, the prevalence of children achieving MDD and MAD was lower than in those living in Java and Bali. CONCLUSIONS It is crucial that more attention and efforts are made to improve the recommended practices throughout Indonesia, since the prevalence of adequate complementary feeding practices remains low.
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Affiliation(s)
- Siti Nurokhmah
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Department of Nutrition Science, Faculty of Health Science, Universitas Muhammadiyah Surakarta, Surakarta, Indonesia
| | - Lucinda Middleton
- Research Institute for the Environment and Livelihoods, Charles Darwin University, Ellengowan Drive, Australia
| | - Aryono Hendarto
- Department of Child Health, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Saaka M, Awini S, Kizito F, Hoeschle-Zeledon I. Fathers' level of involvement in childcare activities and its association with the diet quality of children in Northern Ghana. Public Health Nutr 2022; 26:1-8. [PMID: 36210797 PMCID: PMC10131150 DOI: 10.1017/s1368980022002142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 09/07/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study assessed the level of fathers' involvement in childcare activities and its association with the diet quality of their children in Northern Ghana. SETTING The study was carried out in the Northern, Upper East and Upper West regions of Ghana. The people in the study area mostly depend on agriculture as their main occupation. DESIGN A community-based comparative analytical cross-sectional study. PARTICIPANTS A sample of 422 rural mother-father pairs who had at least one child aged 6-36 months. RESULTS The overall level of fathers' involvement in childcare and feeding activities was high among 63·5 % of the respondents in the 6 months prior to the study. The most common childcare activity men were involved in was providing money for the purchase of food for the child. Minimum acceptable diet was higher for children with a higher level of paternal involvement in childcare activities (adjusted OR = 3·33 (95 % CI: 1·41, 7·90)), compared to their counterparts whose father's involvement was poor. Fathers who had a positive attitude to childcare and feeding were 2·9 more likely to get involved in childcare activities (adjusted OR = 2·90 (95 % CI: 1·87, 4·48)). CONCLUSIONS The findings confirm earlier studies that show that fathers' involvement in childcare activities including feeding is positively associated with improved child feeding practices. The findings point to the need to have a policy shift in which both men and women are key actors in interventions designed to improve child nutritional status in rural settings of Northern Ghana.
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Affiliation(s)
- Mahama Saaka
- University for Development Studies, School of Allied Health Sciences, PO Box 1883, Tamale, Ghana
| | - Simon Awini
- Ghana Health Service, Wa West District Health Directorate, Wechau, Ghana
| | - Fred Kizito
- International Institute of Tropical Agriculture (IITA), Tamale, Ghana
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Birhanu H, Gonete KA, Hunegnaw MT, Aragaw FM. Minimum acceptable diet and associated factors among children aged 6-23 months during fasting days of orthodox Christian mothers in Gondar city, North West Ethiopia. BMC Nutr 2022; 8:76. [PMID: 35948943 PMCID: PMC9364522 DOI: 10.1186/s40795-022-00558-z] [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: 12/02/2021] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Nutritional improvement through appropriate feeding practices is critical for young children's healthy growth and development. Even if children are exempted from fasting, their diets are influenced by the widespread fasting practices of their Orthodox Christian mothers. However, scientific evidence on a minimum acceptable diet (MAD) among children aged 6–23 months during the fasting period was limited. Therefore, this study aimed to assess the minimum acceptable diet and associated factors among children aged 6–23 months during the fasting period among Orthodox Christian mothers in Gondar city, Northwest Ethiopia. Method A community-based cross-sectional study was conducted during the fasting season (Lent) from March 8, 20,121 to April 8, 2021. A total of 738 Orthodox Christian mothers with their children were selected by multistage sampling. A structured questionnaire was used to collect data among mothers to assess children’s MAD status. The degree of association between independent and dependent variables was assessed by using an odds ratio with a 95% confidence interval. Those variables with a p-value of less than 0.05 in the multivariable analysis were considered as a significant factor for MAD among children aged 6–23 months. Data were presented using texts, tables and figures. Results The overall prevalence of MAD among children aged 6–23 months was 19.4% (95% CI: 16.40%-22.20). Having household wealth index of rich and middle (AOR = 4.39, 95% CI: 2.26,8.50) and (AOR = 3.25, 95% CI: 1.69,6.22), respectively, children aged from 12–17 months (AOR = 2.66, 95% CI: 1.43,4.92) and 18–23 months (AOR = 5.39, 95% CI: 2.93,9.95) respectively, Children who lived with a family member who consumed any time without keeping the fasting time(AOR = 1.79, 95% CI: 1.13,2.83) and mothers of young children who were married (AOR = 4.13, 95% CI: 1.29,13.23) have significant association with MAD. Conclusion The practice of minimum acceptable diet was inadequate. Age of child, wealth status, marital status, and presence of family member who fed without keeping fasting time were significantly associated factors for MAD among children aged 6–23 months. Advocacy for appropriate feeding practice and meeting the MAD for children aged 6–23 months during the fasting period should also be strengthened targeting the unmarried women and those with poor households and giving awareness for mothers in collaboration with the respective religious leaders is highly recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00558-z.
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Affiliation(s)
| | - Kedir Abdela Gonete
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melkamu Tamir Hunegnaw
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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George CM, Coglianese N, Bauler S, Perin J, Kuhl J, Williams C, Kang Y, Thomas ED, François R, Ng A, Presence AS, Jean Claude BR, Tofail F, Mirindi P, Cirhuza LB. Low dietary diversity is associated with linear growth faltering and subsequent adverse child developmental outcomes in rural Democratic Republic of the Congo (REDUCE program). MATERNAL & CHILD NUTRITION 2022; 18:e13340. [PMID: 35313062 PMCID: PMC9218309 DOI: 10.1111/mcn.13340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 12/05/2022]
Abstract
The objective of this study was to investigate the association between dietary diversity, child growth and child developmental outcomes. This was a prospective cohort study. Developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem solving and combined developmental scores measured by the Extended Ages and Stages Questionnaire (EASQ) at a 6‐month follow‐up visit. Height and weight were measured at baseline and a 6‐month follow‐up. Baseline minimum dietary diversity (MDD) for children 6–23 months old was defined by consumption of five or more of the following food groups: (1) breast milk; (2) grains, roots and tubers; (3) legumes and nuts; (4) dairy products; (5) flesh foods; (6) eggs; (7) vitamin A‐rich fruits and vegetables and (8) other fruits and vegetables. Participants were 117 children 6–23 months of age. Linear growth faltering was defined as a significant decline (p < 0.05) in length‐for‐age Z‐scores (LAZ) between baseline and follow‐up. Regression models were performed. The study was conducted in rural eastern Democratic Republic of the Congo (DRC). MDD was positively associated with change in LAZ (coefficient: 0.87 [95% confidence interval [CI]: 0.33, 1.40]), and a reduced odds of stunting (LAZ < −2) (odds ratio: 0.21 [95% CI: 0.07, 0.61]). MDD was also associated with a significantly higher combined EASQ‐Z‐scores (coefficient: 0.34 [95% CI: 0.003, 0.68], higher communication EASQ‐Z‐scores [0.50 {95% CI: 0.14, 0.85}], and higher personal social EASQ‐Z‐scores [0.46 {95% CI: 0.11, 0.82}]). This study provides further evidence demonstrating the need for interventions to improve dietary diversity among young children. Dietary diversity was low among young children in our study setting in rural eastern Democratic Republic of the Congo. Low dietary diversity was associated with linear growth faltering and lower child developmental outcomes. This study provides further evidence demonstrating the need for interventions to improve dietary diversity among young children to improve child health.
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Affiliation(s)
- Christine Marie George
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | | | - Sarah Bauler
- Health Division Food for the Hungry Phoenix Arizona USA
| | - Jamie Perin
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Jennifer Kuhl
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Camille Williams
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Yunhee Kang
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Elizabeth D. Thomas
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Ruthly François
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Angela Ng
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | | | | | - Fahmida Tofail
- Nutrition Division International Centre for Diarrhoeal Disease Research Dhaka Bangladesh
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Parvin T, Endres K, Hasan MT, Uddin IM, Bhuyian MSI, Zohura F, Coglianese N, Biswas SK, Alam M, Faruque ASG, Gittelsohn J, Perin J, George CM. Low Fruit and Vegetable Consumption Associated with Linear Growth Faltering among Children in Urban Bangladesh. Am J Trop Med Hyg 2022; 106:tpmd211124. [PMID: 35576951 PMCID: PMC9209935 DOI: 10.4269/ajtmh.21-1124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/31/2022] [Indexed: 11/07/2022] Open
Abstract
The objective of this study was to examine the association between dietary diversity and child growth among children 6 to 23 months of age in urban slums of Bangladesh. This prospective cohort study enrolled 192 participants 6 to 23 months of age in Dhaka, Bangladesh. A total of 170 children with follow-up anthropometric data were included in the analysis. To collect dietary intake information for children 6 to 23 months of age, consumption of five or more of the following eight minimum dietary diversity food groups was recorded using 24-hour dietary recall at enrollment provided by the child's caregiver: 1) breast milk; 2) grains, roots, and tubers; 3) legumes and nuts; 4) dairy products; 5) flesh foods; 6) eggs; 7) vitamin A-rich fruits and vegetables; and 8) other fruits and vegetables. Height and weight were measured at baseline and at a 12-month follow-up. Fifty-five percent of children (106 of 192) consumed five or more of the eight minimum dietary diversity food groups during their first visit to assess dietary intake. Eighty-two percent of children (157 of 192) had a report of consuming an animal source of food (e.g., eggs, diary, flesh foods) in the past 24 hours, 85% (164 of 192) consumed any source of protein (e.g., eggs, diary, flesh foods, nuts, and legumes), and 65% of children (125 of 192) were reported to consume any fruits and vegetables. Child consumption of fruits and vegetables was associated positively with change in length-for-age z-scores from baseline to the 12-month follow-up (coefficient, 0.86; 95% CI, 0.03-1.68). Inadequate fruit and vegetable consumption was associated with linear growth faltering among the young children residing in urban Dhaka, Bangladesh. These findings demonstrate the need for effective interventions to increase fruit and vegetable consumption in this susceptible pediatric population.
