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May TA, Koskey KLK, Provinzano K. Developing and Validating the Preschool Nutrition Education Practices Survey. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:545-555. [PMID: 38691080 DOI: 10.1016/j.jneb.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Validate the Preschool Nutrition Education Practices Survey. DESIGN Iterative approach combining design-based research and Standards for Educational and Psychological Testing. SETTING Los Angeles, CA and Philadelphia, PA Early Care and Education (ECE) classrooms. PARTICIPANTS Expert panel members (n = 7); ECE teachers: interviews (n = 8), pilot survey (n = 31), and final survey (n = 136). VARIABLES MEASURED Early care and education nutrition education practices used in the classroom either during class time or mealtime. ANALYSIS Qualitative content analysis was implemented for content, response process, and consequences of testing validity evidence. Rasch rating scale analysis was conducted for the response process and internal structure validity and reliability evidence. RESULTS Qualitative field-testing produced strong content, response process, and consequences of testing validity evidence to inform survey modifications. Quantitative field-testing generated a psychometrically sound, well-targeted 12-item survey on a 4-point frequency scale with excellent item and person reliability (0.97 and 0.93 respectively) and separation (5.36 and 3.77 respectively); good Rasch Principal Components Analysis findings (60.3%); and productive item fit statistics (0.50-1.50 logits). CONCLUSIONS AND IMPLICATIONS Robust validity (content, response process, consequences of testing, internal structure) and reliability evidence were demonstrated for using the Preschool Nutrition Education Practices Survey to assess ECE teachers' use of nutrition education practices. Future research is needed to examine its relationship to other variables, such as nutrition teaching efficacy, and to determine its ability to detect change in ECE nutrition education practices over time and across groups.
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Affiliation(s)
- Toni A May
- School of Education, Drexel University, Philadelphia, PA.
| | | | - Kathleen Provinzano
- Departments of Teaching, Learning, and Educational Leadership and Social Work, College of Community and Public Affairs, The State University of New York - Binghamton University, Binghamton, NY
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Varela EG, Shelnutt KP, Miller DM, Zeldman J, Mobley AR. Policy, Systems, and Environmental Strategies to Support Healthy Eating Behaviors in Early Childhood: A Scoping Review of Existing Evaluation Tools. J Acad Nutr Diet 2024:S2212-2672(24)00720-2. [PMID: 39033923 DOI: 10.1016/j.jand.2024.07.160] [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: 05/26/2023] [Revised: 06/24/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Policy, systems, and environmental (PSE) change strategies aimed at supporting healthy eating behaviors work to enhance optimal nutrition by making healthy foods more available and accessible in the community. PSE change strategies can complement and strengthen knowledge, skills, and behaviors obtained through individual-level nutrition education. OBJECTIVE This scoping review aimed to identify existing literature evaluating early childhood (ie, children younger than age 5 years) PSE change strategies supporting healthy eating behaviors and to describe the evaluation tools used to assess the identified PSE change strategies. METHODS Three databases (PubMed, Cumulated Index in Nursing and Allied Health Literature, and Web of Science) were used to systematically search for articles published between 2013 and 2023 written in English and conducted in the United States that evaluated PSE change strategies supporting healthy eating behaviors in young children (ie, children younger than age 5 years). Two study members conducted the review, discussing and reconciling discrepancies until a consensus was reached for interobserver reliability. RESULTS Findings from this review identified 48 studies evaluating early childhood PSE change strategies supporting healthy eating behaviors, with 36 studies using 25 PSE-focused evaluation tools to evaluate these strategies. Most tools (80%) assessed PSE change strategies supporting access and availability of healthy food and beverage options in early childhood education settings. Studies did not evaluate child-level outcomes (ie, attitudes, preferences, and behaviors) to showcase improvement of early childhood nutrition. Only 60% of the tools reported evidence of validity or reliability. CONCLUSIONS Most of the studies identified in this scoping review were aimed to evaluate healthy eating PSE change strategies focused on improving access to and availability of healthy foods and beverages in early childhood education settings. Future research is needed to develop and validate PSE-focused evaluation tools assessing child-level healthy eating practices and behaviors.
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Affiliation(s)
- Elder Garcia Varela
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Karla P Shelnutt
- Department of Family, Youth & Community Sciences, University of Florida, Gainesville, Florida
| | - David M Miller
- Collaborative Assessment and Program Evaluation Services, School of Human Development and Organizational Studies in Education, College of Education, University of Florida, Gainesville, Florida
| | - Jamie Zeldman
- Department of Health Education and Behavior, University of Florida, Gainesville, Florida
| | - Amy R Mobley
- Department of Health Education and Behavior, University of Florida, Gainesville, Florida.
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Tran LM, Nguyen PH, Young MF, Martorell R, Ramakrishnan U. The relationships between optimal infant feeding practices and child development and attained height at age 2 years and 6-7 years. MATERNAL & CHILD NUTRITION 2024; 20:e13631. [PMID: 38450914 PMCID: PMC11168365 DOI: 10.1111/mcn.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/31/2023] [Accepted: 01/23/2024] [Indexed: 03/08/2024]
Abstract
Limited evidence exists on the long-term effects of early feeding practices on child growth and development. We examined the relationships between infant feeding practices and child height and development at ages 2 and 6-7 years. We studied 885 mother-child dyads from a randomized controlled trial of preconception supplementation in Vietnam. Early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), breastfeeding (BF) duration and minimum dietary diversity (MDD) were assessed using World Health Organization (WHO) guidelines. Child development was assessed by the Bayley Scales of Infant Development-III at 2 years and the Wechsler Intelligence Scale for Children® - IV at 6-7 years. Child height-for-age z-score (HAZ) was calculated from child height and age. Multivariable regression and structural equation models were used in analyses that controlled for confounding. EIBF and EBF at 6 months occurred in 52% and 62% of children, respectively. Mean breastfeeding duration was 18 months and 83% achieved MDD at 1 year. EIBF was associated with motor (β = 0.13, 95% confidence interval [CI]: 0.00, 0.28) and cognitive development at 2 years (β = 0.12, 95% CI: -0.01, 0.26), which in turn were positively associated with cognitive development at 6-7 years. EBF was directly associated with development at 6-7 years (β = 0.21, 95% CI:0.08, 0.34) whereas motor and cognitive development at 2 years explained 41%-75% of the relationship between EIBF and development at 6-7 years. HAZ at 2 years also mediated 70% of the association between MDD at 1 year and HAZ at 6-7 years. BF duration was not associated with child development and HAZ. Early infant feeding practices, especially EIBF and EBF, have important long-term implications for optimizing child linear growth and cognition as they begin school.
