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Abera M, Berhane M, Grijalva-Eternod CS, Abdissa A, Abate N, Hailu E, Barthorp H, Allen E, McGrath M, Girma T, Wells JC, Kerac M, Beaumont E. Maternal mental health and nutritional status of infants aged under 6 months: A secondary analysis of a cross-sectional survey. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003139. [PMID: 39269974 PMCID: PMC11398659 DOI: 10.1371/journal.pgph.0003139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 08/13/2024] [Indexed: 09/15/2024]
Abstract
Maternal/caregivers' mental health (MMH) and child nutrition are both poor in low- and middle-income countries. Links between the two are plausible but poorly researched. Our aim was to inform future malnutrition management programmes by better understanding associations between MMH and nutritional status of infants aged under six month (u6m). We conducted a health facility-based cross-sectional survey of 1060 infants in rural Ethiopia, between October 2020 and January 2021. We collected data on: MMH status (main exposure) measured using the Patient Health Questionnaire (PHQ-9) and infant anthropometry indicators (outcome); length for age Z-score (LAZ), weight for age Z-score (WAZ), weight for length Z-score (WLZ), mid upper arm circumference (MUAC), head circumference for age Z-score (HCAZ) and lower leg length (LLL). Analysis of secondary data using linear regression was employed to determine associations between the main exposure and outcome variables. The result showed infants' mean (SD) age was 13.4 (6.2) weeks. The median score for MMH problem was 0 (inter quartile range 0-2) points, and 29.5% and 11.2% reported minimal and mild to severe depression score of 1-4 and 5-27 points, respectively. Mean (SD) LAZ was -0.4 (1.4), WAZ -0.7 (1.3), WLZ -0.5 (1.2), MUAC 12.4 (1.3) cm, HCAZ 0.4 (1.3) and LLL 148 (13.9) mm. In adjusted linear regression analysis, minimal MMH problem was negatively associated with infant LAZ marginally (β = -0.2; 95% CI: -0.4, 0.00; p = 0.05) and LLL (β = -2.0; 95% CI: -3.8, -0.1; p = 0.04), but not with other anthropometric indicators. Statistically significant associations were not found between mild to severe depressive symptoms and infant anthropometric outcomes. In conclusion, only minimal, but not mild, moderate or severe, maternal/caregivers' depressive symptoms are associated with infant anthropometry outcomes in this data set. Whilst there is a plausible relationship between maternal mental health problems and offspring nutritional status, we did not observed this. Possible reasons include: PHQ-9 not suited to our population; and only a small number of participants reporting moderate to severe level of depression. Further research to investigate and understand the relationship and pathways between maternal mental health and offspring nutritional status is required.
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Affiliation(s)
- Mubarek Abera
- Department of Psychiatry, Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
- Jimma University Clinical and Nutrition Research Center (JUCAN), Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Jimma University Clinical and Nutrition Research Center (JUCAN), Jimma University, Jimma, Ethiopia
- Department of Pediatrics and Child Health, Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Carlos S Grijalva-Eternod
- Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
- UCL Institute for Global Health, London, United Kingdom
| | - Alemseged Abdissa
- Jimma University Clinical and Nutrition Research Center (JUCAN), Jimma University, Jimma, Ethiopia
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | | | | | | | - Elizabeth Allen
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | | | - Tsinuel Girma
- Jimma University Clinical and Nutrition Research Center (JUCAN), Jimma University, Jimma, Ethiopia
- Harvard Chan School of Public Health, Addis Ababa, Ethiopia
| | - Jonathan Ck Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Marko Kerac
- Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Emma Beaumont
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