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Affiliation(s)
- Tahmina Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Kelly Endres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - M. Tasdik Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ismat Minhaj Uddin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Fatema Zohura
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | - Munirul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abu S. G. Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Gao Y, Sheng J, Mi X, Zhou M, Zou S, Zhou H. Household Water Access, Dietary Diversity and Nutritional Status among Preschoolers in Poor, Rural Areas of Central and Western China. Nutrients 2022; 14:nu14030458. [PMID: 35276816 PMCID: PMC8840283 DOI: 10.3390/nu14030458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 12/28/2022] Open
Abstract
Poor child feeding and childhood malnutrition are major public health problems in rural central and western China, with little evidence about their environmental determinants. This study aimed to investigate whether household water access is associated with dietary diversity and nutritional outcomes. We analyzed the cross-sectional data of 3727 children aged 6 to 59 months in rural central and western China, applying multivariate linear and logistic models to estimate the effect of water access on children’s anthropometric indices, hemoglobin, and dietary diversity. We found that unimproved water access was linked to a lower likelihood of achieving dietary diversity (OR = 0.65, 95% CI 0.44 to 0.98, p = 0.039); lower height-for-age z-score (β = −0.34, 95% CI −0.49 to −0.19, p < 0.001) and hemoglobin concentration (β = −2.78, 95% CI −5.16 to −0.41, p = 0.022); higher odds of stunting (OR = 1.50, 95% CI 1.01 to 2.25, p = 0.047) and anemia (OR = 1.34, 95% CI 1.02 to 1.77, p = 0.037). The associations between water access and nutritional outcomes were not explained by dietary diversity and were stronger in children who did not receive iron supplementation. These findings provide evidence for designing water-based nutritional interventions in China.
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Affiliation(s)
- Yaqing Gao
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.G.); (X.M.); (M.Z.); (S.Z.)
| | - Jie Sheng
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Peking University, Beijing 100191, China;
| | - Xiaoyi Mi
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.G.); (X.M.); (M.Z.); (S.Z.)
| | - Mo Zhou
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.G.); (X.M.); (M.Z.); (S.Z.)
| | - Siyu Zou
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.G.); (X.M.); (M.Z.); (S.Z.)
| | - Hong Zhou
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.G.); (X.M.); (M.Z.); (S.Z.)
- Correspondence: ; Tel.: +86-10-8280-1222
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Shagaro SS, Mulugeta BT, Kale TD. Complementary feeding practices and associated factors among mothers of children aged 6-23 months in Ethiopia: Secondary data analysis of Ethiopian mini demographic and health survey 2019. Arch Public Health 2021; 79:205. [PMID: 34809724 PMCID: PMC8607675 DOI: 10.1186/s13690-021-00725-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/30/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Optimal nutrition in early child's life plays a vital role in improving mental and motor development, reduces the possibility of contracting various infectious diseases and related deaths, decreases the risk of obesity, and fosters better overall development. However, 45% of deaths in children under five years of age that occur globally is attributed to nutrition-related factors and the majority of these deaths occur in low-and middle-income countries. Therefore, this study aims to assess complementary feeding practices and associated factors among mothers of children aged 6-23 months in Ethiopia. METHOD The study used the Ethiopian mini demographic and health survey 2019 data. A two-stage stratified cluster sampling technique was used to select 1465 mothers of children aged 6-23 months in Ethiopia. Two-level multilevel mixed-effects logistic regression model analysis was computed, and variables with p-value of less than 5% and an adjusted odds ratio with a 95% confidence interval in the final model were reported as statistically significant factors with appropriate complementary feeding practice. RESULT The overall prevalence of appropriate complementary feeding practice among mothers of children aged 6-23 months was 9.76%. In our study, mothers who attended primary[AOR = 2.72; 95%CI: 1.47-5.01], secondary[AOR = 2.64; 95%CI: 1.18-5.92] and higher school[AOR = 5.39; 95%CI: 2.29-12.64], being from medium income household[AOR = 2.89; 95%CI: 1.41-5.92], attended 1-3 times ANC visits in index pregnancy[AOR = 0.41; 95%CI: 0.18-0.89], mothers who have 12-17 months[AOR = 1.96; 95%CI: 1.16-3.33] and 18-23 months old children[AOR = 2.61; 95%CI: 1.49-4.54], currently breastfeeding mothers[AOR = 3.69; 95%CI: 1.73-7.91], mothers from pastoralist contextual regions[AOR = 0.29; 95%CI: 0.09-0.91], and mothers who have resided in rural areas[AOR = 0.49; 95%CI: 0.25-0.97] were factors significantly associated with appropriate complementary feeding practice. CONCLUSION This study showed low prevalence of appropriate complementary feeding practice. Therefore, the concerned health authorities need to strengthen the existing approaches designed for provision of nutrition education particularly targeting mothers who are unschooled, who have 6-11 months old children, live in pastoralist regions and reside in rural parts of the country, and create strategies that improve maternal job opportunities.
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Affiliation(s)
- Sewunet Sako Shagaro
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
| | - Be'emnet Tekabe Mulugeta
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Temesgen Dileba Kale
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Young Children Feeding Practices: An Update from the Sultanate of Oman. CHILDREN-BASEL 2021; 8:children8090818. [PMID: 34572250 PMCID: PMC8465673 DOI: 10.3390/children8090818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/06/2021] [Accepted: 09/14/2021] [Indexed: 11/24/2022]
Abstract
Despite proven benefits, most countries fail to meet international targets for appropriate complementary and Breast Feeding (BF) practices. This study assessed feeding practices of children under two years of age and correlated them with family parameters in Oman, a high income country in the Eastern Mediterranean Region. Methods: Data from this study originated from the latest Oman National Nutrition Survey (ONNS). Assessment of children and their mothers’ socioeconomic, anthropometric, and nutritional variables was conducted at the household level. Evaluated feeding practices included age appropriate BF, diet diversity, and minimum acceptable diet (MAD). Results: Pairs of mothers and infants (n = 1344) were assessed. Early BF, exclusive BF at 6 months, infant formula, and iron rich meals were provided to 81, 29, 44, and 84% of children, respectively. Age appropriate BF and MAD were found in 58% and 35% of children, respectively. Low maternal education, younger age, low household income, and governorate negatively affected diet acceptability. Conclusion: Omani children successfully received early BF postpartum and consumed iron rich meals. Yet, rates of exclusive BF rates at six months and MAD for children under two were low. Comprehensive strategies should be placed to assess and influence children feeding practices in the Sultanate.
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Academy of Nutrition and Dietetics Nutrition Research Network: The Saqmolo' Project Rationale and Study Protocol for a Randomized Controlled Trial Examining the Influence of Daily Complementary Feeding of Eggs on Infant Development and Growth in Guatemala. J Acad Nutr Diet 2021; 122:432-444. [PMID: 33962902 DOI: 10.1016/j.jand.2021.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/08/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Adequate nutrition during the complementary feeding period is critical for optimal child growth and development and for promoting long-term educational attainment and economic potential. To prioritize limited public health resources, there is a need for studies that rigorously assess the influence of multicomponent integrated nutrition interventions in children younger than age 2 years in different contexts. This study aimed to describe the rationale and protocol for the Saqmolo' Project using the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. The Saqmolo' (ie, "egg" in the Mayan language, Kaqchiquel) Project is an individually randomized, partially blinded, controlled comparative effectiveness trial to evaluate the influence of adding delivery of a single whole egg per day to local standard nutrition care (ie, growth monitoring, medical care, deworming medication, multiple micronutrient powders for point-of-use food fortification [chispitas], and individualized complementary and responsive feeding education for caregivers) for 6 months, compared with the local standard nutrition care package alone, on child development, growth, and diet quality measures in rural indigenous Mayan infants aged 6 to 9 months at baseline (N = 1,200). The study is being executed in partnership with the Wuqu' Kawoq/Maya Health Alliance, a primary health care organization located in central Guatemala. Primary outcomes for this study are changes in global development scores, assessed using the Guide for Monitoring Global Development and the Caregiver Reported Child Development Instruments. Secondary outcomes include changes in infant hemoglobin, anthropometric measures (including z scores for weight for age, length for age, weight for length, and head circumference for age), and diet quality as measured using the World Health Organization's infant and young child feeding indicators. The results of the Saqmolo' Project may help to inform public health decision making regarding resource allocation for effective nutrition interventions during the complementary feeding period.
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Minimum dietary diversity and associated factors among young infants and children living in the most productive area of Amhara region, Addis Zemen town: A community-based cross-sectional study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Oostendorp R, van Wesenbeeck L, Sonneveld B, Zikhali P. Who lacks and who benefits from diet diversity: evidence from (impact) profiling for children in Zimbabwe. Int J Health Geogr 2020; 19:45. [PMID: 33148268 PMCID: PMC7640455 DOI: 10.1186/s12942-020-00240-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/10/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The impact of diet diversity-defined as the number of different foods or food groups consumed over a given reference period-on child nutrition outcomes strongly interacts with agro-ecological, institutional, and socio-economic drivers of child food and nutrition security. Yet, the literature on the impact of diet diversity typically estimates average treatment effects, largely ignoring impact heterogeneity among different groups. METHODS In this paper, we introduce a new method of profiling to identify groups of treatment units that stand to gain the most from a given intervention. We start from the 'polling approach' which provides a fully flexible (non-parametric) method to profile vulnerability patterns (patterns in 'needs') across highly heterogeneous environments [35]. Here we combine this polling methodology with matching techniques to identify 'impact profiles' showing how impact varies across non-parametric profiles. We use this method to explore the potential for improving child nutrition outcomes, in particular stunting, through targeted improvements in dietary diversity in a physically and socio-economically diverse country, namely Zimbabwe. Complex interaction effects with agro-ecological, institutional and socio-economic conditions are accounted for. Finally, we analyze whether targeting interventions at the neediest (as identified by the polling approach) will also create the largest benefits. RESULTS The dominant profile for stunted children is that they are young (6-12 months), live in poorer/poorest households, in rural areas characterized by significant sloping of the terrain and with one-sided emphasis on maize cultivation and medium dry conditions. When moving from "need" to "maximal impact", we calculate both the coverage in "need" as well as the impact coverage, and find that targeting on need does not always provide the largest impact. CONCLUSIONS Policy-makers need to remain alert that targeting on need is not always the same as targeting on impact. Estimation of heterogeneous treatment effects allows for more efficient targeting. It also enhances the external validity of the estimated impact findings, as the impact of child diet diversity on stunting depends on various agro-ecological variables, and policy-makers can relate these findings to areas outside our study area with similar agro-ecological conditions.
