1
|
Stelle I, Kinshella MLW, Moore SE. Caregiver perceptions of nutrition interventions in infants and children under 24 months of age: a systematic review. Public Health Nutr 2023; 26:1907-1916. [PMID: 37349869 PMCID: PMC10478058 DOI: 10.1017/s1368980023001246] [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: 01/21/2022] [Revised: 05/19/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Efficacy studies show early nutrition interventions improving infant nutrition status, but understanding caregiver acceptability is required for implementation of such interventions. This systematic review examines caregivers' perceptions of nutrition interventions in young children. DESIGN We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL and PsychINFO from date of online journal inception through December 2020. Interventions included oral (powder/liquid/tablet) and/or intravenous supplementation, food fortification and nutrition counselling. Inclusion criteria included primary research, data presented on caregiver perception and studies published in English. Quality assessment was performed using the Critical Appraisal Skills Programme tool. Studies underwent narrative synthesis using inductive thematic analysis. SETTING No restriction. PARTICIPANTS Caregivers of children under 24 months of age. RESULTS Of 11 798 records identified, thirty-seven publications were included. Interventions included oral supplementation, food fortification and nutrition counselling. Caregivers included mothers (83 %), fathers, grandparents and aunts. Perceptions were gathered through individual interviews, focus group discussions, questionnaires, surveys and ratings. Totally, 89 % of studies noted high acceptability (n 33 most notably increased appetite (n 17). In total, 57 % of studies (n 21) cited low acceptability, commonly from side effects (n 13) such as gastrointestinal issues, appetite loss and stained teeth. CONCLUSIONS Positive perceptions and enthusiasm for interventions were frequently reported. Key to implementation was the increased appetite noted by caregivers. A substantial proportion of studies reported negative perceptions, mainly due to side effects. In future interventions, mitigation and education around common side effects are crucial for acceptability. Understanding both positive and negative caregiver perceptions is important for informing future nutrition interventions and strengthening sustainability and implementation.
Collapse
Affiliation(s)
- Isabella Stelle
- Department of Women and Children’s Health, King’s College London, St Thomas’ Hospital, Westminster Bridge Rd, LondonSE1 7EH, UK
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology and BC Children’s Hospital Research Institute, University of British Columbia, VancouverBC, Canada
| | - Sophie E Moore
- Department of Women and Children’s Health, King’s College London, St Thomas’ Hospital, Westminster Bridge Rd, LondonSE1 7EH, UK
- Medical Research Council Unit The Gambia at The London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| |
Collapse
|
2
|
Ahmed S, Chase LE, Wagnild J, Akhter N, Sturridge S, Clarke A, Chowdhary P, Mukami D, Kasim A, Hampshire K. Community health workers and health equity in low- and middle-income countries: systematic review and recommendations for policy and practice. Int J Equity Health 2022; 21:49. [PMID: 35410258 PMCID: PMC8996551 DOI: 10.1186/s12939-021-01615-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/27/2021] [Indexed: 01/06/2023] Open
Abstract
Background The deployment of Community Health Workers (CHWs) is widely promoted as a strategy for reducing health inequities in low- and middle-income countries (LMIC). Yet there is limited evidence on whether and how CHW programmes achieve this. This systematic review aimed to synthesise research findings on the following questions: (1) How effective are CHW interventions at reaching the most disadvantaged groups in LMIC contexts? and (2) What evidence exists on whether and how these programmes reduce health inequities in the populations they serve? Methods We searched six academic databases for recent (2014–2020) studies reporting on CHW programme access, utilisation, quality, and effects on health outcomes/behaviours in relation to potential stratifiers of health opportunities and outcomes (e.g., gender, socioeconomic status, place of residence). Quantitative data were extracted, tabulated, and subjected to meta-analysis where appropriate. Qualitative findings were synthesised using thematic analysis. Results One hundred sixty-seven studies met the search criteria, reporting on CHW interventions in 33 LMIC. Quantitative synthesis showed that CHW programmes successfully reach many (although not all) marginalized groups, but that health inequalities often persist in the populations they serve. Qualitative findings suggest that disadvantaged groups experienced barriers to taking up CHW health advice and referrals and point to a range of strategies for improving the reach and impact of CHW programmes in these groups. Ensuring fair working conditions for CHWs and expanding opportunities for advocacy were also revealed as being important for bridging health equity gaps. Conclusion In order to optimise the equity impacts of CHW programmes, we need to move beyond seeing CHWs as a temporary sticking plaster, and instead build meaningful partnerships between CHWs, communities and policy-makers to confront and address the underlying structures of inequity. Trial registration PROSPERO registration number CRD42020177333. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01615-y.
