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Bang Y, Kim Y, Goto A, Henning M, Kang M. Empowering women as enablers in public health: A quantitative-qualitative systematic review of the gender-transformative approach. Health Care Women Int 2024:1-18. [PMID: 38976814 DOI: 10.1080/07399332.2024.2371372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 06/19/2024] [Indexed: 07/10/2024]
Abstract
Women are expected to take on multiple roles as caregivers and health care providers, but they are still often perceived as victims or beneficiaries rather than enablers. We aimed to explore women's empowerment and gender equality in public health systems and identify proactive enablers that can be incorporated into projects. A systematic review of peer-reviewed literature as well as text analysis were conducted to examine changes in perceptions of women's roles in public health projects. The authors conducted a quantitative analysis of the collected article titles, which revealed a shift in research from identifying risk factors to exploring women's autonomy in health promotion. However, our qualitative review of the articles showed that previous gender-related projects used a gender-sensitive approach that perpetuated the view of women as victims or beneficiaries rather than enablers. The concept of proactive enablers in all aspects of project planning and implementation ensures that women's roles are fully recognized and valued.
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Affiliation(s)
- Yoorim Bang
- Institute for Development and Human Security, Ewha Womans University, Seoul, Republic of Korea
| | - Yanghee Kim
- Department of Global Cooperation, National Health Insurance Service, Wonju, Republic of Korea
| | - Aya Goto
- Department of Public Health, Fukushima Medical University, Fukushima, Japan
| | - Margaret Henning
- Department of Health Sciences, Keene State College, Keene, New Hampshire, USA
| | - Minah Kang
- Department of Public Administration, Ewha Womans University, Seoul, Republic of Korea
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Hanley-Cook GT, Hoogerwerf S, Parraguez JP, Gie SM, Holmes BA. Minimum Dietary Diversity for Women: Partitioning Misclassifications by Proxy Data Collection Methods using Weighed Food Records as the Reference in Ethiopia. Curr Dev Nutr 2024; 8:103792. [PMID: 39050780 PMCID: PMC11266992 DOI: 10.1016/j.cdnut.2024.103792] [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: 12/07/2023] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 07/27/2024] Open
Abstract
Background Nonquantitative list-based or open 24-h recalls (24-HRs) have been shown to overestimate the prevalence of Minimum Dietary Diversity for Women (MDD-W), as compared with direct quantitative observations. However, the main sources of error are unknown. Objectives To assess the measurement agreement of proxy data collection methods for MDD-W, as compared with weighed food records (WFRs). Methods Applying a noninferiority design, data were collected from 431 nonpregnant females in Ethiopia. MDD-W estimates from both proxy data collection methods were compared with the WFR prevalence by McNemar's chi-square tests, Cohen's Kappa, and receiver operator characteristic analyses. Ten-point food group diversity scores (FGDS) were compared by Bland-Altman plots, Wilcoxon matched-pairs tests, and weighted Kappa. Food group misclassifications were partitioned into errors related to respondent biases or the questionnaire development. Results List-based and open 24-HRs overreported MDD-W by 8 and 4 percentage points, respectively, as compared with WFR (objective MDD-W prevalence: 8%). Furthermore, list-based 24-HRs overestimated FGDS by 0.4 points (limits of agreement [LOA]: -1.1, 2.0), whereas open 24-HRs led to a 0.3 point (LOA: -1.2, 1.7) overestimate. Food groups most likely to be misreported using proxy data collection methods were "pulses," "nuts and seeds," "dairy products," and "other fruits." Underreporting of consumption occurred among <4% of females for all food groups. Furthermore, respondent biases were the predominant cause of food group overreporting, except for the "pulses" and "other vegetables" food groups, where food items incorrectly included on the food list were the main source of errors. Conclusions Food group consumption misclassifications by proxy data collection methods were mainly attributable to females overreporting consumption because of respondent biases or the criterion for foods to be counted, rather than the suboptimal development of the food list in Ethiopia. To obtain precise and accurate MDD-W estimates at the (sub)national level, rigorous context-specific food list development, questionnaire pilot testing, and enumerator training are recommended to mitigate identified biases.