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Affiliation(s)
- Remco Oostendorp
- Vrije Universiteit Amsterdam, Tinbergen Institute, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| | - Lia van Wesenbeeck
- Amsterdam Centre for World Food Studies, Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| | - Ben Sonneveld
- Amsterdam Centre for World Food Studies, Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| | - Precious Zikhali
- World Bank, South Africa Office, The World Bank, 442 Rodericks Rd, Lynnwood, Pretoria, 0081 South Africa
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Yisak H, Ambaw B, Walle Z, Alebachew B, Ewunetei A. Minimum Acceptable Diet and Associated Factors Among HIV-Exposed Children Aged 6-24 Months in Debre Tabor Town, Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:639-645. [PMID: 33149697 PMCID: PMC7604248 DOI: 10.2147/hiv.s274764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/04/2020] [Indexed: 11/26/2022]
Abstract
Introduction Minimum acceptable diet is a composite indicator of minimum dietary diversity and minimum meal frequency. World Health Organization’s newborn child feeding and HIV guidelines suggestbeginning complementary nourishments at six months, and breastfeeding for HIV-exposed children. HIV infected mothers may be more sensitive on feeding practices to protect their children from contracting the disease. On the other hand, HIV infection is associated with higher risk food insecurity which may affect feeding practices of children. But in Ethiopia, there is lack of evidence on extent of minimum acceptable diet of HIV-exposed children. Therefore, the objective of this study was to assess minimum acceptable diet and associated factors among HIV-exposed 6–24 months aged children. Methods An institution-based cross-sectional study was conducted in health institutions of Debre Tabor town. The study was conducted on 287 mother-child pairs attending antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) at public health facilities. Descriptive statistics like frequency, proportions, mean and standard deviation were computed. Multi-variable logistic regression was run to identify independent predictors of the outcome variable (minimum acceptable diet). A p-value <0.05 was used to declare statistical significance. Results About 76% (95% CI: 70.8–80.8) and 58.2% (95% CI: 53.0–68.3) children were fed with appropriate meal frequency and recommended dietary diversity, respectively. One hundred (34.8%) (95% CI: 29.3–40.4) of children were fed a minimum acceptable diet and 59.9% (95% CI: 54.0–65.9) of children consumed iron rich or fortified food. Out of the total, 203 (71.0%) (95% CI: 66.1–76.2) of the mothers had good knowledge on minimum dietary diversity and meal frequency feeding practices. In multi-variable logistic regression poor knowledge with AOR = 0.32, 95% CI: 0.17–0.58, maternal workload with AOR = 0.38, 95% CI: 0.19–0.75 and inadequate information about child feeding from health care providers with AOR = 0.46, 95% CI: 0.26–0.81 were statistically significant predictors of minimum acceptable diet. Conclusion The study revealed that the proportion of children who received minimal acceptable diet was lower than that of WHO recommendation for good practice. Knowledge, maternal workload and information related to complementary feeding were associated with low minimum acceptable diet.
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Affiliation(s)
- Hiwot Yisak
- Department of Public Health Nutrition, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Birhanie Ambaw
- Department of Public Health Nutrition, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Zebader Walle
- Department of Health Service and Management, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Banchiayehu Alebachew
- Department of Health Service and Management, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amien Ewunetei
- Department of Pharmacy, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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Adesanmi AR, Malomo SA, Fagbemi TN. Nutritional quality of formulated complementary diet from defatted almond seed, yellow maize and quality protein maize flours. FOOD PRODUCTION, PROCESSING AND NUTRITION 2020. [DOI: 10.1186/s43014-020-00037-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Traditional complementary foods are mainly starchy foods with limiting nutrient quality and can be fortified using protein rich crops like almond seed. This research thus aimed at investigating the nutritional quality of the formulated complementary diet from locally available almond seeds (Prunus amygdalus), high quality protein (QPM) and yellow maize after blending into flours. The proximate and amino acid compositions, in vitro protein qualities and functional properties of the blended flours were determined using standard methods. The in vivo studies involved feeding the weanling Wister albino rats with blended flours and commercial Cerelac (control), followed by hematological and histopathological determinations, while sensory attributes were evaluated by the semi-trained panelists. The protein contents of the flour blends (24–28%) were significantly (p < 0.05) better with adequate indispensable amino acids and improved functionalities than commercial cerelac (23%). Comparatively, the dried germinated QPM (DGQPM) has significant (p < 0.05) higher biological value (~ 37%) than fermented high QPM (FHQPM) (~ 30%), thereby indicating that the germination process improved protein quality of the diets. Besides, the in vivo data showed a positive effect of germination process as the rats fed with DGQPM has low white blood cells (30 × 102) compared to FHQPM (42 × 102) and cerelac (51 × 102). However, the fermentation process improved the packed cell volume of rats fed with FHQPM (49%) when compared to DGQPM and cerelac (47%). The formulated diets have no negative effects on the protein content (45.19–51.88 mg N/g) and weight (0.25–1.36 g) of the internal organs (liver, kidney and tissue) of the animals when compared to cerelac (53.72–55.04 mg N/g; 0.25–1.98 g), respectively. The panelists generally accepted all the formulated diets, hence encouraging their utilization in the global preparation of complimentary foods for young children to meet their nutritional needs and adding value to the locally produced underutilized almond seeds.
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Al-Jawaldeh A, Almamary S, Mahmoud L, Nasreddine L. Leveraging the Food System in the Eastern Mediterranean Region for Better Health and Nutrition: A Case Study from Oman. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7250. [PMID: 33020386 PMCID: PMC7579389 DOI: 10.3390/ijerph17197250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/19/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022]
Abstract
The adoption of a food system approach is vital for the Eastern Mediterranean Region (EMR) in achieving the 2030 Agenda. The objective of this paper is to present a case-study from Oman, where a roadmap of context-specific entry points within the food system was proposed, with the overarching aim of fostering healthier diets in the population. A four-staged process was adopted: (1) selection of potential target food groups; (2) assessment of self-sufficiency and sustainability considerations related to the target foods; (3) characterization of challenges, opportunities and potential interventions related to the target food groups and (4) identification of specific entry points within the three elements of the food system (food supply chain; food environment; and consumer behavior). Data collection was based on a review of pertinent literature as well as a participatory approach involving policy makers and stakeholders. Findings showed that fruit, vegetables, fish and foods that are high in fat, sugar and salt are priority targets for intervention. Specific entry points within the food system were identified and a realistic roadmap of activities was outlined. Findings and recommendations presented in this paper may facilitate policy convergence efforts in Oman and serve as a case-study for other EMR countries.
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Affiliation(s)
- Ayoub Al-Jawaldeh
- World Health Organization (WHO), Regional Office for the Eastern Mediterranean (EMRO), 7608 Cairo, Egypt;
| | | | | | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, 11-0236 Beirut, Lebanon
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Taha Z, Garemo M, Nanda J. Complementary feeding practices among infants and young children in Abu Dhabi, United Arab Emirates. BMC Public Health 2020; 20:1308. [PMID: 32854658 PMCID: PMC7453515 DOI: 10.1186/s12889-020-09393-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 08/17/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Optimal complementary feeding (CF) promotes health and supports growth and development in children. While suboptimal feeding practices are reported for many countries, very limited information exists about such practices in the United Arab Emirates (UAE). The present study describes CF practices in Abu Dhabi, UAE, and evaluates them using the United Nations Children's Fund (UNICEF) Programming Guide: Infant and Young Child Feeding. METHODS In this cross-sectional study, participating mothers of children below the age of two reported on their children's CF introduction and practices via a structured questionnaire. The study received ethical approval (ZU17_006_F) from Zayed University. RESULTS Out of 1822 participating mothers, 938 had initiated complementary feeding for their children, who had a mean age of 7.1 ± 5.9 months. Three quarters of the children (72.2%) were introduced to CF in a timely manner between the ages of 6 and 9 months. A majority (71.4%) consumed ≥4 food groups, i.e. the recommended minimum diet diversity. In total, less than half (47.3%) of the children met the requirements for minimum meal frequency, with the non-breastfed, 6-23 month old children being the least compliant (21.9%) (p < 0.001). Many children were fed with sugar-containing snack items. Overall, 36.2% of the children aged ≥6 months had a minimum acceptable diet. CONCLUSION The gap between the suboptimal CF practices and the recommendations may be attributable to poor knowledge about feeding practices rather than food availability problems. Effective intervention programs can facilitate improvements in the feeding practices to better support a healthy upbringing among Abu Dhabi infants and toddlers.
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Affiliation(s)
- Zainab Taha
- Department of Health Sciences, CNHS, Zayed University, PO Box 144534, Abu Dhabi, United Arab Emirates
| | - Malin Garemo
- Department of Health Sciences, CNHS, Zayed University, PO Box 144534, Abu Dhabi, United Arab Emirates
| | - Joy Nanda
- The John Hopkins Medical Institutions, Baltimore, MD USA
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Burrell A, Kueter AM, Ariful S, Rahaman H, Iellamo A, Mothabbir G. Appropriate Infant and Young Child Feeding Practices in an Emergency for Non-Breastfed Infants Under Six Months: The Rohingya Experience. J Hum Lact 2020; 36:510-518. [PMID: 32167844 DOI: 10.1177/0890334420906838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Since 25 August, 2017 over 693,000 Rohingya have been forced from Myanmar due to mass violence, seeking refuge in neighboring Bangladesh. Nutritional surveys during 2017 revealed worrying levels of malnutrition and poor infant feeding practices, including high numbers of infants not exclusively breastfeeding. Infants under 6 months who are not exclusively breastfed are particularly vulnerable to morbidity and mortality and require specialized feeding support, especially in emergency contexts. RESEARCH AIM To describe Save the Children International's experiences supporting wet nursing, relactation, and artificial feeding for non-breastfed infants under 6 months in the Rohingya Response, Bangladesh. METHODS A retrospective analysis was conducted of routine program data and documentation from Save the Children International's infant and young child feeding in emergencies interventions for the Rohingya Response, Bangladesh, from November 2017 to April 2018. The study population were infants under 6 months identified as not breastfed during the initial assessment (N = 15). RESULTS Although wet nursing was attempted with all infants, it was successful with 6 (40%) of the infants. Additionally, 1 (6.7%) infant's mother was able to successfully relactate. The remaining infants ended up requiring feeding with human milk substitutes. CONCLUSION Gaps exist in operational guidance to support non-breastfed infants with wet nursing and relactation in emergency settings, as well as on how to operationalize safe human milk substitute programming in line with national policies and regulations. There is an urgent need to address this gap to protect the lives of non-breastfed infants in emergencies worldwide.