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Affiliation(s)
- Lan Mai Tran
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate SchoolEmory UniversityAtlantaGeorgiaUSA
| | - Phuong H. Nguyen
- Nutrition, Diets, and Health Unit, International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
- Thai Nguyen University of Pharmacy and MedicineThai NguyenVietnam
| | - Melissa F. Young
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate SchoolEmory UniversityAtlantaGeorgiaUSA
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate SchoolEmory UniversityAtlantaGeorgiaUSA
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate SchoolEmory UniversityAtlantaGeorgiaUSA
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Jensen CL, Sanga E, Kitt H, PrayGod G, Kunzi H, Setebe T, Filteau S, Webster J, Gladstone M, Olsen MF. Developing a context-relevant psychosocial stimulation intervention to promote cognitive development of children with severe acute malnutrition in Mwanza, Tanzania. PLoS One 2024; 19:e0285240. [PMID: 38722956 PMCID: PMC11081340 DOI: 10.1371/journal.pone.0285240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/15/2024] [Indexed: 05/13/2024] Open
Abstract
More than 250 million children will not meet their developmental potential due to poverty and malnutrition. Psychosocial stimulation has shown promising effects for improving development in children exposed to severe acute malnutrition (SAM) but programs are rarely implemented. In this study, we used qualitative methods to inform the development of a psychosocial stimulation programme to be integrated with SAM treatment in Mwanza, Tanzania. We conducted in-depth interviews with seven caregivers of children recently treated for SAM and nine professionals in early child development. We used thematic content analysis and group feedback sessions and organised our results within the Nurturing Care Framework. Common barriers to stimulate child development included financial and food insecurity, competing time demands, low awareness about importance of responsive caregiving and stimulating environment, poor father involvement, and gender inequality. Caregivers and professionals suggested that community-based support after SAM treatment and counselling on psychosocial stimulation would be helpful, e.g., how to create homemade toys and stimulate through involvement in everyday chores. Based on the findings of this study we developed a context-relevant psychosocial stimulation programme. Some issues identified were structural highlighting the need for programmes to be linked with broader supportive initiatives.
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Affiliation(s)
- Cecilie L. Jensen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Erica Sanga
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Heather Kitt
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - George PrayGod
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Happiness Kunzi
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Theresia Setebe
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jayne Webster
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Melissa Gladstone
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Mette F. Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
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Jeong J, Ahun MN, Gunaratna NS, Ambikapathi R, Mapendo F, Galvin L, Kieffer MP, Mwanyika-Sando M, Mosha D, O'Malley SF, Verissimo CK, PrayGod G, Yousafzai AK. Effects of engaging fathers and bundling parenting and nutrition interventions on early child development and maternal and paternal parenting in Mara, Tanzania: a factorial cluster-randomized controlled trial. J Child Psychol Psychiatry 2024; 65:694-709. [PMID: 37800367 DOI: 10.1111/jcpp.13897] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Multicomponent interventions are needed to address the various co-occurring risks that compromise early child nutrition and development. We compared the independent and combined effects of engaging fathers and bundling parenting components into a nutrition intervention on early child development (ECD) and parenting outcomes. METHODS We conducted a 2×2 factorial cluster-randomized controlled trial across 80 villages in Mara Region, Tanzania, also known as EFFECTS (Engaging Fathers for Effective Child Nutrition and Development in Tanzania; ClinicalTrials.gov, NCT03759821). Households with children under 18 months of age residing with their mother and father were enrolled. Villages were randomly assigned to one of five groups: a nutrition intervention for mothers, a nutrition intervention for couples, a bundled nutrition and parenting intervention for mothers, a bundled intervention for couples, and a standard-of-care control. Interventions were delivered by trained community health workers through peer groups and home visits over 12 months. Mothers, fathers, and children were assessed at baseline, midline, and endline or postintervention. We used a difference-in-difference approach with intention-to-treat analysis to estimate intervention effects on ECD (Bayley Scales of Infant and Toddler Development, third edition) and maternal and paternal parenting and psychosocial well-being. RESULTS Between October 29, 2018, and May 24, 2019, 960 households were enrolled (n = 192 per arm). Compared to nutrition interventions, bundled interventions improved children's cognitive (β = .18 [95% CI: 0.01, 0.36]) and receptive language development (β = .23 [0.04, 0.41]). There were no differences between interventions for other ECD domains. Compared to nutrition interventions, bundled interventions achieved additional benefits on maternal stimulation (β = .21 [0.04, 0.38]) and availability of home learning materials (β = .25 [0.07-0.43]) and reduced paternal parenting distress (β = -.34 [-0.55, -0.12]). Compared to interventions with mothers only, interventions that engaged fathers improved paternal stimulation (β = .45 [0.27, 0.63]). CONCLUSIONS Jointly bundling parenting components into nutrition interventions while also engaging both mothers and fathers is most effective for improving maternal and paternal parenting and ECD outcomes.
