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Baye K, Laillou A, Chitekwe S. Empowering women can improve child dietary diversity in Ethiopia. MATERNAL & CHILD NUTRITION 2024; 20 Suppl 5:e13285. [PMID: 34738293 PMCID: PMC11258775 DOI: 10.1111/mcn.13285] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/05/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
Women empowerment is an underlying factor of child feeding and nutrition. However, the lack of standardized measurements has made it difficult to design interventions that embed women empowerment and measure their impacts. This study aimed to assess temporal trends in women empowerment in Ethiopia and evaluate their contribution towards improving dietary diversity in infants and young children. We used women and child data from the Ethiopian Demographic and Health Survey 2005, 2011, and 2016, yielding a total sample of 6113 mother-child pairs. The survey-based women's empowerment index (SWPER) developed and validated for use in Africa was used to assess three dimensions of women empowerment: (i) social autonomy, (ii) decision making; and (iii) attitude to violence. We used multiple-linear and multivariable logistic regression to assess the associations between SWPER and the number of food groups consumed/and the minimum dietary diversity (MDD). To determine drivers of changes over time, a regression decomposition analysis was run. Women empowerment indices have improved over the 2005-2016 period, but a significant proportion of women had low standardized SWPER scores for autonomy/social independence (47%) and attitude to violence (49%) domains in 2016. SWPER autonomy and SWPER decision-making scores were strongly associated with the odds of meeting MDD. Changes in women empowerment accounted for 17% of the improvements in MDD between 2005 and 2016. SWPER was a stronger predictor of the change in MDD, than known predictors like wealth, child age, and urban residence. As a critical underlying driver of child nutrition, women empowerment should be boldly addressed and integrated in nutrition interventions.
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Affiliation(s)
- Kaleab Baye
- Center for Food Science and Nutrition, College of Natural and Computational SciencesAddis Ababa UniversityAddis AbabaEthiopia
- Research Center for Inclusive Development in Africa (RIDA)Addis AbabaEthiopia
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Noonan RJ. What Are the Roots of the Nation's Poor Health and Widening Health Inequalities? Rethinking Economic Growth for a Fairer and Healthier Future. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X241259241. [PMID: 38889922 DOI: 10.1177/2752535x241259241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Health inequalities are differences in health between groups in society. Despite them being preventable they persist on a grand scale. At the beginning of 2024, the Institute of Health Equity revealed in their report titled: Health Inequalities, Lives Cut Short, that health inequalities caused 1 million early deaths in England over the past decade. While the number of studies on the prevalence of health inequalities in the UK has burgeoned, limited emphasis has been given to exploring the factors contributing to these (widening) health inequalities. In this commentary article I will describe how the Government's relentless pursuit of economic growth and their failure to implement the necessary regulatory policies to mitigate against the insecurity and health effects neoliberal free market capitalism (referred to as capitalism herein) causes in pursuit of innovation, productivity and growth (economic dynamism) is one key driver underpinning this social injustice. I contend that if the priority really is to tackle health inequalities and ensure health for all then there is an imperative need to move beyond regulation alone to mitigate the worst effects of capitalist production; the goal of the economy has to change to fully restore the balance between economic growth and public health.
