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Packard-Winkler M, Golding L, Tewodros T, Faerber E, Webb Girard A. Core Principles and Practices for the Design, Implementation, and Evaluation of Social and Behavior Change for Nutrition in Low- and Middle-Income Contexts with Special Applications for Nutrition-Sensitive Agriculture. Curr Dev Nutr 2024; 8:104414. [PMID: 39224137 PMCID: PMC11367532 DOI: 10.1016/j.cdnut.2024.104414] [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: 11/10/2023] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 09/04/2024] Open
Abstract
Background There is currently no cogent set of standards to guide the design, implementation and evaluation of nutrition social and behavior change (SBC), including for nutrition-sensitive agriculture (NSA). Objectives We aimed to capture, consolidate, and describe SBC core principles and practices (CPPs), reflecting professional consensus, and to offer programmatic examples that illustrate their application for NSA projects in low- and middle-income countries. Methods We conducted a narrative review following a 4-step iterative process to identify and describe SBC CPPs. We first reviewed general SBC frameworks and technical documents and developed a preliminary list of CPPs and their definitions. Following review and feedback from 8 content experts, we revised the CPPs, incorporating the panel's feedback, and conducted a more specific search of the peer-reviewed and gray literature. We presented a revised draft of the CPPs to 26 NSA researchers, practitioners, and implementers at the 2022 Agriculture, Nutrition and Health Academy annual conference. We then conducted a focused review of each CPP, and 3 content experts rereviewed the final draft. Results We reviewed ∼475 documents and resources resulting in a set of 4 core principles: 1) following a systematic, strategic method in designing, implementing, and evaluating SBC activities; 2) ensuring design and implementation are evidence-based; 3) grounding design and implementation in theory; and 4) authentically engaging communities. Additionally, we identified 11 core practices and mapped these to the different stages in the SBC design, implementation, and evaluation cycle. Detailed descriptions, illustrative examples and resources for implementation are provided for each CPP. Conclusions An explicit set of CPPs for SBC can serve as a guide for design, research, implementation, and evaluation of nutrition and NSA programs; help standardize knowledge sharing and production; and contribute to improved quality of implementation. Broader consultation with SBC practitioners and researchers will further consensus on this work.
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Affiliation(s)
| | - Lenette Golding
- Save the Children U.S., Department of Global Health, Washington, DC, United States
| | - Tsedenia Tewodros
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, United States
| | - Emily Faerber
- Dietetics and Nutrition Department, College of Health, University of Alaska Anchorage, Anchorage, AK, United States
| | - Amy Webb Girard
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, United States
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, United States
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Furuta C, Sato W, Murakami H, Suri DJ, Otoo GE, Tano-Debrah K, Ghosh SA. Changes of Plasma Amino Acid Profiles in Infants With a Nutrient-Fortified Complementary Food Supplement: Evidence From a 12-Month Single-Blind Cluster-Randomized Controlled Trial. Front Nutr 2021; 8:606002. [PMID: 34660654 PMCID: PMC8514778 DOI: 10.3389/fnut.2021.606002] [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: 09/14/2020] [Accepted: 08/09/2021] [Indexed: 11/17/2022] Open
Abstract
Stunting is reportedly associated with low circulating levels of essential amino acids (EAAs). This study examined the effect of a macronutrient- and micronutrient-fortified complementary food supplement (KOKO Plus) on specific plasma EAA levels and stunting in infants aged 6-18 months. In a single-blind cluster-randomized controlled trial conducted in Ghana, infants were enrolled at 6 months and followed until 18 months. Thirty-eight communities were randomly assigned to receive KOKO Plus (KP, fourteen communities, n = 321), multiple-micronutrient powder (MN, thirteen communities, n = 327), or only nutritional education as control group (NE, eleven communities, n = 318), and all groups received nutrition education. Plasma amino acids (AAs) were measured at 6, 12, and 18 months (end point). Mixed-effects models were used to assess the effect of the intervention on plasma AAs, and the relationship between plasma branched-chain AAs (BCAAs) and the risk of stunting was assessed. At the end point, total BCAA concentrations (±standard error) significantly exceeded baseline in the KP (284.2 ± 4.3 μM) and NE (289.1 ± 4.4 μM) groups but not the MN group (264.4 ± 4.1 μM). After adjustment for compliance at 200 sachets, plasma BCAAs exceeded in the KP group (284.5 ± 4.2 μM) compared to the MN group (264.6 ± 4 μM). Plasma BCAAs were positively correlated with changes in length-for-age Z-score from baseline (R = 0.327, p = 0.048). In conclusion, the plasma BCAA concentrations of infants that received KP and the NE group was significantly higher compared to the MN group but there were no differences between the KP and NE group at end point. Improved plasma BCAAs may be due to improved nutrient intake by infants exposed to KP or NE. Low BCAAs were associated with stunting, replicating the previous finding. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03181178?term=NCT03181178&draw=2&rank=1, identifier: NCT03181178.