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Bhatt Carreno S, Orjuela-Grimm M, Vahedi L, Roesch E, Heckman C, Beckingham A, Gayford M, Meyer SR. Linkages between maternal experience of intimate partner violence and child nutrition outcomes: A rapid evidence assessment. PLoS One 2024; 19:e0298364. [PMID: 38498450 PMCID: PMC10947923 DOI: 10.1371/journal.pone.0298364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 01/24/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND A strong evidence base indicates that maternal caregivers' experience of intimate partner violence [IPV] impacts children's health, cognitive development, and risk-taking behaviors. Our objective was to review peer-reviewed literature describing the associations between a child's indirect exposure to IPV and corresponding nutrition outcomes, with a particular focus on fragile settings in low and middle-income countries [LMICs]. METHODS We conducted a rapid evidence assessment to synthesize quantitative associations between maternal caregivers' IPV experience and children's nutrition/growth outcomes (birthweight, feeding, and growth indicators). We included peer-reviewed research, published in English or Spanish after the year 2000, conducted in fragile settings in LMICs. RESULTS We identified 86 publications that fit inclusion criteria. Amongst all associations assessed, a maternal caregiver's experience of combined forms of IPV (physical, sexual and emotional) or physical IPV only, were most consistently associated with lower birthweight, especially during pregnancy. Women of child-bearing age, including adolescents, exposed to at least one type of IPV showed a decreased likelihood of following recommended breastfeeding practices. Lifetime maternal experience of combined IPV was significantly associated with stunting among children under 5 years of age in the largest study included, though findings in smaller studies were inconsistent. Maternal experience of physical or combined IPV were inconsistently associated with underweight or wasting in the first five years. Maternal experience of sexual IPV during pregnancy appeared to predict worsened lipid profiles among children. CONCLUSION Maternal caregivers' experience of IPV is significantly associated with low birthweight and suboptimal breastfeeding practices, whereas studies showed inconsistent associations with child growth indicators or blood nutrient levels. Future research should focus on outcomes in children aged 2 years and older, investigation of feeding practices beyond breastfeeding, and examination of risk during time periods physiologically relevant to the outcomes. Programmatic implications include incorporation of GBV considerations into nutrition policies and programming and integrating GBV prevention and response into mother and child health and nutrition interventions in LMIC contexts.
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Affiliation(s)
- Silvia Bhatt Carreno
- Department of Epidemiology, Columbia University, New York City, New York, United States of America
| | - Manuela Orjuela-Grimm
- Department of Epidemiology and Pediatrics, Columbia University Irving Medical Center, New York City, New York, United States of America
| | - Luissa Vahedi
- Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | | | | | | | - Megan Gayford
- UNICEF, New York City, New York, United States of America
| | - Sarah R. Meyer
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
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Bukuku DD, Prasopkittikun T, Payakkaraung S, Lenwari C. Factors influencing Tanzanian mothers' feeding practices for toddlers: A predictive correlational study. BELITUNG NURSING JOURNAL 2023; 9:603-610. [PMID: 38130674 PMCID: PMC10731432 DOI: 10.33546/bnj.2974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/20/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023] Open
Abstract
Background Feeding practices are crucial in ensuring toddlers receive an appropriate and varied diet to support their growth and development. In Tanzania, maternal feeding practices for young children are inadequate, and there is limited research on the influencing factors. Objective This study aimed to examine the factors influencing Tanzanian mothers' feeding practices for toddlers, utilizing the health promotion model as the theoretical framework. Methods A predictive correlational design was employed, with a random sample of 399 mothers who brought their toddlers for health supervision at a tertiary care hospital in the United Republic of Tanzania. Data on personal information, depression, perceived benefits, perceived barriers, perceived self-efficacy, social support, situational influences, and maternal feeding practices were collected using self-administered questionnaires between September 2021 and November 2021. Descriptive statistics, correlations, and multiple regression analysis were employed for the analysis. Results All the factors examined in the study accounted for 18.9% of the variance explained in maternal feeding practices. Significantly, only two factors, perceived self-efficacy (β = 0.32, p <0.001) and situational influences (β = 0.24, p <0.001), could predict maternal feeding practices. Conclusion Perceived self-efficacy and situational influences emerged as the primary influencing factors on maternal feeding practices for toddlers. Pediatric nurses should address these modifiable factors when developing nursing interventions and strategies to promote a healthy nutritional status in toddlers.