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Affiliation(s)
- Robert J Noonan
- Faculty of Health and Wellbeing, University of Bolton, Bolton, UK
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Wang N, Wang C, Qi M, Lin X, Zha A, Tan B, Yin Y, Wang J. Phosphatidylethanolamine Improves Postnatal Growth Retardation by Regulating Mucus Secretion of Intestinal Goblet Cells in Piglets. Animals (Basel) 2024; 14:1193. [PMID: 38672341 PMCID: PMC11047706 DOI: 10.3390/ani14081193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/28/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Phosphatidylethanolamine (PE), a multifunctional phospholipid, is necessary for neonate development. This study aimed to explore the impact of the regulation of exogenous PE on postnatal growth retardation (PGR) by improving intestinal barrier function. Thirty-two neonatal pigs were divided into four groups according to their body weight (BW 2.79 ± 0.50 kg or 1.88 ± 0.40 kg) at 7 days old, CON-NBW, PE-NBW, CON-PGR, and PE-PGR. PE was supplemented to NBW piglets and PGR piglets during lactation and post-weaning periods. Compared with the NBW piglets, the growth performance of PGR piglets was lower, while PE improved the poor growth performance. PGR piglets showed injured intestinal morphology, as evidenced by the reduced ratio of villus height to crypt depth (VH/CD) and goblet cell numbers in the jejunum and ileum. PE recovered the intestinal barrier injury by increasing VH/CD and goblet cell numbers. The decreased MUC2 mRNA and protein expressions were observed in the small intestine of PGR piglets, and PE remarkably increased the expression of MUC2. Mechanistically, PE increased the goblet cell differentiation promoting gene spdef mRNA levels and reduced the mRNA expressions involved in endoplasmic reticulum stress in the jejunal and ileal mucosa of PGR piglets. Overall, we found that PE alleviated growth retardation by regulating intestinal health and generalized its application in neonates.
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Affiliation(s)
- Nan Wang
- College of Animal Science and Technology, Hunan Agricultural University, Changsha 410128, China; (N.W.); (C.W.); (M.Q.); (X.L.); (A.Z.)
- Yuelushan Laboratory, Changsha 410128, China;
| | - Chengming Wang
- College of Animal Science and Technology, Hunan Agricultural University, Changsha 410128, China; (N.W.); (C.W.); (M.Q.); (X.L.); (A.Z.)
- Yuelushan Laboratory, Changsha 410128, China;
| | - Ming Qi
- College of Animal Science and Technology, Hunan Agricultural University, Changsha 410128, China; (N.W.); (C.W.); (M.Q.); (X.L.); (A.Z.)
- Yuelushan Laboratory, Changsha 410128, China;
| | - Xingtong Lin
- College of Animal Science and Technology, Hunan Agricultural University, Changsha 410128, China; (N.W.); (C.W.); (M.Q.); (X.L.); (A.Z.)
- Yuelushan Laboratory, Changsha 410128, China;
| | - Andong Zha
- College of Animal Science and Technology, Hunan Agricultural University, Changsha 410128, China; (N.W.); (C.W.); (M.Q.); (X.L.); (A.Z.)
- Yuelushan Laboratory, Changsha 410128, China;
| | - Bie Tan
- College of Animal Science and Technology, Hunan Agricultural University, Changsha 410128, China; (N.W.); (C.W.); (M.Q.); (X.L.); (A.Z.)
- Yuelushan Laboratory, Changsha 410128, China;
| | - Yulong Yin
- Yuelushan Laboratory, Changsha 410128, China;
| | - Jing Wang
- College of Animal Science and Technology, Hunan Agricultural University, Changsha 410128, China; (N.W.); (C.W.); (M.Q.); (X.L.); (A.Z.)
