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Albin MQ, Igihozo G, Musemangezhi S, Namukanga EN, Uwizeyimana T, Alemayehu G, Bekele A, Wong R, Kalinda C. "When we have served meat, my husband comes first": A qualitative analysis of child nutrition among urban and rural communities of Rwanda. PLoS One 2024; 19:e0306444. [PMID: 39012892 PMCID: PMC11251605 DOI: 10.1371/journal.pone.0306444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 06/18/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Stunting among children under five years of age is a global public health concern, especially in low-and middle-income settings. Emerging evidence suggests a gradual reduction in the overall prevalence of stunting in Rwanda, necessitating a qualitative understanding of the contributing drivers to help develop targeted and effective strategies. This qualitative study explored the lived experiences of women and men to identify key issues that influence childhood nutrition and stunting as well as possible solutions to address the problem. METHODS Ten (10) focus group discussions (FGDs) were conducted with fathers and mothers of children under five years of age from five districts, supplemented by forty (40) in-depth interviews (IDIs) with Nurses and Community Health Workers (CHWs). Transcripts were coded inductively and analysed thematically using Dedoose (version 9.0.86). RESULTS Three themes emerged: (1) Awareness of a healthy diet for pregnant women, infants, and children with subthemes Knowledge about maternal and child nutrition and feeding practices; (2) Personal and food hygiene is crucial while handling, preparing, and eating food with subthemes, food preparation practices and the feeding environment (3) factors influencing healthy eating among pregnant women, infants, and children with subthemes; Barriers and facilitators to healthy eating among pregnant women and children. CONCLUSION Several factors influence child stunting, and strategies to address them should recognise the cultural and social contexts of the problem. Prioritisation of nutrition-based strategies is vital and should be done using a multifaceted approach, incorporating economic opportunities and health education, especially among women, and allowing CHWs to counsel households with conflicts.
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Affiliation(s)
- Maria Qambayot Albin
- Centre for One Health, University of Global Health Equity (UGHE), Kigali, Rwanda
| | - Gloria Igihozo
- Centre for One Health, University of Global Health Equity (UGHE), Kigali, Rwanda
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity (UGHE), Kigali, Rwanda
| | - Shuko Musemangezhi
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity (UGHE), Kigali, Rwanda
| | | | - Theogene Uwizeyimana
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity (UGHE), Kigali, Rwanda
| | | | - Abebe Bekele
- School of Medicine, University of Global Health Equity (UGHE), Kigali, Rwanda
| | - Rex Wong
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity (UGHE), Kigali, Rwanda
- School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Chester Kalinda
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity (UGHE), Kigali, Rwanda
- School of Nursing and Public Health (SNPH), Discipline of Public Health Medicine, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
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Rashid S, Meier V, Patrick H. Review of Vitamin B12 deficiency in pregnancy: a diagnosis not to miss as veganism and vegetarianism become more prevalent. Eur J Haematol 2021; 106:450-455. [PMID: 33341967 DOI: 10.1111/ejh.13571] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 01/23/2023]
Abstract
Vegetarianism and veganism are increasingly popular. The Food Standards Agency, biennial Food and You Survey of adults aged 16 years and over living in the UK, found that between 2012 and 2018 the proportion of people who reported never consuming dairy products had increased from 2% to 5%. However, veganism risks development of vitamin B12 deficiency as it is not available from plant sources. Moreover, its impact may be slow to be detected because body stores of vitamin B12 can last years. There is currently no published guidance on antenatal diagnosis and management of vitamin B12 deficiency. This paper reviews the metabolism, diagnosis and treatment of vitamin B12 in pregnancy. It concludes that national screening policymakers should consider introducing screening for B12 deficiency into the Antenatal and Newborn Screening Programmes for mothers and their infants if at risk of vitamin B12 deficiency. In the interim, national policy should be developed for prophylactic vitamin B12 supplementation in high-risk groups around the time of pregnancy.
