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Balthasar MR, Roelants M, Brannsether-Ellingsen B, Stangenes KM, Magnus MC, Håberg SE, Øverland SN, Júlíusson PB. Evaluating national guidelines for monitoring early growth using routinely collected data in Bergen, Norway. Scand J Public Health 2024; 52:718-725. [PMID: 37496420 PMCID: PMC11308290 DOI: 10.1177/14034948231187513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/19/2023] [Accepted: 06/25/2023] [Indexed: 07/28/2023]
Abstract
AIMS The overarching aim of this study was to evaluate the Norwegian guidelines for growth monitoring using routinely collected data from healthy children up to five years of age. We analysed criteria for both status (size for age) and change (centile crossing) in growth. METHODS Longitudinal data were obtained from the electronic health record (EHR) at the well-baby clinic for 2130 children included in the Bergen growth study 1 (BGS1). Measurements of length, weight, weight-for-length, body mass index (BMI) and head circumference were converted to z-scores and compared with the World Health Organization (WHO) growth standards and the national growth reference. RESULTS Using the WHO growth standard, the proportion of children above +2SD was generally higher than the expected 2.3% for all traits at birth and for length at all ages. Crossing percentile channels was common during the first two years of life, particularly for length/height. By the age of five years, 37.9% of the children had been identified for follow-up regarding length/height, 33% for head circumference and 13.6% for high weight-for-length/BMI. CONCLUSIONS The proportion of children beyond the normal limits of the charts is higher than expected, and a surprisingly large number of children were identified for rules concerning length or growth in head circumference. This suggests the need for a revision of the current guidelines for growth monitoring in Norway.
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Affiliation(s)
- Melissa R. Balthasar
- Department of Paediatric and Adolescent Medicine, Stavanger University Hospital, Norway
- Department of Clinical Science, University of Bergen, Norway
| | - Mathieu Roelants
- Department of Public Health and Primary Care, KU Leuven, University of Leuven, Belgium
| | | | - Kristine M. Stangenes
- Department of Health Registry and Development, Norwegian Institute of Public Health, Norway
| | - Maria C. Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Norway
| | - Siri E. Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Norway
| | - Simon N. Øverland
- Section for Health Care Collaboration, Haukeland University Hospital, Norway
| | - Pétur B. Júlíusson
- Department of Clinical Science, University of Bergen, Norway
- Department of Health Registry and Development, Norwegian Institute of Public Health, Norway
- Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Norway
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Manoochehri S, Faradmal J, Poorolajal J, Asadi FT, Soltanian AR. Risk factors associated with underweight in children aged one to two years: a longitudinal study. BMC Public Health 2024; 24:1875. [PMID: 39004703 PMCID: PMC11247798 DOI: 10.1186/s12889-024-19147-9] [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: 01/22/2024] [Accepted: 06/14/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Underweight is a prevalent health issue in children. This study aimed to identify factors associated with underweight in children aged 1-2 years in Hamadan city. Unlike the studies conducted in this field, which are cross-sectional and do not provide information on the effect of age changes on underweight, our longitudinal approach provides insights into weight changes over time. On the other hand, this study focuses on the high-risk age group of 1 to 2 years, which has only been addressed in a few studies. METHODS In this longitudinal study, 414 mothers with 1 to 2 year-old children referred to the health centers of Hamadan city, whose information is in the SIB system, a comprehensive electronic system, were examined to identify factors related to underweight. The response variable was weight-for-age criteria classified into three categories: underweight, normal weight, and overweight. A two-level longitudinal ordinal model was used to determine the factors associated with underweight. RESULTS Of the children studied, 201 (48.6%) were girls and 213 (51.4%) were boys. Significant risk factors for underweight included low maternal education (AOR = 3.56, 95% CI: 1.10-11.47), maternal unemployment (AOR = 3.38, 95% CI: 1.05-10.91), maternal height (AOR = 0.85, 95% CI: 0.79-0.92), lack of health insurance (AOR = 2.85, 95% CI: 1.04-7.84), gestational age less than 24 years (AOR = 3.17, 95% CI: 16.28-0.97), child age 12-15 months (AOR = 2.27, 95% CI: 1.37-3.74), and child's birth weight (AOR = 0.63, 95% CI: 0.70-0.58). CONCLUSION Based on the results of the present study, it seems that the possibility of being underweight among children is more related to the characteristics of mothers; therefore, taking care of mothers can control some of the weight loss of children.
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Affiliation(s)
- Sara Manoochehri
- Department of Biostatistics, Student Research Committee, PhD Candidate of Biostatistics, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Javad Faradmal
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Shahid Fahmideh Boulevard, Hamadan, Iran
| | - Jalal Poorolajal
- Research Center for Health Sciences and Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatemeh Torkaman Asadi
- Department of Infectious Disease, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Islamic Republic of Iran.
| | - Ali Reza Soltanian
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Shahid Fahmideh Boulevard, Hamadan, Iran.
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Donzé A, Tefera A, Baye K, Arnaud S, Chitekwe S, Laillou A. Evaluating the coverage and quality of nutrition programs via a bottom-up approach: A secondary analysis of real-time data from an end-user monitoring system in Ethiopia. MATERNAL & CHILD NUTRITION 2024; 20 Suppl 5:e13360. [PMID: 35415970 PMCID: PMC11258763 DOI: 10.1111/mcn.13360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/18/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
Over the last two decades, great efforts and investments have been made in Ethiopia to ensure that all children have equal access to nutrition services in health facilities. While quality health systems are a prerequisite for quality nutrition services, little attention has been given to the evaluation of the supply and delivery services. The purpose of the study was to evaluate the coverage and quality of the nutrition-specific interventions delivered through the health system. Using an end-user monitoring (EUM) system, we monitored the delivery of nutrition-specific interventions in 500 districts, having 2514 health facilities distributed throughout Ethiopia. Data were collected through third-party monitors between August 2020 and 2021. Roughly 90% of health facilities were performing severe acute malnutrition management in line with the national guideline/protocol, and 2/3 of the assessed facilities were delivering iron and folic acid, vitamin A supplementation and deworming. A third of the messages on AMIYCN were retained by beneficiaries. Warehouse conditions were good in 64.3% of the facilities, but only 22% had good recording practices and about half had problems related to the quality and availability of nutrition supplies. Most beneficiaries were satisfied with the nutrition supplies and service delivered at the health facility level. This study also suggests the relevance of an EUM system to assess the quality of nutrition service delivery and its related supply management, as well as to improve the implementation of nutrition interventions as a decision-making tool.
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Affiliation(s)
| | - Abiy Tefera
- Nutrition Section, UNICEF EthiopiaAddis AbabaEthiopia
| | - Kaleab Baye
- Center for Food Science and NutritionAddis Ababa UniversityAddis AbabaEthiopia
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Thapa DK, Frongillo EA, Suresh S, Adhikari RP, Pun B, Shakya KL, Mandal R, Kole SK, Cunningham K. Impact of Suaahara, an at-scale multisectoral nutrition programme, on health workers' maternal and child health, and nutrition knowledge and skills in Nepal. MATERNAL & CHILD NUTRITION 2024:e13669. [PMID: 38881273 DOI: 10.1111/mcn.13669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/29/2024] [Accepted: 05/03/2024] [Indexed: 06/18/2024]
Abstract
Suaahara, an at-scale multisectoral nutrition programme in Nepal, aimed to advance knowledge and skills of frontline health workers to improve the quality of nutrition and health services at health facility and community levels. This study assessed the impact of Suaahara interventions on knowledge and skills of health facility workers and Female Community Health Volunteers (FCHVs). The study used a quasi-experimental design in which four Suaahara intervention districts were compared with pair-matched comparison districts. One health facility worker and three FCHVs from each survey cluster were included. Baseline survey consisted of 93 health facility workers (2015) and 118 FCHVs (2012), and endline survey (2022) consisted of 40 health facility workers and 120 FCHVs. Difference-in-differences regression models employing intent-to-treat analysis, accounting for clustering at the district level, assessed the impact of intervention. The intervention, relative to comparison, had no effect on health facility workers' knowledge. There was a positive effect, however, on FCHVs' knowledge in intervention relative to comparison areas on exclusive breastfeeding, timing of introduction of complementary feeding, sick child feeding and growth monitoring and promotion (GMP) for children under 2 years. Health facility workers and FCHVs in intervention versus comparison districts had higher endline scores for skills related to measuring the weight of children and pregnant women, measuring the height/length of children, conducting GMP for children under 2 years and identifying malnourished children. Suaahara interventions improved the capacity of health workers, particularly nutrition-related knowledge among FCHVs and GMP-related skills of both health facility workers and FCHVs.
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Affiliation(s)
- Deependra K Thapa
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | | | | | - Bhim Pun
- Helen Keller International, Kathmandu, Nepal
| | | | - Raj Mandal
- Helen Keller International, Kathmandu, Nepal
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Sin MP, Forsberg BC, Peterson SS, Alfvén T. Assessment of Childhood Stunting Prevalence over Time and Risk Factors of Stunting in the Healthy Village Programme Areas in Bangladesh. CHILDREN (BASEL, SWITZERLAND) 2024; 11:650. [PMID: 38929230 PMCID: PMC11202057 DOI: 10.3390/children11060650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
Childhood stunting is a significant public health concern in Bangladesh. This study analysed the data from the Healthy Village programme, which aims to address childhood stunting in southern coastal Bangladesh. The aim was to assess childhood stunting prevalence over time and explore the risk factors in the programme areas. A cross-sectional, secondary data analysis was conducted for point-prevalence estimates of stunting from 2018 to 2021, including 132,038 anthropometric measurements of under-five children. Multivariate logistic regression analyses were conducted for risk factor analysis (n = 20,174). Stunting prevalence decreased from 51% in 2018 to 25% in 2021. The risk of stunting increased in hardcore poor (aOR: 1.46, 95% CI: 1.27, 1.68) and poor (aOR: 1.50, 95% CI: 1.33, 1.70) versus rich households, children with mothers who were illiterate (aOR: 1.25, 95% CI: 1.09, 1.44) and could read and write (aOR: 1.35, 95% CI: 1.16, 1.56) versus mothers with higher education, and children aged 1-2 years compared with children under one year (aOR: 1.32, 95% CI: 1.20, 1.45). The stunting rate was halved over three years in programme areas, which is faster than the national trend. We recommend addressing socioeconomic inequalities when tackling stunting and providing targeted interventions to mothers during the early weaning period.
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Affiliation(s)
- May Phyu Sin
- Department of Orthopedics, Lund University, 221 85 Lund, Sweden;
| | - Birger C. Forsberg
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (S.S.P.); (T.A.)
| | - Stefan Swartling Peterson
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (S.S.P.); (T.A.)
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (S.S.P.); (T.A.)
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Dutch D, Bell L, Zarnowiecki D, Johnson BJ, Denney-Wilson E, Byrne R, Cheng H, Rossiter C, Manson A, House E, Davidson K, Golley RK. Screening tools used in primary health care settings to identify health behaviours in children (birth-16 years); A systematic review of their effectiveness, feasibility and acceptability. Obes Rev 2024; 25:e13694. [PMID: 38192203 DOI: 10.1111/obr.13694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 11/01/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Child health behaviour screening tools have potential to enhance the effectiveness of health promotion and early intervention. This systematic review aimed to examine the effectiveness, acceptability and feasibility of child health behaviour screening tools used in primary health care settings. METHODS A systematic review of studies published in English in five databases (CINAHL, Medline, Scopus, PsycINFO and Web of Science) prior to July 2022 was undertaken. Eligible studies described: 1) screening tools for health behaviours (dietary, physical activity, sedentary or sleep-related behaviours) used in primary health care settings in children birth to 16 years; 2) tool effectiveness for identifying child health behaviours and changing practitioner behaviour; 3) tool acceptability or feasibility from child, caregiver or practitioner perspective and/or 4) implementation of the screening tool. RESULTS Of the 7145 papers identified, 22 studies describing 14 screening tools were included. Only four screening tools measured all four behaviour domains. Fourteen studies reported changes in practitioner self-reported behaviour, knowledge and practice. Practitioners and caregivers identified numerous benefits and challenges to screening. CONCLUSIONS Health behaviour screening can be an acceptable and feasible strategy to assess children's health behaviours in primary health care. Further evaluation is needed to determine effectiveness on child health outcomes.