- Yuelushan Laboratory, Changsha 410128, China;
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Gelli A, Duchoslav J, Gladstone M, Gilligan D, Katundu M, Maleta K, Quisumbing A, Bliznashka L, Ahun M. Impact evaluation of a maternal and child cash transfer intervention, integrated with nutrition, early childhood development, and agriculture messaging (MAZIKO-IE): a study protocol for a cluster-randomised controlled trial. Trials 2024; 25:46. [PMID: 38218938 PMCID: PMC10790253 DOI: 10.1186/s13063-023-07782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 11/06/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Children in Malawi face high rates of malnutrition and are at risk of not reaching their developmental potential. Community-based childcare centres (CBCCs) can be cost-effective platforms for scaling-up early childhood development (ECD) and nutrition social behaviour change (SBC) interventions. However, evidence also suggests potential synergies from coupling nutrition SBC with cash transfers (CT), given that rural households in Malawi face high levels of poverty and recurring extreme lean season food-security shocks. The Maziko trial is aimed at evaluating the effectiveness and cost-effectiveness of using CBCCs and parenting care groups as platforms to improve maternal diets and child nutrition and development by providing nutrition-sensitive SBC and CT intervention packages in communities already receiving a standard of care Government SBC program. METHODS We designed a 3-year cluster-randomised controlled trial in two districts of Malawi, including 156 communities randomised to one of four treatment arms: (1) standard of care (SoC) arm: receiving the standard Government SBC program; (2) SBC arm: receiving the SoC intervention with additional nutrition-sensitive SBC activities to improve nutritious food production, diets, and care practices for young children; (3) low CT arm: SoC plus SBC plus a maternal and child cash transfer ~ 17 USD per month; and (4) high CT arm: SoC plus SBC plus a maternal and child CT ~ 43 USD per month. The trial will enrol pregnant women and children < 2 years of age. The primary outcomes are maternal diet assessed using the mean probability of adequacy and child development assessed using the Malawi Developmental Assessment Tool. Intermediate outcomes along the programme impact pathways will also be measured, including maternal mental health, maternal empowerment, child feeding practices, and child nutritional status. DISCUSSION This is the first study to examine the impact and synergies of combining ECD SBC with nutrition-sensitive SBC and CTs on maternal and child outcomes during the first 1000 days. The findings from this evaluation will inform national ECD and nutrition programmes. TRIAL REGISTRATION ISRCTN ISRCTN53055824. Registered on 7 March 2022.
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Chatterjee P, Chen J, Yousafzai A, Kawachi I, Subramanian SV. Area level indirect exposure to extended conflicts and early childhood anthropometric outcomes in India: a repeat cross-sectional analysis. Confl Health 2023; 17:23. [PMID: 37150814 PMCID: PMC10164367 DOI: 10.1186/s13031-023-00519-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/12/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Protracted, internal conflicts with geographic variations within countries, are an important understudied community exposure for adverse child health outcomes. METHODS Violent events from the Uppsala Conflict Data Program (UCDP) between January 2016-December 2020 and January 2010-December 2015, were included as exposure events for children sampled in National Family Health Surveys (NFHS) 5 (2019-21) and NFHS 4 (2015-16), respectively. Geocoded data from UCDP were merged with residential clusters from NFHS, to identify children living in villages or urban blocks situated at <= 50 km from conflict sites. Within these clusters, which we defined as conflict exposed, we studied risks of stunting, underweight and wasting in children, prenatally, and in 0-3 years. We assessed sensitivity on a subsample of siblings with discordant conflict exposures. RESULTS For NFHS 5, exposure to violence between 0 and 3 years was associated with 1.16 times (95% CI 1.11-1.20) higher risks of stunting, 1.08 (1.04, 1.12) times higher risks of underweight, and no change in wasting. In-utero violence exposure was associated with 1.11 times (95% CI 1.04-1.17) higher risks of stunting, 1.08 (95% CI 1.02-1.14) times higher risks of underweight, and no change in wasting, among children <= 2 years. In 17,760 siblings of 8333 mothers, exposure to violence during 0-3 years, was associated with a 1.19 times higher risk of stunting (95% CI - 0.24 to 0.084). Incremental quartiles of violence exposure had higher risks of stunting and underweight until quartile 3. CONCLUSION In-utero and early childhood indirect exposure to protracted conflicts were associated with increased stunting and underweight in India. Given the continued exposures of such historically and contextually rooted internal conflicts in many LMICs, chronic violence exposures should be targeted in public health policies as important social and political determinant of child health.
