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Bridge R, Lin TK. Evidence on the impact of community health workers in the prevention, identification, and management of undernutrition amongst children under the age of five in conflict-affected or fragile settings: a systematic literature review. Confl Health 2024; 18:16. [PMID: 38413996 PMCID: PMC10900658 DOI: 10.1186/s13031-024-00575-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/28/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Malnutrition, specifically undernutrition, is a significant global challenge that contributes to nearly half of deaths in children under the age of five. The burden of undernutrition is disproportionately borne by conflict-affected, fragile settings (CAFS); children living in a conflict zone being more than twice as likely to suffer from malnourishment. Community health worker (CHW) models have been employed in CAFS to improve healthcare coverage and identify and treat illnesses. However, there lacks systematic evidence on the impact of CHW models in preventing, identifying, and managing child undernutrition in CAFS. We conducted this review to systematically evaluate evidence of CHW models in preventing, identifying, and managing undernutrition in children under the age of five in CAFS. METHODOLOGY This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards. The search strategy was developed using the Population-Intervention-Comparisons-Outcomes-Setting framework as a guide. Searches were performed using Ovid online database search platform, searching the databases of Ovid MEDLINE(R), COCHRANE, Embase Classic, Embase, Econlit, Global Health, SCOPUS, and Social Policy and Practice. Peer-reviewed publications were eligible for inclusion if they evaluated an intervention using a CHW model that aims to prevent, identify, or manage some form of undernutrition in children under five in a CAFS. RESULTS We identified 25 studies-spanning 10 countries-that were included in the systematic review. CHW models were implemented alongside a variety of interventions, including behaviour change communication, supplementary foods, nutrition counselling, and integrated community health programmes. Key barriers in implementing successful CHW models include disruption of programmes due to active conflict, states of emergency, militancy, or political unrest; weak links between the community-based interventions and public health system; weak health system capacity that impeded referral and follow-ups; and cost of care and care-seeking. Key facilitators include CHWs' connection to the community, close proximity of programmes to the community, supervision, and investment in high quality training and tools. CONCLUSIONS The findings suggest that CHW models may be effective, cost-effective, acceptable, feasible, and scalable in the prevention, identification, and management child undernutrition in CAFS. The study findings also confirmed a need for greater evidence in the field. These findings may inform policymaking, programme implementation, and design to strengthen best practices for CHW models addressing child undernutrition in CAFS.
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Affiliation(s)
| | - Tracy Kuo Lin
- Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, 490 Illinois St, 123K, San Francisco, CA, 94158, USA.
- Middle East Centre, London School of Economics and Political Science, London, UK.
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He Q, Qi X, Zhang T, Tang K. Trends in socioeconomic inequalities in malnutrition among children under 5 in the Democratic Republic of the Congo from 2001 to 2018. Nutrition 2023; 115:112182. [PMID: 37573792 DOI: 10.1016/j.nut.2023.112182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Malnutrition in the Democratic Republic of the Congo (DRC) has declined over the past 2 decades. However, malnutrition inequality persists. Evaluating trends of socioeconomic disparities in malnutrition among children under 5 y of age in the DRC can help target meaningful interventions. METHOD Data from the Multiple Indicator Cluster Survey (2001, 2010, 2018) assessed the prevalence of underweight, stunting, and wasting among children under 5. The Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) measured socioeconomic inequalities. We evaluated trends in the entire national sample and stratified subsamples based on place of residence and wealth index quintiles. The final sample included 42 976 children. RESULTS The national prevalence of underweight and wasting decreased from 31% to 26% and 13% to 6% in rural and urban areas. However, trends in stunting prevalence varied between the two areas. Nutritional disparity widened between low- and high-income families (stunting RIIs: 0.61 in 2001, 0.37 in 2018; stunting SIIs: -0.20 in 2001, -0.40 in 2018; underweight RIIs: 0.53 in 2001, 0.35 in 2018; underweight SIIs: -0.21 in 2001, -0.28 in 2018). Urban areas experienced greater inequality than rural areas (stunting in urban RIIs: 0.41 in 2001, 0.33 in 2010, 0.25 in 2018). CONCLUSION Despite progress in reducing malnutrition, persistent socioeconomic disparities, particularly in urban areas, remain a serious public health concern in the DRC. Addressing the root causes of malnutrition and ensuring socioeconomically equitable access to nutrition is critical to promote the full potential of children.