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Affiliation(s)
- Dimity Dutch
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Lucinda Bell
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Dorota Zarnowiecki
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Brittany J Johnson
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Heilok Cheng
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Chris Rossiter
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Alexandra Manson
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Eve House
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kamila Davidson
- Thriving Queensland Kids Partnership, Brisbane, QLD, Australia
| | - Rebecca K Golley
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
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Belew AK, Worku N, Gelaye KA, Gonete KA, Tamir Hunegnaw M, Muhammad EA, Astale T, Mitike G, Abebe Z. Utilisation of growth monitoring and promotion services and associated factors among mothers of children younger than 2 years in Gondar Zuria District, northwest Ethiopia: a community-based, cross-sectional study. BMJ Open 2024; 14:e076147. [PMID: 38331862 PMCID: PMC10860045 DOI: 10.1136/bmjopen-2023-076147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE The study aimed to assess the utilisation of growth monitoring and promotion services and the associated factors among mothers of children under 2 years old in Gondar Zuria District, northwest Ethiopia. DESIGN Community-based, cross-sectional study. SETTING The study was conducted in Gondar Zuria District, Central Gondar Zone. Data collection was conducted from 10 March to 5 April 2022. PARTICIPANTS 576 mother-child pairs, recruited via a multistage, stratified random sampling technique. OUTCOME MEASURES AND ANALYSIS Utilisation of growth monitoring and promotion services was the outcome of the study. Data were entered into Epi Info V.7 and exported to Statistical Package for the Social Sciences V.24.0 for further analysis. Both bivariable and multivariable logistic regression analyses were used to identify factors associated with utilisation of growth monitoring services. A p value less than 0.05 was considered significant for the outcome variable. RESULTS The utilisation of growth monitoring and promotion services among children aged 0-23 months was 26.6% (95% CI 22.9, 30.2). Health centre delivery (adjusted OR (AOR)=1.56; 95% CI 1.02, 2.68), postnatal care visits (AOR=3.13; 95% CI 1.99, 4.90), regular growth monitoring and promotion sessions (AOR=6.53; 95% CI 2.43, 9.34), and wealth status (AOR=5.98; 95% CI 3.09, 10.58) were significantly associated with utilisation of growth monitoring and promotion services. CONCLUSION Less than one in three children aged 0-23 months saw utilisation of growth monitoring and promotion services in the study setting. Birthplace, postnatal care follow-up, regular growth promotion and monitoring sessions, and wealth status were associated with utilisation of growth monitoring and promotion services. Enhancing skilled birth delivery, promoting postnatal care follow-up and expanding the availability of growth monitoring and promotion outreach sites could be useful to improve the utilisation of growth monitoring and promotion services.
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Affiliation(s)
| | - Netsanet Worku
- Department of Human Nutrition, University of Gondar, Gondar, Ethiopia
| | | | | | | | | | - Tigist Astale
- International Institute for Primary Health Care, Addis Ababa, Ethiopia
| | - Getnet Mitike
- International Institute for Primary Health Care, Addis Ababa, Ethiopia
| | - Zegeye Abebe
- Department of Human Nutrition, University of Gondar, Gondar, Ethiopia
- Flinders University, Adelaide, South Australia, Australia
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McLaren SW, Steenkamp L, Ronaasen J. Assessment of growth monitoring among children younger than 5 years at early childhood development centres in Nelson Mandela Bay, South Africa. HEALTH CARE SCIENCE 2024; 3:32-40. [PMID: 38939170 PMCID: PMC11080798 DOI: 10.1002/hcs2.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/23/2023] [Accepted: 12/12/2023] [Indexed: 06/29/2024]
Abstract
Introduction Early childhood development (ECD) centres are important community hubs in South Africa and act as sites for community detection of childhood nutrition problems. This study aimed to assess the ability of trained ECD practitioners with optimal support to correctly classify the nutritional status of infants and young children at ECD centres in the Nelson Mandela Bay. Methods A descriptive, cross-sectional study was used to collect data from 1645 infants and children at 88 ECD centres. Anthropometric measurements were taken by trained fieldworkers and growth monitoring and promotion infrastructure was audited at ECD centres. Results Of the sample, 4.4% (n = 72) were underweight by weight for age Z-score (WAZ < -2) and 0.8% (n = 13) were severely underweight (WAZ < -3). Results showed that 13.1% (n = 214) were stunted by height for age Z-score (HAZ < -2) and 4.5% (n = 74) were severely stunted (HAZ < -3). The prevalence of moderate acute malnutrition was 1.2% and severe acute malnutrition was 0.5%, while the prevalence of overweight was 9.2% and the prevalence of obesity was 4%. A significant level of agreement between the correct interpretation and the ECD practitioners' interpretation was observed across all the anthropometric indicators investigated. The true positive wasting cases had a mean mid-upper arm circumference (MUAC) of 14.6 cm, which may explain the high false negative rate found in terms of children identified with wasting, where ECD practitioners fail to use the weight for height Z-score (WHZ) interpretation for screening. Conclusion By using ECD centres as hub to screen for malnutrition, it may contribute to the early identification of failure to thrive among young children. Although it was concerning that trained ECD practitioners are missing some children with an unacceptably high false negative rate, it may have been due to the fact that wasting in older children cannot be identified with MUAC alone and that accurate WFH plotting is needed. Onsite mentorship by governmental health workers may provide ECD practitioners with more confidence to screen children for growth failure based on regular WFH measurements. Moreover, ECD practitioners will be more confident to monitor the Road to Health booklets for missed vaccinations, vitamin A and deworming opportunities.
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Affiliation(s)
| | - Liana Steenkamp
- Department of DieteticsNelson Mandela UniversityGqeberhaSouth Africa
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Teklemuz N, Sisay M, Baffa LD, Mengistu B, Atenafu A. Utilization of growth monitoring and promotion services among children younger than 2 years in West Armachiho district, Northwest Ethiopia. Front Public Health 2023; 11:1179720. [PMID: 38074737 PMCID: PMC10702942 DOI: 10.3389/fpubh.2023.1179720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction Inadequate physical growth and poor development of children are prevalent and significant problems worldwide, with 149 million children younger than 5 years stunted and 49 million wasted. Growth monitoring and promotion (GMP) is one of the major activities implemented with the aim of capturing growth faltering before the child reaches the status of undernutrition. In relation to this, the Amhara region, where the study area is found, is a highly burdened area for child malnutrition. Thus, it needs further investigation about the utilization of GMP services and associated factors among children younger than 2 years in the study area. Objective The aim of this study was to assess the utilization of growth monitoring and promotion services and associated factors among children younger than 2 years. Methods A community-based cross-sectional study was conducted in the West Armachiho district, including 703 mother-child pairs, with a response rate of 94.7%. A simple random sampling technique was used to select the respondents. Both bivariable and multivariable logistic regression analyzes were performed. An adjusted odds ratio (AOR) with a 95% confidence interval was used to measure the strength of the association. Results The proportion of utilization of growth monitoring and promotion services in the West Armachiho district was 13.7% (95%Cl; 11.2, 16.4). Factors such as maternal educational status (AOR = 2.17, 95%Cl; 1.05, 4.49), institutional delivery (AOR = 3.16, 95%Cl; 1.62, 6.13), family size (AOR = 2.66, 95%Cl; 1.13, 6.23), access to health facility (AOR = 3.17, 95%Cl; 1.45, 6.95), and maternal knowledge (AOR = 4.53, 95%Cl; 2.71, 7.59) were significantly associated with the utilization of growth monitoring and promotion services. Conclusion Utilization of growth monitoring and promotion services in children younger than 2 years in the West Armachiho district was low. Thus, giving due attention to the improvement of the knowledge of the mothers/caregivers about child GMP services and counseling them about the importance of facility delivery is vital to improving growth monitoring and promotion services in the area.
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Affiliation(s)
| | | | - Lemlem Daniel Baffa
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Taylor M, Tapkigen J, Ali I, Liu Q, Long Q, Nabwera H. The impact of growth monitoring and promotion on health indicators in children under five years of age in low- and middle-income countries. Cochrane Database Syst Rev 2023; 10:CD014785. [PMID: 37823471 PMCID: PMC10568659 DOI: 10.1002/14651858.cd014785.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Undernutrition in the critical first 1000 days of life is the most common form of childhood malnutrition, and a significant problem in low- and middle-income countries (LMICs). The effects of undernutrition in children aged under five years are wide-ranging and include increased susceptibility to and severity of infections; impaired physical and cognitive development, which diminishes school and work performance later in life; and death. Growth monitoring and promotion (GMP) is a complex intervention that comprises regular measurement and charting of growth combined with promotion activities. Policymakers, particularly in international aid agencies, have differing and changeable interpretations and perceptions of the purpose of GMP. The effectiveness of GMP as an approach to preventing malnutrition remains a subject of debate, particularly regarding the added value of growth monitoring compared with promotion alone. OBJECTIVES To evaluate the effectiveness of child growth monitoring and promotion for identifying and addressing faltering growth, improving infant and child feeding practices, and promoting contact with and use of health services in children under five years of age in low- and middle-income countries. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 3 November 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs), cohort studies, and controlled before-after studies that compared GMP with standard care or nutrition education alone in non-hospitalised children aged under five years. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods to conduct a narrative synthesis. Our primary outcomes were anthropometric indicators, infant and child feeding practices, and health service usage. Secondary outcomes were frequency and severity of childhood illnesses, and mortality. We used GRADE to assess the certainty of evidence for each primary outcome. MAIN RESULTS We included six studies reported in eight publications. We grouped the findings according to intervention. Community-based growth monitoring and promotion (without supplementary feeding) versus standard care We are unsure if GMP compared to standard care improves infant and child feeding practices, as measured at 24 months by the proportion of infants who have fluids other than breast milk introduced early (49.7% versus 70.5%; 1 study; 4296 observations; very low-certainty evidence). We are unsure if GMP improves health service usage, as measured at 24 months by the proportion of children who receive vitamin A (72.5% versus 62.9%; 1 study; 4296 observations; very low-certainty evidence) and the proportion of children who receive deworming (29.2% versus 14.6%; 1 study; 4296 observations; very low-certainty evidence). No studies reported selected anthropometric indicators (weight-for-age z-score or height-for-age z-score) at 12 or 24 months, infant and child feeding practices at 12 months, or health service usage at 12 months. Community-based growth monitoring and promotion (with supplementary feeding) versus standard care Two studies (with 569 participants) reported the mean weight-for-age z-score at 12 months, providing very low-certainty evidence: in one study, there was little or no difference between GMP and standard care (mean difference (MD) -0.07, 95% confidence interval (CI) -0.19 to 0.06); in the other study, mean weight-for-age z-score worsened in both groups, but we were unable to calculate a relative effect. GMP versus standard care may make little to no difference to the mean height-for-age z-score at 12 months (MD -0.15, 95% CI -0.34 to 0.04; 1 study, 337 participants; low-certainty evidence). Two studies (with 564 participants) reported a range of outcome measures related to infant and child feeding practices at 12 months, showing little or no difference between the groups (very low-certainty evidence). No studies reported health service usage at 12 or 24 months, feeding practices at 24 months, or selected anthropometric indicators at 24 months. AUTHORS' CONCLUSIONS There is limited uncertain evidence on the effectiveness of GMP for identifying and addressing faltering growth, improving infant and child feeding practices, and promoting contact with and use of health services in children aged under five years in LMICs. Future studies should explore the reasons for the apparent limited impact of GMP on key child health indicators. Reporting of GMP interventions and important outcomes must be transparent and consistent.
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Affiliation(s)
- Melissa Taylor
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Israa Ali
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Qin Liu
- Affiliate of the Cochrane China Network, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Helen Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Ekholuenetale M, Okonji OC, Nzoputam CI, Edet CK, Wegbom AI, Arora A. Socioeconomic disparities in Rwanda's under-5 population's growth tracking and nutrition promotion: findings from the 2019-2020 demographic and health survey. BMC Pediatr 2023; 23:467. [PMID: 37716969 PMCID: PMC10504707 DOI: 10.1186/s12887-023-04284-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/01/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Regular growth monitoring can be used to evaluate young children's nutritional and physical health. While adequate evaluation of the scope and quality of nutrition interventions is necessary to increase their effectiveness, there is little research on growth monitoring coverage measurement. The purpose of this study was to investigate socioeconomic disparities in under-5 Rwandan children who participate in growth monitoring and nutrition promotion. METHODS We used data from the 2019-2020 Rwanda Demographic and Health Survey (RDHS), which included 8092under-5 children. Percentage was employed in univariate analysis. To examine the socioeconomic inequalities, concentration indices and Lorenz curves were used in growth monitoring and nutrition promotion among under-5 children. RESULTS A weighted prevalence of 33.0% (95%CI: 30.6-35.6%) under-5 children growth monitoring and nutrition promotion was estimated. Growth monitoring and nutrition promotion among under-5 children had higher uptake in the most disadvantaged cohort, as the line of equality sags below the diagonal line in Lorenz curve. Overall, there was pro-poor growth monitoring and nutrition promotion among under-5 in Rwanda (Conc. Index = 0.0994; SE = 0.0111). Across the levels of child and mother's characteristics, the results show higher coverage of under-5 growth monitoring and nutrition promotion in the most socioeconomic disadvantaged cohort. CONCLUSION The study found a pro-poor disparity in growth monitoring and nutrition promotion among under-5 children in Rwanda. By implication, the most disadvantaged children had a higher uptake of growth monitoring and nutrition promotion. The Rwanda government should develop policies and programmes to achieve the universal health coverage for the well-off and underserved population.
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Affiliation(s)
- Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, 200284, Nigeria
| | | | - Chimezie Igwegbe Nzoputam
- Department of Public Health, Center of Excellence in Reproductive Health Innovation (CERHI), College of Medical Sciences, University of Benin, Benin City, 300001, Nigeria
- Department of Medical Biochemistry, School of Basic Medical Sciences, University of Benin, Benin City, 300001, Nigeria
| | - Clement Kevin Edet
- Department of Community Medicine, College of Medical Sciences, Rivers State University, Port Harcourt, 500101, Nigeria
| | - Anthony Ike Wegbom
- Department of Public Health Sciences, College of Medical Sciences, Rivers State University, Port Harcourt, 500101, Nigeria
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia.
