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Frongillo EA, Suresh S, Thapa DK, Cunningham K, Pandey Rana P, Adhikari RP, Kole S, Pun B, Kshetri I, Adhikari DP, Klemm R. Impact of Suaahara, an integrated nutrition programme, on maternal and child nutrition at scale in Nepal. MATERNAL & CHILD NUTRITION 2024:e13630. [PMID: 38342986 DOI: 10.1111/mcn.13630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/13/2024]
Abstract
Suaahara was an innovative, complex, multi-sectoral, large-scale, nutrition programme in Nepal to increase exposure to nutrition-related information and services, improve nutrition-related knowledge and practices among pregnant women and mothers of infants and young children, and improve their nutrition. This study evaluated the effectiveness of Suaahara to improve nutrition and nutrition-related practices by comparing changes over 10 years between intervention and comparison districts. The samples of households at baseline in 2012 and endline in 2022 were 2040 and 2480, respectively, from 120 old wards. The impact was estimated using intent-to-treat regression models in which survey year, arm and their interaction were fixed effects, accounting for district clustering, with the interaction estimating differences between arms in changes over time. The intervention, relative to comparison, reduced maternal underweight by 8.43 percentage points (p < 0.001), consistent with improved maternal and fetal condition that was manifested as the greater length of 0.761 z-scores (p = 0.004) of infants 0-5.9 months. Complementary feeding practices with children between 6 and 23.9 months of age improved more in the intervention than comparison districts: child dietary diversity by 0.294 food groups (p = 0.072) and minimum dietary diversity by 9.51 percentage points (p = 0.028), feeding sick child more (p = 0.002) and administering oral rehydration solution and zinc for diarrhoea (p = 0.057) by about 17 percentage points each, and minimum meal frequency (p = 0.004) and minimum acceptable diet (p = 0.022) by about 15 percentage points each. Substantial impacts were demonstrated despite political restructuring, earthquakes, and other major challenges that Nepal and Suaahara faced and limitations in statistical power because of the reduced number of districts that then could be included in the study. Registered at clinicaltrials.gov with identifier NCT05448287.
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Affiliation(s)
- Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | | | - Deependra K Thapa
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
| | | | | | | | - Subir Kole
- Helen Keller International, New York City, New York, USA
| | - Bhim Pun
- Helen Keller International, New York City, New York, USA
| | - Indra Kshetri
- Helen Keller International, New York City, New York, USA
| | | | - Rolf Klemm
- Helen Keller International, New York City, New York, USA
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Hossain MI, Kabir S, Zinia FA. Gender disparity in minimum dietary diversity failure among currently breastfed children aged 6-23 months in Bangladesh: evidence from Bangladesh Multiple Indicator Cluster Survey, 2019. J Nutr Sci 2023; 12:e107. [PMID: 37964976 PMCID: PMC10641693 DOI: 10.1017/jns.2023.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/03/2023] [Accepted: 10/06/2023] [Indexed: 11/16/2023] Open
Abstract
Research on children's dietary diversity plays a crucial role in designing effective health interventions. Thus, this study aimed to identify the factors contributing to minimum dietary diversity failure (MDDF) among male and female children aged 6-23 months in Bangladesh. The data for this study was obtained from the Bangladesh Multiple Indicator Cluster Survey, 2019, which included children currently breastfed within a specific age range. Multivariable binary logistic regression was employed to assess the strength and significance of the association. The findings revealed that approximately 59⋅4 % of children in Bangladesh experienced MDDF, with 57⋅8 % of male children and 61 % of female children affected. Proportion test uncovered a significant gender disparity (χ2=6⋅58, P-value = 0⋅01) among children aged 6-23 months. However, the multivariable binary logistic regression analysis revealed that both male and female children shared common risk factors for MDDF, which included child age, maternal educational status, wealth status, number of antenatal care visits, and division. In our study, we observed varied spatial patterns in minimal dietary diversity. Sherpur, Netrokona, Sunamganj, and Sylhet districts showed the highest failure rates. Notably, all are flood-affected areas, impacting food availability and diversity. For targeted regional development programmes, district mapping results may offer valuable insights to policymakers, especially in areas with a high prevalence of dietary diversity failure. By understanding these risk factors, policymakers and stakeholders can implement targeted strategies to improve dietary diversity among children, promoting better health and well-being for the young population in Bangladesh.