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Affiliation(s)
- Joshua Jeong
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marilyn N Ahun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Ramya Ambikapathi
- Department of Public Health, Purdue University, West Lafayette, IN, USA
- Department of Global Development, Cornell University, Ithaca, NY, USA
| | - Frank Mapendo
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | | | | | | | - Dominic Mosha
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Savannah Froese O'Malley
- Department of Public Health, Purdue University, West Lafayette, IN, USA
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | | | - George PrayGod
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Lyaatu I, Mosha D, Sando MM, Jeong J, Yousafzai A, PrayGod G, Evarist R, Galvin L, Kieffer MP, Kumalija E, Simpson J, Ambikapathi R, Boncyk M, Matangi E, Gunaratna NS. Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS): study protocol for a five-arm, cluster-randomized trial. Trials 2024; 25:188. [PMID: 38486278 PMCID: PMC10938806 DOI: 10.1186/s13063-022-07002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/12/2022] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Globally, 144 million children under 5 years are undernourished and 250 million do not meet their developmental potential. Multi-input interventions, such as bundled nutrition and parenting interventions, are designed to mitigate risks for multiple child outcomes. There is limited evidence that bundled interventions have additive benefits to nutrition, growth, or development outcomes. These outcomes share common risks; therefore, designing interventions to tackle these risks using a common theory of change may optimize effectiveness. Emerging evidence suggests explicit engagement of fathers may benefit child outcomes, but few trials have tested this or included data collected from fathers. METHODS Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS) is a community-based cluster-randomized controlled trial that will be implemented in the rural Mara Region, Tanzania. The trial aims (1) to test a bundled nutrition and parenting program delivered to mothers' groups, with or without fathers' groups, over 12 months on child and caregiving outcomes compared to a nutrition program alone, and (2) to test nutrition or bundled nutrition and parenting programs delivered to mothers' and fathers' groups over 12 months on child and caregiving outcomes compared to programs delivered to mothers alone. The trial comprises five arms: (1) mothers' groups receiving a nutrition program, (2) mothers' groups receiving a bundled nutrition and parenting program, (3) mothers' and fathers' groups receiving a nutrition program, (4) mothers' and fathers' groups receiving a bundled nutrition and parenting program, and (5) control receiving standard of care health services. The primary outcomes are child dietary diversity and early child development (mental and motor development). Parents with a child under 18 months will be enrolled in peer groups and receive twice monthly intervention by trained community health workers. Data will be collected from mothers, fathers, and children at baseline (pre-intervention), midline, and endline (post-intervention). DISCUSSION EFFECTS will generate evidence on the effects of bundled nutrition and parenting interventions on child nutrition, growth, and development outcomes; determine the benefits of engaging fathers on child, caregiving, and caregiver outcomes; and investigate common and unique pathways between treatments and child outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT03759821. Registered on November 30, 2018.
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Sharma N, Sanjeevi RR, Balasubramanian K, Chahal A, Sharma A, Sidiq M. A Systematic Review on Prevalence of Overweight and Obesity among School Children and Adolescents in Indian Population. Indian J Endocrinol Metab 2024; 28:104-116. [PMID: 38911116 PMCID: PMC11189280 DOI: 10.4103/ijem.ijem_365_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/07/2023] [Accepted: 01/20/2024] [Indexed: 06/25/2024] Open
Abstract
Obesity has erupted as an epidemic around the world. It has set itself as a fast wave among other prevailing specific clusters of non-communicable diseases. The current study reviews and presents an updated meaningful review of the vast research work performed at schools located in different cities of India. A systematic search was conducted in PubMed, Scopus, Google Scholar and PEDro. Studies representing data on obesity and overweight among children in Indian cities were included in the review. A total of 21 articles with 71,466 participants were included in the review for analysis. Obesity developed in childhood and adolescence is greatly associated with heart disease, stroke and cancer (breast and ovarian in women and prostate in men) in the late stage of life. In India, despite being a country with a faster rate of population becoming overweight and obese in urban areas, in contrast, rural areas are still struggling with malnutrition.
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Affiliation(s)
- Nidhi Sharma
- Uttaranchal College of Health Sciences, Uttaranchal University, Prem Nagar, Dehradun, India
| | - Ramya Ramasamy Sanjeevi
- Physical Therapy Department, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Karthick Balasubramanian
- Physical Therapy Department, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Aksh Chahal
- Department of Physiotherapy, School of Medical and Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Abhishek Sharma
- Department of Physiotherapy, Arogyam Institute of Paramedical and Allied Sciences (Affiliated to H.N.B. Uttarakhand Medical Education University) Roorkee, Uttarakhand, India
| | - Mohammad Sidiq
- Department of Physiotherapy, School of Medical and Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
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Mwita FC, PrayGod G, Sanga E, Setebe T, Joseph G, Kunzi H, Webster J, Gladstone M, Searle R, Ahmed M, Hokororo A, Filteau S, Friis H, Briend A, Olsen MF. Developmental and Nutritional Changes in Children with Severe Acute Malnutrition Provided with n-3 Fatty Acids Improved Ready-to-Use Therapeutic Food and Psychosocial Support: A Pilot Study in Tanzania. Nutrients 2024; 16:692. [PMID: 38474820 PMCID: PMC10934689 DOI: 10.3390/nu16050692] [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: 12/30/2023] [Revised: 02/08/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Children with severe acute malnutrition (SAM) are at high risk of impaired development. Contributing causes include the inadequate intake of specific nutrients such as polyunsaturated fatty acids (PUFAs) and a lack of adequate stimulation. We conducted a pilot study assessing developmental and nutritional changes in children with SAM provided with a modified ready-to-use therapeutic food and context-specific psychosocial intervention in Mwanza, Tanzania. We recruited 82 children with SAM (6-36 months) and 88 sex- and age-matched non-malnourished children. We measured child development, using the Malawi Development Assessment Tool (MDAT), measures of family and maternal care for children, and whole-blood PUFA levels. At baseline, the mean total MDAT z-score of children with SAM was lower than non-malnourished children; -2.37 (95% confidence interval: -2.92; -1.82), as were their total n-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) levels. After 8 weeks of intervention, MDAT z-scores improved in all domains, especially fine motor, among children with SAM. Total n-3 and EPA levels increased, total n-6 fatty acids decreased, and DHA remained unchanged. Family and maternal care also improved. The suggested benefits of the combined interventions on the developmental and nutritional status of children with SAM will be tested in a future trial.