- School of Health Sciences, Western Sydney University, Penrith, NSW, 2751, Australia.
- Health Equity Laboratory, Campbelltown, NSW, 2560, Australia.
- Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia.
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, 2010, Australia.
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Nel S, Pattinson RC, Vannevel V, Feucht UD, Mulol H, Wenhold FAM. Integrated growth assessment in the first 1000 d of life: an interdisciplinary conceptual framework. Public Health Nutr 2023; 26:1523-1538. [PMID: 37170908 PMCID: PMC10410405 DOI: 10.1017/s1368980023000940] [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: 02/16/2023] [Revised: 04/03/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Prenatal growth affects short- and long-term morbidity, mortality and growth, yet communication between prenatal and postnatal healthcare teams is often minimal. This paper aims to develop an integrated, interdisciplinary framework for foetal/infant growth assessment, contributing to the continuity of care across the first 1000 d of life. DESIGN A multidisciplinary think-tank met regularly over many months to share and debate their practice and research experience related to foetal/infant growth assessment. Participants’ personal practice and knowledge were verified against and supplemented by published research. SETTING Online and in-person brainstorming sessions of growth assessment practices that are feasible and valuable in resource-limited, low- and middle-income country (LMIC) settings. PARTICIPANTS A group of obstetricians, paediatricians, dietitians/nutritionists and a statistician. RESULTS Numerous measurements, indices and indicators were identified for growth assessment in the first 1000 d. Relationships between foetal, neonatal and infant measurements were elucidated and integrated into an interdisciplinary framework. Practices relevant to LMIC were then highlighted: antenatal Doppler screening, comprehensive and accurate birth anthropometry (including proportionality of weight, length and head circumference), placenta weighing and incorporation of length-for-age, weight-for-length and mid-upper arm circumference in routine growth monitoring. The need for appropriate, standardised clinical records and corresponding policies to guide clinical practice and facilitate interdisciplinary communication over time became apparent. CONCLUSIONS Clearer communication between prenatal, perinatal and postnatal health care providers, within the framework of a common understanding of growth assessment and a supportive policy environment, is a prerequisite to continuity of care and optimal health and development outcomes.
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Affiliation(s)
- Sanja Nel
- Department of Human Nutrition, University of Pretoria, Pretoria0002, South Africa
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
| | - Robert C Pattinson
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Valerie Vannevel
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Ute D Feucht
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, South Africa
- Tshwane District Health Services, Gauteng Department of Health, Pretoria, South Africa
| | - Helen Mulol
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, South Africa
| | - Friede AM Wenhold
- Department of Human Nutrition, University of Pretoria, Pretoria0002, South Africa
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
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Moyo SA, Mashau NS, Makhado L. Growth Monitoring and Promotion Index Development: A Novel Approach. Healthcare (Basel) 2023; 11:2011. [PMID: 37510452 PMCID: PMC10379847 DOI: 10.3390/healthcare11142011] [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: 03/10/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND There are few growth monitoring and promotion indexes, and currently none of them include any metrics that measure caregiver behaviours. No index to date combines the metrics of both community health worker activeness and caregiver barriers and facilitators towards growth monitoring and promotion (GMP). This study developed a new growth monitoring and promotion index and validated it using the Delphi Technique. METHODS The study began with phase 1, which was a scoping review of the literature on GMP indexes. Phase 2 involved a community health worker (CHW) survey which explored the process of GMP within the Umguza health system, and determined how knowledge of GMP by CHWs translated to frequency of activities. A barrier analysis was also conducted with caregivers of children under five to determine the barriers and facilitators towards GMP attendance by caregivers. Phase 3 was the construction of the index along with its validation, using the Delphi Technique where fifteen experts within the health and nutrition sector were consulted to analyse the constructs/variables of the index. RESULTS A growth monitoring and promotion index was developed and validated by several technical experts in the health and nutrition sector in Zimbabwe. CONCLUSIONS A new index has been developed to improve the quality of growth monitoring and promotion activities within the communities.
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Affiliation(s)
- Shamiso Alice Moyo
- Department of Public Health, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
| | - Ntsieni Stella Mashau
- Department of Public Health, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
| | - Lufuno Makhado
- Office of the Executive Dean, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
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Muhammad EA, Hunegnaw MT, Gonete KA, Worku N, Alemu K, Abebe Z, Astale T, Mitike G, Belew AK. Practical contribution of women development army on growth monitoring and promotion service at Dembya and Gondar Zuria districts, Central Gondar Zone, North West Ethiopia: a community based mixed study. BMC Pediatr 2023; 23:319. [PMID: 37353741 PMCID: PMC10288738 DOI: 10.1186/s12887-023-04124-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 06/10/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND The United Nations' Sustainable Development Goal (SDG)-2 aims to eliminate child hunger or end all forms of child malnutrition by 2030. To achieve this goal the cost-effective method is the implementation of growth monitoring and promotion service with the contribution of Women Development Army (WDA) as community volunteers. However, According to the data, the program's implementation varies throughout the country and lack of evidence on the practical contribution of the WDA to enhancing child nutritional care outcomes. Therefore this study aimed to determine practical contribution of WDA and associated factors on growth monitoring and promotion service in two rural districts of central Gondar zone, Northwest Ethiopia. METHODS A community based mixed study was conducted from March 6 to April 7, 2022 among 615 Women Development Army. Multistage sampling technique was used to select study participants. A structured questionnaire was used to collect quantitative data and in-depth interview were used to generate qualitative information. Qualitative data were coded and grouped and discussed using identified themes. Binary logistic regression was fitted, odds ratio with 95% confidence interval was estimated to identify factors of practical contribution of WDA and qualitative data was analyzed using thematic analysis. RESULTS In this study practical contribution of WDA on growth monitoring was 31.4% (95% CI: 28.0-35.3%). Having GMP training (AOR = 4.2, 95%CI: 1.63, 10.58), regular community conversation (AOR = 6.0, 95%CI: 3.12, 11.54), good knowledge about GMP (AOR = 2.1, 95%CI: 1.17, 3.83) and not having regular schedule of GMP service in the area (AOR = 0.04, 95%CI: 0.02, 0.09), were statistically significantly associated with practical contribution of growth monitoring. During in-depth interview, lack of training, low motivation or commitment among WDA and low communication between WDA and health extension workers were mentioned among the problems faced during growth monitoring service. CONCLUSION In this study, practical contribution of growth monitoring among WDA was low. GMP training regular community conversation, knowledge about GMP and regular schedule of GMP service in the local area were significantly associated for practical contribution of growth monitoring service. Lack of training, low motivation or commitment among WDA and low communication between WDA and health extension workers were reasons for did not contribute effectively for GMP service. Therefore, giving training for WDA and improving community conversation at kebeles level are important to improve GM service. .
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Affiliation(s)
- Esmael Ali Muhammad
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Melkamu Tamir Hunegnaw
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kedir Abdela Gonete
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Netsanet Worku
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kasahun Alemu
- Department of epidemiology and biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Zegeye Abebe
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Flinders Health and Medical Research Institute, College of Medicine and Public health, Flinders University, Adelaide, Australia
| | - Tigist Astale
- International Institute for Primary Health Care -Ethiopia, Addis Ababa, Ethiopia
| | - Getnet Mitike
- International Institute for Primary Health Care -Ethiopia, Addis Ababa, Ethiopia
| | - Aysheshim Kassahun Belew
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Baguune B, Aminu DM, Bekyieriya E, Adokiya MN. Utilization of growth monitoring and promotion services and undernutrition of children less than two years of age in Northern Ghana. BMC Nutr 2023; 9:70. [PMID: 37349769 DOI: 10.1186/s40795-023-00729-6] [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: 06/03/2022] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Child undernutrition is a major public health problem and an important indicator of child's health. Adequate nutrition is critical for a child's growth and development. Growth monitoring and promotion (GMP) services is a nutrition intervention aimed at improving the nutritional status of children. We assessed the utilization of growth monitoring and promotion services and nutritional status of children less than two years of age in northern Ghana. METHODS This was a descriptive cross-sectional study that involved face-to-face interviews among 266 mothers with children < 2 years of age attending child welfare clinics (CWC). We also collected anthropometric measurements. Descriptive statistic was performed and data presented as percentage. The nutritional status of children was classified as underweight (weight-for-age z score < -2 standard deviations), stunted (length-for-age Z score < - 2) and wasted (weight-for-length z score < -2) while utilization of GMP services was based on attendance to CWC and ability to interpret different growth curves. Chi square test was used to determine the relationship between utilization of GMP services and nutritional status of children at an alpha of 0.05. RESULTS The prevalence of undernutrition shows that, 18.6% of the children were underweight, 14.7% were stunted and 7.9% were wasted. About 60% of the mothers accessed GMP services regularly. Less than half of the mothers were able to interpret the children's growth curve correctly: falling growth curve (36.8%), flattening growth curve (35.7%) and rising growth curve (27.4%). In combining children < 6 and 6-23 months of age, only one-third (33.1%) of mothers practiced appropriate infant and young child feeding. Regular GMP services was found to have a statistically significant relationship with underweight (P < 0.001), stunting (P = 0.006) and wasting (P = 0.042). CONCLUSION The level of undernutrition remains high and child feeding practices is poor. Maternal utilization of GMP services is also low in the study area. Similarly, ability to interpret the child's growth curve appropriately persist as a challenge among women. Thus, attention is needed to improve utilization of GMP services to address child undernutrition challenges.
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Affiliation(s)
- Benjamin Baguune
- School of Hygiene, Ministry of Health, Box TL 88, Tamale, Ghana.
| | - Dramani Mahama Aminu
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | | | - Martin Nyaaba Adokiya
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
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16
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Jemere DF, Alemayehu MS, Belew AK. Unhealthy food consumption and its associated factors among infants and young children in Gondar city, northwest Ethiopia: a community based cross sectional study. BMC Nutr 2023; 9:65. [PMID: 37231455 DOI: 10.1186/s40795-023-00722-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Many low- and middle-income countries are now shifting toward diets that are higher in added sugars, unhealthy fats, salt, and refined carbohydrates. Childhood obesity and chronic diseases have all been linked to unhealthy food consumption. Despite this, the majority of Ethiopian infants and children consume unhealthy food. There is also a scarcity of evidence. Therefore, the objective of this study was to assess the prevalence of unhealthy food consumption and its associated factors among children ages 6-23 months in Gondar City, northwest Ethiopia. METHODS A community-based cross-sectional study was conducted from June 30 to July 21, 2022, in Gondar city. Multistage sampling was used to select 811 mother-child pairs. Food consumption was measured through a 24-hour recall. Data were entered into EpI Data 3.1 before being exported to STATA 14 for further analysis. A multivariable logistic regression analysis was employed to identify the factors associated with unhealthy food consumption. An adjusted odds ratio (AOR) with a 95% confidence interval was used to show the strength of the association, while a P-value of 0.05 was used to declare the significance of the association. RESULTS The percentage of children with unhealthy food consumption was 63.7% (95% CI: 60.4%, 67.2%). Maternal education [AOR = 1.89, 95% CI = 1.05, 3.69], living in an urban residence [AOR = 4.55, 95% CI = 3.61, 7.78], GMP service [AOR = 2.07, 95% CI = 1.48, 3.18], age of the child 18-23 months [AOR = 0.53, 95% CI = 0.34, 0.74], and family size of more than four [AOR = 1.22, 95% CI = 1.07, 2.78] were significantly associated with unhealthy food consumption. CONCLUSION In Gondar City, nearly two thirds of infants and children received unhealthy food. Maternal education, urban residence, GMP service, child age, and family size were all significant predictors of unhealthy food consumption. Thus, improving the uptake of GMP services and family planning services is critical to reducing unhealthy food consumption.
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Affiliation(s)
| | - Mekonnen Sisay Alemayehu
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Aysheshim Kassahun Belew
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
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Kiros S, Ibrahim IM, Ahmed KY. Growth Monitoring and Promotion Service Utilisation and Associated Factors among Children in Afar Region, Northeast Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105807. [PMID: 37239538 DOI: 10.3390/ijerph20105807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/27/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
The use of growth monitoring and promotion (GMP) services in the first two years of life can facilitate the early identification of common childhood health issues such as malnutrition and infections. It also creates an opportunity to promote education and nutritional counselling. This study is the first to investigate the use of GMP and its influencing factors among mothers in Ethiopia's pastoralist regions, including the Afar National and Regional State, where childhood malnutrition is a significant cause of morbidity and mortality. Between May and June 2021, a cross-sectional study was conducted within the Semera-Logia city administration. The study used a random sampling technique to select 396 children under two, and data were gathered using an interviewer-administered questionnaire. Multivariable logistic regression was used to analyse the influence of explanatory variables, which included socio-demographic, health service, and health literacy factors, on the utilisation of GMP services. The overall utilisation of GMP services was 15.9% (95% confidence intervals [CI]: 12.0%, 19.5%). Children whose fathers had college or higher education were more likely to utilise GMP services (adjusted odd ratios [AOR] = 7.75; 95% CI: 3.01, 19.99), whereas children living in households with more children were less likely to utilise GMP services (AOR = 0.11; 95% CI: 0.04, 0.28 for households with 3-4 children and AOR = 0.23; 95% CI: 0.08, 0.67 for households with 4+ children). Children who received postnatal care had higher odds of GMP service use (AOR = 8.09; 95% CI: 3.19, 20.50). GMP services are not being fully utilised to decrease infant and child morbidity and mortality caused by malnutrition in Ethiopia. We recommend strengthening GMP services in Ethiopia and taking targeted action to address the low attainment of parental education and poor postnatal care utilisation. Public health initiatives such as the implementation of mobile health (mHealth) approaches and education of mothers by female community healthcare workers on the significance of GMP services could be effective in increasing GMP service utilisation.
