The potential effectiveness of the nutrition improvement program on infant and young child feeding and nutritional status in the Northwest and Southwest regions of Cameroon, Central Africa

Global burden of childhood nutritional deficiencies, 1990-2019

OBJECTIVES

The aim of this study was to estimate the global burden, trends and health inequality of childhood nutritional deficiencies (CND) from 1990 to 2019.

STUDY DESIGN

This was an epidemiological study.

METHODS

Data were extracted from the 2019 Global Burden of Disease study. Estimates and 95% uncertainty intervals (UIs) for the rates and numbers were used to evaluate the global burden of CND. Temporal trends in the burden of CND were examined using Joinpoint analysis and average annual percentage changes. To assess health inequality, the slope index was used.

RESULTS

In 2019, 52 million new cases of CND and 105,000 deaths related to CND were recorded. Additionally, 435 million prevalence cases and 26 million disability-adjusted life years (DALYs) were recorded in the same year. From 1990 to 2019, the incidence rate of CND generally increased globally, except for the years 2010-2017; conversely, the prevalence, death and DALY rates exhibited decreasing trends over the study period. Half of the analysed regions and countries/territories demonstrated decreasing trends in the incidence, prevalence, death and DALY rates associated with CND. The incidence and prevalence of CND remained high in low-middle sociodemographic index (SDI) and low-SDI regions; however, they exhibited decreasing trends over the 30-year study period. The slope indexes showed that there were no significant changes in SDI-related inequality over 30 years.

CONCLUSIONS

Despite decreasing trends in the prevalence, death and DALY rates associated with CND over the three decades, the degree of inequality related to SDI in the burden of nutritional deficiencies has not shown a significant decline. In summary, CND remain a major public health burden in middle-SDI and low-SDI countries.

Public Health Interventions to Reduce Stunting in Toddlers: A Systematic Review

BACKGROUND: Handling stunting in toddlers is not only the responsibility of the government, but the most important thing is family and community responsibility. Public health interventions involving the family and community are important for stunting prevention because the family environment is one of the factors that determine the provision of adequate conditions for the nutritional status and development of children. AIM: The purpose of this systematic review is to synthesize various public health interventions that are practice-based evidence derived from programs implemented to reduce stunting in toddlers. METHODS: Initial steps doing this systematic review articles included in this study were retrieved from ProQuest, EBSCOhost, MEDLINE/CINAHL (Academic Search Complete) that were published within 2011–2019 and written in English. Study Quality Assessment was done using keywords and by assessing compatibility of the articles with the study context. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was used to analyze the found articles. RESULTS: After filtering process, there were 11 articles from 859 articles emphasize on using a combination of two or more Public Health Interventions to reduce stunting in toddlers. The most common public health interventions done to reduce stunting in toddlers are health teaching, counseling, collaboration, and community organizing. CONCLUSIONS: Here, we show that public health interventions performed by public health nurses to reduce stunting require the involvement of the community itself, especially the family. Public health interventions can be combined with one or more other public health interventions to increase success in preventing stunting in children under five.

A qualitative assessment of barriers and facilitators to implementing recommended infant nutrition practices in Mumbai, India

BACKGROUND

Childhood malnutrition has been a longstanding crisis in Mumbai, India. Despite national IYCF (Infant Young Child Feeding) guidelines to promote best practices for infant/toddler feeding, nearly one-third of children under age five are stunted or underweight. To improve child nutrition, interventions should address the cultural, social, and environmental influences on infant feeding practices. This study is an in-depth qualitative assessment of family barriers and facilitators to implementing recommended nutrition practices in two Mumbai slum communities, within the context of an existing nutrition education-based intervention by a local non-governmental non-profit organization.

METHODS

The population was purposively sampled to represent a variety of household demographics. Data were collected through 33 in-depth semi-structured interviews with caregivers (mothers and paternal grandmothers) of children age 0-2 years. Transcripts were translated and transcribed, and analyzed using qualitative analysis procedures and software.