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Affiliation(s)
- Sabia Rashid
- Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK
| | - Violet Meier
- Library and Knowledge Services, University Hospital Lewisham, London, UK
| | - Hannah Patrick
- Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK
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Abdollahi S, Soltani S, de Souza RJ, Forbes SC, Toupchian O, Salehi-Abargouei A. Associations between Maternal Dietary Patterns and Perinatal Outcomes: A Systematic Review and Meta-Analysis of Cohort Studies. Adv Nutr 2021; 12:1332-1352. [PMID: 33508080 PMCID: PMC8321866 DOI: 10.1093/advances/nmaa156] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/10/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023] Open
Abstract
The aim was to systematically review and meta-analyze prospective cohort studies investigating the relation between maternal dietary patterns during pregnancy with pregnancy and birth outcomes. PubMed, Scopus, and ISI Web of Science were searched from inception until October 2019 for eligible studies. Studies reporting relative risk, ORs, or incidences (for binary data) or means ± SDs or B-coefficients (for continuous outcomes) comparing the highest and lowest adherence with maternal dietary patterns were included. Dietary patterns were categorized as "healthy," "unhealthy," or "mixed." No language restrictions were applied. Study-specific effect sizes with SEs for outcomes of interest were pooled using a random-effects model. Quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Sixty-six relevant publications were included. A higher maternal adherence to a healthy diet was associated with a reduced risk of gestational hypertension (14%, P < 0.001), maternal depression (40%, P = 0.004), low birth weight (28%, P = 0.001), preterm birth (56%, P < 0.001), higher gestational weight gain (Hedges' g: 0.15; P = 0.01), and birth weight (Hedges' g: 0.19; P = 0.007). Higher maternal adherence to an unhealthy or a mixed diet was associated with higher odds of gestational hypertension (23%, P < 0.001 for unhealthy, and 8%, P = 0.01 for mixed diet). In stratified analyses, a higher healthy eating index was associated with reduced odds of being large based on gestational age (31%, P = 0.02) and a higher head circumference at birth (0.23 cm, P = 0.02). The Mediterranean and "prudent" dietary patterns were related to lower odds of being small based on gestational age (46%, P = 0.04) and preterm birth (52%, P = 0.03), respectively. The overall GRADE quality of the evidence for most associations was low or very low, indicating that future high-quality research is warranted. This study was registered at http://www.crd.york.ac.uk/PROSPERO as CRD42018089756.
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Affiliation(s)
- Shima Abdollahi
- School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Sepideh Soltani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Scott C Forbes
- Department of Physical Education, Faculty of Education, Brandon University, Brandon, Manitoba, Canada
| | - Omid Toupchian
- School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Schuckit MA, Smith TL, Clarke D, Mendoza LA, Kawamura M, Schoen L. Predictors of Increases in Alcohol Problems and Alcohol Use Disorders in Offspring in the San Diego Prospective Study. Alcohol Clin Exp Res 2019; 43:2232-2241. [PMID: 31454095 PMCID: PMC6779494 DOI: 10.1111/acer.14164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/30/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The 35-year-long San Diego Prospective Study documented 2-fold increases in alcohol problems and alcohol use disorders (AUDs) in young-adult drinking offspring compared to rates in their fathers, the original probands. The current analyses use the same interviews and questionnaires at about the same age in members of the 2 generations to explore multiple potential contributors to the generational differences in adverse alcohol outcomes. METHODS Using data from recent offspring interviews, multiple cross-generation differences in characteristics potentially related to alcohol problems were evaluated in 3 steps: first through direct comparisons across probands and offspring at about age 30; second by backward linear regression analyses of predictors of alcohol problems within each generation; and finally third through R-based bootstrapped linear regressions of differences in alcohol problems in randomly matched probands and offspring. RESULTS The analyses across the analytical approaches revealed 3 consistent predictors of higher alcohol problems in the second generation. These included the following: (i) a more robust relationship to alcohol problems for offspring with a low level of response to alcohol; (ii) higher offspring values for alcohol expectancies; and (iii) higher offspring impulsivity. CONCLUSIONS The availability of data across generations offered a unique perspective for studying characteristics that may have contributed to a general finding in the literature of substantial increases in alcohol problems and AUDs in recent generations. If replicated, these results could suggest approaches to be used by parents, healthcare workers, insurance companies, and industry in their efforts to mitigate the increasing rates of alcohol problems in younger generations.