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Affiliation(s)
- Semhal Kiros
- Afar Regional Health Office, Logiya Primary Hospital, Semera P.O. Box 28, Ethiopia
| | - Ibrahim Mohammed Ibrahim
- Department of Midwifery, College of Medicine and Health Science, Samara University, Semera P.O. Box 132, Ethiopia
| | - Kedir Y Ahmed
- Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
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Singh A, Torres KA, Maharjan N, Shrestha J, Agbozo F, Abubakari A, Abdul-Rahman L, Mukuria-Ashe A. Learning from health system actor and caregiver experiences in Ghana and Nepal to strengthen growth monitoring and promotion. PLoS One 2023; 18:e0282807. [PMID: 36893119 PMCID: PMC9997959 DOI: 10.1371/journal.pone.0282807] [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: 06/27/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Globally, growth monitoring and promotion (GMP) of infants and young children is a fundamental component of routine preventive child health care; however, programs have experienced varying degrees of quality and success with enduring challenges. The objective of this study was to describe implementation of GMP (growth monitoring, growth promotion, data use, and implementation challenges) in two countries, Ghana and Nepal, to identify key actions to strengthen GMP programs. METHODS We conducted semi-structured key informant interviews with national and sub-national government officials (n = 24), health workers and volunteers (n = 40), and caregivers (n = 34). We conducted direct structured observations at health facilities (n = 10) and outreach clinics (n = 10) to complement information from interviews. We coded and analyzed interview notes for themes related to GMP implementation. RESULTS Health workers in Ghana (e.g., community health nurses) and Nepal (e.g., auxiliary nurse midwives) had the knowledge and skills to assess and analyze growth based on weight measurement. However, health workers in Ghana centered growth promotion on the growth trend (weight-for-age over time), whereas health workers in Nepal based growth promotion on measurement from one point in time to determine whether a child was underweight. Overlapping challenges included health worker time and workload. Both countries tracked growth-monitoring data systematically; however, there was variation in growth monitoring data use. CONCLUSION This study shows that GMP programs may not always focus on the growth trend for early detection of growth faltering and preventive actions. Several factors contribute to this deviation from the intended goal of GMP. To overcome them, countries need to invest in both service delivery (e.g., decision-making algorithm) and demand generation efforts (e.g., integrate with responsive care and early learning).
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Affiliation(s)
- Akriti Singh
- USAID Advancing Nutrition, Helen Keller International, New York, New York, United States of America
| | - Kelsey A. Torres
- USAID Advancing Nutrition, JSI Research & Training Institute, Inc., Arlington, Virginia, United States of America
| | - Nashna Maharjan
- Mother and Infant Research Activities, Kathmandu, Bagmati Province, Nepal
| | - Jyoti Shrestha
- Mother and Infant Research Activities, Kathmandu, Bagmati Province, Nepal
| | - Faith Agbozo
- Department of Family and Community Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Abdulai Abubakari
- Department of Global and International Health, University for Development Studies, Tamale, Northern Region, Ghana
| | | | - Altrena Mukuria-Ashe
- USAID Advancing Nutrition, Save the Children, Washington, DC, United States of America
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Jensen N, Lepariyo W, Alulu V, Sibanda S, Kiage BN. Assessing Mbiotisho: A smartphone application used to collect high-frequency health and nutrition data from difficult-to-reach populations. MATERNAL & CHILD NUTRITION 2023:e13496. [PMID: 36876924 DOI: 10.1111/mcn.13496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/19/2023] [Accepted: 02/15/2023] [Indexed: 03/07/2023]
Abstract
There is an urgent need for improved and timely health and nutrition data. We developed and tested a smartphone application that caregivers from a pastoral population used to measure, record and submit high-frequency and longitudinal health and nutrition information on themselves and their children. The data were assessed by comparing caregiver-submitted measurements of mid-upper arm circumference (MUAC) to several benchmark data sets, including data collected by community health volunteers from the participating caregivers during the project period and data generated by interpreting photographs of MUAC measurements submitted by all participants. We found that the caregivers participated frequently and consistently over the 12-month period of the project; most of them made several measurements and submissions in at least 48 of the 52 weeks of the project. The evaluation of data quality was sensitive to which data set was used as the benchmark, but the results indicate that the errors in the caregivers' submissions were similar to that of enumerators in other studies. We then compare the costs of this alternative approach to data collection through more conventional methods, concluding that conventional methods can be more cost-effective for large socioeconomic surveys that value the breadth of the survey over the frequency of data, while the alternative we tested is favoured for those with objectives that are better met by high-frequency observations of a smaller number of well-defined outcomes.
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Affiliation(s)
- Nathaniel Jensen
- Sustainable Livestock Systems, International Livestock Research Institute, Nairobi, Kenya
| | - Watson Lepariyo
- Sustainable Livestock Systems, International Livestock Research Institute, Nairobi, Kenya
| | - Vincent Alulu
- Sustainable Livestock Systems, International Livestock Research Institute, Nairobi, Kenya
| | - Simbarashe Sibanda
- Nutrition Sensitive Agriculture, Food, Agriculture and Natural Resources Policy Analysis, Pretoria, South Africa
| | - Beatrice N Kiage
- Nutrition Sensitive Agriculture, Food, Agriculture and Natural Resources Policy Analysis, Pretoria, South Africa.,Department of Human Nutrition and Dietetics, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
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Kusumajaya AAN, Mubasyiroh R, Sudikno S, Nainggolan O, Nursanyoto H, Sutiari NK, Adhi KT, Suarjana IM, Januraga PP. Sociodemographic and Healthcare Factors Associated with Stunting in Children Aged 6-59 Months in the Urban Area of Bali Province, Indonesia 2018. Nutrients 2023; 15:nu15020389. [PMID: 36678259 PMCID: PMC9863855 DOI: 10.3390/nu15020389] [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: 11/07/2022] [Revised: 12/24/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open
Abstract
Stunting is a worldwide public health concern, including in Indonesia. Even when living in an urban area with urban characteristics, it is still possible for children to be at risk of stunting. The aim of this study was to determine the sociodemographic and healthcare factors associated with stunting in a province experiencing tourism growth, namely, Bali. Cross-sectional data on Bali Province from the Indonesian Basic Health Research Survey (Riskesdas, 2018) were used as the basis for the research analysis. A total of 846 respondents under five years of age were analyzed, indicating a stunting prevalence of 19.0%. Multivariate logistic regression demonstrated low maternal educational attainment (adjustedOR = 1.92; 95% Confidence Interval = 1.24-2.97), the inadequate consumption of iron tablets during pregnancy (adjustedOR = 1.56; 95% Confidence Interval = 1.08-2.24), and no extended family (adjustedOR = 1.55; 95% Confidence Interval = 1.07-2.26) as being significantly associated with stunting. According to these findings, sociodemographic and healthcare factors are associated with stunting in urban Bali. Improving women's education, ensuring sufficient iron tablets are consumed during pregnancy, and encouraging the involvement of the extended family in childcare are recommended.
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Affiliation(s)
| | - Rofingatul Mubasyiroh
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta 10340, Indonesia
- Correspondence:
| | - Sudikno Sudikno
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta 10340, Indonesia
| | - Olwin Nainggolan
- Health Development Policy Agency, Ministry of Health, Jakarta 10560, Indonesia
| | | | - Ni Ketut Sutiari
- Department of Public Health and Preventive Medicine, Medical Faculty, Udayana University, Denpasar 80361, Indonesia
| | - Kadek Tresna Adhi
- Department of Public Health and Preventive Medicine, Medical Faculty, Udayana University, Denpasar 80361, Indonesia
| | - I Made Suarjana
- Health Polytechnic, Ministry of Health, Denpasar 80224, Indonesia
| | - Pande Putu Januraga
- Department of Public Health and Preventive Medicine, Medical Faculty, Udayana University, Denpasar 80361, Indonesia
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Shonchoy AS, Akram AA, Khan M, Khalid H, Mazhar S, Khan A, Kurosaki T. A Community Health Worker-Based Intervention on Anthropometric Outcomes of Children Aged 3 to 21 Months in Urban Pakistan, 2019-2021. Am J Public Health 2023; 113:105-114. [PMID: 36516383 PMCID: PMC9755947 DOI: 10.2105/ajph.2022.307111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 12/15/2022]
Abstract
Objectives. To evaluate the impact of a community health worker-based "in-home growth monitoring with counseling" (IHGMC) intervention on anthropometric outcomes in Pakistan, where 38% of children younger than 5 years are stunted. Methods. We used an individual, single-blind, step-wedge randomized controlled trial and a pure control group recruited at endline. We based the analysis on an intention-to-treat estimation using the coarsened exact matching (CEM) method for sample selection among treatments and the control. We conducted the baseline in July 2019 and completed endline in September-October 2021. We recruited 1639 households (treated: 1188; control: 451) with children aged 3 to 21 months who were residing in an urban informal settlement area. The CEM sample used for analysis numbered 1046 (treated: 636; control: 410). The intervention continued for 6 months. Results. Compared with the control group, the height-for-age z-score in the IHGMC group increased by 0.58 SD (95% confidence interval [CI] = 0.33, 0.83; P = .001) and the weight-for-age z-score by 0.43 SD (95% CI = 0.20, 0.67; P < .01), measured at endline. Conclusions. IHGMC substantially improved child anthropometric outcomes in disadvantaged localities, and this impact persisted during the COVID-19 pandemic. Trial Registration. AER-RCT registry (AEARCTR-0003248). (Am J Public Health. 2023;113(1):105-114. https://doi.org/10.2105/AJPH.2022.307111).