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Affiliation(s)
- Md. Ismail Hossain
- Department of Statistics, Jagannath University, Dhaka 1100, Bangladesh
- Department of Mathematics and Natural Sciences, BRAC University, Dhaka 1212, Bangladesh
| | - Samia Kabir
- Department of Statistics, Jagannath University, Dhaka 1100, Bangladesh
| | - Faozia Afia Zinia
- Department of Statistics, Jagannath University, Dhaka 1100, Bangladesh
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Cunningham K, Pandey Rana P, Rahman MM, Sen Gupta A, Manandhar S, Frongillo EA. Text messages to improve child diets: Formative research findings and protocol of a randomised controlled trial in Nepal. MATERNAL & CHILD NUTRITION 2023. [PMID: 36864635 DOI: 10.1111/mcn.13490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Given the role of malnutrition in childhood morbidity and mortality, the prioritisation of maternal and child nutrition programmes has grown significantly in the 21st century. Policies and programmes aim to improve infant and young child feeding, but questions persist about the most effective combination of interventions to achieve desired behaviour change. There is increasing interest in mobile-based interventions globally, but scant evidence exists to guide donors, policymakers and programme implementers on their effectiveness. Formative research was conducted to assess the feasibility and acceptance of text message-based interventions and to guide the final design of the text message intervention. This protocol is for a cluster-randomised controlled trial to test the effectiveness of adding text messaging to other ongoing SBC interventions to promote egg consumption, dietary diversity and other ideal dietary practices, particularly among children 12-23 months of age in Kanchanpur, Nepal. The trial findings will contribute to the emerging body of evidence on the effectiveness of using text messages for behaviour change, specifically for young child dietary outcomes in South Asia. Recent studies have suggested that mobile-based interventions alone may be insufficient but valuable when added to other social and behavioural interventions; this trial will help to provide evidence for or against this emerging theory. This trial was registered at ClinicalTrials.gov on 11 March 2019 (ID: NCT03926689) and has been updated twice.
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Affiliation(s)
- Kenda Cunningham
- Suaahara II, Helen Keller International, New York, New York, USA.,Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, England
| | | | - Mohammad Masudur Rahman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Aman Sen Gupta
- Suaahara II, Helen Keller International, Kathmandu, Nepal
| | - Shraddha Manandhar
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, England
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Klemm GC, Kayanda R, Kazoba A, McCann J, Nnally LP, Dickin KL. Translating Multisectoral Nutrition Policy into Community Practice: Participation of Nutrition Officers in Tanzania Fosters Effective Collaborative Strategies to Improve Child Nutrition. Curr Dev Nutr 2022; 6:nzac030. [PMID: 35415387 PMCID: PMC8992576 DOI: 10.1093/cdn/nzac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/28/2022] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Globally, multisectoral coordination for nutrition is needed to tackle multiple determinants of undernutrition and address unacceptably high rates of stunting in young children. Tanzania has strong national policies and implementation plans to strengthen multisectoral nutrition (MSN) governance, yet local actors must transcend sector silos to fully implement MSN actions in communities. Objectives We engaged with Nutrition Officers in Regional Secretariats and District Councils to explore strategies, barriers, and facilitators for creating novel "MSN action teams." Methods An initial "Learning Exchange" workshop gathered input from nutrition staff in 5 regions and invited their participation in mentoring and supporting MSN collaboration. Regional Nutrition Officers piloted action teams in their districts, supporting District Nutrition Officers to create teams of 3-4 officers from relevant sectors (agriculture, community development, health, education) to plan and implement community-based activities consistent with sector priorities and national policy. To learn from stakeholder experiences, longitudinal data were collected through individual semistructured interviews and documentation of activities; 27 officers were interviewed 1-4 times over 14 mo. Results Four districts successfully created action teams that bridged communication gaps between administrators and implementors; made progress on advocacy, collaboration, and budgeting for nutrition; and initiated MSN implementation in communities. Participants identified strategies to overcome challenges to cross-sector collaboration including heavy workloads and limited resources and supervisor buy-in. Based on their experiences and innovations in creating MSN action teams, stakeholders shared valuable recommendations for peer learning across sectors to scale up MSN collaboration. Officers' presentation of insights to regional and district leaders buoyed interest in MSN action teams as a feasible and acceptable approach to strengthen local governance and implementation to improve child nutrition. Conclusions Experience-based input from government officers engaged in novel community and intersectoral collaborations provided actionable guidance for putting national MSN policy into practice and leveraging the capacity of implementation staff.