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Affiliation(s)
- Chie Furuta
- Institute of Food Science and Technologies, Ajinomoto Co. Inc., Kawasaki-city, Japan
| | - Wataru Sato
- Research Institute for Bioscience Products and Fine Chemicals, Ajinomoto Co. Inc., Kawasaki-city, Japan
| | - Hitoshi Murakami
- Institute of Food Science and Technologies, Ajinomoto Co. Inc., Kawasaki-city, Japan
| | - Devika J. Suri
- Nevin Scrimshaw International Nutrition Foundation, Boston, MA, United States
| | - Gloria E. Otoo
- Department of Nutrition and Food Science, University of Ghana, Legon-Accra, Ghana
| | - Kwaku Tano-Debrah
- Department of Nutrition and Food Science, University of Ghana, Legon-Accra, Ghana
| | - Shibani A. Ghosh
- Nevin Scrimshaw International Nutrition Foundation, Boston, MA, United States
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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Haileselassie M, Redae G, Berhe G, Henry CJ, Nickerson MT, Tyler B, Mulugeta A. Why are animal source foods rarely consumed by 6-23 months old children in rural communities of Northern Ethiopia? A qualitative study. PLoS One 2020; 15:e0225707. [PMID: 31914130 PMCID: PMC6948827 DOI: 10.1371/journal.pone.0225707] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 11/10/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Animal source foods provide high-quality protein and essential micronutrients within the human diet and are of particular significance for the health and development of children. Despite the availability of domestic livestock in rural households of Ethiopia, the diets of children are often monotonous and mainly cereal-based with low energy and nutrient density. OBJECTIVE Explore barriers and facilitators for the consumption of animal source foods among 6-23 months old children from the rural communities of Northern Ethiopia. METHODS A community-based exploratory qualitative study design was conducted in July through September 2018. A total of eight focus group discussions (56 individuals) and twenty-four qualitative interviews were conducted with mothers who are lactating, fathers, health extension workers, nutrition, and agriculture experts. Purposive sampling technique was used to include study participants based on their potential relevance in delivering a wealth of information. Thematic analysis strategies, a method for identifying, analyzing, and reporting themes within data, were used to code and grouped into related families and synthesize the qualitative data. RESULTS Consumption of animal source foods among 6-23 months old children was very low and the home-reared livestock and their products were mainly used for market purposes. Animal products are consumed during special societal occasions since they are considered as luxury food rather than an essential part of daily children's diet. Lack of nutrition knowledge, high cost of animal source foods, mothers' workload to herd livestock, low household income, low milk production, the poor linkage between health and agriculture sectors, and social norms and beliefs were identified as common barriers. While the presence of nutrition experts, cooking demonstrations, in-kind credit programs, livestock ownership, and government-led stunting reduction programs were the facilitators for the consumption of animal source foods in the study communities. CONCLUSIONS Reduced consumption of animal source foods inadvertently impacted dietary diversity of 6-23 months old children from the study communities. Thus, strengthening social and behavior change communication to promote the consumption of animal source foods, creating opportunities for women to own small livestock for household consumption and provide nutrition education on dietary restriction of animal source foods during religious periods among 6-23 months old children in the rural communities of Northern Ethiopia are recommended.