RESULTS

A complex set of barriers and facilitators influence mothers'/caregivers' infant-toddler feeding practices. Most infants were fed complementary foods and non-nutritious processed snacks, counter to IYCF recommendations. Key barriers included: lack of nutrition knowledge and experience, receiving conflicting messages from different sources, limited social support, and poor self-efficacy for maternal decision-making. Key facilitators included: professional nutrition guidance, personal self-efficacy and empowerment, and family support. Interventions to improve child nutrition should address mothers'/caregivers' key barriers and facilitators to recommended infant-toddler feeding practices.

CONCLUSIONS

Nutrition interventions should prioritize standard messaging across healthcare providers, engage all family members, target prevention of early introduction of sugary and non-nutritious processed foods, and strengthen maternal self-efficacy for following IYCF recommended guidelines.

Nutritional counselling interactions between health workers and caregivers of children under two years: observations at selected child welfare clinics in Ghana

BACKGROUND

This study evaluated the Health Works (HWs) nutritional counselling skills and information shared with caregivers. This was a cross-sectional study in which an observation checklist was used to examine Growth Monitoring and Promotion (GMP) activities and educational/counselling activities undertaken by health workers (HWs) to communicate nutrition information to caregivers, depending on the ages of the children.

METHODS

A total number of 528 counselling interactions between health workers and caregivers in 16 Child welfare Clinics (CWCs) in two rural districts in Ghana were observed. Frequencies were presented for the information that was obtained from each caregiver and those that were provided by the HWs during the nutritional counselling sessions.

RESULTS

About 95.1 and 61.8% of the caregiver-HW interactions involved mothers of children who were less than 6 months of age and those above 6 months respectively. HWs counselled the caregivers on appropriate nutrition for the child. Health talk messages that were shared with caregivers focused mainly on the importance of attending CWCs and vaccination of children and rarely included any teaching materials. In most of the interactions, HWs made of child's feeding practices the past 1 month; and also did not provide advice on specific issues of IYCF. Nutritional counselling information given for non-breastfeeding children was inadequate and in some cases absent. Little attention was given to the feeding of children with animal products during counselling.

CONCLUSION

Generally nutritional information given to caregivers who had children above 6 months was inadequate.

Maternal nutrition counselling is associated with reduced stunting prevalence and improved feeding practices in early childhood: a post-program comparison study

BACKGROUND

Despite progress, suboptimal feeding practices and undernutrition particularly in the form of stunting still remains a major issue among children aged less than 5 years in Bangladesh. Since mothers are the primary caregivers of young children, maternal nutrition counselling can be effective in improving knowledge and practices on child feeding. The Building Resources Across Communities (BRAC) initiated a nutrition counselling intervention using its essential health care (EHC) skeleton in 114 sub-districts of Bangladesh in 2012. This study assessed the role of this intervention on the prevalence of stunting and feeding practices among children aged less than 5 years.

METHODS

The data was collected as part of a nationwide cross-sectional survey, which followed a two-stage cluster random sampling procedure and was conducted between October 2015 and January 2016. The present study analyzed the information of 3009 mother-children dyads from two selected survey areas: i) areas where the EHC package was delivered (comparison; n = 1452), ii) areas with EHC plus nutrition counselling package (intervention; n = 1557) was delivered. The Chi-square test was done to compare the child feeding practices and stunting prevalence between intervention and comparison. The degree of strength of the association of stunting and the intervention was estimated using a mixed-effect logistic regression model.

RESULTS

The study revealed that the prevalence of stunting was significantly lower in areas where the intervention was delivered compared to the comparison areas (29% vs. 37%, P < 0.001). Furthermore, after adjusting for administrative zone, household wealth quintile, child's age, gender, maternal age, education, occupation, cluster disparity, and variation between study groups, it was seen that the risk of stunting was 25% lower in the intervention areas compared to the comparison areas (aOR: 0.75, 95% CI: 0.60-0.94; P = 0.012). Optimal child feeding practices were also more common among mothers from intervention areas than those of the comparison areas (exclusive breastfeeding: 72.7 vs. 59.4%, P = 0.008; feeding 4+ food groups: 42.9 vs. 34.1%, P < 0.001; having minimum acceptable diet: 31.2 vs. 25.3%, P = 0.017; feeding multiple micro-nutrient powder: 16.2 vs. 7.4%, P < 0.001).