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Affiliation(s)
- Qiwei He
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of International Development Cooperation, Chinese Academy of International Trade and Economic Cooperation, Beijing, China
| | - Xinran Qi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tiange Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China.
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Locks LM, Newell KB, Imohe A, Moloney GM, Shaker-Berbari L, Paudyal N, Jefferds MED. The effect of interventions distributing home fortification products on infant and young child feeding (IYCF) practices: A systematic narrative review. MATERNAL & CHILD NUTRITION 2023:e13488. [PMID: 36842164 DOI: 10.1111/mcn.13488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/14/2022] [Accepted: 01/26/2023] [Indexed: 02/27/2023]
Abstract
Interventions distributing micronutrient powders (MNPs) and small-quantity lipid-based nutrient supplements (SQ-LNS), or home fortification products (HFPs), have the potential to improve infant and young child feeding (IYCF) practices and children's nutrition. We systematically searched for studies on the effect of interventions distributing HFP on IYCF practices. We identified 12 (8 MNP, 4 SQ-LNS) studies: seven programmes with IYCF behaviour change communications (BCC) and MNP (IYCF-MNP) and one provided MNP without IYCF BCC (MNP only). Three SQ-LNS studies came from randomised trials without an IYCF component (SQ-LNS only) and one from a programme with both IYCF BCC and SfQ-LNS (IYCF-SQ-LNS). Five IYCF-MNP programmes reported positive associations with some IYCF practices-four with minimum dietary diversity, two with minimum meal frequency, four with minimum acceptable diet, and three with the initiation of complementary foods at 6 months. Two reported no association between MNP and IYCF indicators, and one reported a decline in IYCF practices during the intervention, although it also reported significant changes to the IYCF programme during the evaluation period. Two studies from interventions that distributed SQ-LNS (one from a related set of randomised controlled trials and the sole IYCF-SQ-LNS programme) reported a positive association with IYCF practices; one trial reported no change in breast milk intake with the provision of SQ-LNS and one found no association with IYCF practices. SQ-LNS and MNP can address nutrient gaps for young children in low-resource settings; our findings indicate that programmes that combine HFP with IYCF interventions may also contribute to improved IYCF practices in some settings.
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Affiliation(s)
- Lindsey M Locks
- Department of Health Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts, USA.,Department of Global Health, Boston University, Boston, Massachusetts, USA
| | - Katharine B Newell
- Department of Health Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts, USA
| | - Annette Imohe
- United Nation Children's Fund (UNICEF) Headquarters, New York City, New York, USA
| | - Grainne M Moloney
- United Nation Children's Fund (UNICEF) Headquarters, New York City, New York, USA
| | - Linda Shaker-Berbari
- United Nation Children's Fund (UNICEF) Headquarters, New York City, New York, USA
| | - Naveen Paudyal
- United Nation Children's Fund (UNICEF) Nepal Country Office, Kathmandu, Nepal
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George CM, Coglianese N, Bauler S, Perin J, Kuhl J, Williams C, Kang Y, Thomas ED, François R, Ng A, Presence AS, Jean Claude BR, Tofail F, Mirindi P, Cirhuza LB. Low dietary diversity is associated with linear growth faltering and subsequent adverse child developmental outcomes in rural Democratic Republic of the Congo (REDUCE program). MATERNAL & CHILD NUTRITION 2022; 18:e13340. [PMID: 35313062 PMCID: PMC9218309 DOI: 10.1111/mcn.13340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 12/05/2022]
Abstract
The objective of this study was to investigate the association between dietary diversity, child growth and child developmental outcomes. This was a prospective cohort study. Developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem solving and combined developmental scores measured by the Extended Ages and Stages Questionnaire (EASQ) at a 6‐month follow‐up visit. Height and weight were measured at baseline and a 6‐month follow‐up. Baseline minimum dietary diversity (MDD) for children 6–23 months old was defined by consumption of five or more of the following food groups: (1) breast milk; (2) grains, roots and tubers; (3) legumes and nuts; (4) dairy products; (5) flesh foods; (6) eggs; (7) vitamin A‐rich fruits and vegetables and (8) other fruits