Collapse
|
3
|
Strategies to address anaemia among pregnant and lactating women in India: a formative research study. Public Health Nutr 2020; 23:795-805. [DOI: 10.1017/s1368980019003938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:Over half of pregnant women in India are affected by anaemia, which can lead to premature birth, low birth weight and maternal and child mortality. Using formative research, we aimed to understand social and cultural factors around iron and folic acid (IFA) supplement provision and adherence to identify potential strategies for improving adherence and behaviours to prevent and treat anaemia among pregnant and lactating Indian women.Design:In-depth interviews and focus group discussions with women and key informant interviews with health officials and workers.Setting:Four districts in two Indian states: Allahabad and Bara Banki districts in Uttar Pradesh and Chikkballapura and Mandya districts in Karnataka.Participants:Pregnant and lactating women (n 65) and district officials and community health workers (n 14).Results:Most women were aware of anaemia but did not understand its seriousness and consequences. All women received IFA supplements (predominantly for free), but many were not adherent because of side effects; lack of information from healthcare providers on the causes of anaemia, its seriousness and solutions and low social support. To address anaemia, women were most confident in their ability to prepare and eat healthier foods but lacked control over resources such as appropriate food availability.Conclusions:Based on the findings, we recommend multicomponent interventions to train healthcare providers, address systemic barriers and involve family members to support IFA supplement adherence and dietary changes. Future research will determine which strategies are most effective to reduce the burden of anaemia in India among pregnant and lactating women.
Collapse
|
4
|
Shet AS, Zwarenstein M, Rao A, Jebaraj P, Arumugam K, Atkins S, Mascarenhas M, Klar N, Galanti MR. Effect of a Community Health Worker-Delivered Parental Education and Counseling Intervention on Anemia Cure Rates in Rural Indian Children: A Pragmatic Cluster Randomized Clinical Trial. JAMA Pediatr 2019; 173:826-834. [PMID: 31329246 PMCID: PMC6646977 DOI: 10.1001/jamapediatrics.2019.2087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Iron deficiency anemia, the largest cause of anemia worldwide, adversely affects cognitive development in children. Moreover, the imperceptible childhood anemia prevalence reduction in response to anemia control measures is associated with tremendous social and economic cost. OBJECTIVE To evaluate the effects of community-based parental education/counseling when combined with usual treatment on children's anemia cure rate. DESIGN, SETTING, AND PARTICIPANTS A pragmatic cluster randomized clinical trial in children aged 12 to 59 months from 55 villages from the rural Chamrajnagar district in southern India was conducted between November 2014 and July 2015; 6-month follow-up ended in January 2016. Villages were randomly assigned to either usual treatment (n = 27) or to the intervention (n = 28). Among 1144 participating children, 534 were diagnosed as having anemia (hemoglobin levels <11 g/dL and >7.9 g/dL; to convert to grams per liter, multiply by 10) and constituted the study sample in this analysis. Data were analyzed between July 2016 and September 2017. INTERVENTIONS Iron and folic acid (IFA), 20 mg/d, 5 times daily per week, for 5 months (usual treatment) or health worker-delivered education/counseling combined with usual treatment (intervention). MAIN OUTCOMES AND MEASURES The primary outcome was anemia cure rate defined as hemoglobin level at or greater than 11 g/dL during follow-up. RESULTS Of the children included in the study, the mean age was 30 months, with a slightly higher ratio of boys to girls. Of 534 children with anemia (intervention n = 303; usual treatment n = 231), 517 were reassessed after 6 months (intervention n = 298; usual treatment n = 219) while 17 were lost to follow-up (intervention n = 5 and usual treatment n = 12). Anemia cure rate was higher in children in the intervention group compared with children receiving usual treatment (55.7% [n = 166 of 298] vs 41.4% [n = 90 of 219]). The risk ratio derived through multilevel logistic regression was 1.37 (95% CI, 1.04-1.70); the model-estimated risk difference was 15.1% (95% CI, 3.9-26.3). Intervention-group children demonstrated larger mean hemoglobin increments (difference, intervention vs control: 0.25 g/dL; 95% CI, 0.07-0.44 g/dL) and improved IFA adherence (61.7%; 95% CI, 56.2-67.3 vs 48.4%; 95% CI, 41.7-55.1 consumed >75% of tablets provided). Adverse events were mild (intervention: 26.8%; 95% CI, 21.8-31.9 vs usual treatment: 21%; 95% CI, 15.6-26.4). To cure 1 child with anemia, 7 mothers needed to be counseled (number needed to treat: 7; 95% CI, 4-26). CONCLUSIONS AND RELEVANCE Parental education and counseling by a community health worker achieved perceivable gains in curing childhood anemia. Policy makers should consider this approach to enhance population level anemia control. TRIAL REGISTRATION ISRCTN identifier: ISRCTN68413407.