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Affiliation(s)
- Mekonnen Haileselassie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Tigray National Regional State, Bureau of Science and Technology, Mekelle, Tigray, Ethiopia
| | - Getachew Redae
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Gebretsadik Berhe
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Carol J. Henry
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Michael T. Nickerson
- Department of Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Bob Tyler
- Department of Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Afework Mulugeta
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Minocha S, Makkar S, Swaminathan S, Thomas T, Webb P, Kurpad AV. Supply and demand of high quality protein foods in India: Trends and opportunities. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2019. [DOI: 10.1016/j.gfs.2019.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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A macro- and micronutrient-fortified complementary food supplement reduced acute infection, improved haemoglobin and showed a dose-response effect in improving linear growth: a 12-month cluster randomised trial. J Nutr Sci 2019; 8:e22. [PMID: 31275576 PMCID: PMC6598226 DOI: 10.1017/jns.2019.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 02/05/2023] Open
Abstract
Inadequate protein quality may be a risk factor for poor growth. To examine the effect of a macronutrient-micronutrient supplement KOKO Plus (KP), provided to infants from 6 to 18 months of age, on linear growth, a single-blind cluster-randomised study was implemented in Ghana. A total of thirty-eight communities were randomly allocated to receive KP (fourteen communities, n 322), a micronutrient powder (MN, thirteen communities, n 329) and nutrition education (NE, eleven communities, n 319). A comparison group was followed cross-sectionally (n 303). Supplement delivery and morbidity were measured weekly and anthropometry monthly. NE education was provided monthly. Baseline, midline and endline measurements at 6, 12 and 18 months included venous blood draws, diet, anthropometry, morbidity, food security and socio-economics. Length-for-age Z-score (LAZ) was the primary outcome. Analyses were intent-to-treat using mixed-effects regressions adjusted for clustering, sex, age and baseline. No differences existed in mean LAZ scores at endline (-1·219 (sd 0·06) KP, -1·211 (sd 0·03) MN, -1·266 (sd 0·03) NE). Acute infection prevalence was lower in the KP than NE group (P = 0·043). Mean serum Hb was higher in KP infants free from acute infection (114·02 (sd 1·87) g/l) than MN (107·8 (sd 2·5) g/l; P = 0·047) and NE (108·8 (sd 0·99) g/l; P = 0·051). Compliance was 84·9 % (KP) and 87·2 % (MN) but delivery 60 %. Adjusting for delivery and compliance, LAZ score at endline was significantly higher in the KP v. MN group (+0·2 LAZ; P = 0·026). A macro- and micronutrient-fortified supplement KP reduced acute infection, improved Hb and demonstrated a dose-response effect on LAZ adjusting consumption for delivery.