and vegetables. Participants were 117 children 6–23 months of age. Linear growth faltering was defined as a significant decline (p < 0.05) in length‐for‐age Z‐scores (LAZ) between baseline and follow‐up. Regression models were performed. The study was conducted in rural eastern Democratic Republic of the Congo (DRC). MDD was positively associated with change in LAZ (coefficient: 0.87 [95% confidence interval [CI]: 0.33, 1.40]), and a reduced odds of stunting (LAZ < −2) (odds ratio: 0.21 [95% CI: 0.07, 0.61]). MDD was also associated with a significantly higher combined EASQ‐Z‐scores (coefficient: 0.34 [95% CI: 0.003, 0.68], higher communication EASQ‐Z‐scores [0.50 {95% CI: 0.14, 0.85}], and higher personal social EASQ‐Z‐scores [0.46 {95% CI: 0.11, 0.82}]). This study provides further evidence demonstrating the need for interventions to improve dietary diversity among young children. Dietary diversity was low among young children in our study setting in rural eastern Democratic Republic of the Congo. Low dietary diversity was associated with linear growth faltering and lower child developmental outcomes. This study provides further evidence demonstrating the need for interventions to improve dietary diversity among young children to improve child health.
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Affiliation(s)
- Christine Marie George
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | | | - Sarah Bauler
- Health Division Food for the Hungry Phoenix Arizona USA
| | - Jamie Perin
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Jennifer Kuhl
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Camille Williams
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Yunhee Kang
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Elizabeth D. Thomas
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Ruthly François
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Angela Ng
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | | | | | - Fahmida Tofail
- Nutrition Division International Centre for Diarrhoeal Disease Research Dhaka Bangladesh
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Ford ND, Ruth LJ, Ngalombi S, Lubowa A, Halati S, Ahimbisibwe M, Whitehead RD, Mapango C, Jefferds ME. An Integrated Enhanced Infant and Young Child Feeding (IYCF) and Micronutrient Powder Intervention Improved Select IYCF Practices Among Caregivers of Children Aged 12-23 Months in Eastern Uganda. Curr Dev Nutr 2021; 5:nzab003. [PMID: 33634219 PMCID: PMC7888698 DOI: 10.1093/cdn/nzab003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is little evidence of the impact of integrated programs distributing nutrition supplements with behavior change on infant and young child feeding (IYCF) practices. OBJECTIVE We evaluated the impact of an integrated IYCF/micronutrient powder intervention on IYCF practices among caregivers of children aged 12-23 mo in eastern Uganda. METHODS We used pre-post data from 2 population-based, cross-sectional surveys representative of children aged 12-23 mo in Amuria (intervention) and Soroti (nonintervention) districts (n = 2816). Caregivers were interviewed in June/July at baseline in 2015 and 12 mo after implementation in 2016. We used generalized linear mixed models with cluster as a random effect to calculate the average intervention effect on receiving IYCF counseling, ever breastfed, current breastfeeding, bottle feeding, introducing complementary feeding at age 6 mo, continued breastfeeding at ages 1 and 2 y, minimum meal frequency (MMF), minimum dietary diversity, minimum acceptable diet (MAD), and consumption of food groups the day preceding the survey. RESULTS Controlling for child age and sex, household wealth and food security, and caregiver schooling, the intervention was positively associated with having received IYCF counseling by village health team [adjusted prevalence difference-in-difference (APDiD): +51.6%; 95% CI: 44.0%, 59.2%]; timely introduction of complementary feeding (APDiD: +21.7%; 95% CI: 13.4%, 30.1%); having consumed organs or meats (APDiD: +9.0%; 95% CI: 1.4%, 16.6%) or vitamin A-rich fruits or vegetables (APDiD: +17.5%; 95% CI: 4.5%, 30.5%); and MMF (APDiD: +18.6%; 95% CI: 11.2%, 25.9%). The intervention was negatively associated with having consumed grains, roots, or tubers (APDiD: -4.4%; 95% CI: -7.0%, -1.7%) and legumes, nuts, or seeds (APDiD: -15.6%; 95% CI: -26.2%, -5.0%). Prevalences of some IYCF practices were low in Amuria at endline including MAD (19.1%; 95% CI :16.3%, 21.9%). CONCLUSIONS The intervention had a positive impact on several IYCF practices; however, endline prevalence of some indicators suggests a continued need to improve complementary feeding practices.