Collapse
Affiliation(s)
- Arun S. Shet
- Department of Hematology/Medical Oncology, St Johns Medical College and Hospital, Bangalore, India,Sickle Cell Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Merrick Zwarenstein
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Abha Rao
- Department of Hematology/Medical Oncology, St Johns Medical College and Hospital, Bangalore, India
| | - Paul Jebaraj
- Department of Hematology/Medical Oncology, St Johns Medical College and Hospital, Bangalore, India
| | - Karthika Arumugam
- Department of Hematology/Medical Oncology, St Johns Medical College and Hospital, Bangalore, India
| | - Salla Atkins
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden,New Social Research and Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Neil Klar
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Maria Rosaria Galanti
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden,Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Stockholm, Sweden
| |
Collapse
|
5
|
Liang Y, Ren HY, Zuo PX. Associations Between Maternal Nutrition Knowledge, Attitude, and Practice and 25-Hydroxyvitamin D Levels and Rickets in Children in Xinjiang Province, People's Republic of China. Asia Pac J Public Health 2018; 30:378-386. [PMID: 29652179 DOI: 10.1177/1010539518768034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We explored the association between maternal nutrition knowledge, attitude, and practice (KAP) and 25-hydroxyvitamin D (25(OH)D) values in children with rickets in Xinjiang, People's Republic of China. We recruited 514 mothers with children (<2 years) from pediatric outpatient departments. We determined general status of families, maternal nutrition KAP, and 25(OH)D values in 212 children with rickets, with doctors using "Prevention and Treatment Program for Infant and Young Children Rickets" and "Application Guideline for Vitamin D and Bone Health in Adult Chinese (2014 Standard Edition)" to identify. We then assessed the associations between nutrition KAP and 25(OH)D values. The 25(OH)D values were positively correlated with maternal nutrition KAP scores. Factors influencing rickets included per-capita monthly dietary expenditure and spousal education level. Factors associated with nutrition practice included maternal education level, gestational vitamin D level, and nutrition knowledge. Augmented maternal nutrition KAP may improve 25(OH)D levels in children with rickets to a normal range.
Collapse
Affiliation(s)
- Yu Liang
- 1 Department of Medical School, University of Shihezi, Shihezi, Xinjiang, People's Republic of China
| | - Hai-Yan Ren
- 1 Department of Medical School, University of Shihezi, Shihezi, Xinjiang, People's Republic of China
| | - Peng-Xiang Zuo
- 1 Department of Medical School, University of Shihezi, Shihezi, Xinjiang, People's Republic of China
| |
Collapse
|
6
|
Wendt A, Stephenson R, Young M, Webb-Girard A, Hogue C, Ramakrishnan U, Martorell R. Individual and facility-level determinants of iron and folic acid receipt and adequate consumption among pregnant women in rural Bihar, India. PLoS One 2015; 10:e0120404. [PMID: 25793866 PMCID: PMC4368810 DOI: 10.1371/journal.pone.0120404] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 01/23/2015] [Indexed: 11/29/2022] Open
Abstract
Background In Bihar, India, high maternal anemia prevalence and low iron and folic acid supplement (IFA) receipt and consumption have continued over time despite universal IFA distribution and counseling during pregnancy. Purpose To examine individual and facility-level determinants of IFA receipt and consumption among pregnant women in rural Bihar, India. Methods Using District Level Household Survey (2007–08) data, multilevel modeling was conducted to examine the determinants of two outcomes: IFA receipt (any IFA receipt vs. none) and IFA consumption (≥90 days vs. <90 days). Individual-level and facility-level factors were included. Factor analysis was utilized to construct antenatal care (ANC) quality and health sub-center (HSC) capacity variables. Results Overall, 37% of women received any IFA during their last pregnancy. Of those, 24% consumed IFA for 90 or more days. Women were more likely to receive any IFA when they received additional ANC services and counseling, and attended ANC earlier and more frequently. Significant interactions were found between ANC quality factors (odds ratio (OR): 0.37, 95% confidence interval (CI): 0.25, 0.56) and between ANC services and ANC timing and frequency (OR: 0.68, 95% CI: 0.56, 0.82). No HSC factors were significantly associated with IFA receipt. Women were more likely to consume IFA for ≥90 days if they attended at least 4 ANC check-ups and received more ANC services. IFA supply at the HSC (OR: 1.37, 95% CI: 1.04, 1.82) was also significantly associated with IFA consumption. Conclusions Our findings indicate that individual and ANC factors (timing, frequency, and quality) play a key role in facilitating IFA receipt and consumption. Although HSC capacity factors were not found to influence our outcomes, significant variation at the facility level indicates unmeasured factors that could be important to address in future interventions.
Collapse
Affiliation(s)
- Amanda Wendt
- Nutrition and Health Sciences, Division of Biological and Biomedical Sciences, Emory University, Atlanta, Georgia, United States of America
- Epidemiology and Biostatistics Unit, Institute of Public Health, Heidelberg University, Heidelberg, Germany
- * E-mail:
| | - Rob Stephenson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Melissa Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Amy Webb-Girard
- Nutrition and Health Sciences, Division of Biological and Biomedical Sciences, Emory University, Atlanta, Georgia, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Carol Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Usha Ramakrishnan
- Nutrition and Health Sciences, Division of Biological and Biomedical Sciences, Emory University, Atlanta, Georgia, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Reynaldo Martorell
- Nutrition and Health Sciences, Division of Biological and Biomedical Sciences, Emory University, Atlanta, Georgia, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| |
Collapse
|