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Affiliation(s)
- Gina C Klemm
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | | | | | - Juliet McCann
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Luitfrid P Nnally
- Tanzania Food and Nutrition Centre, Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
| | - Katherine L Dickin
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY, USA
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Dallmann D, Marquis GS, Colecraft EK, Kanlisi R, Aidam BA. Maternal Participation Level in a Nutrition-Sensitive Agriculture Intervention Matters for Child Diet and Growth Outcomes in Rural Ghana. Curr Dev Nutr 2022; 6:nzac017. [PMID: 35295712 PMCID: PMC8921653 DOI: 10.1093/cdn/nzac017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/02/2021] [Accepted: 01/27/2022] [Indexed: 11/27/2022] Open
Abstract
Background Little is known about how the level of program participation affects child nutrition in rural interventions. Objectives This study examined the association between participation level in a nutrition-sensitive agriculture intervention and children's diet and anthropometric outcomes in rural Ghana. Methods Nutrition Links was a cluster randomized controlled trial (clinicaltrials.gov NCT01985243), which enrolled caregivers with children (aged less than 2 mo in 2014-2015 and less than 18 mo in 2016-2017). Of the 287 caregivers in 19 intervention communities who enrolled, 233 adopted the intervention and received layer poultry, garden inputs, and weekly child feeding education. The egg production and repayment of poultry were monitored, and feed was sold at the weekly meetings. After endline, the nutrition educators rated each woman who adopted the intervention on a scale [very poor (1) to excellent (5)] for: 1) meeting attendance, 2) egg productivity, 3) feed and poultry loan payment, 4) contributions during meetings, and 5) attentiveness towards group members. Participation level was classified as high, medium, and low by dividing the sum of these 5 items into tertiles; 54 women who did not adopt the intervention were classified as "no participation." Generalized mixed linear models tested the difference in changes in children's diet and anthropometric indices between the participation levels and the control category - 213 caregiver-child dyads in 20 communities who received standard-of-care health and agricultural services. Results Compared with the control category, only high participation was associated with egg consumption [adjusted OR (aOR) = 3.03; 95% CI: 1.15, 7.94]. Both medium and high participation levels were associated with length-for-age z-scores (LAZ)/height-for-age z-scores (HAZ) [adjusted β-coefficients (aβ) = 0.44; 95% CI: 0.16, 0.72 and 0.40; 95% CI: 0.12, 0.67, respectively]. Conclusion These results highlight the importance of promoting and monitoring the level of beneficiary participation to estimate the full potential of nutrition-sensitive agriculture interventions to improve nutritional outcomes.