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Affiliation(s)
- Abu S Shonchoy
- Abu S. Shonchoy is with the Department of Economics, Steven J. Green School of International and Public Affairs, Florida International University, Miami. At the time of this work, Agha A. Akram was with the Department of Economics, Mushtaq Ahmad Gurmani School of Social Science, Lahore University of Management Sciences; Mahrukh Khan was with the Centre for Economic Research in Pakistan; Hina Khalid was with the Department of Economics, School of Humanities and Social Sciences, Information Technology University; and Sidra Mazhar was with the Center for Economic Research in Pakistan, Lahore, Pakistan. Akib Khan is with the Department of Economics, Uppsala University, Uppsala, Sweden. Takashi Kurosaki is with the Institute of Economic Research, Hitotsubashi University, Tokyo, Japan
| | - Agha A Akram
- Abu S. Shonchoy is with the Department of Economics, Steven J. Green School of International and Public Affairs, Florida International University, Miami. At the time of this work, Agha A. Akram was with the Department of Economics, Mushtaq Ahmad Gurmani School of Social Science, Lahore University of Management Sciences; Mahrukh Khan was with the Centre for Economic Research in Pakistan; Hina Khalid was with the Department of Economics, School of Humanities and Social Sciences, Information Technology University; and Sidra Mazhar was with the Center for Economic Research in Pakistan, Lahore, Pakistan. Akib Khan is with the Department of Economics, Uppsala University, Uppsala, Sweden. Takashi Kurosaki is with the Institute of Economic Research, Hitotsubashi University, Tokyo, Japan
| | - Mahrukh Khan
- Abu S. Shonchoy is with the Department of Economics, Steven J. Green School of International and Public Affairs, Florida International University, Miami. At the time of this work, Agha A. Akram was with the Department of Economics, Mushtaq Ahmad Gurmani School of Social Science, Lahore University of Management Sciences; Mahrukh Khan was with the Centre for Economic Research in Pakistan; Hina Khalid was with the Department of Economics, School of Humanities and Social Sciences, Information Technology University; and Sidra Mazhar was with the Center for Economic Research in Pakistan, Lahore, Pakistan. Akib Khan is with the Department of Economics, Uppsala University, Uppsala, Sweden. Takashi Kurosaki is with the Institute of Economic Research, Hitotsubashi University, Tokyo, Japan
| | - Hina Khalid
- Abu S. Shonchoy is with the Department of Economics, Steven J. Green School of International and Public Affairs, Florida International University, Miami. At the time of this work, Agha A. Akram was with the Department of Economics, Mushtaq Ahmad Gurmani School of Social Science, Lahore University of Management Sciences; Mahrukh Khan was with the Centre for Economic Research in Pakistan; Hina Khalid was with the Department of Economics, School of Humanities and Social Sciences, Information Technology University; and Sidra Mazhar was with the Center for Economic Research in Pakistan, Lahore, Pakistan. Akib Khan is with the Department of Economics, Uppsala University, Uppsala, Sweden. Takashi Kurosaki is with the Institute of Economic Research, Hitotsubashi University, Tokyo, Japan
| | - Sidra Mazhar
- Abu S. Shonchoy is with the Department of Economics, Steven J. Green School of International and Public Affairs, Florida International University, Miami. At the time of this work, Agha A. Akram was with the Department of Economics, Mushtaq Ahmad Gurmani School of Social Science, Lahore University of Management Sciences; Mahrukh Khan was with the Centre for Economic Research in Pakistan; Hina Khalid was with the Department of Economics, School of Humanities and Social Sciences, Information Technology University; and Sidra Mazhar was with the Center for Economic Research in Pakistan, Lahore, Pakistan. Akib Khan is with the Department of Economics, Uppsala University, Uppsala, Sweden. Takashi Kurosaki is with the Institute of Economic Research, Hitotsubashi University, Tokyo, Japan
| | - Akib Khan
- Abu S. Shonchoy is with the Department of Economics, Steven J. Green School of International and Public Affairs, Florida International University, Miami. At the time of this work, Agha A. Akram was with the Department of Economics, Mushtaq Ahmad Gurmani School of Social Science, Lahore University of Management Sciences; Mahrukh Khan was with the Centre for Economic Research in Pakistan; Hina Khalid was with the Department of Economics, School of Humanities and Social Sciences, Information Technology University; and Sidra Mazhar was with the Center for Economic Research in Pakistan, Lahore, Pakistan. Akib Khan is with the Department of Economics, Uppsala University, Uppsala, Sweden. Takashi Kurosaki is with the Institute of Economic Research, Hitotsubashi University, Tokyo, Japan
| | - Takashi Kurosaki
- Abu S. Shonchoy is with the Department of Economics, Steven J. Green School of International and Public Affairs, Florida International University, Miami. At the time of this work, Agha A. Akram was with the Department of Economics, Mushtaq Ahmad Gurmani School of Social Science, Lahore University of Management Sciences; Mahrukh Khan was with the Centre for Economic Research in Pakistan; Hina Khalid was with the Department of Economics, School of Humanities and Social Sciences, Information Technology University; and Sidra Mazhar was with the Center for Economic Research in Pakistan, Lahore, Pakistan. Akib Khan is with the Department of Economics, Uppsala University, Uppsala, Sweden. Takashi Kurosaki is with the Institute of Economic Research, Hitotsubashi University, Tokyo, Japan
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22
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Girma D, Teshome D, kerie Y, Kaso AW, Kaso M. Growth monitoring and promotion services utilization and associated factors among children less than two years of age in Digelu Tijo district, south central Ethiopia. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2022.101203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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23
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Moyo SA, Mashau NS, Makhado L. Development of a growth monitoring and promotion index to improve child health in Zimbabwe. MethodsX 2022; 10:101958. [PMID: 36606121 PMCID: PMC9807990 DOI: 10.1016/j.mex.2022.101958] [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: 09/19/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022] Open
Abstract
In Zimbabwe, growth monitoring and promotion as conducted by community health workers are part of the nutritional surveillance system. This study seeks to develop a new index which will combine both caregiver behaviours, attitudes and CHW growth monitoring and promotion activities. An explanatory sequential mixed method design will be conducted in three phases. Phase one will comprise a scoping literature review. The second phase will comprise a needs analysis through quantitative data collection using two surveys of community health workers and caregivers of children under five years. Thereafter, qualitative data will be collected from caregivers of children under five years. The quantitative data will be analysed using SPSS while qualitative data will be collected and analysed using Atlas-ti. Phase three will be the development phase for the growth monitoring and promotion Index. The growth monitoring and promotion Index will be used to classify the GMP performance of districts through the DHIS2 thus strengthening the quality of growth monitoring and promotion. Recommendations on the findings and the adoption of the Index will be shared with the Ministry of Health and Child Care and key stakeholders implementing maternal, newborn and child health programmes in Zimbabwe for adoption and use in growth monitoring and promotion programming.
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Endale G, Melis T, Dendir A, Lentiro K, Sahle T. Growth monitoring service utilization and its associated factors among mothers of children less than 2 years in Muhir Aklil district, Gurage zone, Southern Ethiopia, 2020. SAGE Open Med 2022; 10:20503121221133936. [PMID: 36405979 PMCID: PMC9666843 DOI: 10.1177/20503121221133936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 10/03/2022] [Indexed: 12/25/2023] Open
Abstract
INTRODUCTION United Nations International Children's Emergency Fund recommends a 100% growth monitoring and promotion coverage, but the prevalence of growth monitoring and promotion service utilization rate in Ethiopia is only 16.9%. Even though Ethiopia is attempting different strategies to cope up with this low rate, the problem is still unresolved. OBJECTIVE The aim of this study is to assess the prevalence of growth monitoring service utilization and its associated factors among mothers of children less than 2 years in Muhir Aklil district. METHODS A community-based cross-sectional study was conducted on 443 study participants from 10 February to 8 March 2020. The study participants in the study were selected using simple random sampling technique. The collected data were entered in to EpiData3.1 and exported to SPSS version 23. Bivariate and multi-variable logistic regression analysis was used to identify factors associated with growth monitoring service utilization. Statistically significance was declared at p value < 0.05% and 95% confidence interval. RESULTS In this study, the overall growth monitoring and service utilization was 32.9%. Fully empowered mothers adjusted odds ratio: 2.7, 95% confidence interval: 1.5-4.3), receiving counseling (adjusted odds ratio: 2.8; 95% confidence interval: 2.0-4.7) and regularly participating on community conversation (adjusted odds ratio: 2.8, 95% confidence interval: 1.8-7.6) were significantly associated with growth monitoring service utilization. CONCLUSION Growth monitoring services utilization was 32.9%. Maternal empowerment on decision-making, engaging women on financial control, knowledge of mothers receiving counseling and regularly participating on community conversation were the independent factors for growth monitoring service utilization. The health extension workers should strengthen maternal empowerment and community conversation through increasing maternal awareness.
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Affiliation(s)
- Getu Endale
- Department of Public Health, College of
Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Tamirat Melis
- Department of Public Health, College of
Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Andamlak Dendir
- Department of Public Health, College of
Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Kifle Lentiro
- Department of Public Health, College of
Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Tadesse Sahle
- Department of Nursing, Wolkite
University, Wolkite, Ethiopia
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Endris BS, Fenta E, Getnet Y, Spigt M, Dinant G, Gebreyesus SH. Barriers and facilitators to the implementation of nutrition interventions at primary health care units of Ethiopia: A consolidated framework for implementation research. MATERNAL & CHILD NUTRITION 2022; 19:e13433. [PMID: 36197123 PMCID: PMC9749594 DOI: 10.1111/mcn.13433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/12/2022] [Accepted: 09/07/2022] [Indexed: 12/15/2022]
Abstract
Accumulating evidence clearly shows poor implementation of nutrition interventions, in Ethiopia and other African countries, with many missed opportunities in the first 1000 days of life. Even though there are high-impact interventions in this critical period, little is known about the barriers and facilitators influencing their implementation. This paper aims to explore barriers and facilitators for the implementation of nutrition services for small children with a focus on growth monitoring and promotion, iron-folic acid supplementation and nutrition counselling. We conducted a qualitative study in four districts of Ethiopia. The data collection and analysis were guided by the consolidated framework for implementation research (CFIR). A total of 42 key informant interviews were conducted with key stakeholders and service providers. Interviews were transcribed verbatim and coded using CIFR constructs. We found that from 39 constructs of CFIR, 14 constructs influenced the implementation of nutrition interventions. Major barriers included lack of functional anthropometric equipment and high caseload (complexity), poor staff commitment and motivation (organisational incentive and reward), closed health posts (patient need and resource), false reporting (culture), lack of priority for nutrition service (relative priority), poor knowledge among service providers (knowledge and belief about the intervention) and lack of active involvement and support from leaders (leadership engagement). Adaptability and tension for change were the facilitators for the implementation of nutrition interventions. Effective implementation of nutrition interventions at primary health care units requires several actions such as improving the healthcare providers' motivation, improving leadership engagement, and creating a strong system for monitoring, supportive supervision and accountability.
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Affiliation(s)
- Bilal Shikur Endris
- Department of Nutrition and Dietetics, School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
| | - Esete Fenta
- Department of Nutrition and Dietetics, School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
| | - Yalemwork Getnet
- Department of Nutrition and Dietetics, School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
| | - Mark Spigt
- School CAPHRI, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands,General Practice Research Unit, Department of Community MedicineThe Arctic University of TromsøTromsøNorway
| | - Geert‐Jan Dinant
- School CAPHRI, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Seifu H. Gebreyesus
- Department of Nutrition and Dietetics, School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
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Mabesa T, Knight S, Nkwanyana N. Completeness of the road-to-health card and factors affecting knowledge and practices of growth monitoring and promotion in caregivers of young children in KwaZulu-Natal. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2022. [DOI: 10.1080/16070658.2022.2114405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- T Mabesa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - S Knight
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - N Nkwanyana
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Kebede GG, Dawed YA, Seid KA. Child growth monitoring and promotion practice and associated factors among health care workers at public health facilities in south Wollo Zone, Northeast Ethiopia: a facility-based cross-sectional study. BMC Nutr 2022; 8:99. [PMID: 36076259 PMCID: PMC9454228 DOI: 10.1186/s40795-022-00597-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/26/2022] [Indexed: 12/02/2022] Open
Abstract
Background Growth monitoring and promotion (GMP) is one of the health care priorities to assess and follow the growth pattern of children under 2 years old. Appropriate GMP services enable health care workers to control growth faltering early and child mortality. However, there is limited information showing the practice and associated factors of GMP service among health care workers in Ethiopia. Therefore, this study aimed to assess the practice and identify associated factors of GMP service among health care workers at public health facilities of the South Wollo Zone, northeast Ethiopia. Methods A facility-based cross-sectional study was conducted on 397 randomly selected health care workers in the South Wollo Zone, northeast Ethiopia, from May 25 to July 7, 2020. A pretested self-administered questionnaire and in-depth interview were used to collect the quantitative and qualitative data, respectively. Quantitative data were entered using Epi data Version 3.1 and exported to statistical software for social sciences (SPSS) version 20.0 software for further analysis. Binary logistic regression analyses were used to identify factors associated with GMP practice. Statistical tests at a P value < 0.05 with a 95% confidence interval were taken as a cutoff point to determine the statistical significance. Qualitative data were analyzed by using thematic analysis. Results In this study, the proportion of GMP practice among health care workers was 58.4% (95% CI: 54.0–63.0). Being a holder of first degree (AOR = 2.25; 95% CI: 1.01, 5.05), being a holder of a diploma (AOR = 3.52; 95% CI: 2.04, 6.09), work experience with GMP (AOR = 3.13; 95% CI: 1.58, 6.20), receiving GMP training (AOR = 4.83; 95% CI: 2.89, 8.06), availability of GMP equipment (AOR = 2.75; 95% CI: 1.64, 4.58) and having a positive attitude toward GMP (AOR = 3.70; 95% CI: 2.23, 6.17) were factors significantly associated with GMP practice. Conclusions and recommendations The proportion of GMP practice among health care workers was still low. Educational level, work experience with GMP, GMP training, GMP equipment and attitude toward GMP were positively associated with GMP practice. Availability of GMP equipment brings positive attitudes toward GMP, and GMP training for health care workers with less experience should be strengthened to improve GMP practice.
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Affiliation(s)
| | - Yeshimebet Ali Dawed
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Kemal Ahmed Seid
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
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Tufa Y, Mitiku A, Shemsu S, Bidira K. Utilisation of growth monitoring service by mothers of infants in Mettu town, Southwest Ethiopia. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001588. [PMID: 36645776 PMCID: PMC9511599 DOI: 10.1136/bmjpo-2022-001588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/24/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Growth monitoring (GM) is a preventive activity that serves as the core function in an integrated child health and nutrition programme. In most developing nations, including Ethiopia, however, the use of GM service is insufficient. Hence, the purpose of this study was to evaluate the use of GM services and associated characteristics among mothers of infants in Mettu town, Southwest Ethiopia. OBJECTIVE To assess the utilisation of GM service by mothers of infants in Mettu town, Southwest Ethiopia, 2021. METHOD A community-based cross-sectional study was conducted among 354 randomly selected mothers with children aged 0-23 months old from 25 June to 27 July 2021 in Mettu town. EpiData V.4.6.0 was used to enter data, which were then exported to SPSS V.25 for analysis. Simple binary and multivariable logistic regression analyses were performed to identify factors associated with GM service utilisation. RESULTS A total of 354 study participants were included in the study, yielding a response rate of 95.2%. The proportion of GM service utilisation was 25.2% (95% CI: 20.24% to 29.33%). In multivariable regression analysis, age of index child 0-11 months (AOR (adjusted OR)=1.58; 95% CI: 1.052 to 3.713), early postnatal care (PNC) (AOR=1.72; 95% CI: 1.657 to 6.467), middle tertile wealth status (AOR=0.108; 95% CI: 0.047 to 0.319) and lower tertile wealth status (AOR=0.073; 95% CI: 0.013 to 0.874), utilisation of family health cards (AOR=2.09; 95% CI: 1.384 to 5.343) and taking ≤30 min to reach the nearest health facility (AOR=2.23; 95% CI: 2.061 to 7.350) were significantly associated with GM service utilisation. CONCLUSION AND RECOMMENDATION In this study, only one-fourth of mothers with children aged 0-23 months old were using GM services. GM service utilisation was found to be significantly associated with child age, early PNC visit, wealth status, utilisation of family health cards and time taking ≤30 min to reach the nearest health facility. Hence, appropriate strategies that promote and encourage GM service utilisation should be designed.