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Affiliation(s)
- Nicole D Ford
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, US Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
- McKing Consulting Corporation, Chamblee, GA 30341, USA
| | - Laird J Ruth
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, US Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
- McKing Consulting Corporation, Chamblee, GA 30341, USA
| | | | - Abdelrahman Lubowa
- School of Food Technology, Nutrition, and Bioengineering, Makerere University, Kampala, Uganda
| | - Siti Halati
- United Nations World Food Program, Kampala, Uganda
| | | | - Ralph D Whitehead
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, US Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Carine Mapango
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, US Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Maria Elena Jefferds
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, US Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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Addo OY, Locks LM, Jefferds ME, Nanama S, Albert B, Sandalinas F, Nanema A, Whitehead RD, Mei Z, Clayton HB, Garg A, Kupka R, Tripp K. Combined infant and young child feeding with small-quantity lipid-based nutrient supplementation is associated with a reduction in anemia but no changes in anthropometric status of young children from Katanga Province of the Democratic Republic of Congo: a quasi-experimental effectiveness study. Am J Clin Nutr 2020; 112:683-694. [PMID: 32710737 PMCID: PMC7458772 DOI: 10.1093/ajcn/nqaa170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/03/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Small-quantity lipid-based nutrient supplements (SQ-LNS) are efficacious in controlled settings; data are scarce on the effectiveness utilizing health care delivery platforms. OBJECTIVE We evaluated the impact of an infant young child feeding (IYCF)-SQ-LNS intervention on anemia and growth in children aged 6-18 mo in the Democratic Republic of Congo following a quasi-experimental effectiveness design. METHODS An intervention health zone (HZ) received enhanced IYCF including improved counseling on IYCF during pregnancy until 12 mo after birth and daily use of SQ-LNS for infants 6-12 mo; the control HZ received the standard IYCF package. We analyzed data from 2995 children, collected in repeated cross-sectional surveys. We used adjusted difference-in-difference analyses to calculate changes in anemia, iron and vitamin A deficiencies, stunting, wasting, and underweight. RESULTS Of mothers, 70.5% received SQ-LNS at least once in the intervention HZ, with 99.6% of their children consuming SQ-LNS at least once. The mean number of batches of SQ-LNS (28 sachets per batch, 6 batches total) received was 2.3 ± 0.8 (i.e., 64.4 ± 22.4 d of SQ-LNS). The enhanced program was associated with an 11.0% point (95% CI: -18.1, -3.8; P < 0.01) adjusted relative reduction in anemia prevalence and a mean +0.26-g/dL (95% CI: 0.04, 0.48; P = 0.02) increase in hemoglobin but no effect on anthropometry or iron or vitamin A deficiencies. At endline in the intervention HZ, children aged 8-13 mo who received ≥3 monthly SQ-LNS batch distributions had higher anthropometry z scores [length-for-age z score (LAZ): +0.40, P = 0.04; weight-for-age z score (WAZ): +0.37, P = 0.04] and hemoglobin (+0.65 g/dL, P = 0.007) and a lower adjusted prevalence difference of stunting (-16.7%, P = 0.03) compared with those who received none. CONCLUSIONS The enhanced IYCF-SQ-LNS intervention using the existing health care delivery platform was associated with a reduction in prevalence of anemia and improvement in mean hemoglobin. At endline among the subpopulation receiving ≥3 mo of SQ-LNS, their LAZ, WAZ, and hemoglobin improved. Future research could explore contextual tools to maximize coverage and intake adherence in programs using SQ-LNS.