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Affiliation(s)
- Diana Dallmann
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
| | - Grace S Marquis
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
| | - Esi K Colecraft
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Roland Kanlisi
- Animal Science Department of the University of Ghana, Legon, Ghana
| | - Bridget A Aidam
- Technical Services and Innovation, Action Against Hunger, NY, USA
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Cunningham K, Nagle D, Gupta P, Adhikari RP, Singh S. Associations between parents' exposure to a multisectoral programme and infant and young child feeding practices in Nepal. MATERNAL & CHILD NUTRITION 2021; 17 Suppl 1:e13143. [PMID: 34241957 PMCID: PMC8269143 DOI: 10.1111/mcn.13143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/07/2020] [Accepted: 01/04/2021] [Indexed: 12/28/2022]
Abstract
In Nepal, an at-scale, multisectoral programme-Suaahara (2011-2023)-aims to improve nutrition behaviours. Suaahara II (2016-2023) transitioned from a mother/child dyad focus to explicitly targeting all family members. Evidence is scant, however, regarding how exposure by men to social and behaviour change interventions relates to nutrition outcomes. This study uses a 2019 cross-sectional monitoring dataset to test associations between maternal and male household head exposure to Suaahara II interventions (interacting with a frontline worker, participating in a community event or listening to the Bhanchhin Aama radio programme) and adoption of three infant and young child feeding practices: minimum dietary diversity, minimum acceptable diet and sick child feeding, in households with a child under 2 years (n = 1827). Maternal exposure to Suaahara II had a positive association with minimum dietary diversity (OR: 1.71, 95% CI [1.27, 2.28], P < 0.001), minimum acceptable diet (OR: 1.60, 95% CI [1.19, 2.14], P = 0.002) and increased feeding to a sick child (OR: 2.11, 95% CI [1.41, 3.17], P < 0.001). Male household head exposure was only associated with increased feeding to a sick child (OR: 2.21, 95% CI [1.27, 3.84], P = 0.005). Among households with an exposed mother, having an exposed male household head nearly tripled the odds of appropriate sick child feeding (OR: 2.90, 95% CI [1.57, 5.34], P = 0.001) but was not significantly associated with the other two outcomes. These findings suggest that the relationships between exposure to nutrition programmes and outcomes are complex and further research is needed to understand variation by family member, behavioural outcome and context.
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Affiliation(s)
- Kenda Cunningham
- Helen Keller InternationalNew YorkNew YorkUSA
- Department of Population Health, Faculty of Epidemiology, London School of Hygiene and Tropical MedicineLondonEngland
| | - Devin Nagle
- Heilbrunn Department of Population and Family Health, Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Poonam Gupta
- Department of International Health, Johns Hopkins Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
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Ruducha J, Bhatia A, Mann C, Torlesse H. Multisectoral nutrition planning in Nepal: Evidence from an organizational network analysis. MATERNAL AND CHILD NUTRITION 2021; 18 Suppl 1:e13112. [PMID: 33661554 PMCID: PMC8770655 DOI: 10.1111/mcn.13112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/22/2020] [Accepted: 11/03/2020] [Indexed: 01/10/2023]
Abstract
Multisectoral approaches are central to the global Scaling Up Nutrition (SUN) movement and the Sustainable Development Goals. Nepal joined SUN in 2011 and approved the first 5‐year Multisectoral Nutrition Plan (MSNP) in 2012, covering 2013–2017. This mixed methods study draws on organizational network analysis (ONA) and qualitative interviews with a sample of 22 organizations to examine (1) levels of engagement and network dynamics among government sectors and development organizations and (2) milestones and processes in the development and implementation of Nepal's MSNP. Findings suggest that the development of the MSNP was related to the high density of organizational connections; the leadership role of the Nepal's National Planning Commission and the National Nutrition and Food Security Secretariat; and the bridging roles played by a few government ministries and UN agencies that linked organizations that did not have direct relationships with each other. Specialized roles were observed for the three types of working relationships: policy dialogue, strategic planning and implementation. Partners were less connected on MSNP implementation than for policy dialogue and strategic planning, which may have constrained collaborative scale‐up efforts. The Ministry of Agricultural Development, in particular, was the conduit for connecting non‐health sectors into the broader network. Our study offers insights into the structure and dynamics of multisectoral planning in Nepal. It also contributes to a small but growing literature that illustrates how ONA can be applied to measure and use network results to elucidate the processes for strengthening multisectoral planning and implementation of nutrition‐specific and nutrition‐sensitive interventions.