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Affiliation(s)
- Alice Burrell
- 5030 Save the Children UK, London, UK.,372561 Save the Children International Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Anne M Kueter
- 5030 Save the Children UK, London, UK.,372561 Save the Children International Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Sujan Ariful
- 372561 Save the Children International Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Habibur Rahaman
- 372561 Save the Children International Bangladesh, Dhaka, Dhaka District, Bangladesh
| | | | - Golam Mothabbir
- 372561 Save the Children International Bangladesh, Dhaka, Dhaka District, Bangladesh
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Effect of Eel Biscuit Supplementation on Height of Children with Stunting Aged 36-60 Months: A Pilot Study. J Nutr Metab 2020; 2020:2984728. [PMID: 32566278 PMCID: PMC7273496 DOI: 10.1155/2020/2984728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 03/14/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Stunting is a major health problem in developing countries. Animal-based supplements can increase the height of children with stunting. This study was aimed at determining the effect of eel biscuit supplementation on increase in the height of children with stunting aged 36-60 months. Methods A pilot study with pretest-post-test design. The study was conducted in two villages in the Priangan Region, West Java Province, Indonesia. The participants were divided into two groups: intervention group (10 supplemented eel biscuit pieces) and control group (biscuits from the government's biscuit programme). A total of 56 children aged 36-60 months with the height-for-age z-score of <-2 SD were recruited voluntarily for sampling. Results The initial height-for-age z-score of the intervention group was -3.45 SD and that of the control group was -3.11 SD. After 3 months of supplemented eel biscuit consumption, the height-for-age z-score of the intervention group changed to -2.52 SD and that of the control group changed to -2.51 SD. The average shift of the height-for-age z-score after 3 months of supplemented eel biscuit consumption was 0.93 SD in the intervention group and 0.6 SD in the control group. There were significant differences in delta and percent increase in the height-for-age z-score between both groups. Conclusions Consumption of supplemented eel biscuits for 3 months increased the height-for-age z-score of children with stunting aged 36-60 months by 0.93 SD.
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Sanchez JJ, Alam MA, Stride CB, Haque MA, Das S, Mahfuz M, Roth DE, Sly PD, Long KZ, Ahmed T. Campylobacter infection and household factors are associated with childhood growth in urban Bangladesh: An analysis of the MAL-ED study. PLoS Negl Trop Dis 2020; 14:e0008328. [PMID: 32407313 PMCID: PMC7252635 DOI: 10.1371/journal.pntd.0008328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 05/27/2020] [Accepted: 04/27/2020] [Indexed: 01/24/2023] Open
Abstract
The dual burden of enteric infection and childhood malnutrition continues to be a global health concern and a leading cause of morbidity and death among children. Campylobacter infection, in particular, is highly prevalent in low- and middle-income countries, including Bangladesh. We examined longitudinal data to evaluate the trajectories of change in child growth, and to identify associations with Campylobacter infection and household factors. The study analyzed data from 265 children participating in the MAL-ED Study in Mirpur, Bangladesh. We applied latent growth curve modelling to evaluate the trajectories of change in children's height, as measured by length-for-age z-score (LAZ), from age 0-24 months. Asymptomatic and symptomatic Campylobacter infections were included as 3- and 6-month lagged time-varying covariates, while household risk factors were included as time-invariant covariates. Maternal height and birth order were positively associated with LAZ at birth. An inverse association was found between increasing age and LAZ. Campylobacter infection prevalence increased with age, with over 70% of children 18-24 months of age testing positive for infection. In the final model, Campylobacter infection in the preceding 3-month interval was negatively associated with LAZ at 12, 15, and 18 months of age; similarly, infection in the preceding 6-month interval was negatively associated with LAZ at 15, 18, and 21 months of age. Duration of antibiotic use and access to treated drinking water were negatively associated with Campylobacter infection, with the strength of the latter effect increasing with children's age. Campylobacter infection had a significant negative effect on child's growth and this effect was most powerful between 12 and 21 months. The treatment of drinking water and increased antibiotic use have a positive indirect effect on linear child growth trajectory, acting via their association with Campylobacter infection.
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Affiliation(s)
- J. Johanna Sanchez
- Children’s Health Research Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Md. Ashraful Alam
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Christopher B. Stride
- The Institute of Work Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Md. Ahshanul Haque
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Subhasish Das
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Daniel E. Roth
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Peter D. Sly
- Children’s Health Research Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kurt Z. Long
- Children’s Health Research Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
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Shrestha SK, Vicendese D, Erbas B. Water, sanitation and hygiene practices associated with improved height-for-age, weight-for-height and weight-for-age z-scores among under-five children in Nepal. BMC Pediatr 2020; 20:134. [PMID: 32293376 PMCID: PMC7092611 DOI: 10.1186/s12887-020-2010-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/27/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Evidence of the influence of water, sanitation and hygiene (WASH) behaviors on childhood nutritional status is inconsistent. Few studies have examined their interactive effects. This study aimed to examine associations and interactions between WASH variables and preschool child undernutrition. METHODS Data from a nationally representative sample of 2352 children assessed during the 2016 Nepal Demographic and Health Survey were analyzed by multi-variable linear regression to understand the association between height-for-age (HAZ), weight-for-height (WHZ) and weight-for-age (WAZ) z-scores and WASH variables. Interactions between WASH variables, sex and area of residence on childhood nutritional status were also examined. RESULTS The mean z-score [standard deviation] for children's WAZ, HAZ and WHZ scores were - 1.33 [1.1], - 1.52 [1.3] and - 0.65 [1.1], respectively. A unit increase in cluster sanitation coverage was associated with an increase of 0.30 (95%CI: 0.12 to 0.48) for WAZ and 0.28 (95%CI: 0.001 to 0.56) for HAZ scores. Household water purification practice was associated with an increase of 0.24 (95%CI: 0.07 to 0.41) in WHZ score. Handwashing practice with water and soap was associated with an increase of 0.15 (95%CI: 0.04 to 0.25) in WAZ and 0.13 (95%CI: 0.01 to 0.24) in WHZ scores. The effect of water purification practice was higher for rural areas compared to urban settings for HAZ scores (p-value for interaction = 0.02). CONCLUSIONS Consistent with findings from other countries in the South Asian region, findings of this study highlight the potential importance of good WASH practices, and therefore the potential of WASH interventions, to contribute to improved nutritional status in rural Nepal.
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Affiliation(s)
| | - Don Vicendese
- The Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia
| | - Bircan Erbas
- The Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia
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Das S, Sanchez JJ, Alam A, Haque A, Mahfuz M, Ahmed T, Long KZ. Dietary Magnesium, Vitamin D, and Animal Protein Intake and Their Association to the Linear Growth Trajectory of Children from Birth to 24 Months of Age: Results From MAL-ED Birth Cohort Study Conducted in Dhaka, Bangladesh. Food Nutr Bull 2020; 41:200-210. [PMID: 32064926 DOI: 10.1177/0379572119892408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Evidence suggests lack of understanding of the association of specific nutrients with different time points of linear growth trajectory. OBJECTIVE We investigated the role of dietary macro- and micronutrients on length-for-age z (LAZ) score trajectory of children across first 24 months of their life. METHODS The MAL-ED Bangladesh birth cohort study recruited 265 healthy newborn children after birth. The linear growth trajectory of those children was modeled using latent growth curve modeling (LGCM) technique. RESULTS Dietary magnesium intake at 9 to 11 months was positively associated (coefficient β = 0.006, P < .02) with LAZ at 12 months. Animal protein intake at 15 to 17 months, in turn, was positively associated (β = 0.03, P < .03) with LAZ at 18 months. However, vitamin D intake at 15 to 17 months was negatively associated (β = -0.06, P < .02) with LAZ at 18 months. Other micro- and macronutrients did not show any statistically significant association with the linear growth trajectory. We also found that birth weight (β = 0.91, P < .01), treating water (β = 0.35, P < 0.00), and maternal height (β = 3.4, P < .00) were positively associated with intercept. Gender had a significant negative association with the intercept, but a positive association with the slope (β = -0.39, P < .01; β = 0.08, P < .04), respectively. Conversely, birth weight had negative association with the slope (β = -0.12, P < .01). CONCLUSIONS Dietary magnesium and animal protein were positively and vitamin D was negatively associated with the linear growth trajectory. Maternal height, birth weight, gender, and treatment of drinking water also played significant roles in directing the trajectory.
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Affiliation(s)
- Subhasish Das
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - J Johanna Sanchez
- Faculty of Medicine, Children's Health Research Centre, University of Queensland, Brisbane, Australia
| | - Ashraful Alam
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Ahshanul Haque
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Kurt Z Long
- Faculty of Medicine, Children's Health Research Centre, University of Queensland, Brisbane, Australia.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Kragel EA, Merz A, Flood DMN, Haven KE. Risk Factors for Stunting in Children under the Age of 5 in Rural Guatemalan Highlands. Ann Glob Health 2020; 86:8. [PMID: 32064226 PMCID: PMC7006585 DOI: 10.5334/aogh.2433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Previously, a study conducted by UNICEF found that malnutrition affects approximately 80% of the indigenous children in Guatemala. Objective Identify prevalence and risk factors for stunted growth in communities surrounding Lake Atitlán, Guatemala. Methods Height-for-age measurements of children under the age of five, N = 84, determined stunting prevalence and presumed burden of malnutrition in this region of the Guatemalan highlands. Mothers of a subset of this sample, N = 29, were interviewed to assess factors contributing to stunting. Analysis assessed the following risk factors: inadequate nutrition, increased infectious disease risk, high rate self-report illness, inadequate breastfeeding, and inadequate utilization of prenatal care. Findings The majority of children under the age of five were stunted (65.6%) and likely malnourished. ANOVA analysis showed significant differences in mean height-for-age Z scores (HAZs) between groups with and without adequate nutrition (F = 7.069, p = 0.013), as well has with and without high rates of self-report illness (F = 6.894, p = 0.014). Both groups with inadequate nutrition (mean HAZs = -2.9, 95% CI = [-3.58, -2.24]) and high rates of self-report illness (mean HAZs = -2.8, 95% CI = [-3.13, -2.38]) had mean HAZs that are indicative of stunting. No other risk factors were associated with stunting. Conclusion These pilot study results offer methods by which to obtain baseline data for assessing nutritional and public health interventions to improve stunting and malnutrition status as well as the health outcomes of children in rural, indigenous communities.