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Affiliation(s)
- Yohanis Tufa
- Department of Health Extension Service, Mettu Health Science College, Mettu, Ethiopia
| | - Abeza Mitiku
- Department of Public Health, Mettu University, Mettu, Ethiopia
| | - Shuayib Shemsu
- Department of Public Health, Mettu University, Mettu, Ethiopia
| | - Kebebe Bidira
- Department of Nursing, Mettu University, Mettu, Ethiopia
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29
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Jackson A, Ashworth A, Annan RA. The International Malnutrition Task Force: A model for the future? Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Marume A, Mahomed S, Archary M. Evaluation of the child growth monitoring programme in two Zimbabwean provinces. Afr J Prim Health Care Fam Med 2022; 14:e1-e8. [PMID: 35924624 PMCID: PMC9350461 DOI: 10.4102/phcfm.v14i1.3373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/24/2022] Open
Abstract
Background The child growth monitoring (CGM) programme is an important element of nutrition programmes, and when combined with other child health programmes, it can assist in successful management and control of malnutrition in children. Aim This study aimed to assess the extent to which the CGM programme is able to identify instances of childhood malnutrition and how much this contributes towards malnutrition reduction in Zimbabwe. Setting The study was conducted in Manicaland and Matabeleland South provinces of Zimbabwe. The two provinces were purposively selected for having the highest and least proportion of children affected by stunting in the country. Methods The CGM programme in Zimbabwe was evaluated using the logic model to assess the ability of the programme to identify growth faltering and link children to appropriate care. Results Records from 60 health facilities were reviewed. Interviews were conducted with 60 nurses, 100 village health workers (VHWs) and 850 caregivers (300 health facility exit interviews, 450 community based). Nearly all (92%) health facilities visited had functional measuring scales. Twelve health facilities (20%) had no functional height board, with five using warped height boards for measuring children’s height. Less than a quarter (21%) of the children had complete records for weight for age and height for age. A large proportion of children eligible for admission for the management of moderate (83%) and severe malnutrition (84%) were missed. Conclusion The CGM programme in Zimbabwe is not well equipped for assessing child height for age and management of children identified with malnutrition, thus failing to timely identify and manage childhood stunting.
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Affiliation(s)
- Anesu Marume
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; and, Ministry of Health and Child Care Zimbabwe, Health Promotion, Government of Zimbabwe, Harare.
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Passarelli S, Sudfeld C, Davison KK, Fawzi W, Donato K, Tessema M, Gunaratna NS, De Groote H, Cohen J, McConnell M. Caregivers Systematically Overestimate Their Child's Height-for-Age Relative to Other Children in Rural Ethiopia. J Nutr 2022; 152:1327-1335. [PMID: 35102394 PMCID: PMC9071331 DOI: 10.1093/jn/nxac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Stunting affects one-quarter of children <5 y of age, yet little is known about the accuracy of caregivers' perceptions regarding their child's linear growth. Most existing quantitative research on this topic has been conducted in high-income countries and has examined perceptions of children's weight rather than height. OBJECTIVES In rural Ethiopia where linear growth faltering is highly prevalent, this study aimed to better understand how caregivers perceive their child's growth. The objectives of this analysis were to 1) assess caregivers' perceptions of their child's height; 2) investigate whether there is a discrepancy between a child's actual height and caregivers' perceptions of their child's height; and 3) examine the factors that influence discrepancies in estimating a child's height (secondary outcomes), including the role of the average height in the community (primary outcome). METHODS We conducted a cross-sectional analysis using data from 808 woman caregivers of children ages 6-35 mo in the Oromia region of Ethiopia. We assessed caregivers' rankings (from 1 to 10) of their child's height relative to other children their age in their village. We then converted these rankings to z scores based on an age- and region-specific distribution in order to calculate their difference with the child's actual height-for-age z score and to determine the degree of overestimation. Lastly, we used multivariate log Poisson regressions to determine factors associated with overestimating a child's height. RESULTS Forty-three percent of caregivers scored their child's height as the median; 37% overestimated their child's height relative to other children. Regression results showed caregivers who were poorer, and had children who were female, older, and stunted, were more likely to overestimate. CONCLUSIONS Our findings suggest that caregivers of young children in Oromia systematically overestimated their children's height, which could adversely affect child health if these misperceptions translate to insufficient care-seeking behavior or feeding choices for children.
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Affiliation(s)
- Simone Passarelli
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Christopher Sudfeld
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Kirsten K Davison
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Wafaie Fawzi
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | | | | | - Hugo De Groote
- International Maize and Wheat Improvement Center (CIMMYT), Nairobi, Kenya
| | - Jessica Cohen
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Margaret McConnell
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
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Tesfa M, Gonete KA, Chane Y, Yohannes S. Growth Monitoring Practice and Associated Factors Among Health Professionals at Public Health Facilities of Bahir Dar Health Centers, Northwest Ethiopia, 2021. Pediatric Health Med Ther 2022; 13:195-215. [PMID: 35620235 PMCID: PMC9128747 DOI: 10.2147/phmt.s355214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/09/2022] [Indexed: 12/18/2022] Open
Affiliation(s)
- Migbaru Tesfa
- Ministry of Health Ethiopia, Eka Kotebe General Hospital, Addis Abeba, Ethiopia
| | - Kedir Abdela Gonete
- Department of Human Nutrition, College of Medicine and Health Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Yawkal Chane
- Department of Nutrition, College of Medicine and Health Science, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Senay Yohannes
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- Correspondence: Senay Yohannes, Tel +251 918-232-916, Email
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van Zadelhoff SJN, Haisma HH. How Is Context Addressed in Growth Monitoring? A Comparison of the Tanzanian, Indian, and Dutch Manuals. Curr Dev Nutr 2022; 6:nzac023. [PMID: 35434471 PMCID: PMC9007241 DOI: 10.1093/cdn/nzac023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/09/2022] [Accepted: 02/10/2022] [Indexed: 11/22/2022] Open
Abstract
Background To address malnutrition in all its forms, context should be taken into account in growth-monitoring (GM) practices. Objectives The aim was to compare GM manuals of countries with different nutrition problems, and to assess how these manuals are adapted to the different biological, socioeconomic, and cultural contexts. Methods GM manuals from Tanzania, India, and the Netherlands were compared with each other, and with the materials for the WHO training course on child growth assessment. First, the aims of GM, growth measurements, interpretation of these measurements, and counseling approaches are compared. Second, contextual determinants of malnutrition are identified using the UNICEF framework for malnutrition as an analytical model. Results Our results show that the GM manuals differ in their descriptions of the aim of GM, growth measurements, their interpretation, and counseling approaches. Assessing normal growth and detecting growth problems are among the aims of GM in all of the analyzed countries. In Tanzania and India, the focus is mainly on undernutrition, whereas the Dutch manuals focus on overweight and on underlying pathologies that contribute to poor linear growth. The findings of our analysis of contextual factors within the UNICEF framework show that the Tanzanian protocol is only minimally adapted to the local context. Of the manuals examined in our study, the Indian manual is most focused on the contextual determinants of malnutrition, and stresses the importance of taking customs and beliefs into account. The Dutch protocol, by contrast, emphasizes the importance of the biological environment, including parental height and ethnicity, as determinants of child growth. Conclusions The country manuals we analyzed only partly reflect the contexts in which children live. To address malnutrition in all its forms, the GM manuals should take children's biological, socioeconomic, and cultural contexts into account, as this would help health professionals to tailor counseling messages for parents.
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Affiliation(s)
- Saskia J N van Zadelhoff
- Population Research Center, Department of Demography, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
| | - Hinke H Haisma
- Population Research Center, Department of Demography, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
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Farisni TN, Yarmaliza Y, Burdansyah F, Reynaldi F, Zakiyuddin Z, Syahputri VN, Arundhana AI. Healthy Family Index of Families with Children Experiencing Stunting. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Stunting is a global problem that has a long-term impact on the quality of human resources. Stunting prevention can be achieved throughout supervision during the first 1000 days of life. The study aimed to examine whether health-conscious families can reduce and prevent stunting. The study location was in the operational area of Mifa Bersaudara Ltd. from March to September 2019. The research method used in this study was a quantitative observational study using a cross-sectional design. The instrument assessing the family health indicators issued by the Ministry of Health of Indonesia was used. The data were analysed using the health-conscious family index formula and Z-score for the infant nutritional status. The study participants were 293 families with toddlers. The study results show that the families living surrounding the operational area of the Mifa Bersaudara Ltd. are mostly pre-healthy families (51.5%) with more than 30% (n=88) of stunted children. There is a relationship between a healthy family index and stunting (p-value<0.05). The logistic regression test shows a significant relationship between the incidence of stunting and the families following the family planning program, exclusive breastfeeding, toddlers receiving monitoring, and no family members who smoke. Stunting is associated with health-conscious families. The incidence of stunting in infants and toddlers is associated with families that plan the pregnancy spacing (family planning), babies getting exclusive breastfeeding, toddlers getting growth monitoring, and no smoking family members.
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Gassmann F, de Groot R, Dietrich S, Timar E, Jaccoud F, Giuberti L, Bordon G, Fautsch-Macías Y, Veliz P, Garg A, Arts M. Determinants and drivers of young children's diets in Latin America and the Caribbean: Findings from a regional analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000260. [PMID: 36962164 PMCID: PMC10021987 DOI: 10.1371/journal.pgph.0000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 06/09/2022] [Indexed: 11/19/2022]
Abstract
The Latin America and Caribbean region exhibit some of the lowest undernutrition rates globally. Yet, disparities exist between and within countries and countries in the region increasingly face other pressing nutritional concerns, including overweight, micronutrient deficiencies and inadequate child feeding practices. This paper reports findings from a regional analysis to identify the determinants and drivers of children's diets, with a focus on the complementary feeding window between the age of 6-23 months. The analysis consists of a narrative review and descriptive data analysis, complemented with qualitative interviews with key informants in four countries: Guatemala, Paraguay, Peru and Uruguay. Findings indicate that poverty and inequality (disparities within countries by wealth and residence), unequal access to services, inadequate coverage of social programmes and lack of awareness on appropriate feeding practices are important drivers for inadequate diets. We conclude that countries in the region need to invest in policies to tackle overweight and micronutrient deficiencies in young children, considering inequalities between and within countries, enhance coverage of social protection programmes, improve coordination between sectors to improve children's diets and expand the coverage and intensity of awareness campaigns on feeding practices, using iterative programme designs.
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Affiliation(s)
| | | | | | - Eszter Timar
- UNU-MERIT, Maastricht University, Maastricht, Netherlands
| | | | | | - Giulio Bordon
- UNU-MERIT, Maastricht University, Maastricht, Netherlands
| | - Yvette Fautsch-Macías
- UNICEF Latin America and Caribbean Regional Office, New York, New York, United States of America
| | - Paula Veliz
- UNICEF Latin America and Caribbean Regional Office, New York, New York, United States of America
| | - Aashima Garg
- UNICEF, New York, New York, United States of America
| | - Maaike Arts
- UNICEF Latin America and Caribbean Regional Office, New York, New York, United States of America
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King SE, Sheffel A, Heidkamp R, Xu YY, Walton S, Munos MK. Advancing nutrition measurement: Developing quantitative measures of nutrition service quality for pregnant women and children in low‐ and middle‐income country health systems. MATERNAL & CHILD NUTRITION 2022; 18:e13279. [PMID: 34734469 PMCID: PMC8710116 DOI: 10.1111/mcn.13279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Shannon E. King
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Ashley Sheffel
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Rebecca Heidkamp
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Yvonne Yiru Xu
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Shelley Walton
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Melinda K. Munos
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
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Yeshaneh A, Fentahun T, Belachew T, Mohammed A, Adane D. Utilization of growth monitoring and promotion services and associated factors among children aged 0-23 months in Banja District, Northwest Ethiopia 2020: A cross-sectional study. PLoS One 2021; 16:e0259968. [PMID: 34780536 PMCID: PMC8592466 DOI: 10.1371/journal.pone.0259968] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 10/30/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Growth monitoring and promotion are the basic malnutrition preventive strategies usually used to assess the growth of children using anthropometric measurements in comparison with world health organization standards. However, the utilization of growth monitoring and promotion services is inadequate in most developing countries. Therefore, this study aimed to assess the utilization of growth monitoring and promotion service and associated factors among children aged 0-23-month in Banja District, Northwest Ethiopia, 2020. METHODS A community-based cross-sectional study was conducted from February 2 to April 1, 2020. A total of 572 children were selected using a simple random sampling technique. Data were collected using structured and pre-tested interviewer-administered questionnaires. Data were entered into Epi data version 4.6 and analyzed using the statistical package for social science (SPSS) version 25. Both binary and multivariable logistic regression analyses with a 95% confidence level were used to identify the associated factors. Statistical significance was set at p <0.05. RESULTS This finding revealed that the proportion of growth monitoring and promotion services utilization was 38.9% [95%CI: 34.8%, 43.0%]. Child age from 0-11 months [AOR = 4.98 (95% CI: 2.75,8.37)], mothers who can read and write Amharic language [AOR = 2.04 (95%CI: 1.02,4.08)], know the benefits of weighing their child monthly [AOR = 2.9 (95%CI: 1.23, 6.94)], presence of growth monitoring service nearby [AOR = 3.2 (95%CI: 1.59,6.31)] and monthly income ≥2000 Ethiopian birr [AOR = 1.75(95% CI = 1.08, 3.02)] were some of the factors significantly associated with utilization of growth monitoring and promotion services. CONCLUSION AND RECOMMENDATION The findings indicate that utilization of growth monitoring and promotion services is mainly affected by child age, mother/caregiver ability to read and write Amharic language, having maternal information on the benefit of the weighing child, presence of service nearby health facility, and mother/caregiver monthly income. Preparation of growth monitoring charts in local language (Awigna) and creating awareness on the proper utilization of growth monitoring and promotion services is strongly recommended.