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Affiliation(s)
- Jenny Ruducha
- Braintree Global Health, Vancouver, British Columbia, Canada
| | - Amiya Bhatia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Carlyn Mann
- Braintree Global Health, Vancouver, British Columbia, Canada
| | - Harriet Torlesse
- Nutrition Section, UNICEF Regional Office for South Asia, Kathmandu, Nepal
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Dickin KL, Litvin K, McCann JK, Coleman FM. Exploring the Influence of Social Norms on Complementary Feeding: A Scoping Review of Observational, Intervention, and Effectiveness Studies. Curr Dev Nutr 2021; 5:nzab001. [PMID: 33718753 PMCID: PMC7937492 DOI: 10.1093/cdn/nzab001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 01/09/2023] Open
Abstract
The influence of social norms on child feeding is recognized, but guidance is lacking on how to address norms and related perceptions that hinder or support positive nutrition practices. We reviewed recent peer-reviewed and grey literature to summarize social norms relevant to complementary feeding (CF), intervention approaches that address norms, and their impacts on social norms and CF outcomes. Many reports described various norms, customs, and perceptions related to appropriate foods for young children, parenting practices, gender, and family roles, but rarely explored how they motivated behavior. Community engagement and media interventions addressed norms through facilitated discussions, challenging negative norms, portraying positive norms, engaging emotions, and correcting misperceptions. Evaluations of norms-focused interventions reported improved CF practices, but few assessed impacts on social norms. Although multiple contextual factors influence CF practices, evidence suggests the feasibility and effectiveness of addressing social norms as one component of programs to improve CF practices.
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Affiliation(s)
- Katherine L Dickin
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
- USAID Advancing Nutrition, Crystal City, VA, USA
| | - Kate Litvin
- USAID Advancing Nutrition, Crystal City, VA, USA
| | - Juliet K McCann
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Fiona M Coleman
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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Assessing the challenges to women's access and implementation of text messages for nutrition behaviour change in rural Tanzania. Public Health Nutr 2020; 24:1478-1491. [PMID: 33118901 PMCID: PMC8025099 DOI: 10.1017/s1368980020003742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This process evaluation aimed to understand factors affecting the implementation of a government-sponsored short message service (SMS) programme for delivering nutrition information to rural populations, including message access, acceptability and putting messages into action. DESIGN The study was nested within a larger randomised controlled trial. Cross-sectional data collection included structured surveys and in-depth interviews. Data were analysed for key trends and themes using Stata and ATLAS.ti software. SETTING The study took place in Tanzania's Mtwara region. PARTICIPANTS Surveys were conducted with 205 women and 93 men already enrolled in the randomised controlled trial. A sub-set of 30 women and 14 men participated in the in-depth interviews. RESULTS Among women relying on a spouse's phone, sharing arrangements impeded regular SMS access; men were commonly away from home, forgot to share SMS or did not share them in women's preferred way. Phone-owning women faced challenges related to charging their phones and defective handsets. Once SMS were delivered, most participants viewed them as trustworthy and comprehensible. However, economic conditions limited the feasibility of applying certain recommendations, such as feeding meat to toddlers. A sub-set of participants concurrently enrolled in an interpersonal counselling (IPC) intervention indicated that the SMS provided reminders of lessons learned during the IPC; yet, the SMS did not help participants contextualise information and overcome the challenges of putting that information into practice. CONCLUSIONS The challenges to accessing and implementing SMS services highlighted here suggest that such platforms may work well as one component of a comprehensive nutrition intervention, yet not as an isolated effort.
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Broaddus-Shea ET, Shrestha BT, Rana PP, Winch PJ, Underwood CR. Navigating structural barriers to the implementation of agriculture-nutrition programs in Nepal. Food Secur 2020. [DOI: 10.1007/s12571-020-01031-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kim C, Mansoor GF, Paya PM, Ludin MH, Ahrar MJ, Mashal MO, Todd CS. Review of policies, data, and interventions to improve maternal nutrition in Afghanistan. MATERNAL AND CHILD NUTRITION 2020; 16:e13003. [PMID: 32293806 PMCID: PMC7507462 DOI: 10.1111/mcn.13003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 03/12/2020] [Accepted: 03/19/2020] [Indexed: 11/27/2022]
Abstract
Malnutrition contributes to direct and indirect causes of maternal mortality, which is particularly high in Afghanistan. Women's nutritional status before, during, and after pregnancy affects their own well‐being and mortality risk and their children's health outcomes. Though maternal nutrition interventions have documented positive impact on select child health outcomes, there are limited data regarding the effects of maternal nutrition interventions on maternal health outcomes globally. This scoping review maps policies, data, and interventions aiming to address poor maternal nutrition outcomes in Afghanistan. We used broad search categories and approaches including database and website searches, hand searches of reference lists from relevant articles, policy and programme document requests, and key informant interviews. Inclusion and exclusion criteria were developed by type of source document, such as studies with measures related to maternal nutrition, relevant policies and strategies, and programmatic research or evaluation by a third party with explicit interventions targeting maternal nutrition. We abstracted documents systematically, summarized content, and synthesized data. We included 20 policies and strategies, 29 data reports, and nine intervention evaluations. The availability of maternal nutrition intervention data and the inclusion of nutrition indicators, such as minimum dietary diversity, have increased substantially since 2013, yet few nutrition evaluations and population surveys include maternal outcomes as primary or even secondary outcomes. There is little evidence on the effectiveness of interventions that target maternal nutrition in Afghanistan. Policies and strategies more recently have shifted towards multisectoral efforts and specifically target nutrition needs of adolescent girls and women of reproductive age. This scoping review presents evidence from more than 10 years of efforts to improve the maternal nutrition status of Afghan women. We recommend a combination of investments in measuring maternal nutrition indicators and improving maternal nutrition knowledge and behaviours.