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Affiliation(s)
- Fredrick Cyprian Mwita
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - George PrayGod
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - Erica Sanga
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - Theresia Setebe
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - Gaudensia Joseph
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - Happyness Kunzi
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - Jayne Webster
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Melissa Gladstone
- Department of Women and Children’s Health, University of Liverpool, Alder Hey Children’s Hospital, Liverpool L12 2AP, UK; (M.G.); (R.S.)
| | - Rebecca Searle
- Department of Women and Children’s Health, University of Liverpool, Alder Hey Children’s Hospital, Liverpool L12 2AP, UK; (M.G.); (R.S.)
| | - Maimuna Ahmed
- Department of Paediatrics, Bugando Medical Centre, Mwanza P.O. Box 1370, Tanzania; (M.A.); (A.H.)
| | - Adolfine Hokororo
- Department of Paediatrics, Bugando Medical Centre, Mwanza P.O. Box 1370, Tanzania; (M.A.); (A.H.)
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200 Copenhagen, Denmark; (H.F.); (A.B.); (M.F.O.)
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200 Copenhagen, Denmark; (H.F.); (A.B.); (M.F.O.)
- Tampere Centre for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere University, Arvo Ylpön Katu 34, 33100 Tampere, Finland
| | - Mette Frahm Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200 Copenhagen, Denmark; (H.F.); (A.B.); (M.F.O.)
- Department of Infectious Diseases, Rigshospitalet, 2100 Copenhagen, Denmark
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Khanam SJ, Khan MN. Examining the influence of child nutritional disorders on early childhood development in Bangladesh: insights from the multiple indicator cluster survey. Public Health Nutr 2024; 27:e76. [PMID: 38384260 DOI: 10.1017/s1368980024000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVE The objective of this study was to explore the relationship between various forms of child nutritional disorders and early childhood development in Bangladesh. DESIGN We analysed data from the nationally representative cross-sectional 2019 Multiple Indicator Cluster Survey. Early childhood development was evaluated using the Early Childhood Development Index (ECDI), which comprised 10 yes-or-no questions across four domains: literacy-numeracy, physical well-being, socio-emotional development, and learning abilities. Nutritional disorders (e.g. stunting, wasting, and underweight) were measured based on the World Health Organization's height and weight guidelines. To investigate the relationships between child development and nutritional disorders, we used multilevel logistic regression models. SETTING Bangladesh. PARTICIPANTS Data of 9,455 children aged 3 and 4 years. RESULTS Approximately 38 % of the children analysed experienced a nutritional disorder, with stunting being the most prevalent at 28·15 %. Overall, 25·27 % did not meet expected developmental progress measured by the ECDI. Stunted children were more likely to be off track developmentally, while those without any nutritional disorder were more likely to be on track. Socio-demographic factors, including age, sex, attendance in early childhood education programme, maternal education, maternal functional difficulties, region, and income, were identified as determinants of ECDI. CONCLUSIONS Childhood nutrition and socio-demographic factors significantly affect multiple developmental domains and overall ECDI among children aged 3-4 years. Prioritising policies and programmes that improve nutrition and address these determinants are crucial for fostering optimal development in children.
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Affiliation(s)
- Shimlin Jahan Khanam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
| | - Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
- Centre for Women's Health Research, Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
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Lin K, Zhou YM, Ma HP, He F, Huang XN, Tian XB, Zheng Y, Sun J. Quality of childcare and delayed child development in left-behind children in China. Pediatr Res 2024; 95:809-818. [PMID: 37845526 PMCID: PMC10899099 DOI: 10.1038/s41390-023-02840-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Inequalities in job opportunities and income prompts many Chinese parents to leave rural regions to work in urban regions. Their children are left behind in rural regions, subjected to worse quality of childcare that jeopardizes their development. This study aimed to examine the association between quality of childcare and delayed child development in under-three years children left behind in China. METHODS Cross-sectional national survey was conducted in children left behind in rural China in 2017. Exploratory and confirmatory factor analysis was used to develop a quality of childcare index. Mutlilevel analyses determined factors associated with quality of childcare and child development on a province and individual level. RESULT The largest population of at-risk children left behind were found in higher-GDP provinces. Children left behind had the lowest mean quality of childcare score. Multilevel analysis found that province level accounted for a great proportion of variance observed. CONCLUSIONS While migration to urban regions for work may improve household income, a trade-off in worse quality of childcare and developmental delays exists. With improving household income often being the greatest contributing factor for parental migration, policies to reduce inequalities in job opportunities and wealth between rural and urban regions are required. IMPACT Previous studies identified higher prevalence of developmental delays in children left behind in China. However, quality of childcare has not been examined. Based on WHO's Nurturing Care Framework, we developed a quality of childcare index to assess its association with child development in children left behind. Greatest proportion of children left behind at-risk of developmental delays resided in higher-GDP states, indicating a trade-off in worse quality of childcare and developmental delays. Since improving household income is the main factor for parental migration, policies to close inequalities in job opportunities and wealth between rural and urban regions are required.
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Affiliation(s)
- Kelly Lin
- Institute of Integrated Intelligence and Systems, and School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Yu-Ming Zhou
- Beijing Anding Hospital, Capital Medical University & The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Hai-Ping Ma
- Youfu Hospital of Binzhou City, No. 585, Changjiang 1st Road, Bincheng District, Binzhou City, Shandong Province, People's Republic of China
| | - Fan He
- Beijing Anding Hospital, Capital Medical University & The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Xiao-Na Huang
- United Nations Children's Fund (UNICEF China Office), Beijing, People's Republic of China
| | - Xiao-Bo Tian
- United Nations Children's Fund (UNICEF China Office), Beijing, People's Republic of China
| | - Yi Zheng
- Beijing Anding Hospital, Capital Medical University & The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.
| | - Jing Sun
- Institute of Integrated Intelligence and Systems, and School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia.