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Affiliation(s)
- Alex Yeshaneh
- Departments of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Temesgen Fentahun
- School of Public Health, College of Medicine and health science, Wollo University, Dessie, Ethiopia
| | - Tefera Belachew
- Nutrition and Dietetics Department, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Anissa Mohammed
- School of Public Health, College of Medicine and health science, Wollo University, Dessie, Ethiopia
| | - Daniel Adane
- Departments of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
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Dagne S, Aliyu J, Menber Y, Wassihun Y, Petrucka P, Fentahun N. Determinants of growth monitoring and promotion service utilization among children 0-23 months of age in northern Ethiopia: unmatched case-control study. BMC Nutr 2021; 7:67. [PMID: 34743741 PMCID: PMC8573945 DOI: 10.1186/s40795-021-00470-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 09/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the strategies to promote child health and reduce child mortality is growth monitoring and promotion services. But, there is limited information on determinants of Growth Monitoring and Promotion service utilization. OBJECTIVE To identify determinants of growth monitoring and promotion (GMP) service utilization among children 0-23 months of age in Legambo district, South Wollo zone, Northern Ethiopia, 2020. METHODS Community based un-matched case-control study was conducted on 363 (91 cases and 272 controls) study participants from March 15 to April 15, 2020. A multi-stage sampling technique was employed to select the study participants. Bivariable and multivariable logistic regressions were performed and an adjusted odds ratio with 95% confidence intervals was estimated to identify determinants of GMP service utilization. RESULTS A total of 358 mothers (89 cases and 269 controls) with 98.6% response rate were included in the study. The mean (±SD) age of child was 11.66(±6.29) months among controls and 15.02 (±6.06) months among cases. Good maternal knowledge (AOR) = 2.42; 95% CI: 1.23, 4.75), favorable attitude (AOR = 2.45; 95% CI; 1.20, 4.98), counseling on GMP (AOR = 2.34; 95% CI; 1.19, 4.56), attending ante natal care services (AOR = 2.46; 95% CI: 1.18, 5.16), index child age 12-17 months (AOR = 3.45; 95% CI: 1.26, 9.41) and 18-23 months (AOR = 4.38; 95% CI: 1.53, 12.49), and short distance to health facilities (AOR = 4.53; 95% CI; 1.99, 10.28) were determinants of GMP service utilization. CONCLUSION Index child age, good knowledge, favorable attitude, attending antenatal care services, receiving nutritional counseling, and a short distance to health facility were determinants of GMP service utilization. Nutritional interventions should emphasize nutritional counseling and accessibility of growth monitoring and promotion services.
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Affiliation(s)
- Samuel Dagne
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir dar University, Bahir dar, Ethiopia
| | - Jemal Aliyu
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir dar University, Bahir dar, Ethiopia
| | - Yonatan Menber
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir dar University, Bahir dar, Ethiopia
| | - Yosef Wassihun
- Department of Health Promotion and Behavioral Sciences, School of Public Health, College of Medicine and Health Sciences, Bahir dar University, Bahir dar, Ethiopia
| | | | - Netsanet Fentahun
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir dar University, Bahir dar, Ethiopia
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Lyons OC, Kerr MA, McNulty H, Ward F, Walton J, Livingstone MBE, McNulty BA, Kehoe L, Byrne PA, Saul I, Flynn MAT. Addressing nutrient shortfalls in 1- to 5-year-old Irish children using diet modeling: development of a protocol for use in country-specific population health. Am J Clin Nutr 2021; 115:105-117. [PMID: 34718385 PMCID: PMC8755081 DOI: 10.1093/ajcn/nqab311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/10/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Dietary habits formed in early childhood can track into later life with important impacts on health. Food-based dietary guidelines (FBDGs) may have a role in improving population health but are lacking for young children. OBJECTIVES We aimed to establish a protocol for addressing nutrient shortfalls in 1- to 5-y-old children (12-60 mo) using diet modeling in a population-based sample. METHODS Secondary analysis of 2010-2011 Irish National Pre-School Nutrition Survey data (n = 500) was conducted to identify typical food consumption patterns in 1- to 5-y-olds. Nutrient intakes were assessed against dietary reference values [European Food Safety Authority (EFSA) and Institute of Medicine (IOM)]. To address nutrient shortfalls using diet modeling, 4-d food patterns were developed to assess different milk-feeding scenarios (human milk, whole or low-fat cow milk, and fortified milks) within energy requirement ranges aligned with the WHO growth standards. FBDGs to address nutrient shortfalls were established based on 120 food patterns. RESULTS Current mean dietary intakes for the majority of 1- to 5-y-olds failed to meet reference values (EFSA) for vitamin D (≤100%), vitamin E (≤88%), DHA (22:6n-3) + EPA (20:5n-3) (IOM; ≤82%), and fiber (≤63%), whereas free sugars intakes exceeded recommendations of <10% energy (E) for 48% of 1- to 3-y-olds and 75% of 4- to 5-y-olds. "Human milk + Cow milk" was the only milk-feeding scenario modeled that predicted sufficient DHA + EPA among 1- to 3-y-olds. Vitamin D shortfalls were not correctable in any milk-feeding scenario, even with supplementation (5 µg/d), apart from the "Follow-up Formula + Fortified drink" scenario in 1- to 3-y-olds (albeit free sugars intakes were estimated at 12%E compared with ≤5%E as provided by other scenarios). Iron and vitamin E shortfalls were most prevalent in scenarios for 1- to 3-y-olds at ≤25th growth percentile. CONCLUSIONS Using WHO growth standards and international reference values, this study provides a protocol for addressing nutrient shortfalls among 1- to 5-y-olds, which could be applied in country-specific population health.
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Affiliation(s)
- Oonagh C Lyons
- Food Safety Authority of Ireland, Dublin, Ireland,Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, United Kingdom
| | - Maeve A Kerr
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, United Kingdom
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, United Kingdom
| | - Fiona Ward
- Clinical Nutrition and Dietetics, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Janette Walton
- Department of Biological Sciences, Munster Technological University, Cork, Ireland
| | - M Barbara E Livingstone
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, United Kingdom
| | - Breige A McNulty
- UCD Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Laura Kehoe
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | | | - Ita Saul
- Clinical Nutrition and Dietetics, Children's Health Ireland at Crumlin, Dublin, Ireland
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Liu Q, Taylor M, Nabwera H, Long Q. The impact of growth monitoring and promotion on health indicators in children under five years of age in low- and middle-income countries. Hippokratia 2021. [DOI: 10.1002/14651858.cd014785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Qin Liu
- Affiliate of the Cochrane China Network; School of Public Health and Management, Chongqing Medical University; Chongqing China
| | - Melissa Taylor
- Department of Clinical Sciences; Liverpool School of Tropical Medicine; Liverpool UK
| | - Helen Nabwera
- Department of Clinical Sciences; Liverpool School of Tropical Medicine; Liverpool UK
| | - Qian Long
- Global Health Research Center; Duke Kunshan University; Kunshan China
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Seidu F, Mogre V, Yidana A, Ziem JB. Utilization of growth monitoring and promotion is highest among children aged 0-11 months: a survey among mother-child pairs from rural northern Ghana. BMC Public Health 2021; 21:910. [PMID: 33985477 PMCID: PMC8117293 DOI: 10.1186/s12889-021-10980-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background More than half of all deaths in under 5 children is related to malnutrition. Child malnutrition could be prevented through regular monitoring of the growth and development of children and the implementation of growth promotion activities referred to as growth monitoring and promotion (GMP). Mothers’/caregivers utilization of these activities through child welfare clinics could improve the growth and development of under 5 children. We evaluated mothers’ knowledge on GMP, utilization and associated factors among mother-child pairs from a poor socio-economic district in Northern Ghana. Methods Using an analytical cross-sectional design, participants included mothers with children aged 0–59 months, grouped into 0–11 months, 12–23 months and 24–59 months. A semi-structured questionnaire containing both closed- and open-ended questions was used to collect data. Multivariate logistic regression was used to identify determinants of GMP utilization. Results Four hundred mother-child pairs were included in the study. Overall, 28.5% (n = 114) of the mothers utilized GMP services. Almost 60%(n = 237) of the mothers knew the recommended age to seek for GMP service for their children. Only 9% of the mothers could correctly interpret the directions of the growth curves in their children’s Health Record booklet. Mothers with children aged 0–11 months were 3.9 times more likely (p = 0.009) to utilize GMP services compared to their counterparts with children aged 12–23 months and 24–59 months. Mothers who had low level of knowledge were 2.19 times (p = 0.003) more likely to utilize GMP services compared to their counterparts with high level of knowledge.. Conclusion Utilization of GMP services was low and particularly lower in children aged 24–59 months. Mothers’ knowledge in GMP was optimal although there were notable gaps.
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Affiliation(s)
- Fusheini Seidu
- Department of Community Health and Family Medicine, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
| | - Victor Mogre
- Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Ghana.
| | - Adadow Yidana
- Department of Community Health and Family Medicine, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
| | - Juventus B Ziem
- Department of Clinical Microbiology, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
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Heidkamp RA, Piwoz E, Gillespie S, Keats EC, D'Alimonte MR, Menon P, Das JK, Flory A, Clift JW, Ruel MT, Vosti S, Akuoku JK, Bhutta ZA. Mobilising evidence, data, and resources to achieve global maternal and child undernutrition targets and the Sustainable Development Goals: an agenda for action. Lancet 2021; 397:1400-1418. [PMID: 33691095 DOI: 10.1016/s0140-6736(21)00568-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/28/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022]
Abstract
As the world counts down to the 2025 World Health Assembly nutrition targets and the 2030 Sustainable Development Goals, millions of women, children, and adolescents worldwide remain undernourished (underweight, stunted, and deficient in micronutrients), despite evidence on effective interventions and increasing political commitment to, and financial investment in, nutrition. The COVID-19 pandemic has crippled health systems, exacerbated household food insecurity, and reversed economic growth, which together could set back improvements in undernutrition across low-income and middle-income countries. This paper highlights how the evidence base for nutrition, health, food systems, social protection, and water, sanitation, and hygiene interventions has evolved since the 2013 Lancet Series on maternal and child nutrition and identifies the priority actions needed to regain and accelerate progress within the next decade. Policies and interventions targeting the first 1000 days of life, including some newly identified since 2013, require renewed commitment, implementation research, and increased funding from both domestic and global actors. A new body of evidence from national and state-level success stories in stunting reduction reinforces the crucial importance of multisectoral actions to address the underlying determinants of undernutrition and identifies key features of enabling political environments. To support these actions, well-resourced nutrition data and information systems are essential. The paper concludes with a call to action for the 2021 Nutrition for Growth Summit to unite global and national nutrition stakeholders around common priorities to tackle a large, unfinished undernutrition agenda-now amplified by the COVID-19 crisis.
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Affiliation(s)
| | - Ellen Piwoz
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Stuart Gillespie
- International Food Policy Research Institute, Washington, DC, USA
| | - Emily C Keats
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Purnima Menon
- International Food Policy Research Institute, Delhi, India
| | - Jai K Das
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | | | | | - Marie T Ruel
- International Food Policy Research Institute, Washington, DC, USA
| | - Stephen Vosti
- Department of Agricultural and Resource Economics, and Institute for Global Nutrition, University of California, Davis, CA, USA
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada; Centre of Excellence in Women and Child Health and Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan.