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Affiliation(s)
- O Yaw Addo
- Address correspondence to OYA (e-mail: )
| | - Lindsey M Locks
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- UNICEF Headquarters, New York, NY, USA
| | - Maria Elena Jefferds
- Centers for Disease Control and Prevention (CDC), Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program (IMMPaCt) Unit, Atlanta, GA, USA
| | - Simeon Nanama
- UNICEF, Kinshasa and Lubumbashi, Democratic Republic of Congo
| | - Bope Albert
- National Statistics Institute, Lubumbashi, Democratic Republic of Congo
| | | | - Ambroise Nanema
- UNICEF, Kinshasa and Lubumbashi, Democratic Republic of Congo
| | - R Donnie Whitehead
- Centers for Disease Control and Prevention (CDC), Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program (IMMPaCt) Unit, Atlanta, GA, USA
| | - Zuguo Mei
- Centers for Disease Control and Prevention (CDC), Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program (IMMPaCt) Unit, Atlanta, GA, USA
| | - Heather B Clayton
- Centers for Disease Control and Prevention (CDC), Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program (IMMPaCt) Unit, Atlanta, GA, USA
| | | | | | - Katie Tripp
- Present address for KT: Independent Consultant, Nutrition Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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An Integrated Infant and Young Child Feeding and Small-Quantity Lipid-based Nutrient Supplementation Program Is Associated with Improved Gross Motor and Communication Scores of Children 6-18 Months in the Democratic Republic of Congo. J Pediatr 2020; 222:154-163. [PMID: 32122634 PMCID: PMC9396473 DOI: 10.1016/j.jpeds.2020.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/05/2019] [Accepted: 01/10/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the impact of an infant, young child feeding practices-small-quantity lipid nutrient supplements (SQ-LNS) intervention on child development scores in children aged 6-18 months in the Katanga Province, Democratic Republic of Congo (DRC). STUDY DESIGN We analyzed data of 2595 children from 2 health zones in a quasi-experimental design with preimplementation and postimplementation surveys to evaluate program impact on child development scores. Standard care was received in the comparison health zone and the intervention health zone received standard care plus enhanced infant, young child feeding practices with a monthly supply of 28 SQ-LNS sachets for up to 1 year. Program exposure and communication and motor domains of the Ages and Stages questionnaire were collected to assess changes in child development scores. A quasi-intent-to-treat and adjusted difference-in-difference analyses were used to quantify impact of the enhanced compared with the standard package. RESULTS In adjusted models contrasting endline with baseline, there was a greater relative increase in proportion of children with normal communication (difference-in-difference, +13.7% [95%CI, 7.9-19.6; P < .001] and gross motor scores, +7.4% [95% CI: 1.3-13.5; P < .001]) in the intervention vs comparison health zones. Further, in separate analyses among children of intervention health zone at endline, each additional SQ-LNS distribution was associated with +0.09 (95% CI, 0.03-0.16) z-score unit increase in gross motor scores (P < .01). CONCLUSIONS The integrated infant, young child feeding practice-SQ-LNS intervention was positively associated with larger relative improvements in measures of child communication and motor development in the Katanga province of DRC.