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Key Words
- AGP, α-1-acid-glycoprotein
- B, baseline
- CRP, C-reactive protein
- Complementary feeding
- E, endline
- GHS, Ghana Health Service
- Hb
- IGF-1, insulin-like growth factor-1
- KOKO Plus
- KP, KOKO Plus
- LAZ, length-for-age Z-score
- Linear growth
- M, midline
- MN, micronutrient powder
- MUAC, mid upper arm circumference
- NE, nutrition education
- RNI, recommended nutrient intakes
- WAZ, weight-for-age Z-score
- WHZ, weight-for-height Z-score
- WLZ, weight-for-length Z-score
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Tano-Debrah K, Saalia FK, Ghosh S, Hara M. Development and Sensory Shelf-Life Testing of KOKO Plus: A Food Supplement for Improving the Nutritional Profiles of Traditional Complementary Foods. Food Nutr Bull 2019; 40:340-356. [PMID: 31242762 DOI: 10.1177/0379572119848290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Providing nutritionally adequate complementary foods is essential in preventing malnutrition in young infants. Koko made from fermented corn dough constitutes the most common complementary food in Ghana. However, these do not meet the nutrient requirements. OBJECTIVE To develop and test the acceptability and shelf-life of an energy-dense complementary food supplement for improving the nutritional profile of traditional complementary foods. METHODS Surveys of families in urban and rural communities and stakeholder engagements with health professionals were done to identify the most predominant traditional complementary foods and young infants' feeding practices. A food supplement, KOKO Plus, that would improve the nutritional profile of koko and other complementary foods needed to be developed. Linear programming was used in ingredient formulations for the food supplement based on locally available foods. The acceptability of the food supplement, KOKO Plus, in koko and soup was assessed using 14 trained assessors in a 2 × 2 crossover design. Shelf-life of the product was estimated using the difference in control sensory test method at different storage temperatures (24°C, 34°C, and 44°C). RESULTS Koko was the most predominant complementary food in many homes. The KOKO Plus food supplement improved the nutritional profile of koko to satisfy the nutrient intake requirements of young infants as recommended by World Health Organization. KOKO Plus was microbiologically safe, with estimated shelf-life of more than 12 months. CONCLUSION The development of KOKO Plus as a food supplement provides a practical solution to improve the nutritional status of weaning children in Ghana.
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Affiliation(s)
- Kwaku Tano-Debrah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Firibu Kwesi Saalia
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Shibani Ghosh
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,Nevin Scrimshaw International Nutrition Foundation, Boston, MA, USA
| | - Masashi Hara
- Ajinomoto Co, Inc, Institute of Food Sciences & Technologies, Kawasaki, Japan
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Kurpad AV. 90th Anniversary Commentary: Amino Acid Imbalances: Still in the Balance. J Nutr 2018; 148:1647-1649. [PMID: 30281120 PMCID: PMC7100003 DOI: 10.1093/jn/nxy195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 07/24/2018] [Indexed: 01/20/2023] Open
Affiliation(s)
- Anura V Kurpad
- Department of Physiology, St. John's Medical College, Bangalore, India
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8
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Armar-Klemesu M, Osei-Menya S, Zakariah-Akoto S, Tumilowicz A, Lee J, Hotz C. Using Ethnography to Identify Barriers and Facilitators to Optimal Infant and Young Child Feeding in Rural Ghana: Implications for Programs. Food Nutr Bull 2018; 39:231-245. [PMID: 29486585 DOI: 10.1177/0379572117742298] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Understanding the context of infant and young child feeding (IYCF) is recognized as essential for designing appropriate complementary feeding interventions. OBJECTIVE Our objective was to study household IYCF behaviors in 2 districts in southern and northern Ghana to identify opportunities to improve existing nutrition programs. METHODS We interviewed 80 caregivers of children aged 6 to 23 months using ethnographic methods, including free listing, guided discussions and cognitive mapping techniques, and 24-hour dietary recall. Descriptive statistics and thematic content analysis were used to analyze quantitative and qualitative data. RESULTS In both settings, children's diets were predominantly maize based. Fish, the main animal source food, was consumed daily but in very small quantities. Milk was consumed by only a few children, in tea and porridge. Fruits were seldom consumed. Household food production did not meet requirements, and the markets were heavily relied on for staples and other key ingredients. Most caregivers demonstrated basic knowledge and understanding of key health and nutrition concepts. Barriers to optimal child feeding identified were lack of money to purchase the nutritious foods recommended for children, seasonal food insecurity, and some caregiver beliefs, practices, and nutrition knowledge gaps. Positive contextual features include caregiver recognition of the dietary needs of young children and commitment to provide foods to meet these needs. CONCLUSION Our findings suggest that complementary feeding in these rural settings can be improved through reinforcement or modification of strategic components of local health and nutrition education in light of existing barriers and enablers to optimal IYCF.