CONCLUSIONS

The study highlighted that nutrition counselling of mothers may be effective in reducing childhood stunting with concomitant improvement in optimal feeding practices in children under 5 years of age. The frontline community health workers can be trained to counsel mothers on optimal child feeding practices and this could help reduce the prevalence of stunting.

Educational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under

BACKGROUND

Although complementary feeding is a universal practice, the methods and manner in which it is practiced vary between cultures, individuals and socioeconomic classes. The period of complementary feeding is a critical time of transition in the life of an infant, and inappropriate complementary feeding practices, with their associated adverse health consequences, remain a significant global public health problem. Educational interventions are widely acknowledged as effective in promoting public health strategy, and those aimed at improving complementary feeding practices provide information about proper complementary feeding practices to caregivers of infants/children. It is therefore important to summarise evidence on the effectiveness of educational interventions to improve the complementary feeding practices of caregivers of infants.

OBJECTIVES

To assess the effectiveness of educational interventions for improving the complementary feeding (weaning) practices of primary caregivers of children of complementary feeding age, and related health and growth outcomes in infants.

SEARCH METHODS

In November 2017, we searched CENTRAL, MEDLINE, Embase, 10 other databases and two trials registers. We also searched the reference lists of relevant studies and reviews to identify any additional studies. We did not limit the searches by date, language or publication status.

SELECTION CRITERIA

Randomised controlled trials (RCTs), comparing educational interventions to no intervention, usual practice, or educational interventions provided in conjunction with another intervention, so long as the educational intervention was only available in the experimental group and the adjunctive intervention was available to the control group. Study participants included caregivers of infants aged 4 to 24 months undergoing complementary feeding. Pregnant women who were expected to give birth and commence complementary feeding during the period of the study were also included.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data on participants, settings, interventions, methodology and outcomes using a specifically-developed and piloted data extraction form. We calculated risk ratios (RR) and 95% confidence intervals (CIs) for dichotomous data, and mean differences (MD) and 95% CIs for continuous data. Where data permitted, we conducted a meta-analysis using a random-effects model. We assessed the included studies for risk of bias and also assessed the quality of evidence using the GRADE approach.

MAIN RESULTS

We included 23 studies (from 35 reports) with a total of 11,170 caregiver-infant pairs who were randomly assigned to receive an educational intervention delivered to the caregiver or usual care. Nineteen of the included studies were community-based studies while four were facility-based studies. In addition, 13 of the included studies were cluster-randomised while the others were individually randomised. Generally, the interventions were focused on the introduction of complementary feeding at the appropriate time, the types and amount of complementary foods to be fed to infants, and hygiene. Using the GRADE criteria, we assessed the quality of the evidence as moderate, mostly due to inadequate allocation concealment and insufficient blinding.Educational interventions led to improvements in complementary feeding practices for age at introduction of complementary foods (average RR 0.88, 95% CI 0.83 to 0.94; 4 studies, 1738 children; moderate-quality evidence) and hygiene practices (average RR 1.38, 95% CI 1.23 to 1.55; 4 studies, 2029 participants; moderate-quality evidence). For duration of exclusive breastfeeding, pooled results were compatible with both a reduction and an increase in the outcome (average RR 1.58, 95% CI 0.77 to 3.22; 3 studies, 1544 children; very low-quality evidence). There was limited (low to very low-quality) evidence of an effect for all growth outcomes.Quality of evidenceThere is moderate to very low-quality evidence that educational interventions can improve complementary feeding practices but insufficient evidence to conclude that it impacts growth outcomes.

AUTHORS' CONCLUSIONS

Overall, we found evidence that education improves complementary feeding practices.