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Affiliation(s)
- Giles T Hanley-Cook
- Food and Nutrition Division (ESN), Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Sara Hoogerwerf
- Food and Nutrition Division (ESN), Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Juan Pablo Parraguez
- Food and Nutrition Division (ESN), Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Simone M Gie
- Food and Nutrition Division (ESN), Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Bridget A Holmes
- Food and Nutrition Division (ESN), Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
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Lyaatu I, Mosha D, Sando MM, Jeong J, Yousafzai A, PrayGod G, Evarist R, Galvin L, Kieffer MP, Kumalija E, Simpson J, Ambikapathi R, Boncyk M, Matangi E, Gunaratna NS. Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS): study protocol for a five-arm, cluster-randomized trial. Trials 2024; 25:188. [PMID: 38486278 PMCID: PMC10938806 DOI: 10.1186/s13063-022-07002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/12/2022] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Globally, 144 million children under 5 years are undernourished and 250 million do not meet their developmental potential. Multi-input interventions, such as bundled nutrition and parenting interventions, are designed to mitigate risks for multiple child outcomes. There is limited evidence that bundled interventions have additive benefits to nutrition, growth, or development outcomes. These outcomes share common risks; therefore, designing interventions to tackle these risks using a common theory of change may optimize effectiveness. Emerging evidence suggests explicit engagement of fathers may benefit child outcomes, but few trials have tested this or included data collected from fathers. METHODS Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS) is a community-based cluster-randomized controlled trial that will be implemented in the rural Mara Region, Tanzania. The trial aims (1) to test a bundled nutrition and parenting program delivered to mothers' groups, with or without fathers' groups, over 12 months on child and caregiving outcomes compared to a nutrition program alone, and (2) to test nutrition or bundled nutrition and parenting programs delivered to mothers' and fathers' groups over 12 months on child and caregiving outcomes compared to programs delivered to mothers alone. The trial comprises five arms: (1) mothers' groups receiving a nutrition program, (2) mothers' groups receiving a bundled nutrition and parenting program, (3) mothers' and fathers' groups receiving a nutrition program, (4) mothers' and fathers' groups receiving a bundled nutrition and parenting program, and (5) control receiving standard of care health services. The primary outcomes are child dietary diversity and early child development (mental and motor development). Parents with a child under 18 months will be enrolled in peer groups and receive twice monthly intervention by trained community health workers. Data will be collected from mothers, fathers, and children at baseline (pre-intervention), midline, and endline (post-intervention). DISCUSSION EFFECTS will generate evidence on the effects of bundled nutrition and parenting interventions on child nutrition, growth, and development outcomes; determine the benefits of engaging fathers on child, caregiving, and caregiver outcomes; and investigate common and unique pathways between treatments and child outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT03759821. Registered on November 30, 2018.
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Sunder N, Gupta S, Pingali PL. Leveraging men's education as an effective pathway for improving diet quality: Evidence from rural India. PLoS One 2023; 18:e0283935. [PMID: 37972085 PMCID: PMC10653534 DOI: 10.1371/journal.pone.0283935] [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: 04/04/2022] [Accepted: 03/21/2023] [Indexed: 11/19/2023] Open
Abstract
Investing in nutrition sensitive sectors such as education can be an effective strategy for combatting malnutrition. In this paper we analyze the role that men's education plays in determining dietary diversity outcomes using primary data from 3600 households across four districts of India. Dietary diversity scores were calculated to reflect the quality of food intake, for households and women. Men's education level was considered as the primary driver of diet diversity. To establish a causal link between men's education and diet diversity, the education level of parents and siblings were used as instrumental variables. We find that men's education levels are associated with significantly higher diet diversity scores both for the household and for women. The role of men's education continues to be a significant determinant of diet quality after controlling for household and individual- level confounding factors including the education level of the woman. The results are consistent across different definitions of the diet diversity score and reference period. Methodologically we extend the evidence on the education-nutrition pathway from being associational to causal in nature. Results from this study point to the benefits of leveraging men's education as an effective pathway for improving nutritional outcomes within households.
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Affiliation(s)
- Naveen Sunder
- Department of Economics, Bentley University, Waltham, MA, United States of America
| | - Soumya Gupta
- Tata- Cornell Institute for Agriculture and Nutrition, Cornell University, Ithaca, NY, United States of America
| | - Prabhu L. Pingali
- Tata- Cornell Institute for Agriculture and Nutrition, Cornell University, Ithaca, NY, United States of America
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Ma L, Xu H, Zhang Z, Li L, Lin Z, Qin H. Nutrition knowledge, attitudes, and dietary practices among parents of children and adolescents in Weifang, China: A cross-sectional study. Prev Med Rep 2023; 35:102396. [PMID: 37705881 PMCID: PMC10495675 DOI: 10.1016/j.pmedr.2023.102396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023] Open
Abstract
Parent's nutrition knowledge, attitudes, and dietary practices (KAP) play imperative roles in preventing malnutrition for themselves and their children. Our study aimed to determine the status and contributing factors of nutrition KAP among parents of children and adolescents. A total of 1746 parents (mean age 39.67 ± 5.38 years, females accounting for 69.82%) of primary and junior high school students in Weifang, China, completed a self-reported KAP questionnaire in August 2021. An analysis of Pearson product-moment correlation was conducted to determine the relationship between knowledge, attitudes, and practices. Chi-square test, followed by a multivariable robust Poisson regression analysis, was performed to identify the contributing factors to parents' KAP. A 65.94% awareness rate of nutritional knowledge was observed. The correlations between nutrition knowledge and attitudes (r = 0.03, P = 0.23), knowledge and practices (r = 0.02, P = 0.34), and attitudes and practices (r = 0.16, P < 0.01) were relatively weak. After adjusting for other contributing factors, females [prevalence ratio (PR) = 1.28, 95% confidence interval (CI) = 1.13-1.45], participants with secondary education (PR = 4.64, 95% CI = 1.60-13.50), junior college education (PR = 5.87, 95% CI = 2.01-17.13) and college degree or above education (PR = 6.58, 95% CI = 2.25-19.23) acquired higher nutrition knowledge scores. Moreover, healthy diet behaviors were more commonly implemented by females than males (PR = 1.42, 95% CI = 1.14-1.76), and which needed to be improved in those with abnormal body mass indexes (BMIs) [overweight (PR = 0.86, 95% CI = 0.74-0.99) and obese (PR = 0.76, 95% CI = 0.56-0.99)]. It was necessary for nutrition KAP promotion to be emphasized in nutritional knowledge and dietary practices, as well as health behavior guidance, especially for parents with low education and elevated BMIs.