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Affiliation(s)
- Marc A. Schuckit
- University of California, San Diego - Department of Psychiatry, 8950 Villa La Jolla Dr Suite B-218, La Jolla, CA 92037, United States
| | - Tom L. Smith
- University of California, San Diego - Department of Psychiatry, 8950 Villa La Jolla Dr Suite B-218, La Jolla, CA 92037, United States
| | - Dennis Clarke
- University of California, San Diego - Department of Psychiatry, 8950 Villa La Jolla Dr Suite B-218, La Jolla, CA 92037, United States
| | - Lee Anne Mendoza
- University of California, San Diego - Department of Psychiatry, 8950 Villa La Jolla Dr Suite B-218, La Jolla, CA 92037, United States
| | - Mari Kawamura
- University of California, San Diego - Department of Psychiatry, 8950 Villa La Jolla Dr Suite B-218, La Jolla, CA 92037, United States
| | - Lara Schoen
- University of California, San Diego - Department of Psychiatry, 8950 Villa La Jolla Dr Suite B-218, La Jolla, CA 92037, United States
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Tan C, Zhao Y, Wang S. Is a vegetarian diet safe to follow during pregnancy? A systematic review and meta-analysis of observational studies. Crit Rev Food Sci Nutr 2019; 59:2586-2596. [PMID: 29621406 DOI: 10.1080/10408398.2018.1461062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Whether a vegetarian diet is appropriate for pregnancy remains unclear. Objective: This study aimed to determine the association between vegetarian diet during pregnancy and various maternal-fetal outcomes. Method: PubMed-Medline, EMBASE, and Cochrane Library databases were searched for relevant articles published by August 30, 2017. Quantitative data were analyzed by a random-effects model with pooled odds ratios or weighted mean difference (WMD) and 95% confidence interval as aggregate estimations. Results: A total of 19 observational studies were identified for each of meta-analysis and narrative review. The overall estimated relation between vegetarian pregnancy and low birth weight (LBW) was marginally significant (1.27 (0.98, 1.65), P = 0.07, I2=0%). Asian (India/Nepal) vegetarian mothers exhibited increased risks to deliver a baby with LBW (1.33 (1.01, 1.76), P = 0.04, I2=0%). However, the WMD of neonatal birth weight in five studies suggested no difference between vegetarians and omnivores. Given the high heterogeneity of the included studies, lack of high-quality evidence, and limited studies included for each category, we failed to reach conclusive results regarding the risks of hypospadias, intrauterine growth retardation, maternal anemia, and gestational diabetes mellitus. Conclusion: Asian vegetarian mothers presented increased risks to deliver babies with LBW than those of omnivores. Large-scale prospective studies focusing on pre- and/or early gestational nutrition will help clarify the correlation between vegetarian diet and various pregnancy outcomes.
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Affiliation(s)
- Chang Tan
- Department of Nutrition and Food Hygiene, School of Health Sciences , Wuhan University , Wuhan , China
| | - Yudi Zhao
- Department of Computer Science, Volgenau School of Engineering , George Mason University , Fairfax , Virginia , USA
| | - Suqing Wang
- Department of Nutrition and Food Hygiene, School of Health Sciences , Wuhan University , Wuhan , China.,Hubei Provincial Key Laboratory for Applied Toxicology, Hubei Provincial Academy for Preventive Medicine , Wuhan , 430060 , China
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Funabashi M. Human augmentation of ecosystems: objectives for food production and science by 2045. NPJ Sci Food 2018; 2:16. [PMID: 31304266 PMCID: PMC6550257 DOI: 10.1038/s41538-018-0026-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 12/31/2022] Open
Abstract
Current food production systems require fundamental reformation in the face of population growth, climate change, and degradation of health and the environment. Over the course of human history, every agricultural system that has emerged has featured some sort of trade-off between productivity and environmental load. These trade-offs are causing the planet to exceed the boundaries of its biogeochemical cycles and are triggering an unprecedented extinction rate of wild species, thus pushing global ecosystems to the brink of collapse. In this era, characterized as it is by human activity that can profoundly influence climate and the environment (i.e., the Anthropocene epoch), tipping points can be either negative or positive. While a negative tipping point can produce sudden, rapid, and irreversible deterioration of social and environmental systems, a positive tipping point can produce improved health and sustainable social-ecological systems. The key to promoting positive global tipping points is a thorough understanding of human activity and life history on an evolutionary scale, along with the comprehensive integration of science and technology to produce intelligent policies and practices of food production, particularly in the developing world (See Supplementary Material 1 summary for policymakers). Simply increasing the efficiency and scale of monoculture-intensive agriculture is unlikely to drive social-ecological change in a positive and sustainable direction. A new solution to the health-diet-environment trilemma must be developed to achieve a net positive impact on biodiversity through the anthropogenic augmentation of ecosystems based on the ecological foundation of genetic, metabolic, and ecosystem health. This paper discusses the fundamental requirements for sustainable food production on the molecular, physiological, and ecological scales, including evolutionary and geological insights, in an attempt to identify the global conditions needed for the primary food production to ensure we survive this century. Particular emphasis is placed on how to make extensive use of this planet's genetic resources without irretrievably losing them.
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Affiliation(s)
- Masatoshi Funabashi
- Sony Computer Science Laboratories, Inc., 3-14-13 Higashi-Gotanda, Shinagawa-ku Tokyo, 141–0022 Japan
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