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Affiliation(s)
- Pritha Chatterjee
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Jarvis Chen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Aisha Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- Harvard Center for Population and Development Studies, Cambridge, MA, 02138, USA
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Brou AM, Djalega FA, Tokpa V, Seri ECG, Anoua ALF, Robinson JA. Urban-rural differences in the relationship between stunting, preschool attendance, home learning support, and school readiness: A study in Côte d'Ivoire. Front Public Health 2023; 10:1035488. [PMID: 36699902 PMCID: PMC9868242 DOI: 10.3389/fpubh.2022.1035488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/12/2022] [Indexed: 01/10/2023] Open
Abstract
Background Stunted physical growth during early childhood is a marker of chronic undernutrition, and the adverse life circumstances that underlie it. These have the potential to disrupt normal brain development and the acquisition of foundational cognitive, language, social and motor skills. Stunting is prevalent in most low-and middle-income countries. Because the prevention of stunting requires large-scale structural and attitudinal changes, several psycho-educational interventions have been developed to mitigate the adverse association between early stunting and skill development. However, the resource-intensive nature of custom-designed interventions limit their sustainability and scalability in resource-limited settings. This study explored the possibility that available resources that promote positive development (existing preschool education programs, and no- or low-cost home-based learning activities and resources) may protect against any negative association between stunting and the acquisition of foundational skills required for academic learning and adaptation at school. Method Data for 36-to 59-month-old children (n = 3,522; M = 46.7 months; 51.2% male; 74.1% rural) were drawn from the most recent Multiple Indicator Cluster Survey conducted in Côte d'Ivoire (MICS5, 2016). Stunting was assessed using the WHO Child Growth Standards. Preschool attendance and home learning activities and resources were assessed by maternal report. School readiness was assessed using the 8-item form of the Early Child Development Index (ECDI). Results A high percentage of children met the criteria for stunting (28.5%; 19.7% moderate; 8.8% severe). There were marked urban-rural differences in the prevalence of stunting, rates of preschool attendance, home learning activities and resources, children's school readiness scores, and the relationships between stunting, the protective factors and school readiness scores. These urban-rural differences in ECDI scores could be fully explained by differences between these settings in stunting and the protective factors. However, only two protective factors (access to books and home-based activities that promote learning) made independent contributions to variance in ECDI scores. There was tentative evidence that stunted children whose homes provided highly diverse learning activities and multiple types of learning resources were more likely than those who did not to have a high level of school readiness. Conclusion Capitalizing on the existing practices of families that show positive deviance in caregiving may provide a basis for culturally appropriate, low-cost interventions to improve school readiness among children in low- and middle-income countries, including children with stunted growth.
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Affiliation(s)
- Abenin Mathieu Brou
- Institute of Anthropological Development Sciences (ISAD), University of Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire,*Correspondence: Abenin Mathieu Brou ✉
| | - Franck Adjé Djalega
- Laboratory of Nutrition and Food Security of the Department of Food Science and Technology, University of Nangui Abrogoua, Abidjan, Côte d'Ivoire
| | - Venance Tokpa
- Department of Language Sciences, University of Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Edy Constant Gbala Seri
- Ivorian Center for Studies and Research in Applied Psychology, University of Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Apie Léa Fabienne Anoua
- Institute of Anthropological Development Sciences (ISAD), University of Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Julie Ann Robinson
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
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Bliznashka L, Jeong J, Jaacks LM. Maternal and paternal employment in agriculture and early childhood development: A cross-sectional analysis of Demographic and Health Survey data. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001116. [PMID: 36962809 PMCID: PMC10021554 DOI: 10.1371/journal.pgph.0001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/08/2022] [Indexed: 01/09/2023]
Abstract
Considerable literature from low- and lower-middle-income countries (LLMICs) links maternal employment to child nutritional status. However, less is known about the role of parental employment and occupation type in shaping child development outcomes. Additionally, little empirical work has examined the mechanisms through which parental occupation influences child outcomes. Our objective was to investigate the associations between maternal and paternal employment (comparing agricultural and non-agricultural employment) and child development and to examine childcare practices and women's empowerment as potential mechanisms. We pooled nine Demographic and Health Surveys (Benin, Burundi, Cambodia, Congo, Haiti, Rwanda, Senegal, Togo, and Uganda) with data on 8,516 children aged 36-59 months. We used generalised linear models to estimate associations between parental employment and child development, child stimulation (number of activities provided by the mother, father, and other household members), child supervision (not left alone or with older child for >1 hour), early childhood care and education programme (ECCE) attendance, and women's empowerment. In our sample, all fathers and 85% of mothers were employed. In 40% of families, both parents were employed in agriculture. After adjusting for child, parental and household confounders, we found that parental agricultural employment, relative to non-agricultural employment, was associated with poorer child development (relative risk (RR) 0.86 (95% CI 0.80, 0.92), more child stimulation provided by other household members (mean difference (MD) 0.26 (95% CI 0.09, 0.42)), less adequate child supervision (RR, 0.83 (95% 0.78, 0.80)), less ECCE attendance (RR 0.46 (95% CI 0.39, 0.54)), and lower women's empowerment (MD -1.01 (95% CI -1.18, -0.84)). Parental agricultural employment may be an important risk factor for early childhood development. More research using more comprehensive exposure and outcome measures is needed to unpack these complex relationships and to inform interventions and policies to support working parents in the agricultural sector with young children.