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Affiliation(s)
- Lirong Ma
- School of Public Health, Weifang Medical University, 7166 Baotongxi Street, Weifang, Shandong 261053, China
| | - Huasheng Xu
- Department of Health Education, Weifang Center for Disease Control and Prevention, 4801 Huixian Road, Weifang, Shandong 261061, China
| | - Zhuoran Zhang
- School of Public Health, Weifang Medical University, 7166 Baotongxi Street, Weifang, Shandong 261053, China
| | - Liyang Li
- School of Public Health, Weifang Medical University, 7166 Baotongxi Street, Weifang, Shandong 261053, China
| | - Zhijuan Lin
- School of Basic Medical Sciences, Weifang Medical University, 7166 Baotongxi Street, Weifang, Shandong 261053, China
- Key Laboratory of Immune Microenvironment and Inflammatory Disease Research in Universities of Shandong Province, Weifang Medical University, 7166 Baotongxi Street, Weifang, Shandong 261053, China
| | - Hao Qin
- School of Public Health, Weifang Medical University, 7166 Baotongxi Street, Weifang, Shandong 261053, China
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Mechlowitz K, Singh N, Li X, Chen D, Yang Y, Rabil A, Cheraso AJ, Ahmed IA, Amin JK, Gebreyes WA, Hassen JY, Ibrahim AM, Manary MJ, Rajashekara G, Roba KT, Usmane IA, Havelaar AH, McKune SL. Women's empowerment and child nutrition in a context of shifting livelihoods in Eastern Oromia, Ethiopia. Front Nutr 2023; 10:1048532. [PMID: 37457972 PMCID: PMC10338874 DOI: 10.3389/fnut.2023.1048532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 05/24/2023] [Indexed: 07/18/2023] Open
Abstract
Agriculture, and particularly livestock and animal source foods, has been closely linked to improvements in human nutrition. Production, income, and women's empowerment improve household food security and child nutritional outcomes in interacting ways. Khat production in Eastern Ethiopia is changing the economic and livelihood landscape for communities that have traditionally relied upon small-scale mixed agriculture and livestock production. How this shifting livelihood landscape and the empowerment of women in these communities are affecting nutritional outcomes has not been investigated. Using cross-sectional data collected during formative research for the Campylobacter Genomics and Environmental Enteric Dysfunction (CAGED) project, we developed models to examine the roles of livelihood activities, including livestock production, staple crop production, and khat production, and women's empowerment in child nutrition outcomes. Survey participants were randomly selected mothers of children aged 10-15 months from Haramaya district, Eastern Hararghe, Oromia, Ethiopia. Nested logistic regression models were performed for each nutrition outcome: children's animal source food consumption, children's dietary diversity, and child stunting, wasting, and underweight. Explanatory variables included those for livelihood (tropical livestock unit, crop production, and khat production ladder) and women's empowerment (as indicated by domains of the Women's Empowerment in Agriculture Index), and covariates including child sex, mother's age, mother's education, assets, income, and kebele. Results indicated that khat production and tropical livestock units were not significantly associated with any of the child nutrition outcomes. However, results did indicate that the odds of reporting child animal source food consumption in households where the mother was empowered in the leadership domain was 3.33 times that in households where the mother wasn't (p < 0.05). In addition, the odds of having a stunted child in households where the mother was empowered in the time domain was 2.68 times that in households where the mother wasn't (p < 0.05). The results from this study both support and complicate the existing literature on the associations between women's empowerment in agriculture and child nutrition outcomes, underscoring the important role that livelihood, contextual factors, and location may have on the complex relationship between empowerment domains and nutritional outcomes.