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Anemia, micronutrient deficiencies, malaria, hemoglobinopathies and malnutrition in young children and non-pregnant women in Ghana: Findings from a national survey. PLoS One 2020; 15:e0228258. [PMID: 31999737 PMCID: PMC6991996 DOI: 10.1371/journal.pone.0228258] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/12/2020] [Indexed: 12/21/2022] Open
Abstract
Nationally representative data on the micronutrient status of Ghanaian women and children are very scarce. We aimed to document the current national prevalence of micronutrient deficiencies, anemia, malaria, inflammation, α-thalassemia, sickle cell disease and trait, and under- and over-nutrition in Ghana. In 2017, a two-stage cross-sectional design was applied to enroll pre-school children (6–59 months) and non-pregnant women (15–49 years) from three strata in Ghana: Northern, Middle and Southern Belt. Household and individual questionnaire data were collected along with blood samples. In total, 2123 households completed the household interviews, 1165 children and 973 women provided blood samples. Nationally, 35.6% (95%CI: 31.7,39.6) of children had anemia, 21.5% (18.4,25.0) had iron deficiency, 12.2% (10.1,14.7) had iron deficiency anemia, and 20.8% (18.1,23.9) had vitamin A deficiency; 20.3%(15.2,26.6) tested positive for malaria, 13.9% (11.1,17.3) for sickle trait plus disease, and 30.7% (27.5,34.2) for α-thalassemia. Anemia and micronutrient deficiencies were more prevalent in rural areas, poor households and in the Northern Belt. Stunting and wasting affected 21.4% (18.0,25.2) and 7.0% (5.1,9.5) of children, respectively. Stunting was more common in rural areas and in poor households. Among non-pregnant women, 21.7% (18.7,25.1) were anemic, 13.7% (11.2,16.6) iron deficient, 8.9% (6.7,11.7) had iron deficiency anemia, and 1.5% (0.8,2.9) were vitamin A deficient, 53.8% (47.6,60.0) were folate deficient, and 6.9% (4.8,9.8) were vitamin B12 deficient. Malaria parasitemia in women [8.4% (5.7,12.2)] was lower than in children, but the prevalence of sickle cell disease or trait and α-thalassemia were similar. Overweight [24.7% (21.0,28.8)] and obesity [14.3% (11.5,17.7)] were more common in wealthier, older, and urban women. Our findings demonstrate that anemia and several micronutrient deficiencies are highly present in Ghana calling for the strengthening of Ghana’s food fortification program while overweight and obesity in women are constantly increasing and need to be addressed urgently through governmental policies and programs.
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Ara G, Sanin KI, Khanam M, Sarker SA, Khan SS, Rifat M, Chowdhury IA, Askari S, Afsana K, Ahmed T. Study protocol to assess the impact of an integrated nutrition intervention on the growth and development of children under two in rural Bangladesh. BMC Public Health 2019; 19:1437. [PMID: 31675943 PMCID: PMC6823939 DOI: 10.1186/s12889-019-7777-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 10/14/2019] [Indexed: 12/22/2022] Open
Abstract
Background The period from birth to two years is the “critical window” for achieving optimal growth and development. An inadequate quality and quantities of complementary foods, poor child-feeding practices and infection negatively impact the growth of under-twos. Approximately one-third of under-fives in developing countries are stunted; many are also micronutrient deficient. An estimated 6% of mortalities among under-fives can be prevented by ensuring optimal complementary feeding. The objective of the study was to assess the ability of a 12-month integrated nutrition intervention to improve the nutritional status (length-for-age Z-score) of 6 to 12-month-old children in rural Bangladesh. Methods In this community-based randomized controlled trial, the intervention group received a package of interventions that includes, food vouchers; to prepare egg-based nutritious snacks (suji firni for < 1-year-olds, suji halwa for > 1-year-olds), micronutrient powder to fortify children’s food at home, child feeding counselling and water, sanitation and hygiene (WASH), behaviour change communication. The control group received routine health messages provided by the government. Baseline and endline surveys were conducted; Data collection was performed monthly on children’s growth, food voucher utilization, child feeding and morbidity. In addition, we assessed the cognitive development of the children after 12 months of intervention. Conclusion This trial aims to explore whether an integrated nutrition intervention can mitigate childhood stunting during the critical window of opportunity in rural Bangladesh. The results may provide robust evidence to improve the linear growth of children in developing countries. Trial registration The study was retrospectively registered on August 17, 2018 and is available online at ClinicalTrials.gov (ID: NCT02768181).
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Affiliation(s)
- Gulshan Ara
- icddr,b, GPO BOX 128, 68, Shaheed Tajuddin Ahmed Sarani, Dhaka, Bangladesh.
| | | | - Mansura Khanam
- icddr,b, GPO BOX 128, 68, Shaheed Tajuddin Ahmed Sarani, Dhaka, Bangladesh
| | | | - Sihan Sadat Khan
- icddr,b, GPO BOX 128, 68, Shaheed Tajuddin Ahmed Sarani, Dhaka, Bangladesh
| | | | | | - Sufia Askari
- The Children's Investment Fund Foundation, 7 Clifford Street, London, W1S 2FT, UK
| | | | - Tahmeed Ahmed
- icddr,b, GPO BOX 128, 68, Shaheed Tajuddin Ahmed Sarani, Dhaka, Bangladesh
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Briaux J, Fortin S, Kameli Y, Agboka Y, Romedenne M, Boko J, Martin‐Prevel Y, Becquet R, Savy M. Dissimilarities across age groups in the associations between complementary feeding practices and child growth: Evidence from rural Togo. MATERNAL & CHILD NUTRITION 2019; 15:e12843. [PMID: 31102494 PMCID: PMC6859998 DOI: 10.1111/mcn.12843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 11/27/2022]
Abstract
Adequate complementary feeding (CF) practices are essential for achieving optimal growth but challenging to measure comprehensively. This paper describes CF practices in 2,034 children aged 6-23 months and investigates their relationships with length-for-age z-score (LAZ) and stunting, using cross-sectional data collected from May to July 2014 in rural Northern Togo. The World Health Organization infant and young child feeding indicators were computed, along with ancillary indicators on feeding style and timing of introduction of complementary foods. The associations between those indicators and children's LAZ and stunting were assessed using linear and logistic regressions after stratification by age group and adjustment for children, maternal, and household characteristics. CF practices were suboptimal, and their associations with child's growth varied across indicators and age groups. In children aged 6-11 months, reaching the minimum dietary diversity and the minimum acceptable diet was associated with higher LAZ (p < .05). In 18- to 23-month-old children, only the consumption of iron-rich food was associated with both LAZ (p = .02) and stunting (p = .05). The late introduction of family foods was associated with higher odds of being stunted and lower LAZ in children aged 12-17 months (p < .001). The untimely introduction of porridge was associated with higher odds of stunting in children aged 9-23 months (p < .05). Unexpectedly, helping the child to eat was negatively associated with linear growth in all age groups. These findings nurture the ongoing process of review of the World Health Organization infant and young child feeding indicators showing that, in their current version, they hardly capture the links between CF and child's growth at different ages.
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Affiliation(s)
- Justine Briaux
- UMR 204 Nutripass, Institut de Recherche pour le Développement (IRD), University of Montpellier, Montpellier SupAgroMontpellierFrance
- UMR 1219 Bordeaux Population Health Research Center, team IDLIC, Institut National de la Santé et de la Recherche Médicale (INSERM), University of BordeauxBordeauxFrance
| | - Sonia Fortin
- UMR 204 Nutripass, Institut de Recherche pour le Développement (IRD), University of Montpellier, Montpellier SupAgroMontpellierFrance
| | - Yves Kameli
- UMR 204 Nutripass, Institut de Recherche pour le Développement (IRD), University of Montpellier, Montpellier SupAgroMontpellierFrance
| | - Yawavi Agboka
- Projet de Développement Communautaire et Filets Sociaux, Ministère du Développement à la BaseLoméTogo
| | - Magali Romedenne
- Child Survival and Development, UNICEF, Togo country officeLoméTogo
| | - Joachim Boko
- Social Protection and Labor Global Practice, The World Bank, Benin country officeCotonouBenin
| | - Yves Martin‐Prevel
- UMR 204 Nutripass, Institut de Recherche pour le Développement (IRD), University of Montpellier, Montpellier SupAgroMontpellierFrance
| | - Renaud Becquet
- UMR 1219 Bordeaux Population Health Research Center, team IDLIC, Institut National de la Santé et de la Recherche Médicale (INSERM), University of BordeauxBordeauxFrance
| | - Mathilde Savy
- UMR 204 Nutripass, Institut de Recherche pour le Développement (IRD), University of Montpellier, Montpellier SupAgroMontpellierFrance
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Weatherspoon DD, Miller S, Ngabitsinze JC, Weatherspoon LJ, Oehmke JF. Stunting, food security, markets and food policy in Rwanda. BMC Public Health 2019; 19:882. [PMID: 31272435 PMCID: PMC6610945 DOI: 10.1186/s12889-019-7208-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/20/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Over the past two decades, Rwanda has experienced impressive economic growth, resulting in considerable improvements in living standards and poverty reduction. Despite these gains, progress on reducing the level of stunting in smallholder rural children, particularly boys, continues to be a serious concern. METHODS Policies, dietary diversity and socio-economic factors that may influence stunting in rural Rwandan children were evaluated using a logit model with clustered variance-covariance estimators based on village membership of the household. RESULTS Stunting of rural children was found to be multidimensionally related to the child's gender, weight and age; the dietary diversity, marriage status and education level of the head of household; mother's height; presence of a family garden or if they owned livestock; environmental factors such as altitude and soil fertility and location relative to a main road en route to a market; and a policy that promoted food production. CONCLUSIONS Findings suggest that agricultural policies may be subsidizing poor dietary behavior in that the aggregation of production encourages households to sell high quality nutritious food such as fruit and vegetables, for more voluminous amounts of nutritionally substandard goods, hence low dietary diversity. However, it is less clear if rural food markets are capable of supplying diverse and nutritious foods at affordable prices on a consistent basis, resulting in a lack of diversity and hence, low nutrient quality diets. Rwanda's next round of food security policies should focus on nutrition insecurity with special emphasis on the lack of protein, micronutrients and calories. Multipronged policies and programs focused on income growth, food security, enhanced access to markets and gender-related nutrition risks from inception through 2 years of age in the rural areas are required to improve rural household health outcomes, stunting in particular.