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Affiliation(s)
- Margaret Armar-Klemesu
- 1 Nutrition Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Sarah Osei-Menya
- 1 Nutrition Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Sawudatu Zakariah-Akoto
- 1 Nutrition Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | | | - James Lee
- 2 Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - Christine Hotz
- 2 Global Alliance for Improved Nutrition, Geneva, Switzerland
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Killilea DW, Rohner F, Ghosh S, Otoo GE, Smith L, Siekmann JH, King JC. Identification of a Hemolysis Threshold That Increases Plasma and Serum Zinc Concentration. J Nutr 2017; 147:1218-1225. [PMID: 28490675 PMCID: PMC5443468 DOI: 10.3945/jn.116.247171] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/19/2017] [Accepted: 03/28/2017] [Indexed: 12/20/2022] Open
Abstract
Background: Plasma or serum zinc concentration (PZC or SZC) is the primary measure of zinc status, but accurate sampling requires controlling for hemolysis to prevent leakage of zinc from erythrocytes. It is not established how much hemolysis can occur without changing PZC/SZC concentrations.Objective: This study determines a guideline for the level of hemolysis that can significantly elevate PZC/SZC.Methods: The effect of hemolysis on PZC/SZC was estimated by using standard hematologic variables and mineral content. The calculated hemolysis threshold was then compared with results from an in vitro study and a population survey. Hemolysis was assessed by hemoglobin and iron concentrations, direct spectrophotometry, and visual assessment of the plasma or serum. Zinc and iron concentrations were determined by inductively coupled plasma spectrometry.Results: A 5% increase in PZC/SZC was calculated to result from the lysis of 1.15% of the erythrocytes in whole blood, corresponding to ∼1 g hemoglobin/L added into the plasma or serum. Similarly, the addition of simulated hemolysate to control plasma in vitro caused a 5% increase in PZC when hemoglobin concentrations reached 1.18 ± 0.10 g/L. In addition, serum samples from a population nutritional survey were scored for hemolysis and analyzed for changes in SZC; samples with hemolysis in the range of 1-2.5 g hemoglobin/L showed an estimated increase in SZC of 6% compared with nonhemolyzed samples. Each approach indicated that a 5% increase in PZC/SZC occurs at ∼1 g hemoglobin/L in plasma or serum. This concentration of hemoglobin can be readily identified directly by chemical hemoglobin assays or indirectly by direct spectrophotometry or matching to a color scale.Conclusions: A threshold of 1 g hemoglobin/L is recommended for PZC/SZC measurements to avoid increases in zinc caused by hemolysis. The use of this threshold may improve zinc assessment for monitoring zinc status and nutritional interventions.
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Affiliation(s)
| | | | - Shibani Ghosh
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA; and
| | - Gloria E Otoo
- Department of Nutrition and Food Sciences, University of Ghana, Accra, Ghana
| | - Lauren Smith
- Children's Hospital Oakland Research Institute, Oakland, CA
| | | | - Janet C King
- Children's Hospital Oakland Research Institute, Oakland, CA
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Leyvraz M, Aaron GJ, Poonawala A, van Liere MJ, Schofield D, Myatt M, Neufeld LM. Coverage of Nutrition Interventions Intended for Infants and Young Children Varies Greatly across Programs: Results from Coverage Surveys in 5 Countries. J Nutr 2017; 147:995S-1003S. [PMID: 28404839 PMCID: PMC5404212 DOI: 10.3945/jn.116.245407] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/06/2017] [Accepted: 02/07/2017] [Indexed: 11/14/2022] Open
Abstract