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Affiliation(s)
- Karah Mechlowitz
- Department of Social and Behavioral Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Nitya Singh
- Department of Animal Sciences, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL, United States
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
- Food Systems Institute, University of Florida, Gainesville, FL, United States
| | - Xiaolong Li
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Dehao Chen
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Yang Yang
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Anna Rabil
- Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Adriana Joy Cheraso
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Ibsa Abdusemed Ahmed
- Department of Public Health and Health Policy, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
- School of Public Health, Haramaya University, Haramaya, Ethiopia
| | - Jafer Kedir Amin
- College of Veterinary Medicine, Haramaya University, Haramaya, Ethiopia
| | - Wondwossen A. Gebreyes
- Global One Health Initiative, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Jemal Y. Hassen
- School of Rural Development and Agricultural Innovation, College of Agriculture and Environmental Science, Haramaya University, Haramaya, Ethiopia
| | | | - Mark J. Manary
- Department of Pediatrics, Washington University, St. Louis, MO, United States
| | - Gireesh Rajashekara
- Center for Food Animal Health, Department of Animal Sciences, College of Food, Agricultural, and Environmental Sciences, The Ohio State University, Wooster, OH, United States
| | - Kedir Teji Roba
- Department of Public Health and Health Policy, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Ibsa Aliyi Usmane
- School of Rural Development and Agricultural Innovation, College of Agriculture and Environmental Science, Haramaya University, Haramaya, Ethiopia
| | - Arie H. Havelaar
- Department of Animal Sciences, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL, United States
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
- Food Systems Institute, University of Florida, Gainesville, FL, United States
| | - Sarah L. McKune
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
- Center for African Studies, University of Florida, Gainesville, FL, United States
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Kawarazuka N, Ibrahim F, Rahaman EHMS, Prain G. The roles of community nutrition scholars in changing mothers' child feeding, food preparation, and hygiene practices in southern Bangladesh. Front Public Health 2023; 11:1135214. [PMID: 37397738 PMCID: PMC10311016 DOI: 10.3389/fpubh.2023.1135214] [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: 12/31/2022] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction This qualitative study evaluates a nutrition and hygiene education program led by trained community nutrition scholars for 5,000 mothers of small children in the Khulna and Satkhira districts in southern Bangladesh. The objectives of this study are as follows: (1) understanding the processes and reasonings behind mothers' improvement in child feeding, food preparation, hygiene, and homestead garden production, (2) understanding men's roles in facilitating women's behavioral changes, and (3) assessing the degree of changes in subjective notions of self-confidence, decision-making, and recognition among mothers and nutrition scholars. Methods Data were collected through 14 focus group discussions with 80 participants and in-depth interviews with 6 women community nutrition scholars. Data was then analysed qualitatively by drawing on direct quotes from focus group discussions and interviews with detailed interpretation and account for respondents' behaviors and perceptions. Results Overall findings confirm behavior changes by women, their spouses, and other family members. Many women were able to independently decide to change food allocation and child feeding practices after gaining self-confidence through the training. Men performed vital roles, such as purchasing nutritious food in local markets, providing labor for land preparation of homestead gardens, and defending the women from the resistance to change by their mothers-in-law. Discussion While the study supports the literature that women's bargaining power in food/resource allocation is critical in child health and nutrition, the evaluation found that this process involves negotiations among family members. Engaging men and mothers-in-law in nutrition interventions have great potential to make nutrition interventions more effective.
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Affiliation(s)
- Nozomi Kawarazuka
- International Potato Center, The Consultative Group on International Agricultural Research (CGIAR), Hanoi, Vietnam
| | - Farhana Ibrahim
- International Potato Center, The Consultative Group on International Agricultural Research (CGIAR), Dhaka, Bangladesh
| | - Ebna Habib Md Shofiur Rahaman
- International Potato Center, The Consultative Group on International Agricultural Research (CGIAR), Dhaka, Bangladesh
| | - Gordon Prain
- Independent Consultant, The Consultative Group on International Agricultural Research (CGIAR), Cambridge, United Kingdom
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Rothstein JD, Klemm RDW, Kang Y, Niyeha D, Smith E, Nordhagen S. Engaging men in maternal, infant and young child nutrition in rural Tanzania: Outcomes from a cluster randomized control trial and qualitative study. MATERNAL & CHILD NUTRITION 2023; 19:e13460. [PMID: 36482813 PMCID: PMC10019044 DOI: 10.1111/mcn.13460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/02/2022] [Accepted: 10/26/2022] [Indexed: 12/13/2022]
Abstract
There is growing recognition that engaging men in maternal, infant and young child nutrition (MIYCN) interventions can benefit child health and disrupt harmful gender norms. We conducted a cluster-randomized controlled trial in Tanzania, which engaged men and women in behaviour change via mobile messaging (short message service [SMS]) and traditional interpersonal communication (IPC), separately and in combination. Here, we evaluate intervention effects on individual-level men's MIYCN knowledge and discuss barriers to male engagement. Eligible clusters were dispensary catchment areas with >3000 residents. Forty clusters were stratified by population size and randomly allocated to the four study arms, with 10 clusters per arm. Data on knowledge and intervention exposure were collected from 1394 men through baseline and endline surveys (March-April 2018 and July-September 2019). A process evaluation conducted partway through the 15-18-month intervention period included focus group discussions and interviews. Data were analysed for key trends and themes using Stata and ATLAS.ti software. Male participants in the short message service + interpersonal communication (SMS + IPC) group reported higher exposure to IPC discussions than IPC-only men (43.8% and 21.9%, respectively). Knowledge scores increased significantly across all three intervention groups, with the greatest impact in the SMS + IPC group. Qualitative findings indicated that the main barriers to male participation were a lack of interest in health/nutrition and perceptions that these topics were a woman's responsibility. Other challenges included meeting logistics, prioritizing income-earning activities and insufficient efforts to engage men. The use of a combined approach fusing IPC with SMS is promising, yet countering gender norms and encouraging stronger male engagement may require additional strategies.