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11
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Smith JA, Powell CA, Chang SM, Ganga E, Tanyanyiwa H, Walker SP. A cluster randomised controlled trial of an early childhood parenting programme delivered through early childhood education centres in rural Zimbabwe. Child Care Health Dev 2024; 50:e13189. [PMID: 37882173 DOI: 10.1111/cch.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/05/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Early childhood is a critical period for child development. Effective approaches to support families in low-resource settings in the use of responsive and stimulating parenting are needed. AIM The aim of this study was to examine the effects of the Reach Up early childhood parenting programme on children's development, parenting attitudes and practices, when delivered through early childhood development (ECD) centres in Zimbabwe. METHODS A cluster randomised controlled trial was conducted in Sanyati, a rural district in Zimbabwe. Twenty-four of 51 available centres were randomised to intervention (n = 12) or control (n = 12) groups. Sixteen mothers with a child aged 12-30 months were recruited from each centre's catchment area (n = 189 intervention; n = 193 control). The intervention comprised two home visits per month delivered by centre teaching assistants over a period of 27 months. Primary outcomes were child Developmental Quotient (DQ), Language, Eye and Hand coordination, Performance and Practical Reasoning subscale scores assessed at follow-up. Secondary outcomes were mothers' attitudes about child development, parenting practices and maternal depressive symptoms all measured at baseline and follow-up. Intention to treat analyses was conducted using mixed-effects regression models with the standard error adjusted for cluster and inverse proportionality weights to adjust for attrition. Significance was set at P < 0.05. RESULTS A total of 285 (74.6%) of 382 children enrolled were tested, with 97 children lost to follow-up. The intervention improved the children's DQ by 3.55 points (95% CI 0.82 to 6.28), Eye and Hand by 3.58 (95% CI 0.59 to 6.56) and Practical Reasoning by 4.19 (95% CI 0.96 to 7.42). No significant improvements to Performance or Language scores, parenting attitudes, parenting practices and depressive symptoms were identified. CONCLUSIONS A home visiting intervention delivered by ECD teaching assistants promoted children's development. This suggests that outreach from preschools may be an effective platform for delivery of parenting interventions.
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Affiliation(s)
- Joanne A Smith
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Christine A Powell
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Susan M Chang
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Emily Ganga
- Robert Mugabe School of Education and Culture, Great Zimbabwe University, Masvingo, Zimbabwe
| | | | - Susan P Walker
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
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Czarniecka-Skubina E, Hamulka J, Jeruszka-Bielak M, Gutkowska K. Do Food and Meal Organization Systems in Polish Primary Schools Reflect Students' Preferences and Healthy and Sustainable Dietary Guidelines? The Results of Qualitative Research for the Junior-Edu-Żywienie (JEŻ) Project. Foods 2023; 13:61. [PMID: 38201089 PMCID: PMC10778281 DOI: 10.3390/foods13010061] [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: 11/29/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
The school environment, together with that of the family, shapes students' eating behaviors, and is an important element of formal and informal nutrition education. The informal and practical dimensions can be realized through the food and meals offered/sold in school canteens, shops, and vending machines. As children and adolescents spend 6-10 h/day in schools and consume at least two meals there, the school food environment is important from a public health perspective. The aim of this study is to assess food and meal organization in primary schools in Poland. The study was conducted using individual in-depth interviews (IDIs) involving 24 school headmasters and 24 representatives of people employed in school canteens or catering companies involved in meal organization in schools. The nutritional food on offer at schools is important for shaping students' food preferences and choices, consequently influencing the development, functioning, and health of this subpopulation. The school environment can be an ideal place for hands-on nutrition education. In addition to the knowledge provided, there must be a consistent message concerning the provision of nutrition information to students between the teachings of parents, teachers, and, indirectly, the food and meals available at school. Our qualitative study is confirmed by the results of quantitative research to better understand the organization of nutrition and the problems and needs of primary schools in this area.
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Affiliation(s)
- Ewa Czarniecka-Skubina
- Department of Food Gastronomy and Food Hygiene, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 166 Nowoursynowska Street, 02-787 Warsaw, Poland
| | - Jadwiga Hamulka
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 166 Nowoursynowska Street, 02-787 Warsaw, Poland; (J.H.); (M.J.-B.)
| | - Marta Jeruszka-Bielak
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 166 Nowoursynowska Street, 02-787 Warsaw, Poland; (J.H.); (M.J.-B.)