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Mulugeta Y, Mohammed AA, Ibrahim IM, Getachew G, Ahmed KY. Postpartum depression and associated factors in Afar Region, northeast Ethiopia. Heliyon 2023; 9:e19914. [PMID: 37809513 PMCID: PMC10559328 DOI: 10.1016/j.heliyon.2023.e19914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/11/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Background To effectively address the burden of postpartum depression (PPD), it is crucial to gain a comprehensive understanding of its magnitude and the factors associated with it in the pastoral and hot region of the Afar Region. This will help identify the progress made thus far and highlight areas that require further attention to accelerate efforts toward reducing the impact of PPD. Notably, no previous study has examined the prevalence and associated factors of PPD specifically in pastoral communities within Ethiopia, including the Afar Region. Accordingly, we investigated the prevalence and associated factors of PPD among postpartum women in the Afar Region, Northeast Ethiopia. Methods An institution-based cross-sectional study was conducted in the Awsi Rasu Zone of Afar Regional State from June to July 2021. The study employed a systematic random sampling method to select a total of 302 postpartum mothers who had visited the Expanded Program of Immunisation (EPI) clinics in public health facilities within the Awsi Rasu Zone of the Afar Region. The measurement of PPD was performed using the Edinburgh Postnatal Depression Scale (EPDS). Multivariable binary logistic regression modelling was used to investigate associations between sociodemographic, obstetric and health service, and psychosocial factors with PPD. Results The overall prevalence of PPD was 37.4% with a 95% confidence interval (CI) from 32.0% to 43.0%. Postpartum women who attained high school education were associated with a lower odds of PPD compared to those who did not attain formal schooling (adjusted odds ratio [AOR] = 0.31; 95% CI: 0.12, 0.82). Postpartum women with a family history of mental illness (AOR = 2.34; 95% CI: 1.24, 4.41), those who had trouble in infant feeding (AOR = 4.26; 95% CI: 2.32, 7.83), and those who experienced intimate partner violence (AOR = 3.09; 95% CI: 1.58, 6.04) were positively associated with PPD. Conclusion The results of our study revealed that the prevalence of PPD in the Awsi Rasu Zone of the Afar Region is higher than both the national and global averages. The findings also highlighted the need for targeted interventions addressing the needs of pastoral postpartum women who experience various stressors, such as feeding difficulties and intimate partner violence.
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Affiliation(s)
| | - Ahmed Adem Mohammed
- Department of Nursing, College of Medicine and Health Science, Samara University, PO Box: 132, Samara, Ethiopia
| | - Ibrahim Mohammed Ibrahim
- Department of Midwifery, College of Medicine and Health Science, Samara University, PO Box: 132, Samara, Ethiopia
| | | | - Kedir Y. Ahmed
- Department of Public Health, College of Medicine and Health Science, Samara University, PO Box: 132, Samara, Ethiopia
- Rural Health Research Institute, Charles Sturt University, Orange, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
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Sasaki K, Watanabe M, Ximenes L, Pacheco C, Higuchi M. Associations between infant and young child feeding (IYCF) practice and attitudes toward intimate partner violence (IPV) in Timor-Leste. BMC Womens Health 2023; 23:65. [PMID: 36782221 PMCID: PMC9926698 DOI: 10.1186/s12905-023-02206-5] [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: 04/07/2022] [Accepted: 02/01/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Both the proportions of malnutrition among children and women's justifying partner's intimate partner violence (IPV) are high in Timor-Leste. However, no study has looked at the associations between acceptable infant and young child feeding (IYCF) and women's attitudes toward IPV, as a women's empowerment index. In light of the lack of evidence described above, the study objective was to examine associations between IYCF practice and attitudes toward IPV in Timor-Leste and other women's characteristics. METHODS A secondary analysis of children's records from the Demographic and Health Survey Timor-Leste 2016 was conducted using a cross-sectional design. Univariable and multivariable analyses were performed to investigate associations between acceptable IYCF and women's agreement that men are justified in beating their wives for five specific reasons and socio-economic factors. RESULTS The day before the survey, 33.4% of mothers gave their child at least the minimum dietary diversity and 46.4% at least the minimum meal frequency; and 15.0% practiced acceptable IYCF. Among all respondents, 17.5% did not agree that all five specific reasons for beating are justified. The adjusted odds ratio (aOR) of acceptable IYCF for mothers who did not agree was 1.51 (95% confidence interval [CI] 1.09-2.09) compared to those who agreed. The aOR of acceptable IYCF for mothers who worked outside the home was 1.48 (95% CI 1.16-1.96) compared to those who did not. Compared to mothers in the poorest quintile, the aORs of acceptable IYCF among those in the poorer, middle, richer, and richest quintiles were 1.33 (95% CI 0.83-2.21), 1.90 (95% CI 1.15-3.14), 2.01 (95% CI 1.17-3,45), and 2.99 (95% CI 1.63-5.50) respectively. Compared to children aged 6-11 months, the aORs of acceptable IYCF for children aged 12-17 months and 18-23 months were 2.14 (95% CI 1.54-2.97) and 1.63 (95% CI 1.14-2.34), respectively. CONCLUSIONS Acceptable IYCF was associated with mothers' attitudes toward wife-beating, wealth quintile, and mother's work. Factors that we found associated with IYCF were all related to women's empowerment. It implies that women's empowerment is a key to improving mothers' childcare. Merely promoting a specific childcare practice may not be enough for better child health.