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Affiliation(s)
- Jessica D. Rothstein
- Headquarters Nutrition DivisionHelen Keller InternationalWashingtonDistrict of ColumbiaUSA
- Division of Community Health SciencesUniversity of Illinois at Chicago School of Public HealthChicagoIllinoisUSA
| | - Rolf D. W. Klemm
- Headquarters Nutrition DivisionHelen Keller InternationalWashingtonDistrict of ColumbiaUSA
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Yunhee Kang
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Debora Niyeha
- Tanzania Country OfficeHelen Keller InternationalDar es SalaamTanzania
| | - Erin Smith
- Nepal Country OfficeHelen Keller InternationalKathmanduNepal
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Chen Y, Wu Y, Dill SE, Guo Y, Westgard CM, Medina A, Weber AM, Darmstadt GL, Zhou H, Rozelle S, Sylvia S. Effect of the mHealth-supported Healthy Future programme delivered by community health workers on maternal and child health in rural China: study protocol for a cluster randomised controlled trial. BMJ Open 2023; 13:e065403. [PMID: 36669837 PMCID: PMC9872510 DOI: 10.1136/bmjopen-2022-065403] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 01/04/2023] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Millions of young rural children in China still suffer from poor health and malnutrition, partly due to a lack of knowledge about optimal perinatal and child care among rural mothers and caregivers. Meanwhile, there is an urgent need to improve maternal mental health in rural communities. Comprehensive home visiting programmes delivered by community health workers (CHWs) can bridge the caregiver knowledge gap and improve child health and maternal well-being in low-resource settings, but the effectiveness of this approach is unknown in rural China. Additionally, grandmothers play important roles in child care and family decision-making in rural China, suggesting the importance of engaging multiple caregivers in interventions. The Healthy Future programme seeks to improve child health and maternal well-being by developing a staged-based curriculum that CHWs deliver to mothers and caregivers of young children through home visits with the assistance of a tablet-based mHealth system. This protocol describes the design and evaluation plan for this programme. METHODS AND ANALYSIS We designed a cluster-randomised controlled trial among 119 rural townships in four nationally designated poverty counties in Southwestern China. We will compare the outcomes between three arms: one standard arm with only primary caregivers participating in the intervention, one encouragement arm engaging primary and secondary caregivers and one control arm with no intervention. Families with pregnant women or infants under 6 months of age are invited to enrol in the 12-month study. Primary outcomes include children's haemoglobin levels, exclusive breastfeeding rates and dietary diversity in complementary feeding. Secondary outcomes include a combination of health, behavioural and intermediate outcomes. ETHICS AND DISSEMINATION Ethical approval has been provided by Stanford University, Sichuan University and the University of Nevada, Reno. Trial findings will be disseminated through national and international peer-reviewed publications and conferences. TRIAL REGISTRATION NUMBER ISRCTN16800789.