Background: The efficacy of a number of interventions that include fortified complementary foods (FCFs) or other products to improve infant and young child feeding (IYCF) is well established. Programs that provide such products free or at a subsidized price are implemented in many countries around the world. Demonstrating the impact at scale of these programs has been challenging, and rigorous information on coverage and utilization is lacking.Objective: The objective of this article is to review key findings from 11 coverage surveys of IYCF programs distributing or selling FCFs or micronutrient powders in 5 countries.Methods: Programs were implemented in Ghana, Cote d'Ivoire, India, Bangladesh, and Vietnam. Surveys were implemented at different stages of program implementation between 2013 and 2015. The Fortification Assessment Coverage Toolkit (FACT) was developed to assess 3 levels of coverage (message: awareness of the product; contact: use of the product ≥1 time; and effective: regular use aligned with program-specific goals), as well as barriers and factors that facilitate coverage. Analyses included the coverage estimates, as well as an assessment of equity of coverage between the poor and nonpoor, and between those with poor and adequate child feeding practices.Results: Coverage varied greatly between countries and program models. Message coverage ranged from 29.0% to 99.7%, contact coverage from 22.6% to 94.4%, and effective coverage from 0.8% to 88.3%. Beyond creating awareness, programs that achieved high coverage were those with effective mechanisms in place to overcome barriers for both supply and demand.Conclusions: Variability in coverage was likely due to the program design, delivery model, quality of implementation, and product type. Measuring program coverage and understanding its determinants is essential for program improvement and to estimate the potential for impact of programs at scale. Use of the FACT can help overcome this evidence gap.
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Affiliation(s)
- Magali Leyvraz
- Global Alliance for Improved Nutrition, Geneva, Switzerland; and
| | - Grant J Aaron
- Global Alliance for Improved Nutrition, Geneva, Switzerland; and
| | - Alia Poonawala
- Global Alliance for Improved Nutrition, Geneva, Switzerland; and
| | | | | | - Mark Myatt
- Brixton Health, Llawryglyn, United Kingdom
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11
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Aaron GJ, Strutt N, Boateng NA, Guevarra E, Siling K, Norris A, Ghosh S, Nyamikeh M, Attiogbe A, Burns R, Foriwa E, Toride Y, Kitamura S, Tano-Debrah K, Sarpong D, Myatt M. Assessing Program Coverage of Two Approaches to Distributing a Complementary Feeding Supplement to Infants and Young Children in Ghana. PLoS One 2016; 11:e0162462. [PMID: 27755554 PMCID: PMC5068796 DOI: 10.1371/journal.pone.0162462] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 08/23/2016] [Indexed: 12/02/2022] Open
Abstract
The work reported here assesses the coverage achieved by two sales-based approaches to distributing a complementary food supplement (KOKO Plus™) to infants and young children in Ghana. Delivery Model 1 was conducted in the Northern Region of Ghana and used a mixture of health extension workers (delivering behavior change communications and demand creation activities at primary healthcare centers and in the community) and petty traders recruited from among beneficiaries of a local microfinance initiative (responsible for the sale of the complementary food supplement at market stalls and house to house). Delivery Model 2 was conducted in the Eastern Region of Ghana and used a market-based approach, with the product being sold through micro-retail routes (i.e., small shops and roadside stalls) in three districts supported by behavior change communications and demand creation activities led by a local social marketing company. Both delivery models were implemented sub-nationally as 1-year pilot programs, with the aim of informing the design of a scaled-up program. A series of cross-sectional coverage surveys was implemented in each program area. Results from these surveys show that Delivery Model 1 was successful in achieving and sustaining high (i.e., 86%) effective coverage (i.e., the child had been given the product at least once in the previous 7 days) during implementation. Effective coverage fell to 62% within 3 months of the behavior change communications and demand creation activities stopping. Delivery Model 2 was successful in raising awareness of the product (i.e., 90% message coverage), but effective coverage was low (i.e., 9.4%). Future programming efforts should use the health extension / microfinance / petty trader approach in rural settings and consider adapting this approach for use in urban and peri-urban settings. Ongoing behavior change communications and demand creation activities is likely to be essential to the continued success of such programming.