| | - Krystyna Gutkowska
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 166 Nowoursynowska Street, 02-787 Warsaw, Poland;
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Adise S, Marshall AT, Kan E, Gonzalez MR, Sowell ER. Relating neighborhood deprivation to childhood obesity in the ABCD study: Evidence for theories of neuroinflammation and neuronal stress. Health Psychol 2023; 42:868-877. [PMID: 36469439 PMCID: PMC10239784 DOI: 10.1037/hea0001250] [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] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We evaluated whether relationships between area deprivation (ADI), body mass index (BMI) and brain structure (e.g., cortical thickness, subcortical volume) during preadolescence supported the immunologic model of self-regulation failure (NI) and/or neuronal stress (NS) theories of overeating. The NI theory proposes that ADI causes structural alteration in the brain due to the neuroinflammatory effects of overeating unhealthy foods. The NS theory proposes that ADI-related stress negatively impacts brain structure, which causes stress-related overeating and subsequent obesity. METHOD Data were gathered from the Adolescent Brain Cognitive Development Study (9 to 12 years old; n = 3,087, 51% male). Linear mixed-effects models identified brain regions that were associated with both ADI and BMI; longitudinal associations were evaluated with mediation models. The NI model included ADI and BMI at 9 to 10 years old and brain data at 11 to 12 years old. The NS model included ADI and brain data at 9 to 10 years old and BMI at 11 to 12 years old. RESULTS BMI at 9 to 10 years old partially mediated the relationship between ADI and ventral diencephalon (DC) volume at 11 to 12 years old. Additionally, the ventral DC at 9 to 10 years old partially mediated the relationship between ADI and BMI at 11 to 12 years old, even in youth who at baseline, were of a healthy weight. Results were unchanged when controlling for differences in brain structure and weight across the 2-years. CONCLUSION Greater area deprivation may indicate fewer access to resources that support healthy development, like nutritious food and nonstressful environments. Our findings provide evidence in support of the NI and NS theories of overeating, specifically, with greater ADI influencing health outcomes of obesity via brain structure alterations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Shana Adise
- Department of Pediatrics, Division of Pediatric Research Administration, Keck School of Medicine of the University of Southern California, Children's Hospital Los Angeles
| | - Andrew T Marshall
- Department of Pediatrics, Division of Neurology, Keck School of Medicine of the University of Southern California, Children's Hospital Los Angeles
| | - Eric Kan
- Department of Pediatrics, Division of Pediatric Research Administration, Keck School of Medicine of the University of Southern California
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Gaidhane A, Khatib MN, Telrandhe S, Patil M, Kogade P, Gaidhane S, Choudhari SG, Holding PA, Saxena D, Syed ZQ. Design-redesign, implementation, and evaluation of effectiveness of maternal nutrition and responsive parenting program on child development at 2 years of age from rural India: a cluster RCT. Front Public Health 2023; 11:1165728. [PMID: 38035279 PMCID: PMC10682778 DOI: 10.3389/fpubh.2023.1165728] [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: 03/21/2023] [Accepted: 10/17/2023] [Indexed: 12/02/2023] Open
Abstract
Background To promote early childhood development (ECD), we require information not only on what needs to be addressed and on what effects can be achieved but also on effective delivery methods that can be adapted to local context. We describe design, implementation, and evaluation of a complex intervention to strengthen nurturing environment for young children. Methods Study participants were pregnant women and their children from birth to 2 years. We used design and redesign, implementation, and evaluation approaches for the study. We co-created curriculum and delivery plan with stakeholders, based on the theoretical framework, findings from formative research, and our preliminary work. We recruited 656 pregnant women and newborns, 326 (49.69%) from intervention and 330 (50.30%) from the control group. We conducted a cluster randomized controlled trial to evaluate the program's effectiveness. The outcomes of children were assessed at 12 and 24 months. Findings At recruitment, study participants from both the study arms were similar in sociodemographic characteristics. We conducted 6,665 home visits, 25 toy-making workshops, and 65 caregiver-meetings. The initial examination of program data revealed gaps in quality and coverage of interventions. The intervention was redesigned based on feedback from stakeholders in community meetings. At recruitment, participants in both study groups had similar socio-demographics. We conducted 6,665 home visits, 25 toy workshops, and 65 caregiver meetings. Initial program data showed intervention quality and coverage gaps, leading to a redesign program based on community and stakeholder feedback. Post-re-designing, session quality improved, with program coverage rising from 32 to 98%. Male participation in home visits increased from 4.3 to 32.65%, and data errors reduced from 270 to 140 per month on average. At 24 months, program showed moderate-mild impact on ECD - cognitive (0.31, 95%CI: 0.13-0.48), language (0.2, 95%CI: 0.01-0.39), and socioemotional-development (0.19, 95%CI: 0.01-0.37), moderate effect on home-environment and mother-child interaction. 96% of women initiated breastfeed within one-hour of delivery, and exclusive-breastfeeding rate of 89.80%. Interpretations The study provides an evidence-based community centered ECD curriculum and implementation strategies to enhance service providers, and caregivers' knowledge and skills for promoting ECD in low-resource settings with the potential to scale within existing Government Program. Funding The trial was funded by the Saving Brains Round 5 Initiative of Grand Challenges Canada (Grant no. SB-1707-05084), and we are grateful for their ongoing support through online sessions and orientation workshops. The trial was also supported by the Indian Council of Medical Research (File No: 5/7/1693/CH/Adhoc/RBMCH-2020).
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Affiliation(s)
- Abhay Gaidhane
- Centre of One Health, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Mahalaqua Nazli Khatib
- Global Evidence Synthesis Initiative, Division of Evidence Synthesis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Shital Telrandhe
- Global Health Academy, Centre of Early Childhood Development - Stepping Stones Project, Wardha, India
- Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Manoj Patil
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Priti Kogade
- Global Health Academy, Centre of Early Childhood Development - Stepping Stones Project, Wardha, India
- Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Shilpa Gaidhane
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Sonali G. Choudhari
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Penny A. Holding
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Deepak Saxena
- i Health Consortium, Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Zahiruddin Quazi Syed
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
- South Asia Infant Feeding Research Network (SAIFRN), School of Epidemiology and Public Health, Wardha, Maharashtra, India
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15
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Adams IKR, Meshelemiah JCA, Noble ST, Piperata BA. The complementary feeding practices of low-income Black mothers with infants between 6 and 24 months of age: A qualitative study. J Hum Nutr Diet 2023; 36:1874-1886. [PMID: 37282806 DOI: 10.1111/jhn.13189] [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: 02/08/2023] [Accepted: 05/18/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND The period from 6 to 24 months in an infant's life presents a critical window for understanding feeding practices and for designing culturally appropriate interventions. However, little is known about the complementary feeding practices of Black mothers and how this period can be used to optimise the long-term health of their children. The present study aimed to identify factors that influence the complementary feeding practices of low-income Black mothers with children aged 6-24 months. METHODS Participants were recruited through Research Match, Facebook advertising, flyers, and snowballing techniques. Low-income, Black mothers, with a 6-24-month-old infant, and who lived in Franklin County, Ohio, USA, were eligible for the study. A cross-sectional design using in-depth interviews was used. Reflexive thematic analysis was utilised to analyse and interpret the feeding practices of Black mothers. RESULTS Mothers (n = 8) were aged between 18 and 30 years old and most completed college or had some college education (n = 6). Half (n = 4) were married, employed, and rated their diet quality and their children's as very good. Three themes emerged: (a) complementary feeding at ≥ 6 months of age; (b) involvement of health care providers and service organisations in feeding decisions; and (c) use of responsive feeding cues. CONCLUSIONS All mothers breastfed exclusively and most (n = 6) initiated complementary feeding at 6 months. Paediatricians, other health providers and service organisations were instrumental in helping Black mothers adopt complementary feeding practices. Mothers also engaged in responsive feeding practices. These findings point to the critical nature of access and education in helping Black mothers in the study achieve feeding recommendations for their infants.