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Affiliation(s)
- Yunwei Chen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yuju Wu
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Sarah-Eve Dill
- Stanford Center on China's Economy and Institutions, Stanford University, Stanford, CA, USA
| | - Yian Guo
- Stanford Center on China's Economy and Institutions, Stanford University, Stanford, CA, USA
| | - Christopher Michael Westgard
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexis Medina
- Stanford Center on China's Economy and Institutions, Stanford University, Stanford, CA, USA
| | - Ann M Weber
- Department of Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada, Reno, Reno, NV, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Huan Zhou
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Scott Rozelle
- Stanford Center on China's Economy and Institutions, Stanford University, Stanford, CA, USA
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Fongar A, Linderhof V, Ekesa B, Dijkxhoorn Y, Nalweyiso MD. Impact of healthy food and diet information on household food security: A randomized control trial in Kampala, Uganda. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2023. [DOI: 10.3389/fsufs.2022.1063331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Healthy diets are unaffordable for almost 3.1 billion people worldwide, and in 2018, already 43% of the African population were urban dwellers. Our food systems are changing rapidly, coupled with rising dietary aspirations. What are healthy diets and how can healthy diets be reached and increased in an urban context was the question of project NOURICITY. Looking into different information channels to deliver information on healthy diets in a low-income area in urban Kampala, Uganda, two packages of interventions were developed based on information on the selected focus group discussions with parish representatives. The first package consisted of a flier including graphic information on healthy diets and three food groups (treatment group 1). The second included the same flier plus interactive voice responses (IVRs) as a phone call to deliver the flier information in a different format (treatment group 2). For the study, we targeted 450 randomly selected households, which were randomly assigned into three groups (control, treatment group 1, and treatment group 2). Respondents from Kanyanya (a low-income parish of Kampala city) were randomly selected. They were visited two times in March as well as in December of the year 2021, while the intervention was rolled out in the period from September to November 2021. Healthy diets are measured using the Household Dietary Diversity Score and the food variety score is based on a 7-day food consumption recall, while dietary quality is measured for a subsample of women and the minimum dietary diversity for all of the selected women. The results indicated statistically significant changes per group at household food consumption in March 2021 compared to December 2021. However, the results of the difference-in-difference method between the control and the treatment groups did not display any significant difference at the household level. However, increased dairy and meat consumption in the treatment groups was observed. Over 90% of the households in treatment group 2 listened to any type of IVR message. Although no significant treatment effects were found, almost all households receiving intervention package 2 mentioned that the IVR calls were easy to follow, while almost 80% indicated sharing the information with their neighbors and 92% enjoyed receiving the message. However, the intervention has potential but needs to be improved upon.
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Shaun MMA, Nizum MWR, Shuvo MA, Fayeza F, Faruk MO, Alam MF, Hawlader MDH, Mali SK. Determinants of minimum dietary diversity of lactating mothers in rural northern region of Bangladesh: A community-based cross-sectional study. Heliyon 2022; 9:e12776. [PMID: 36632115 PMCID: PMC9826838 DOI: 10.1016/j.heliyon.2022.e12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023] Open
Abstract
Background Breastfeeding requires additional diversified foods for the nutritional requirements of mothers and children, especially in preventing micronutrient deficiencies. The minimum dietary diversity for women (MDD-W) is a proxy indicator of micronutrient adequacy for women. Objectives This study aimed to identify the determinants associated with MDD in lactating women. Methods A community-based cross-sectional study was conducted among lactating mothers having at least one live birth in last three years from two districts of Bangladesh between 31st May 2021 and 9th June 2021. Dietary and socio-demographic information was obtained using a single 24-h recall and socio-economic status questionnaires. MDD was defined as at least four food groups consumed in the last 24 hours. In binary logistic regression, adjusted models were used to assess the relationship between MDD and socio-economic factors. Results The mean Dietary Diversity Score (DDS) was 3.9 ± 1.2. The MDD was met by 29.7% of women. Respondent's ages 20-24 years [Adjusted Odds Ratio (AOR) = 0.5; 95% CI: 0.3-0.9], 25-34 years [AOR = 0.5; 95% CI: 0.3-0.8], and 35-49 years [AOR = 0.5; 95% CI: 0.2-0.9], husband's academic qualifications more than 12 years [AOR = 1.9; 95% CI: 1.0-3.7], family income more than 15000 BDT per month [AOR = 2.3; 95% CI: 1.2-4.3], and husband's profession as a day labor [AOR = 0.5; 95% CI: 0.3-0.7] were significant factors to have MDD. Conclusions DDS and MDD were very poor among the mothers, whereas women's age, husband's education, and the family's monthly income were independent determinants of MDD. Special interventions may be needed to improve MDD.
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Affiliation(s)
- Md Mahbubul Alam Shaun
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki, 8602, Patuakhali, Bangladesh
- Corresponding author.