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Affiliation(s)
- Dave D. Weatherspoon
- Agricultural, Food & Resource Economics Department, Michigan State University, Rm. 213C Morrill Hall of Agriculture, 446 W. Circle Dr, East Lansing, MI 48824 USA
| | - Steve Miller
- Agricultural, Food & Resource Economics Department, Rm. 81 Morrill Hall of Agriculture, 446 W. Circle Dr, East Lansing, MI 48824 USA
| | - Jean Chrysostome Ngabitsinze
- Department of Rural Development and Agricultural Economics, College of Agriculture, Animal Sciences and Veterinary Medicine, University of Rwanda, P.O. Box 210, Musanze, 3971 Rwanda
| | - Lorraine J. Weatherspoon
- Department of Food Science and Human Nutrition, Michigan State University, 469 Wilson Road, Rm 140 Trout Food Science Bldg, East Lansing, MI 48824-1224 USA
| | - James F. Oehmke
- United States Agency for International Development, Bureau For Food Security, Ronald Reagan Bldg., 1300 Pennsylvania Ave. NW, Washington, DC 20229 USA
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Kajjura RB, Veldman FJ, Kassier SM. Effect of Nutrition Education on Knowledge, Complementary Feeding, and Hygiene Practices of Mothers With Moderate Acutely Malnourished Children in Uganda. Food Nutr Bull 2019; 40:221-230. [PMID: 31067997 DOI: 10.1177/0379572119840214] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Inappropriate infant and young child complementary feeding practices related to a lack of maternal knowledge contributes to an increased risk of malnutrition, morbidity, and mortality. There is a lack of data regarding the effect of nutrition education on maternal knowledge, feeding, and hygiene practices as part of a supplementary feeding intervention targeting infants and young children with moderate acute malnutrition in low-income countries like Uganda. OBJECTIVE To determine whether nutrition education improves knowledge, feeding, and hygiene practices of mothers with infants and young children diagnosed with moderate acute malnutrition. METHODS A cross-sequential study using a pretest-posttest design included 204 mother-infant pairs conveniently sampled across 24 randomly selected clusters. Weekly nutrition education sessions were embedded in a supplementary porridge intervention for 3 months. Mean scores and proportions for knowledge, feeding, and hygiene practices were determined at baseline and end line. The difference between mean scores at the 2 time points were calculated with the paired t test analysis, while the proportions between baseline and end line were calculated using a z test analysis. RESULTS Mean scores for knowledge, dietary diversity, and meal frequency were higher at end line compared to baseline (P < .001). Handwashing did not improve significantly (P = .183), while boiling water to enhance water quality improved (P < .001). CONCLUSION Nutrition education in conjunction with a supplementary feeding intervention targeting infants and young children with moderate acute malnutrition improved meal frequency, dietary diversity and water quality.
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Affiliation(s)
- Richard B Kajjura
- 1 School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.,2 School of Agricultural, Earth & Environmental Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Frederick J Veldman
- 3 School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Susanna M Kassier
- 2 School of Agricultural, Earth & Environmental Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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Makori N, Matemu A, Kimanya M, Kassim N. Inadequate management of complementary foods contributes to the risk of aflatoxin exposure and low nutrition status among children. WORLD MYCOTOXIN J 2019. [DOI: 10.3920/wmj2018.2354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Early exposure to aflatoxins through complementary food is linked to impaired growth in childhood. The current study assessed the household’s practices on management of complementary foods in relation to the risk of aflatoxin exposure and poor nutritional status among infant and young children in Tanzania. A cross-sectional study of complementary feeding practices, aflatoxin exposure and nutritional status was conducted to 101 infants and young children aged between 6-23 months in Dodoma region of Tanzania. The intake of complementary food was estimated by using repeated 24 h dietary recall. Flour used as complementary food was sampled from each of the 101 families and aflatoxins were analysed using high-performance liquid chromatography. A deterministic approach was used to estimate dietary exposure of aflatoxins in the complementary foods. Anthropometric measurements were taken and rates of stunting, underweight and wasting estimated according to the WHO standard procedures. Multivariate logistic regression analysis was used to assess the association between feeding practices and aflatoxin exposure or the growth performance among subjects. The average consumption of complementary flour was 118 g per child per day and 52% of the flours contained groundnuts. AFB1 was detected in 42.5% of the flour and levels ranged from 0.3 to 2,128.0 μg/kg (mean 228.11±49.84 μg/kg). Dietary exposures of aflatoxin B1 ranged from 0.1 to 23,172.81 ng/kg body weight per day (mean 1,337±392.5 ng/kg). Of the subjects, 40.4% (95% CI; 29.8; 50.9) were stunted and significant association was found between stunted growth and dietary exposure of AFB1 (adjusted odd ratio (AOR)=5.9; 95% CI: 0.019-0.028). Early introduction of cereal-and groundnut-based complementary foods in Tanzania is associated with high risk of aflatoxin exposure and impaired growth in children. There is need to integrate aflatoxin management measures in the guidelines for Infant and Young Children Feeding of Tanzania.
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Affiliation(s)
- N. Makori
- Department of Food Biotechnology and Nutritional Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, P.O. Box 447, Arusha, Tanzania
| | - A. Matemu
- Department of Food Biotechnology and Nutritional Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, P.O. Box 447, Arusha, Tanzania
| | - M. Kimanya
- Department of Food Biotechnology and Nutritional Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, P.O. Box 447, Arusha, Tanzania
| | - N. Kassim
- Department of Food Biotechnology and Nutritional Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, P.O. Box 447, Arusha, Tanzania
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Wirth JP, Kitilya B, Petry N, PrayGod G, Veryser S, Mngara J, Zwahlen C, Wieringa F, Berger J, de Onis M, Rohner F, Becquey E. Growth Status, Inflammation, and Enteropathy in Young Children in Northern Tanzania. Am J Trop Med Hyg 2018; 100:192-201. [PMID: 30398137 DOI: 10.4269/ajtmh.17-0720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Recent evidence suggests that enteropathy of the gut due to environmental conditions (i.e., environmental enteropathy [EE]) in young children is negatively associated with linear growth. Using a case-control study design, we examined the potential determinants of stunting in stunted and non-stunted children 22-28 months of age. Potential determinants included inflammation biomarkers C-reactive protein, alpha-1-acid glycoprotein (AGP), and endotoxin-core antibody (EndoCAb) measured in serum samples; enteropathy markers alpha-1-antitrypsin, neopterin, myeloperoxidase (MPO) measured in stools samples; and demographic, health, feeding, and household characteristics. We also explored the determinants of EE by testing associations of composite EE scores and individual biomarkers with potential risk factors. Fifty-two percent of children (n = 310) were found to be stunted, and mean height-for-age Z scores (HAZ) were -1.22 (standard deviation [SD] ± 0.56) among non-stunted (control) children and -2.82 (SD ± 0.61) among stunted (case) children. Child HAZ was significantly (P < 0.05) and inversely associated with AGP, and child stunting was significantly positively associated (P < 0.05) with low dietary diversity, severe household hunger, and absence of soap in the household. Alpha-1-acid glycoprotein and EndoCAb concentrations were also significantly higher (P < 0.05) among children in households with no soap. Our study documented a seemingly localized cultural practice of young children (25%) being fed their dirty bathwater, which was associated with significantly higher concentrations of MPO (P < 0.05). Alpha-1-acid glycoprotein showed the most consistent associations with child growth and hygiene practices, but fecal EE biomarkers were not associated with child growth. The lack of retrospective data in our study may explain the null findings related to fecal EE biomarkers and child growth.
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Affiliation(s)
- James P Wirth
- GroundWork, Fläsch, Switzerland.,Unité Mixte de Recherche (UMR)-204, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, Montpellier, France
| | - Brenda Kitilya
- National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | | | - George PrayGod
- National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | | | - Julius Mngara
- National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | | | - Frank Wieringa
- Unité Mixte de Recherche (UMR)-204, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, Montpellier, France
| | - Jacques Berger
- Unité Mixte de Recherche (UMR)-204, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, Montpellier, France
| | | | | | - Elodie Becquey
- International Food Policy Research Institute (IFPRI), Dakar, Senegal
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Temesgen H, Negesse A, Woyraw W, Mekonnen N. Dietary diversity feeding practice and its associated factors among children age 6-23 months in Ethiopia from 2011 up to 2018: a systematic review and meta-analysis. Ital J Pediatr 2018; 44:109. [PMID: 30223854 PMCID: PMC6142683 DOI: 10.1186/s13052-018-0567-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 09/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally Less than one fourth of children aged 6-23 months get the recommended minimum dietary diversity feeding practice. Despite this issue is common in Ethiopia, fragmented and inconsistent findings were found. Therefore the main objective of this meta-analysis was to estimate the pooled prevalence of dietary diversity feeding practice and to identify its associated factors among children aged 6-23 months in Ethiopia. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. Articles were systematically searched through PubMed, Google scholar, Google, Hinari and Cochrane library. Newcastle-Ottawa Scale adapted for cross-sectional studies quality assessment tool was used to assess the quality of each study. A total of 14 studies were extracted and analyzed using STATA 14. Random effect model was used to estimate the pooled prevalence; whereas subgroup analysis and meta-regression was performed to identify the probable source of heterogeneity. Both egger's and begg's test were used to check publication bias. Furthermore, the effect between associated factor variables, and dietary diversity feeding practices were examined. RESULTS A total of 154 studies were retrieved and 14 studies were included in meta-analysis. The Meta analysis result showed that the pooled prevalence of dietary feeding practice among children age 6-23 months in Ethiopia was 23.25% with considerable heterogeneity (I2 = 98.8, p = 0.00). In the subgroup analysis, the lowest prevalence was observed in Amhara region (12.58%). Home delivery OR: 0.63, antenatal care follow up OR: 1.80, postnatal care visit OR: 2.61, mothers decision making status OR: 1.65, mothers media exposure status OR: 2.79 and being urban residence OR: 2.18 (1.26, 3.77) were significant factors for minimum dietary diversity feeding practice in Ethiopia. CONCLUSIONS The pooled prevalence of dietary diversity feeding practice among children aged 6-23 months in Ethiopia was low. Place of delivery, post natal care, antenatal care service, mothers decision making status, mothers media exposure status and being urban residence were found to be the significant factors.
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Affiliation(s)
- Habtamu Temesgen
- Department of Human Nutrition and Food Sciences, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Ayenew Negesse
- Department of Human Nutrition and Food Sciences, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Wubetu Woyraw
- Department of Human Nutrition and Food Sciences, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Nakachew Mekonnen
- Department of Public Health, College of Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
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Jannat K, Luby SP, Unicomb L, Rahman M, Winch PJ, Parvez SM, Das KK, Leontsini E, Ram PK, Stewart CP. Complementary feeding practices among rural Bangladeshi mothers: Results from WASH Benefits study. MATERNAL AND CHILD NUTRITION 2018; 15:e12654. [PMID: 30101576 PMCID: PMC6519265 DOI: 10.1111/mcn.12654] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 06/08/2018] [Accepted: 06/21/2018] [Indexed: 01/07/2023]
Abstract
Inappropriate complementary feeding contributes to linear growth faltering in early childhood. Behaviour change interventions have been effective at improving practice, but few studies have investigated the effects of multicomponent integrated interventions. We conducted a cluster‐randomized controlled trial in rural Bangladesh in which geographic clusters were randomized into seven arms: water treatment (W), sanitation (S), handwashing (H), water, sanitation, and handwashing (WSH), improved nutrition with infant and young child feeding messages and lipid‐based nutrient supplementation for 6‐ to 24‐month olds (N), N+WSH, and control. The objective of this paper was to examine the independent and combined effects of interventions on indicators of complementary feeding. Approximately 1 and 2 years after initiation of the intervention, research assistants surveyed mothers about infant feeding practices. Complementary feeding was examined using the World Health Organization indicators of infant and young child feeding practices. We used Poisson regression models to estimate prevalence ratios and linear regression models for prevalence differences with clustered sandwich estimators to adjust for clustering. A total of 4,718 households from 720 clusters were surveyed at year 1 and 4,667 at year 2. The children in the nutrition arms had a higher prevalence of meeting the minimum dietary diversity score compared with controls (year 1: N: 66.4%; N+WSH: 65.0% vs. C:32.4%; year 2: N: 91.5%; N+WSH: 91.6% vs. C:77.7%). Children in the nutrition arms received diverse food earlier than the children in control arm. In addition, the average consumption of lipid‐based nutrient supplementation was >90% in each follow‐up. Nutrition‐specific interventions could be integrated with nutrition‐sensitive interventions such as WSH without compromising the uptake of the nutrition intervention.