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Affiliation(s)
- Grant J. Aaron
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
- * E-mail:
| | - Nicholas Strutt
- International Nutrition Foundation (INF), Boston, Massachusetts, United States of America
| | | | | | - Katja Siling
- Valid International, Oxford, England, United Kingdom
| | - Alison Norris
- Valid International, Oxford, England, United Kingdom
| | - Shibani Ghosh
- International Nutrition Foundation (INF), Boston, Massachusetts, United States of America
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | | | | | | | | | | | | | | | | | - Mark Myatt
- Brixton Health, Llawryglyn, Wales, United Kingdom
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12
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Ackatia-Armah NM, Addy NA, Ghosh S, Dubé L. Fostering reflective trust between mothers and community health nurses to improve the effectiveness of health and nutrition efforts: An ethnographic study in Ghana, West Africa. Soc Sci Med 2016; 158:96-104. [DOI: 10.1016/j.socscimed.2016.03.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 03/25/2016] [Accepted: 03/28/2016] [Indexed: 10/22/2022]
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Uauy R, Suri DJ, Ghosh S, Kurpad A, Rosenberg IH. Low Circulating Amino Acids and Protein Quality: An Interesting Piece in the Puzzle of Early Childhood Stunting. EBioMedicine 2016; 8:28-29. [PMID: 27428415 PMCID: PMC4919554 DOI: 10.1016/j.ebiom.2016.05.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ricardo Uauy
- London School of Hygiene and Tropical Medicine, London, UK; Nevin Scrimshaw International Nutrition Foundation, Boston, MA, USA
| | | | - Shibani Ghosh
- Nevin Scrimshaw International Nutrition Foundation, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | | | - Irwin H Rosenberg
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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14
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Bogard JR, Hother AL, Saha M, Bose S, Kabir H, Marks GC, Thilsted SH. Inclusion of Small Indigenous Fish Improves Nutritional Quality During the First 1000 Days. Food Nutr Bull 2015; 36:276-89. [PMID: 26297705 DOI: 10.1177/0379572115598885] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Within food-based approaches to improve nutrition during the first 1000 days of life, improved formulations of food products and the use of animal source foods, such as fish, are 2 widely cited strategies; however, there are few examples where the 2 strategies are combined. Furthermore, although small indigenous fish are highly nutritious and available to the poor in many regions of the world, their importance is often overlooked. OBJECTIVE To document the development of 2 nutritious fish-based food products in Bangladesh: a chutney for pregnant and lactating women (PLW) and a complementary food (CF) for infants and young children (6-23 months), including potential contributions to recommended or desirable nutrient intakes in the first 1000 days, processing methods, and nutrient composition. METHODS Local nutrient-rich ingredients and simple processing methods based on traditional knowledge (for the chutney), and a literature review (for the CF), were selected and trial batches produced. Products were analyzed for nutrient composition using standard analytical procedures and results compared with recommended or desirable nutrient intakes for women and children. RESULTS Both products could contribute significantly to micronutrient intakes of PLW (24% of iron and 35% of calcium recommended intakes) and macro- and micronutrient intake of infants and young children (≥ 65% of vitamin A, ≥ 61% of zinc, and 41% of iron desirable intakes) when consumed in the proposed serving size. CONCLUSION Inclusion of small indigenous fish as an underutilized animal source food in combination with other local nutrient-rich ingredients in food products represents a promising food-based strategy to improve nutrition, with many additional potential benefits for communities involved in production, and therefore warrants further investigation.