| | - Md Wahidur Rahman Nizum
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, 1229, Bangladesh
| | - Md Asaduzzaman Shuvo
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, 1229, Bangladesh
| | - Fahmida Fayeza
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki, 8602, Patuakhali, Bangladesh
| | - Md Omar Faruk
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki, 8602, Patuakhali, Bangladesh
| | - Md Fakrul Alam
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki, 8602, Patuakhali, Bangladesh
| | | | - Sujan Kanti Mali
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki, 8602, Patuakhali, Bangladesh
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Flax VL, Ipadeola A, Schnefke CH, Kwasu S, Mikail AA, Bose S, Brower AO, Edwards S. Complementary Feeding Social and Behavior Change Communication for Fathers and Mothers Improves Children's Consumption of Fish and Eggs and Minimum Meal Frequency in Kaduna State, Nigeria. Curr Dev Nutr 2022; 6:nzac075. [PMID: 35669047 PMCID: PMC9154220 DOI: 10.1093/cdn/nzac075] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background Fathers are key influencers of complementary feeding practices, but few studies in low- and middle-income countries have measured the effects of complementary feeding social and behavior change communication (SBCC) targeted at both fathers and mothers. Objectives The aims of this study were to measure the effects of an SBCC intervention on children's dietary diversity (primary outcome) and other complementary feeding indicators, fathers' and mothers' complementary feeding knowledge, and fathers' support for complementary feeding (secondary outcomes). Methods The 12-mo intervention in Kaduna State, Nigeria, engaged parents through community meetings, religious services, home visits from community health extension workers (CHEWs), mobile phone messages (fathers only), and mass media. Cross-sectional population-based surveys of cohabiting fathers and mothers with a child aged 6-23 mo were conducted, and regression models were used to compare results at baseline (n = 497) and endline (n = 495). Results Children's minimum dietary diversity did not change from baseline to endline (62% to 65%, P = 0.441). Children's consumption of fish (36% to 44%, P = 0.012) and eggs (8% to 20%, P = 0.004) and minimum meal frequency (58% to 73%, P < 0.001) increased. Fathers' and mothers' knowledge of the timing of introduction of different foods and meal frequency improved. Fathers' support for child feeding by providing money for food increased (79% to 90%, P < 0.001). Fathers' and mothers' reported intervention exposure was low (11-26% across types of SBCC). Child feeding outcomes were not associated with fathers' exposure. Children's odds of both fish and egg consumption increased significantly with mothers' exposure to community meetings, religious services, home visits, and television spots, and children's odds of minimum meal frequency increased significantly with mothers' exposure to home visits. Conclusions A multipronged SBCC intervention improved complementary feeding practices, fathers' and mothers' knowledge of complementary feeding, and fathers' support for complementary feeding, despite low levels of reported exposure, which may have been influenced by coronavirus disease 2019 (COVID-19) disruptions. This trial was registered at ClinicalTrials.gov as NCT04835662.
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Keding GB, Gramzow A, Ochieng J, Laizer A, Muchoki C, Onyango C, Hanson P, Yang RY. Nutrition integrated agricultural extension-a case study in Western Kenya. Health Promot Int 2021; 37:6365822. [PMID: 34491316 PMCID: PMC9053460 DOI: 10.1093/heapro/daab142] [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] [Indexed: 11/14/2022] Open
Abstract
Integrating nutrition communication in agricultural intervention programs aimed at increased food availability and accessibility in resource-poor areas is crucial. To enhance the sustainability and scalability of nutrition communication, the present study piloted the approach of ‘nutrition integrated agricultural extension’ and tested nutrition-related outcomes with two types of nutrition messages (specific vs. sensitive) and two delivery channels (public sector vs. private sector). The study intervention comprised (i) vegetable seed kit distribution, (ii) ongoing agricultural extension activities by public or private sectors and (iii) nutrition communication with two different messages. The intervention was tested with three treatment arms and reached 454 farmers (>65% female) in rural Kakamega County, Western Kenya. Pre-/post-surveys measured outcome variables focused on farmers’ nutrition-related knowledge, attitudes and practices in vegetable production and consumption, and household dietary diversity score. Results showed that all treatments increased nutrition knowledge (p < 0.05). Nutrition-specific communication was more effective than nutrition-sensitive communication. Nutrition communication through either the public or the private agricultural sector was both effective. Before the study intervention, many participants believed that vegetable consumption was beneficial and wanted to increase intake. After the intervention, the number of participants who felt eating more vegetables was challenging decreased slightly. Nutrition communication was found to be especially important in conveying recommended food amounts and promoting increased vegetable consumption. Seasonality affected on-farm crop diversity and vegetable consumption results in this study.