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Mattei D, Cavarzere P, Gaudino R, Antoniazzi F, Piacentini G. DYSMORPHIC features and adult short stature: possible clinical markers of KBG syndrome. Ital J Pediatr 2021; 47:15. [PMID: 33494799 PMCID: PMC7830821 DOI: 10.1186/s13052-021-00961-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Growth monitoring is an essential part of primary health care in children and short stature is frequently regarded as a relatively early sign of poor health. The association of short stature and dysmorphic features should always lead to exclude an underlying syndromic disorder. CASE PRESENTATION We report the case of an Indian school-aged boy with dysmorphic features, intellectual disability and a clinical history characterized by seizures and hearing problems. Although his height was always included in the normal range for age and sex throughout childhood, he presented a short near-adult stature in relation to his mid-parent sex-adjusted target height. This is probably due to a rapidly progressive pubertal development. CONCLUSIONS In the presence of characteristic dysmorphic features, intellectual disability, seizures and hearing problems, KBG syndrome should always be considered. This emergent condition presents a wide spectrum of clinical phenotypes and is often associated with adult short stature.
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Affiliation(s)
- Davide Mattei
- Department of Pediatrics, University Hospital of Verona, Verona, Italy
| | - Paolo Cavarzere
- Department of Pediatrics, University Hospital of Verona, Verona, Italy.
| | - Rossella Gaudino
- Department of Pediatrics, University Hospital of Verona, Verona, Italy.,Pediatric Clinic, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Pediatrics, University Hospital of Verona, Verona, Italy.,Pediatric Clinic, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Regional Center for the diagnosis and treatment of children and adolescents rare skeletal disorders. Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Pediatrics, University Hospital of Verona, Verona, Italy.,Pediatric Clinic, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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An empirical study of factors associated with height-for-age z-scores of children aged 6-23 months in northwest Rwanda: the role of care practices related to child feeding and health. Br J Nutr 2020; 126:1203-1214. [PMID: 33298231 DOI: 10.1017/s0007114520004961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We aimed to identify the factors influencing child height-for-age z-scores (HAZ) as a measure of child nutritional status in Rwanda, and to examine the role of child feeding and health practices. We conducted a cross-sectional study involving 379 children (aged 6-23 months) and their mothers in northwest Rwanda. Data were collected using a pre-tested, structured questionnaire. An infant and young child feeding practices index (ICFI) and health practices index (HPI) were developed and categorised into tertiles, and linear regression analyses were performed to assess their association with child HAZ. Overall, mothers of non-stunted children exhibited better feeding and health practices than those of stunted children. ICFI was positively associated with child HAZ. We found an adjusted mean HAZ difference of 0·14 between children whose mothers were in high ICFI tertile compared with those in low tertile. Neither HPI nor any of its components were significantly associated with child HAZ. Other factors that were positively associated with child HAZ were infant birth weight (P < 0·001) and maternal height (P < 0·001). Child age, sex (male) (P < 0·05) and altitude (P < 0·05) were negatively associated with child HAZ. Diarrhoea (P < 0·05) and respiratory infections (P < 0·05) were negatively associated with HAZ in younger children aged 6-11 months. Policies to reduce stunting in this population must focus on both pre- and postnatal factors. Appropriate child feeding practices, particularly breast-feeding promotion and improvement in children's dietary diversity combined with measures to control infections should be given priority.
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45
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Daga S, Daga A. Enhancing consultation time for primary paediatric care in the outpatient department. INTEGRATED HEALTHCARE JOURNAL 2020. [DOI: 10.1136/ihj-2019-000012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectiveTo improve the duration and quality of consultation times during paediatric ambulatory care.Methods and analysisThis, before and after study, compares consultation time and core activities. All the subjects attended the paediatric outpatient department (P-OPD) between 1 July 2013 and 31 October 2013.Initially, consultation time was recorded directly by using observer timing with a stopwatch on 10–12 patients on 3 consecutive days and estimated indirectly after the study. All subjects underwent some or all of the following assessments and interventions (core activities): danger sign detection, illness treatment and referral, growth assessment followed by appropriate dietetic advice, immunisation and parent counselling. We implemented an intervention structure that divided work among staff members and then compared core activities.ResultsDuring the study period, 2204 patients attended the P-OPD over 108 days. Before the study, the average consultation time was less than 5 min (range 3.5–5 min), and the core activities included the treatment and referrals of illnesses and immunisation only. No treatment guidelines existed, and weight record was primarily for calculating the dose of the drug to be prescribed. The protocol did not include growth assessment and maintenance of detailed clinical records.After implementing the core activities through effective utilisation of existing resources, on an average, 20 patients received consultations per day, and the consultation time was approximately 12 min per patient.ConclusionThe P-OPD consultation time increased from 3.5–5 min to approximately 12 min per patient. Using the structured interventions, the range of assessments and interventions, during these consultations, increased without having to hire more staff.
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Kosowan L, Page J, Protudjer J, Williamson T, Queenan J, Singer A. Characteristics associated with pediatric growth measurement collection in electronic medical records: a retrospective observational study. BMC FAMILY PRACTICE 2020; 21:191. [PMID: 32933471 PMCID: PMC7490864 DOI: 10.1186/s12875-020-01259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 09/02/2020] [Indexed: 11/23/2022]
Abstract
Background Complete growth measurements are an essential part of pediatric care providing a proxy for a child’s overall health. This study describes the frequency of well-child visits, documented growth measurements, and clinic and provider factors associated with measurement. Methods Retrospective cross-sectional study utilizing electronic medical records (EMRs) from primary care clinics between 2015 and 2017 in Manitoba, Canada. This study assessed the presence of recorded height, weight and head circumference among children (0–24 months) who visited one of 212 providers participating in the Manitoba Primary Care Research Network. Descriptive and multivariable logistic regression analyses assessed clinic, provider, and patient factors associated with children having complete growth measurements. Results Our sample included 4369 children. The most frequent growth measure recorded was weight (79.2% n = 3460) followed by height (70.8% n = 3093) and head circumference (51.4% n = 2246). 67.5% of children (n = 2947) had at least one complete growth measurement recorded (i.e. weight, height and head circumference) and 13.7% (n = 599) had complete growth measurements at all well-child intervals attended. Pediatricians had 2.7 higher odds of documenting complete growth measures within well-child intervals compared to family physicians (95% CI 1.8–3.8). Additionally, urban located clinics (OR 1.7, 95% CI 1.2–2.5), Canadian trained providers (OR 2.3, 95% CI 1.4–3.7), small practice size (OR 1.6, 95% CI 1.2–2.2) and salaried providers (OR 3.4, 95% CI 2.2–5.2) had higher odds of documented growth measures. Conclusions Growth measurements are recorded in EMRs but documentation is variable based on clinic and provider factors. Pediatric growth measures at primary care appointments can improve primary prevention and surveillance of child health outcomes.
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Affiliation(s)
- Leanne Kosowan
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John Page
- The Children's Hospital of Winnipeg, Winnipeg, Manitoba, Canada
| | - Jennifer Protudjer
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tyler Williamson
- Departments of Biostatistics & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - John Queenan
- Centre for Studies in Primary Care, Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alexander Singer
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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" When I Breastfeed, It Feels as if my Soul Leaves the Body": Maternal Capabilities for Healthy Child Growth in Rural Southeastern Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176215. [PMID: 32867111 PMCID: PMC7504657 DOI: 10.3390/ijerph17176215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 11/21/2022]
Abstract
The burden of childhood stunting in Tanzania is persistently high, even in high food-producing regions. This calls for a paradigm shift in Child Growth Monitoring (CGM) to a multi-dimensional approach that also includes the contextual information of an individual child and her/his caregivers. To contribute to the further development of CGM to reflect local contexts, we engaged the Capability Framework for Child Growth (CFCG) to identify maternal capabilities for ensuring healthy child growth. Ethnographic fieldwork was conducted in Southeastern Tanzania using in-depth interviews, key informant interviews, participant observation, and focus group discussions with caregivers for under-fives. Three maternal capabilities for healthy child growth emerged: (1) being able to feed children, (2) being able to control and make decisions on farm products and income, and (3) being able to ensure access to medical care. Mothers’ capability to feed children was challenged by being overburdened by farm and domestic work, and gendered patterns in childcare. Patriarchal cultural norms restricted women’s control of farm products and decision-making on household purchases. The CFCG could give direction to the paradigm shift needed for child growth monitoring, as it goes beyond biometric measures, and considers mothers’ real opportunities for achieving healthy child growth.
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Pollifrone MM, Cunningham K, Pandey Rana P, Philbin MM, Manandhar S, Lamsal KP, Mandal RN, Deuja V. Barriers and facilitators to growth monitoring and promotion in Nepal: Household, health worker and female community health volunteer perceptions. MATERNAL AND CHILD NUTRITION 2020; 16:e12999. [PMID: 32657015 PMCID: PMC7507439 DOI: 10.1111/mcn.12999] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 11/29/2022]
Abstract
Growth monitoring and promotion (GMP) is both a service for diagnosing inadequate child growth in its earliest stages and a delivery platform for nutrition counselling. The widespread use of GMP services in developing countries has the potential to substantially reduce persistent child undernutrition through early diagnosis and by linking caregivers and their children to key health and nutrition services. However, researchers have questioned the effectiveness of GMP services, which are frequently undermined by underdeveloped health systems and inconsistent implementation. This analysis examined both supply‐ and demand‐side factors for GMP utility in Nepal from the perspectives of beneficiaries and service providers, particularly focusing on three components of GMP: growth assessment, analysis of growth status and counselling. The most common factors influencing GMP uptake included beneficiaries' perceptions of the relative importance of GMP and the knowledge and skill of frontline workers. Both providers and beneficiaries viewed GMP as a secondary health and nutrition activity and therefore less important than curative services. We found deficits in GMP‐related knowledge and skills among providers (i.e. health workers and female community health volunteers), as well as indications of poor training quality and coverage. Furthermore, we found variation in GMP utilization by maternal age, education and residency (alone, nuclear or extended), as well as household socio‐economic well‐being and rurality. This study is the first to assess factors influencing both beneficiaries and service providers for GMP utilization. Further research is needed to explore the implementation of improved GMP protocols and to evaluate facility‐level implementation barriers.
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Affiliation(s)
- Madeline M Pollifrone
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | | | | | - Morgan M Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
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Improving Child Survival in Sub-Saharan Africa: Key Environmental and Nutritional Interventions. Ann Glob Health 2020; 86:73. [PMID: 32704478 PMCID: PMC7350947 DOI: 10.5334/aogh.2908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Many countries in Sub-Saharan Africa (SSA), did not achieve the Millennium Development Goal 4 target of reducing under-five mortality by two-thirds between 1990 and 2015. A large proportion of under-five deaths in SSA and other developing regions have been attributed to undernutrition and poor household environmental conditions. Failure to address nutritional deficit and household environmental pollution in SSA will therefore likely result in many countries not meeting the Sustainable Development Goal (SDG) 3.2 target which aims to reduce under-five mortality to less than 25 deaths per 1000 livebirths by 2030. This paper pinpoints the nutritional and environmental threats to child health in SSA, and identify interventions that will work best to improve child survival in countries. It is important to broaden the spectrum of interventions for improving child survival beyond health systems strengthening to enable countries meet the SDG 3.2 target. The following interventions are thus proposed: strengthening child welfare clinics through digital technologies; investment in school feeding programmes; addressing household air pollution; and improving water, sanitation and hygiene (WASH) services in basic schools. There are certainly barriers to effective implementation of the proposed interventions in countries but are surmountable with strong political will and involvement of the private sector.
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Mapesa J, Meme J, Muthamia O. Effect of community-based nutrition on infant nutrition and associated health practices in Narok, Kenya. Afr Health Sci 2020; 20:724-734. [PMID: 33163037 PMCID: PMC7609109 DOI: 10.4314/ahs.v20i2.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Lack of knowledge, and poor attitudes and practices among rural women have been shown to negatively influence maternal, infant and young child nutrition outcomes as well as child health and cognitive development. Objectives The aim of the study was to assess the impact of community-based nutrition on infant nutrition. Methods A mixed method approach using a structured questionnaire to collect quantitative data (n=234) and Focus Group Discussions (FGDs) for qualitative data was used in Narok County, Kenya. Results About 57% of the participants received nutrition and health information from hospital trained health personnel. Whereas most women indicated having attended antenatal clinics, very few delivered in the hospital (17%). Exclusive breastfeeding knowledge was below 50%, although not statistically significant (p=0.584) across the education spectrum as opposed to identification of malnutrition signs, which was significant (p<0.05). Whereas 74% of the participants had knowledge about signs of malnutrition, only 58% could identify the causes. Rating for complementary feeding among the study participants was about 61% for introduction of complementary foods and 80% for frequency of feeding. Vitamin A supplementation knowledge, antenatal clinic attendance and type of waste disposal were statistically significant (p<0.05) in relation to education level of the study participants. Conclusion This study reveals the need to educate rural women for increased understanding and practice of appropriate infant and nutrition care through sustainable and effective essential nutrition actions.
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Affiliation(s)
- Job Mapesa
- Kenya Methodist University Nairobi Campus, Public Health Human Nutrition and Dietetics
| | - Joyce Meme
- Kenya Methodist University Nairobi Campus, Public Health Human Nutrition and Dietetics
| | - Olive Muthamia
- Kenya Methodist University Nairobi Campus, Public Health Human Nutrition and Dietetics
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