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Affiliation(s)
- Ingrid K R Adams
- College of Food, Agricultural, and Environmental Sciences, The Ohio State University Extension, Columbus, OH, USA
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, Columbus, OH, USA
| | | | - ShyAnne T Noble
- Morehouse Medical Plaza Tower, The Ohio State University, Columbus, OH, USA
| | - Barbara A Piperata
- 4054 Smith Laboratory, Department of Anthropology, College of Arts and Sciences, Columbus, OH, USA
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Hill Z, Zafar S, Soremekun S, Sikander S, Avan BI, Roy R, Aziz S, Kumar D, Parveen N, Saleem S, Verma D, Sharma KK, Skordis J, Hafeez A, Rahman A, Kirkwood B, Divan G. Can home visits for early child development be implemented with sufficient coverage and quality at scale? Evidence from the SPRING program in India and Pakistan. Front Nutr 2023; 10:1152548. [PMID: 37404854 PMCID: PMC10315833 DOI: 10.3389/fnut.2023.1152548] [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: 01/27/2023] [Accepted: 03/27/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction There is limited evidence from low and middle-income settings on the effectiveness of early child development interventions at scale. To bridge this knowledge-gap we implemented the SPRING home visiting program where we tested integrating home visits into an existing government program (Pakistan) and employing a new cadre of intervention workers (India). We report the findings of the process evaluation which aimed to understand implementation. Methods and materials We collected qualitative data on acceptability and barriers and facilitators for change through 24 in-depth interviews with mothers; eight focus group discussions with mothers, 12 with grandmothers, and 12 with fathers; and 12 focus group discussions and five in-depth interviews with the community-based agents and their supervisors. Results Implementation was sub-optimal in both settings. In Pakistan issues were low field-supervision coverage and poor visit quality related to issues scheduling supervision, a lack of skill development, high workloads and competing priorities. In India, issues were low visit coverage - in part due to employing new workers and an empowerment approach to visit scheduling. Coaching caregivers to improve their skills was sub-optimal in both sites, and is likely to have contributed to caregiver perceptions that the intervention content was not new and was focused on play activities rather than interaction and responsivity - which was a focus of the coaching. In both sites caregiver time pressures was a key reason for low uptake among families who received visits. Discussion Programs need feasible strategies to maximize quality, coverage and supervision including identifying and managing problems through monitoring and feedback loops. Where existing community-based agents are overstretched and system strengthening is unlikely, alternative implementation strategies should be considered such as group delivery. Core intervention ingredients such as coaching should be prioritized and supported during training and implementation. Given that time and resource constraints were a key barrier for families a greater focus on communication, responsivity and interaction during daily activities could have improved feasibility.
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Affiliation(s)
- Zelee Hill
- Institute for Global Health, University College London, London, United Kingdom
| | - Shamsa Zafar
- Fazaia Medical College, Air University, Islamabad, Pakistan
| | - Seyi Soremekun
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Siham Sikander
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Bilal Iqbal Avan
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Reetabrata Roy
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Sangath, Goa, India
| | - Sarmad Aziz
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Nazia Parveen
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Shumaila Saleem
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | | | - Jolene Skordis
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Betty Kirkwood
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Esquivel MK, Aflague TF, Yamanaka AB, Guerrero RTL, Coleman P, Fialkowski MK, Shallcross L, Fleming T, Davis J, Boushey CJ, Wilkens LR, Braun K, Novotny R. Children's Dietary Intake by Early Care and Education Setting in the US Affiliated Pacific. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:437-446. [PMID: 37029080 PMCID: PMC10353568 DOI: 10.1016/j.jneb.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Examine differences in dietary intake of children aged 2-5 years in early care and education (ECE) setting in the US Affiliated Pacific (USAP). DESIGN Secondary analysis of cross-sectional data collected by the Children's Healthy Living program. PARTICIPANTS Children (n = 1,423) with complete dietary records and information on the ECE setting. MAIN OUTCOME MEASURES Dietary intake by ECE setting; Head Start (HS), other ECE (OE), and no ECE. ANALYSIS Comparison of mean dietary intake across ECE settings and multivariate logistic regression to evaluate ECE setting and likelihood for meeting dietary reference intake (DRI). RESULTS Children in HS and OE settings had a significantly higher intake of several food groups and nutrients, compared with no ECE; vegetables (0.4 cup-equivalents per thousand kcals [CETK] vs 0.3 CETK; P < 0.001), fruits (0.8 CETK vs 0.6 CETK; P = 0.001), milk (0.9 CETK for HS and 1.0 CETK for OE vs 0.8 CETK; P < 0.001). Sixty-five percent of the HS group met DRI and had greater odds of meeting calcium DRI (odds ratio, 1.8; 95% confidence interval, 1.2-2.7) compared with other groups. The OE group had the lowest proportion of children meeting recommended intakes for 19 out of 25 nutrients. CONCLUSIONS AND IMPLICATIONS Mean intakes of foods and nutrients for children across the USAP meet some, but not all, recommendations and intakes vary across children attending various ECE setting types. Additional research on the clinical importance of these differences and the impact of the complex food systems in the USAP may identify systematic strategies for improving diet among children.