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Affiliation(s)
- Jessica R Bogard
- School of Public Health, The University of Queensland, Brisbane, Australia WorldFish, Bangladesh & South Asia Office, Dhaka, Bangladesh
| | | | - Manika Saha
- WorldFish, Bangladesh & South Asia Office, Dhaka, Bangladesh
| | | | | | - Geoffrey C Marks
- School of Public Health, The University of Queensland, Brisbane, Australia
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Dubé L, Webb P, Arora NK, Pingali P. Agriculture, health, and wealth convergence: bridging traditional food systems and modern agribusiness solutions. Ann N Y Acad Sci 2015; 1331:1-14. [PMID: 25514864 DOI: 10.1111/nyas.12602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The causes of many vexing challenges facing 21st-century society are at the nexus of systems involved in agriculture, health and wealth production, consumption, and distribution. Using food as a test bed, and on the basis of emerging roadmaps that set achievable objectives over a 1- to 3-year horizon, we introduce this special feature with convergence thinking and practice at its core. Specifically, we discuss academic papers structured around four themes: (1) evidence for a need for convergence and underlying mechanisms at the individual and societal levels; (2) strategy for mainstreaming convergence as a driver of business engagement and innovation; (3) convergence in policy and governance; (4) convergence in metrics and methods. Academic papers under each theme are accompanied by a roadmap paper reporting on the current status of concrete transformative convergence-building projects associated with that theme. We believe that the insights provided by these papers have the potential to enable all actors throughout society to singly and collectively work to build supply and demand for nutritious food, in both traditional and modern food systems, while placing the burdens of malnutrition and ill health on their core strategic agendas.
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Affiliation(s)
- Laurette Dubé
- Desautels Faculty of Management.,McGill Centre for the Convergence of Health and Economics (MMCHE), McGill University, Montréal, Québec, Canada
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Narendra K Arora
- Clinical Epidemiology, The INCLEN Trust International, New Delhi, India
| | - Prabhu Pingali
- Charles H. Dyson School of Applied Economics and Management, Cornell University, Ithaca, New York
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Addy NA, Poirier A, Blouin C, Drager N, Dubé L. Whole-of-society approach for public health policymaking: a case study of polycentric governance from Quebec, Canada. Ann N Y Acad Sci 2014; 1331:216-229. [PMID: 25118135 DOI: 10.1111/nyas.12503] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 07/08/2014] [Accepted: 07/09/2014] [Indexed: 11/28/2022]
Abstract
In adopting a whole-of-society (WoS) approach that engages multiple stakeholders in public health policies across contexts, the authors propose that effective governance presents a challenge. The purpose of this paper is to highlight a case for how polycentric governance underlying the WoS approach is already functioning, while outlining an agenda to enable adaptive learning for improving such governance processes. Drawing upon a case study from Quebec, Canada, we employ empirically developed concepts from extensive, decades-long work of the 2009 Nobel laureate Elinor Ostrom in the governance of policy in nonhealth domains to analyze early efforts at polycentric governance in policies around overnutrition, highlighting interactions between international, domestic, state and nonstate actors and processes. Using information from primary and secondary sources, we analyze the emergence of the broader policy context of Quebec's public health system in the 20th century. We present a microsituational analysis of the WoS approach for Quebec's 21st century policies on healthy lifestyles, emphasizing the role of governance at the community level. We argue for rethinking prescriptive policy analysis of the 20th century, proposing an agenda for diagnostic policy analysis, which explicates the multiple sets of actors and interacting variables shaping polycentric governance for operationalizing the WoS approach to policymaking in specific contexts.
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Affiliation(s)
- Nii A Addy
- McGill Centre for the Convergence of Health and Economics (MCCHE) and the Desautels Faculty of Management, McGill University, Montréal, Québec, Canada
| | - Alain Poirier
- Institut national de santé publique du Québec, Montréal, Québec, Canada
| | - Chantal Blouin
- Agri-food and health, Institut national de santé publique du Québec, Québec City, Québec, Canada
| | - Nick Drager
- McGill Centre for the Convergence of Health and Economics (MCCHE) and the Desautels Faculty of Management, McGill University, Montréal, Québec, Canada.,London School of Hygiene and Tropical Medicine, London, England
| | - Laurette Dubé
- McGill Centre for the Convergence of Health and Economics (MCCHE) and the Desautels Faculty of Management, McGill University, Montréal, Québec, Canada
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