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Affiliation(s)
- Gudrun B Keding
- Center for Development Research, University of Bonn, Bonn, Germany Genscherallee 3, 53113 Bonn, Germany
| | - Andreas Gramzow
- World Vegetable Center - Eastern and Southern Africa, Arusha, Tanzania P.O. Box 10, Duluti, Arusha, Tanzania
| | - Justus Ochieng
- World Vegetable Center - Eastern and Southern Africa, Arusha, Tanzania P.O. Box 10, Duluti, Arusha, Tanzania
| | - Alaik Laizer
- World Vegetable Center - Eastern and Southern Africa, Arusha, Tanzania P.O. Box 10, Duluti, Arusha, Tanzania
| | - Charity Muchoki
- National Commission for Science, Technology and Innovation, Nairobi, Kenya O. Box 30623, 00100 Nairobi, Kenya
| | - Charles Onyango
- Syngenta Foundation for Sustainable Agriculture, 6th Floor, Avenue 5 Building, Rose Avenue, Nairobi, Kenya
| | - Peter Hanson
- World Vegetable Center, West and Central Africa - Coastal and Humid Regions IITA-Benin Campus, 08 BP 0932 Tri Postal, Cotonou Benin
| | - Ray-Yu Yang
- World Vegetable Center, Headquarters, Tainan, No. 60, Yi-Min Liao, Shanhua, Tainan, 74199, Taiwan (ROC)
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Mulaw GF, Feleke FW, Mare KU. Only one in four lactating mothers met the minimum dietary diversity score in the pastoral community, Afar region, Ethiopia: a community-based cross-sectional study. J Nutr Sci 2021; 10:e41. [PMID: 34164120 PMCID: PMC8190715 DOI: 10.1017/jns.2021.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 12/01/2022] Open
Abstract
Maternal dietary feeding practice is one of the proxy indicators of maternal nutrient adequacy and it improves outcomes for both mothers and their offspring. The minimum maternal dietary diversity score of lactating women is defined as when the mother ate at least four and above food groups from the nine food groups 24 h preceding the survey regardless of the portion size. Therefore, the present study aimed to determine the minimum dietary diversity score (MDDS) and its predictors among lactating mothers in the Pastoralist community, Ethiopia. A community-based cross-sectional study design was employed on 360 lactating mothers using a multi-stage sampling technique from 5 January 2020 to 10 February 2020. Data were collected using questionnaires and anthropometry measurements. Data were entered using EPI-data 4.6.02 and exported into SPSS version 25. Statistical significance was declared at P-value <0⋅05 at multivariable logistic regression. Only one in four lactating mothers met the MDDS. The majority of them consumed cereals in the preceding 24 h of data collection. The most important predictors were maternal meal frequency (adjusted odds ratio (AOR) 6⋅26; 95 % confidence interval (CI) (3⋅51, 11⋅15)), antenatal care (ANC) follow-up one to three times and four and above times (AOR: 2⋅58; 95 % CI (1⋅24, 5⋅36), 4⋅77 (1⋅90, 11⋅95), respectively) and secondary paternal education (AOR 2⋅97; 95 % CI (1⋅44, 6⋅11)). The MDDS among lactating mothers was low. Paternal education, maternal meal frequency and ANC follow-up were the significant predictors. Therefore, to improve maternal dietary diversity score emphasis should be given to those predictors.
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Ambikapathi R, Passarelli S, Madzorera I, Canavan CR, Noor RA, Abdelmenan S, Tewahido D, Tadesse AW, Sibanda L, Sibanda S, Munthali B, Madzivhandila T, Berhane Y, Fawzi W, Gunaratna NS. Men's nutrition knowledge is important for women's and children's nutrition in Ethiopia. MATERNAL AND CHILD NUTRITION 2020; 17:e13062. [PMID: 32755057 PMCID: PMC7729551 DOI: 10.1111/mcn.13062] [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: 10/16/2019] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 12/12/2022]
Abstract
In an effort to address undernutrition among women and children in rural areas of low‐income countries, nutrition‐sensitive agriculture (NSA) and behaviour change communication (BCC) projects heavily focus on women as an entry point to effect nutritional outcomes. There is limited evidence on the role of men's contribution in improving household diets. In this Agriculture to Nutrition trial (Clinicaltrials.gov identifier: NCT03152227), we explored associations between men's and women's nutritional knowledge on households', children's and women's dietary diversity. At the midline evaluation conducted in July 2017, FAO's nutrition knowledge questionnaire was administered to male and female partners in 1396 households. There was a high degree of agreement (88%) on knowledge about exclusive breastfeeding between parents; however, only 56–66% of the households had agreement when comparing knowledge of dietary sources of vitamin A or iron. Factor analysis of knowledge dimensions resulted in identifying two domains, namely, ‘dietary’ and ‘vitamin’ knowledge. Dietary knowledge had a larger effect on women's and children's dietary diversities than vitamin knowledge. Men's dietary knowledge had strong positive associations with households' dietary diversity scores (0.24, P value = 0.001), children's dietary diversity (0.19, P value = 0.008) and women's dietary diversity (0.18, P value < 0.001). Distance to markets and men's education levels modified the effects of nutrition knowledge on dietary diversity. While previous NSA and BCC interventions predominantly focused on uptake among women, there is a large gap and strong potential for men’s engagement in improving household nutrition. Interventions that expand the role of men in NSA may synergistically improve household nutrition outcomes.
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Affiliation(s)
- Ramya Ambikapathi
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA.,Department of Public Health, Purdue University, West Lafayette, Indiana, USA
| | - Simone Passarelli
- Departments of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Isabel Madzorera
- Departments of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Chelsey R Canavan
- Departments of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ramadhani A Noor
- Departments of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | | | - Lindiwe Sibanda
- Food, Agriculture and Natural Resources Policy Analysis Network, Pretoria, South Africa
| | - Simbarashe Sibanda
- Food, Agriculture and Natural Resources Policy Analysis Network, Pretoria, South Africa
| | - Bertha Munthali
- Food, Agriculture and Natural Resources Policy Analysis Network, Pretoria, South Africa
| | | | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Wafaie Fawzi
- Departments of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Departments of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nilupa S Gunaratna
- Department of Public Health, Purdue University, West Lafayette, Indiana, USA
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