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Affiliation(s)
- Lilia Bliznashka
- International Food Policy Research Institute, Washington, DC, United States of America
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Midlothian, United Kingdom
| | - Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Lindsay M Jaacks
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Midlothian, United Kingdom
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Ali SH, Lloyd-Montgomery J, Lowery CM, Vedovato GM, Trude ACB. Equity-Promoting Strategies in Online Grocery Shopping: Recommendations Provided by Households of Low Income. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:998-1010. [PMID: 36357044 DOI: 10.1016/j.jneb.2022.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To explore barriers and facilitators of online grocery shopping and identify community-driven strategies to promote equity in online food access. DESIGN This qualitative study used a purposive recruitment strategy to conduct 11 focus groups and 5 in-depth interviews between November 2020 and March 2021. SETTING Data collection was conducted virtually with participants residing in diverse (majority urban) regions of Maryland. PARICIPANTS 44 primary household food purchasers with young children (aged < 8 years) eligible for the Supplemental Nutrition Assistance Program (SNAP). PHENOMENON OF INTEREST Barriers and facilitators of online grocery shopping and strategies elicited by the community to leverage SNAP and online food retailer services to reduce inequities in healthy food access. ANALYSIS We coded and analyzed transcripts on the basis of the Socioecological Model, Theory of Planned Behavior, and an Equity-Oriented Framework. RESULTS Overall, we identified 10 themes across all socioecological levels, all of which reflected both barriers and facilitators to online shopping: (1) individual: trust of shoppers, technology, (2) interpersonal: spousal/children needs, (3) community: safety and security, (4) organizational: retail experience and food quality, and (5) policy: SNAP and structural inequities. Participant recommendations included improving food access and communication with hired shoppers, implementing more payment/cost-saving options, and offering educational programming for SNAP participants on using benefits online. CONCLUSIONS AND IMPLICATIONS Households of low-income identified barriers and facilitators of online grocery shopping across the socioecological levels, emphasizing the need for a multilevel approach to equity promotion. We recommend future work to explore the suggested actionable pathways, which involve delivery providers, grocery stores, nutrition educators, and policymakers leveraging online grocery features (ie, meal planning support) and policies (ie, expansion of the SNAP Online Purchasing Pilot to more retailers) to reducing deterrents (ie, delivery fees waived) for an equity-promoting online grocery environment.
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Affiliation(s)
- Shahmir H Ali
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY
| | - Joy Lloyd-Montgomery
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Caitlin M Lowery
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gabriela M Vedovato
- Institute of Health and Society, Federal University of São Paulo, Santos, São Paulo, Brazil
| | - Angela C B Trude
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD; Department of Nutrition and Food Studies, New York University Steinhardt School of Culture, Education, and Human Development, New York, NY.