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Affiliation(s)
- Kyoko Sasaki
- grid.260433.00000 0001 0728 1069Nagoya City University Graduate School of Nursing, Nagoya, Japan
| | - Mika Watanabe
- grid.260433.00000 0001 0728 1069Nagoya City University Graduate School of Nursing, Nagoya, Japan
| | - Leonard Ximenes
- grid.449844.1Faculty of Public Health, Universidade da Paz, Dili, Timor-Leste
| | - Cipriano Pacheco
- grid.449844.1Faculty of Public Health, Universidade da Paz, Dili, Timor-Leste
| | - Michiyo Higuchi
- Nagoya City University Graduate School of Nursing, Nagoya, Japan.
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Abou-Rizk J, Jeremias T, Cocuz G, Nasreddine L, Jomaa L, Hwalla N, Frank J, Scherbaum V. Food insecurity, low dietary diversity and poor mental health among Syrian refugee mothers living in vulnerable areas of Greater Beirut, Lebanon. Br J Nutr 2022; 128:1832-1847. [PMID: 34842129 PMCID: PMC9592946 DOI: 10.1017/s0007114521004724] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 11/08/2021] [Accepted: 11/25/2021] [Indexed: 12/29/2022]
Abstract
Syrian refugees in Lebanon are facing vulnerabilities that are affecting their food insecurity (FI) levels. The objectives of this study were to measure dietary diversity, FI and mental health status of Syrian refugee mothers in Lebanon and to explore its associations with their anaemia and nutritional status. A cross-sectional study was conducted among mothers with children under 5 years (n 433) in Greater Beirut, Lebanon. Dietary diversity was measured using the Minimum Dietary Diversity for Women (MDD-W) of reproductive age and FI using the global Food Insecurity Experience Scale at the individual level. Depression and post-traumatic stress disorder (PTSD) were measured to assess the maternal mental health status. Data on socio-economic characteristics, anthropometric measurements and Hb concentrations were collected. Overall, 63·3 % of the mothers had a low dietary diversity (LDD) and 34·4 % were moderately to severely food insecure, with 12·5 % being severely food insecure. The prevalence of PTSD, moderate depression and severe depression was 13·2, 11·1 and 9·9 %, respectively. A significant correlation was found between LDD and FI (P < 0·001). Low income was significantly associated with LDD and FI. Poor mental health was significantly associated with FI. LDD and FI were not associated with anaemia and nutritional status of mothers. Low-income households had significantly higher intakes of grains and refined starchy staples, whereas high-income households consumed more nutritious foods and sweets. Evidence of inadequate diet quality, FI and poor mental health among Syrian refugee mothers in Lebanon is presented. Multifaceted actions are needed to reduce FI and improve dietary diversity.
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Affiliation(s)
- Joana Abou-Rizk
- Institute of Nutritional Sciences (140), University of Hohenheim, Stuttgart, Germany
| | - Theresa Jeremias
- Institute of Nutritional Sciences (140), University of Hohenheim, Stuttgart, Germany
| | - Georgiana Cocuz
- Institute of Nutritional Sciences (140), University of Hohenheim, Stuttgart, Germany
| | - Lara Nasreddine
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Lamis Jomaa
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Jan Frank
- Institute of Nutritional Sciences (140), University of Hohenheim, Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutritional Sciences (140), University of Hohenheim, Stuttgart, Germany
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