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Affiliation(s)
- Christine Kim
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ghulam Farooq Mansoor
- FHI 360/Integrated Hygiene, Sanitation, and Nutrition (IHSAN) project, Kabul, Afghanistan
| | - Pir Mohammad Paya
- FHI 360/Integrated Hygiene, Sanitation, and Nutrition (IHSAN) project, Kabul, Afghanistan
| | - Mohammad Homayoun Ludin
- Public Nutrition Directorate, Ministry of Public Health, Islamic Republic of Afghanistan, Kabul, Afghanistan
| | - Mohammad Javed Ahrar
- Rural Water Supply and Irrigation Programme (RuWATSIP) Department, Ministry of Rural Rehabilitation and Development (MRRD), Islamic Republic of Afghanistan, Kabul, Afghanistan
| | - Mohammad Omar Mashal
- FHI 360/Integrated Hygiene, Sanitation, and Nutrition (IHSAN) project, Kabul, Afghanistan
| | - Catherine S Todd
- Division of Reproductive, Maternal, Newborn, and Child Health, FHI 360, Durham, North Carolina, USA
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Thorne-Lyman AL, Parajuli K, Paudyal N, Chitekwe S, Shrestha R, Manandhar DL, West KP. To see, hear, and live: 25 years of the vitamin A programme in Nepal. MATERNAL AND CHILD NUTRITION 2020; 18 Suppl 1:e12954. [PMID: 32108438 PMCID: PMC8770656 DOI: 10.1111/mcn.12954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/20/2019] [Accepted: 12/29/2019] [Indexed: 11/30/2022]
Abstract
Nepal has a rich history of vitamin A research and a national, biannual preschool vitamin A supplementation (VAS) programme that has sustained high coverage for 25 years despite many challenges, including conflict. Key elements of programme success have included (a) evidence of a 26–30% reduction in child mortality from two, in‐country randomized trials; (b) strong political and donor support; (c) positioning local female community health volunteers as key operatives; (d) nationwide community mobilization and demand creation for the programme; and (e) gradual expansion of the programme over a period of several years, conducting and integrating delivery research, and monitoring to allow new approaches to be tested and adapted to available resources. The VAS network has served as a platform for delivering other services, including anthelmintic treatment and screening for acute malnutrition. We estimate that VAS has saved over 45,000 young lives over the past 15 years of attained national coverage. Consumption of vitamin A‐ and carotenoid‐rich foods by children and women nationally remains low, indicating that supplementation is still needed. Current challenges and opportunities to improving vitamin A status include lower VAS coverage among younger children (infants 6–11 months of age), finding ways to increase availability and access to dietary vitamin A sources, and ensuring local programme investments given the recent decentralization of the government.
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Affiliation(s)
- Andrew L Thorne-Lyman
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kedar Parajuli
- Nutrition Section, Family Welfare Division, Ministry of Health and Population Nepal, Kathmandu, Nepal
| | | | | | - Ram Shrestha
- Nepali Technical Assistance Group, Kathmandu, Nepal
| | | | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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