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Affiliation(s)
- Kaniz Jannat
- Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Stephen P Luby
- Medicine - Med/Infectious Diseases, Stanford University, Stanford, California
| | - Leanne Unicomb
- Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarker M Parvez
- Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Kishor K Das
- Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Elli Leontsini
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Pavani K Ram
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
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43
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Cunningham K, Ferguson E, Ruel M, Uauy R, Kadiyala S, Menon P, Ploubidis G. Water, sanitation, and hygiene practices mediate the association between women's empowerment and child length-for-age z-scores in Nepal. MATERNAL AND CHILD NUTRITION 2018; 15:e12638. [PMID: 30047247 DOI: 10.1111/mcn.12638] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 05/19/2018] [Accepted: 05/22/2018] [Indexed: 12/29/2022]
Abstract
In Nepal, more than one-third of children are stunted. Prior studies have shown that women's empowerment in agriculture is associated with child (<2 years) length-for-age z-scores (LAZ) in Nepal. This study tests whether child dietary diversity (DD) and household water, sanitation, and hygiene (WASH) facilities and practices mediate the associations between women's empowerment and LAZ. With a cross-sectional dataset of 4,080 households from 240 rural communities across 16 districts of Nepal, we used ordinary least squares regression models to first estimate the associations between women's empowerment and LAZ for children 6 to 24 months (n = 1,402; our previous published analysis included all children <24 months of age), using the Women's Empowerment in Agriculture Index's Five Domains of Empowerment subindex. We used standardized structural equation models to test whether child DD and/or household WASH mediated the association between women's empowerment and child LAZ. Overall, women's empowerment was positively associated with child LAZ (β = 0.24, P = 0.03), as found in our previous analyses. In the mediation analysis, women's empowerment was positively associated with WASH (β = 0.78, P < 0.001), and in turn child LAZ (β = 0.09, P < 0.001). Women's empowerment was not associated with DD, but DD was associated with LAZ (β = 0.06, P = 0.05). Empowered women had better WASH practices than nonempowered women, which translated into higher child LAZ. Child DD was not a mediating factor in the association between women's empowerment and child LAZ. More research is needed to explore other pathways by which women's empowerment may affect child nutrition outcomes.
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Affiliation(s)
| | - Elaine Ferguson
- Department of Population Health, Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Marie Ruel
- Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, D.C., USA
| | - Ricardo Uauy
- Department of Population Health, Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Institute of Food Nutrition and Food Technology, Santiago, Chile
| | - Suneetha Kadiyala
- Department of Population Health, Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Purnima Menon
- Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, D.C., USA.,Poverty Health and Nutrition Division, International Food Policy Research Institute, New Delhi, India
| | - George Ploubidis
- Department of Quantitative Social Science, Centre for Longitudinal Studies; Institute of Education, London, UK
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44
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Pearson R, Killedar M, Petravic J, Kakietek JJ, Scott N, Grantham KL, Stuart RM, Kedziora DJ, Kerr CC, Skordis-Worrall J, Shekar M, Wilson DP. Optima Nutrition: an allocative efficiency tool to reduce childhood stunting by better targeting of nutrition-related interventions. BMC Public Health 2018; 18:384. [PMID: 29558915 PMCID: PMC5861618 DOI: 10.1186/s12889-018-5294-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 03/12/2018] [Indexed: 11/11/2022] Open
Abstract
Background Child stunting due to chronic malnutrition is a major problem in low- and middle-income countries due, in part, to inadequate nutrition-related practices and insufficient access to services. Limited budgets for nutritional interventions mean that available resources must be targeted in the most cost-effective manner to have the greatest impact. Quantitative tools can help guide budget allocation decisions. Methods The Optima approach is an established framework to conduct resource allocation optimization analyses. We applied this approach to develop a new tool, ‘Optima Nutrition’, for conducting allocative efficiency analyses that address childhood stunting. At the core of the Optima approach is an epidemiological model for assessing the burden of disease; we use an adapted version of the Lives Saved Tool (LiST). Six nutritional interventions have been included in the first release of the tool: antenatal micronutrient supplementation, balanced energy-protein supplementation, exclusive breastfeeding promotion, promotion of improved infant and young child feeding (IYCF) practices, public provision of complementary foods, and vitamin A supplementation. To demonstrate the use of this tool, we applied it to evaluate the optimal allocation of resources in 7 districts in Bangladesh, using both publicly available data (such as through DHS) and data from a complementary costing study. Results Optima Nutrition can be used to estimate how to target resources to improve nutrition outcomes. Specifically, for the Bangladesh example, despite only limited nutrition-related funding available (an estimated $0.75 per person in need per year), even without any extra resources, better targeting of investments in nutrition programming could increase the cumulative number of children living without stunting by 1.3 million (an extra 5%) by 2030 compared to the current resource allocation. To minimize stunting, priority interventions should include promotion of improved IYCF practices as well as vitamin A supplementation. Once these programs are adequately funded, the public provision of complementary foods should be funded as the next priority. Programmatic efforts should give greatest emphasis to the regions of Dhaka and Chittagong, which have the greatest number of stunted children. Conclusions A resource optimization tool can provide important guidance for targeting nutrition investments to achieve greater impact.
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Affiliation(s)
- Ruth Pearson
- Burnet Institute, Melbourne, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. .,Optima Consortium for Decision Science, Melbourne, Australia.
| | - Madhura Killedar
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Optima Consortium for Decision Science, Melbourne, Australia
| | - Janka Petravic
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Optima Consortium for Decision Science, Melbourne, Australia
| | | | - Nick Scott
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Optima Consortium for Decision Science, Melbourne, Australia
| | - Kelsey L Grantham
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Optima Consortium for Decision Science, Melbourne, Australia
| | - Robyn M Stuart
- Burnet Institute, Melbourne, Australia.,Optima Consortium for Decision Science, Melbourne, Australia.,Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David J Kedziora
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Optima Consortium for Decision Science, Melbourne, Australia
| | - Cliff C Kerr
- Burnet Institute, Melbourne, Australia.,Optima Consortium for Decision Science, Melbourne, Australia.,Complex Systems Group, School of Physics, University of Sydney, Sydney, Australia
| | - Jolene Skordis-Worrall
- Optima Consortium for Decision Science, Melbourne, Australia.,Institute for Global Health, University College London, London, UK
| | - Meera Shekar
- The World Bank, ICF International, Washington D.C., USA
| | - David P Wilson
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Optima Consortium for Decision Science, Melbourne, Australia
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45
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Kumera G, Tsedal E, Ayana M. Dietary diversity and associated factors among children of Orthodox Christian mothers/caregivers during the fasting season in Dejen District, North West Ethiopia. Nutr Metab (Lond) 2018; 15:16. [PMID: 29456587 PMCID: PMC5813384 DOI: 10.1186/s12986-018-0248-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 01/25/2018] [Indexed: 12/03/2022] Open
Abstract
Background Proper feeding practices during early childhood is fundamental for optimal child growth and development. However, scientific evidences on the determinants of dietary diversity are scanty. Particularly, the impact of fasting on children`s dietary diversity is not explored in Ethiopia. The aim of this study was to assess dietary diversity and associated factors among children aged 6–23 months, whose mothers/care-givers were Orthodox Christians during the fasting season (Lent), in Dejen District, North West Ethiopia, 2016. Methods A community based cross-sectional study was conducted during the fasting season from March to April, 2016. The study sample were children aged 6–23 months, whose mothers/care-givers were Orthodox Christians. A systematic random sampling technique was used to select a sample of 967 children proportionally from all selected kebeles. Data was entered using Epi data and statistical analysis were done using logistic regression. P-value < 0.05 at 95% confidence interval was taken as statistically significant. Results Only 13.6% of children surveyed met the minimum requirement for dietary diversity. Unsatisfactory exposure to media [AOR = 5.22] and low household monthly income [AOR = 2.20] were negatively associated with dietary diversity. As compared to economic related reasons, mothers/caregivers who do not feed diet of animal origin to their children due to fear of utensil contamination for family food preparation were 1.5 times [AOR=1.5; 95% CI (1.05 – 2.53)] less likely to feed the recommended dietary diversity. Conclusions The findings of this study revealed that the diet of children in the study area lacked diversity. Promoting mass media and socioeconomic empowerment of women have positive contribution to optimal child feeding practice. Sustained nutrition education to mothers regarding proper infant and young child feeding practice in collaboration with the respective religious leaders is highly recommended.
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Affiliation(s)
- Gemechu Kumera
- Department of Public Health, College of Health Sciences and Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Endalkachew Tsedal
- Department of Public Health, College of Health Sciences and Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Mulatu Ayana
- Department of Public Health, College of Health Sciences and Medicine, Debre Markos University, Debre Markos, Ethiopia
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46
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Bournez M, Ksiazek E, Wagner S, Kersuzan C, Tichit C, Gojard S, Thierry X, Charles MA, Lioret S, de Lauzon-Guillain B, Nicklaus S. Factors associated with the introduction of complementary feeding in the French ELFE cohort study. MATERNAL AND CHILD NUTRITION 2017; 14:e12536. [PMID: 29052955 DOI: 10.1111/mcn.12536] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 12/21/2022]
Abstract
The objectives of this study were to estimate the age of complementary feeding introduction (CFI) and investigate the related health, demographic, and socio-economic factors. Analyses were based on 10,931 infants from the French national birth cohort ELFE, born in 2011. Health, demographic, and socio-economic data concerning infants and parents were collected at birth (face-to-face interviews and medical records) and 2 months (telephone interviews). Data on milk feeding and CFI practices were collected at birth and 2 months then monthly from 3 to 10 months using online or paper questionnaires. The associations between both health and social factors and CFI age were tested by multivariable multinomial logistic regressions. The mean CFI age was 5.2 ± 1.2 months; 26% of the infants started complementary feeding before 4 months of age (CF < 4 months), 62% between 4 and 6 months of age, and 12% after 6 months of age (CF > 6 months). CF < 4 months was more likely when mothers smoked, were overweight/obese, younger (<29 years), and used their personal experience as an information source in child caregiving and when both parents were not born in France. CF < 4 months was less likely when the infant was a girl, second-born, when the mother breastfed longer, and had attended at least one birth preparation class. Mothers of second-born infants and who breastfed their child longer were more likely to introduce CF > 6 months. Couples in which fathers were born in France and mothers were not born in France were less likely to introduce CF > 6 months. CF < 4 months occurred in more than 25% of the cases. It is important to continue promoting clear CFI recommendations, especially in smoking, overweight, young, not born in France, and nonbreastfeeding mothers.