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Pérez-Escamilla R, Jimenez EY, Dewey KG. Responsive Feeding Recommendations: Harmonizing Integration into Dietary Guidelines for Infants and Young Children. Curr Dev Nutr 2021; 5:nzab076. [PMID: 34104850 PMCID: PMC8178105 DOI: 10.1093/cdn/nzab076] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/08/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
Responsive feeding (RF) involves reciprocal nurturing feeding practices between the caregiver and the child that encourage the child to develop preferences for healthy foods and beverages and to eat autonomously. In this commentary, we summarize RF-related findings from a recent US National Academies of Sciences, Engineering, and Medicine (National Academies) consensus study report examining consistency in infant and young child feeding (IYCF) recommendations in guidelines from high-income countries, and we discuss implications for future IYCF guidelines. Although existing guidelines included generally consistent messages about several RF behaviors, such as the importance of encouraging self-feeding and self-regulation in infants and toddlers, they generally did not present the recommendations as part of a cohesive RF interdisciplinary framework. Moving forward, evidence-based RF recommendations should be routinely incorporated and identified in dietary guidance for IYCF based on a consensus definition of RF grounded in sound responsive parenting and feeding frameworks. We recommend replicating the National Academies' scoping review in low- and middle- income countries and mixed-methods implementation science research to improve our understanding of how best to disseminate and implement RF-related recommendations across settings (e.g., home and early care and education centers), taking the social determinants of health into account.
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Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Elizabeth Yakes Jimenez
- Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, NM, USA
| | - Kathryn G Dewey
- Department of Nutrition and Institute for Global Nutrition, University of California at Davis, Davis, CA, USA
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Desmond C, Erzse A, Watt K, Ward K, Newell ML, Hofman K. Realising the potential human development returns to investing in early and maternal nutrition: The importance of identifying and addressing constraints over the life course. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000021. [PMID: 36962074 PMCID: PMC10022083 DOI: 10.1371/journal.pgph.0000021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/15/2021] [Indexed: 11/18/2022]
Abstract
The benefits of interventions which improve early nutrition are well recognised. These benefits, however, only accrue to the extent that later life circumstances allow. Consequently, in adverse contexts many of the benefits will never be realised, particularly for the most vulnerable, exacerbating inequality. Returns to investment in early nutrition could be improved if we identified contextual factors constraining their realisation and interventions to weaken these. We estimate cost and impact of scaling 10 nutrition interventions for a cohort of South African children born in 2021. We estimate associated declines in malnutrition and mortality, and improvements in years of schooling and future earnings. To examine the role of context over the life-course we estimate benefits with and without additional improvements in school quality and employment opportunities by socio-economic quintile. Scale up reduces national stunting (height for age < = -2SD) rates among children at 24 months by 3.18 percentage points, implying an increase in mean height for age z-score (HAZ) of 0.10, and 53,000 years of additional schooling. Quintile 1 (the poorest) displays the largest decline in stunting, and largest increase in mean HAZ. Estimated total cost of increasing coverage of the interventions for the cohort is US$90 million. The present value of the additional years of schooling is estimated at close to US$2 billion. Cost-benefit ratios suggest the highest return occurs in quintile 5 (1:23). Reducing inequality in school quality closes the gap between quintile 5 and the lower quintiles. If school quality and labour force participation were equal the highest returns are in quintile 1(1:31). An enabling environment is key to maximising human development returns from investing in early nutrition, and to avoid exacerbating existing inequality. Therefore, particularly for children in adverse conditions, it is essential to identify and implement complementary interventions over the life course.
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Affiliation(s)
- Chris Desmond
- Faculty of Health Sciences, SAMRC/Wits Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Agnes Erzse
- Faculty of Health Sciences, SAMRC/Wits Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Kathryn Watt
- Centre for Rural Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Kate Ward
- Faculty of Medicine, School of Human Development and Health, University of Southampton, Southampton, United Kingdom
| | - Marie-Louise Newell
- Faculty of Medicine, School of Human Development and Health, University of Southampton, Southampton, United Kingdom
| | - Karen Hofman
- Faculty of Health Sciences, SAMRC/Wits Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Johannesburg, South Africa
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