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Locks LM, Nanama S, Addo OY, Albert B, Sandalinas F, Nanema A, Whitehead RD, Garg A, Kupka R, Jefferds ME, Tripp K. An integrated infant and young child feeding and small-quantity lipid-based nutrient supplementation programme in the Democratic Republic of Congo is associated with improvements in breastfeeding and handwashing behaviours but not dietary diversity. MATERNAL AND CHILD NUTRITION 2019; 15:e12784. [PMID: 30659750 PMCID: PMC6617809 DOI: 10.1111/mcn.12784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/21/2018] [Accepted: 01/09/2019] [Indexed: 01/23/2023]
Abstract
Integrating small‐quantity lipid‐based nutrient supplements (SQ‐LNS) into infant and young child feeding (IYCF) programmes can increase consumption of essential nutrients among children in vulnerable populations; however, few studies have assessed the impact of integrated IYCF–SQ‐LNS programmes on IYCF practices. A 2‐year, enhanced IYCF intervention targeting pregnant women and infants (0–12 months) was implemented in a health zone in the Democratic Republic of Congo (DRC). The enhanced IYCF intervention included community‐ and facility‐based counselling for mothers on handwashing, SQ‐LNS, and IYCF practices, plus monthly SQ‐LNS distributions for children 6–12 months; a control zone received the national IYCF programme (facility‐based IYCF counselling with no SQ‐LNS distributions). Cross‐sectional preintervention and postintervention surveys (n = 650 and 638 in intervention and control areas at baseline; n = 654 and 653 in each area at endline, respectively) were conducted in mothers of children 6–18 months representative of both zones. Difference in differences (DiD) analyses used mixed linear regression models. There were significantly greater increases in the proportion of mothers in the intervention (vs. control) zone who reported: initiating breastfeeding within 1 hr of birth (Adj. DiD [95% CI]: +56.4% [49.3, 63.4], P < 0.001), waiting until 6 months to introduce water (+66.9% [60.6, 73.2], P < 0.001) and complementary foods (+56.4% [49.3, 63.4], P < 0.001), feeding the minimum meal frequency the previous day (+9.2% [2.7, 15.7], P = 0.005); feeding the child in a separate bowl (+9.7% [2.2, 17.2], P = 0.01); awareness of anaemia (+16.9% [10.4, 23.3], P < 0.001); owning soap (+14.9% [8.3, 21.5], P < 0.001); and washing hands after defecating and before cooking and feeding the child the previous day (+10.5% [5.8, 15.2], +12.5% [9.3, 15.6] and +15.0% [11.2, 18.8], respectively, P < 0.001 for all). The enhanced IYCF intervention in the DRC was associated with an improvement in several important IYCF practices but was not associated with a change in dietary diversity (minimum dietary diversity and minimum acceptable diet remained below 10% in both zones without significant differences between zones). The provision of fortified complementary foods, such as SQ‐LNS, may be an important source of micronutrients and macronutrients for young children in areas with high rates of poverty and limited access to diverse foods. Future research should verify the potential of integrated IYCF–SQ‐LNS to improve IYCF practices, and ultimately children's nutritional status.
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Affiliation(s)
- Lindsey M Locks
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Programme Division, United Nations Children's Emergency Fund (UNICEF) Headquarters, New York, NY, USA
| | - Simeon Nanama
- Programme Division, United Nations Children's Emergency Fund (UNICEF), Kinshasa and Lubumbashi, Democratic Republic of Congo
| | - O Yaw Addo
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.,International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bope Albert
- National Statistics Institute, Lubumbashi, Democratic Republic of Congo
| | - Fanny Sandalinas
- West and Central Africa Regional Office, United Nations Children's Emergency Fund (UNICEF), Dakar, Senegal
| | - Ambroise Nanema
- Programme Division, United Nations Children's Emergency Fund (UNICEF), Kinshasa and Lubumbashi, Democratic Republic of Congo
| | - Ralph D Whitehead
- International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aashima Garg
- Programme Division, United Nations Children's Emergency Fund (UNICEF) Headquarters, New York, NY, USA
| | - Roland Kupka
- Programme Division, United Nations Children's Emergency Fund (UNICEF) Headquarters, New York, NY, USA
| | - Maria Elena Jefferds
- International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katie Tripp
- International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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