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Affiliation(s)
- Marie Bournez
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, Dijon, France.,Centre Hospitalier Universitaire de Dijon, Hopital d'Enfants, Peediatrics, Dijon, France
| | - Eléa Ksiazek
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, Dijon, France
| | - Sandra Wagner
- INSERM, CRESS, ORCHAD team, Villejuif, France.,Paris Descartes University, CRESS, Villejuif, France
| | - Claire Kersuzan
- ALISS UR1303, INRA, Université Paris-Saclay, Ivry-sur-Seine, France
| | - Christine Tichit
- ALISS UR1303, INRA, Université Paris-Saclay, Ivry-sur-Seine, France.,Centre Maurice Halbwachs, CNRS, ENS, EHESS, Paris, France
| | - Séverine Gojard
- ALISS UR1303, INRA, Université Paris-Saclay, Ivry-sur-Seine, France.,Centre Maurice Halbwachs, CNRS, ENS, EHESS, Paris, France
| | - Xavier Thierry
- Institut national d'études démographiques, Paris, France
| | - Marie-Aline Charles
- INSERM, CRESS, ORCHAD team, Villejuif, France.,Paris Descartes University, CRESS, Villejuif, France
| | - Sandrine Lioret
- INSERM, CRESS, ORCHAD team, Villejuif, France.,Paris Descartes University, CRESS, Villejuif, France
| | | | - Sophie Nicklaus
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, Dijon, France
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Tracking of infant and young child feeding practices among 9- to 24-month-old children in Nepal: the MAL-ED Birth Cohort Study. Public Health Nutr 2017; 21:355-364. [PMID: 29037267 DOI: 10.1017/s1368980017002294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The present study aimed to assess infant and young child feeding (IYCF) practices and the tracking of dietary diversity score (DDS), intakes of Fe- and vitamin A-rich foods and meal frequency in a peri-urban area in Nepal. Furthermore, to explore whether sociodemographic factors were associated with tracking patterns of these IYCF practices. DESIGN Longitudinal study. Monthly food intake was measured by 24 h recall. Four time slots were used (9-12, 13-16, 17-20 and 21-24 months). Tracking of IYCF practices was investigated using generalized estimating equations (GEE) models and Cohen's weighted kappa. Multinominal logistic regression was used to identify determinants for tracking of the IYCF practices. SETTING Bhaktapur municipality, Nepal. SUBJECTS Children (n 229) aged 9-24 months, randomly selected. RESULTS Prevalence of minimum meal frequency was higher than for minimum dietary diversity at all time slots. Tracking based on absolute measures (GEE models) was moderate for DDS (0·48) and meal frequency (0·53), and low for intakes of Fe- (0·23) and vitamin A-rich (0·35) foods. Tracking based on rank measured was moderate for DDS and meal frequency, and fair for Fe- and vitamin A-rich foods. Low socio-economic status significantly increased the odds (OR; 95 % CI) of tracking of low v. high DDS (3·31; 1·44, 7·60) and meal frequency (3·46; 1·54, 7·76). CONCLUSIONS Low tracking for intakes of Fe- and vitamin A-rich foods implies that interventions to improve these IYCF practices must address underlying causes for irregular intake to have sustainable effects.
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Akombi BJ, Agho KE, Hall JJ, Wali N, Renzaho AMN, Merom D. Stunting, Wasting and Underweight in Sub-Saharan Africa: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E863. [PMID: 28788108 PMCID: PMC5580567 DOI: 10.3390/ijerph14080863] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 01/24/2023]
Abstract
Introduction: Child undernutrition is a major public health problem. One third of all undernourished children globally reside in Sub-Saharan Africa (SSA). The aim of this study was to systematically review studies to determine the factors associated with stunting, wasting and underweight in SSA and contribute to the existing body of evidence needed for the formulation of effective interventions. Methods: This systematic review was conducted using the 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Five computerized bibliographic databases were searched: Scopus, PubMed, PsycINFO, CINAHL and Embase. The included studies were rated using eight quality-appraisal criteria derived from the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist: sample size, sampling methodology, response rate, outcome measures, statistical analyses, control for confounding, study limitation, and ethical consideration. Results: Of a total of 2810 articles retrieved from the five databases, 49 studies met our inclusion criteria. The most consistent factors associated with childhood stunting, wasting and underweight in SSA were: low mother's education, increasing child's age, sex of child (male), wealth index/SES (poor household), prolonged duration of breastfeeding (>12 months), low birth weight, mother's age (<20 years), source of drinking water (unimproved), low mother's BMI (<18.5), birth size (small), diarrhoeal episode, low father's education and place of residence (rural). Conclusions: The factors that predispose a child to undernutrition are multisectoral. To yield a sustainable improvement in child nutrition in SSA, a holistic multi-strategy community-based approach is needed that targets the factors associated with undernutrition, thereby setting the region on the path to achieving the WHO global nutrition target by 2025.
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Affiliation(s)
- Blessing J Akombi
- School of Science and Health, Western Sydney University, Penrith, NSW 2571, Australia.
| | - Kingsley E Agho
- School of Science and Health, Western Sydney University, Penrith, NSW 2571, Australia.
| | - John J Hall
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Nidhi Wali
- School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW 2751, Australia.
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW 2751, Australia.
| | - Dafna Merom
- School of Science and Health, Western Sydney University, Penrith, NSW 2571, Australia.
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49
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Owais A, Schwartz B, Kleinbaum DG, Suchdev PS, Faruque ASG, Das SK, Stein AD. Minimum Acceptable Diet at 9 Months but Not Exclusive Breastfeeding at 3 Months or Timely Complementary Feeding Initiation Is Predictive of Infant Growth in Rural Bangladesh. PLoS One 2016; 11:e0165128. [PMID: 27776161 PMCID: PMC5077142 DOI: 10.1371/journal.pone.0165128] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/06/2016] [Indexed: 11/18/2022] Open
Abstract
The association between suboptimal infant feeding practices and growth faltering is well-established. However, most of this evidence comes from cross-sectional studies. To prospectively assess the association between suboptimal infant feeding practices and growth faltering, we interviewed pregnant women at 28–32 weeks’ gestation and followed-up their offspring at postnatal months 3, 9, 16 and 24 months in rural Bangladesh. Using maternal recall over the past 24 hours, exclusive breastfeeding (EBF) status at 3 months, age at complementary feeding (CF) initiation, and receipt of minimum acceptable diet (MAD; as defined by WHO) at 9 months were assessed. Infant length and weight measurements were used to produce length-for-age (LAZ) and weight-for-length (WLZ) z-scores at each follow-up. Generalized estimating equations were used to estimate associations of LAZ and WLZ with infant feeding practices. All models were adjusted for baseline SES, infant sex, maternal height, age, literacy and parity. Follow-up was completed by 2189, 2074, 1969 and 1885 mother-child dyads at 3, 9, 16 and 24 months, respectively. Stunting prevalence increased from 28% to 57% between infant age 3 and 24 months. EBF at 3 months and age at CF initiation were not associated with linear infant growth, but receipt of MAD at 9 months was. By age 24 months, infants receiving MAD had attained a higher LAZ compared to infants who did not receive MAD (adjusted β = 0.25, 95% CI: 0.13–0.37). Although prevalence of stunting was already high at age 3 months, ensuring infants receive a diverse, high quality diet from 6 months onwards may reduce rates of stunting in the second year of life.
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Affiliation(s)
- Aatekah Owais
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, GA, United States of America
| | - Benjamin Schwartz
- Los Angeles County Department of Public Health, Los Angeles, CA, United States of America
| | - David G. Kleinbaum
- Department of Epidemiology, Emory University, Atlanta, GA, United States of America
| | - Parminder S. Suchdev
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States of America
| | - A. S. G. Faruque
- International Center for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Sumon K. Das
- International Center for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Aryeh D. Stein
- Department of Epidemiology, Emory University, Atlanta, GA, United States of America
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States of America
- * E-mail:
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50
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Abeshu MA, Lelisa A, Geleta B. Complementary Feeding: Review of Recommendations, Feeding Practices, and Adequacy of Homemade Complementary Food Preparations in Developing Countries - Lessons from Ethiopia. Front Nutr 2016; 3:41. [PMID: 27800479 PMCID: PMC5065977 DOI: 10.3389/fnut.2016.00041] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/20/2016] [Indexed: 12/26/2022] Open
Abstract
Breastfeeding provides the ideal food during the first 6 months of life. Complementary feeding starts when breast milk is no longer sufficient by itself, where the target age is for 6-23 months. The gap between nutritional requirement and amount obtained from breast milk increases with age. For energy, 200, 300, and 550 kcal per day is expected to be covered by complementary foods at 6-8, 9-11, and 12-23 months, respectively. In addition, the complementary foods must provide relatively large proportions of micronutrients such as iron, zinc, phosphorus, magnesium, calcium, and vitamin B6. In several parts of the developing world, complementary feeding continues as a challenge to good nutrition in children. In Ethiopia, only 4.2% of breastfed children of 6-23 months of age have a minimum acceptable diet. The gaps are mostly attributed to either poor dietary quality or poor feeding practices, if not both. Commercial fortified foods are often beyond the reach of the poor. Thus, homemade complementary foods remain commonly used. Even when based on an improved recipe, however, unfortified plant-based complementary foods provide insufficient key micronutrients (especially, iron, zinc, and calcium) during the age of 6-23 months. Thus, this review assessed complementary feeding practice and recommendation and reviewed the level of adequacy of homemade complementary foods.
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Affiliation(s)
| | - Azeb Lelisa
- Micronutrient Initiative-Ethiopia , Addis Ababa , Ethiopia
| | - Bekesho Geleta
- Ethiopian Public Health Institute , Addis Ababa , Ethiopia
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