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Affiliation(s)
- Monica Kazlausky Esquivel
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, HI.
| | - Tanisha F Aflague
- Consumer and Family Sciences, College of Natural and Applied Sciences, University of Guam, Mangilao, Guam
| | - Ashley B Yamanaka
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, HI
| | | | - Patricia Coleman
- Cooperative Research, Extension, and Education Services, Northern Marianas College, Saipan, Marianas Pacific
| | - Marie Kainoa Fialkowski
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, HI
| | - Leslie Shallcross
- Natural Resources and Extension, University of Alaska Fairbanks Institute of Agriculture, Fairbanks, AK
| | - Travis Fleming
- Agriculture, Community and Natural Resources Division, American Samoa Community College, Pago Pago, American Samoa
| | - James Davis
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI
| | - Carol J Boushey
- Nutrition Support Shared Resources, University of Hawai'i Cancer Center, Honolulu, HI
| | - Lynne R Wilkens
- Biostatistics Shared Resource, University of Hawai'i Cancer Center, Honolulu, HI
| | - Kathryn Braun
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI
| | - Rachel Novotny
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, HI
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Hanson J, Heslon K, Ogourtsova T. Mental health services and resources for children with developmental disabilities and their families: scan of local practices, gaps, and opportunities created. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1118769. [PMID: 37325126 PMCID: PMC10267822 DOI: 10.3389/fresc.2023.1118769] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/16/2023] [Indexed: 06/17/2023]
Abstract
Background Mental health concerns in children with disabilities are common and have a significant and negative impact. Clinicians have reported high demand for this population to receive early, targeted, and family-centred mental health interventions. Objective We sought to map out and describe existing pediatric mental health services/resources for children with disabilities and their families across clinical sites and local and online communities. Methods Using a mixed-method triangulation study design, we outreached to clinical managers at the participating clinical sites and conducted a rapid online search of local in-person, telehealth, and web-based information. The nature, access method, admission criteria, target, focus, and other pertinent information were recorded and analyzed using descriptive statistics and a narrative synthesis approach. Results Eighty-one (n = 81) services/resources (in-person, n = 48; telehealth, n = 10; web-based information, n = 33) were identified. Few (n = 6, 13%) in-person services had a method of care access through an online booking portal. Nearly half of in-person resources (n = 23, 47%) had admission criteria specific for children with disabilities (e.g., diagnosis, age limit), and many (n = 32, 67%) required a formal referral. A small number of in-person and telehealth services targeted the mental health concerns of the entire family (n = 23, 47%; n = 2, 20%). Very few (n = 13, 16%) services incorporated follow-up support. Important gaps emerged for certain populations (e.g., children with cerebral palsy). Practitioners' inadequate training when intervening with co-existing mental health demands of children with disabilities was noted by clinical managers. Conclusion Findings could be used to create a user-friendly database to easily identify suitable services and to advocate for services/resources that are lacking.
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Affiliation(s)
- Jessica Hanson
- Integrated Center of Health and Social Services of Laval, The Research Center of the Jewish Rehabilitation Hospital, Laval, QC, Canada
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Kayla Heslon
- Integrated Center of Health and Social Services of Laval, The Research Center of the Jewish Rehabilitation Hospital, Laval, QC, Canada
- Faculty of Arts and Sciences, McGill University, Montreal, QC, Canada
| | - Tatiana Ogourtsova
- Integrated Center of Health and Social Services of Laval, The Research Center of the Jewish Rehabilitation Hospital, Laval, QC, Canada
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
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19
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Oh J. Prevalence and factors associated with multidimensional child deprivation: Findings from the Future of Families and Child Well-Being Study. CHILDREN AND YOUTH SERVICES REVIEW 2023; 148:106890. [PMID: 37736253 PMCID: PMC10512438 DOI: 10.1016/j.childyouth.2023.106890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Despite the growing importance of the multidimensional methods of assessing child poverty, few studies in the U.S. have applied a rights-based approach to examining child deprivation. This study examines multidimensional child deprivation using eight dimensions and twelve indicators based on the Convention on the Rights of the Child (CRC). Using a sample of children at age nine from the fifth wave of the Future of Families and Child Well-being Study, this study applied the multiple overlapping deprivation analysis (MODA), a comprehensive analytic method to assess the multidimensionality of child deprivation and to provide a detailed picture of material and social forms of deprivation among the U.S. children. This study found that the overall child deprivation rate was 8.89%; environmental safety (20.36%), information (15.94%), and housing security (14.23%) dimensions contributed the highest to the overall child deprivation; the overlap between deprivation and income poverty was 12.83%. Results suggest that understanding multifaceted and interrelated contexts of child deprivation is crucial to promote child rights.
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Affiliation(s)
- Jihyun Oh
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, United States
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20
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Neuhouser ML, Prentice RL, Tinker LF, Lampe JW. Enhancing Capacity for Food and Nutrient Intake Assessment in Population Sciences Research. Annu Rev Public Health 2023; 44:37-54. [PMID: 36525959 PMCID: PMC10249624 DOI: 10.1146/annurev-publhealth-071521-121621] [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] [Indexed: 12/23/2022]
Abstract
Nutrition influences health throughout the life course. Good nutrition increases the probability of good pregnancy outcomes, proper childhood development, and healthy aging, and it lowers the probability of developing common diet-related chronic diseases, including obesity, cardiovascular disease, cancer, and type 2 diabetes. Despite the importance of diet and health, studying these exposures is among the most challenging in population sciences research. US and global food supplies are complex; eating patterns have shifted such that half of meals are eaten away from home, and there are thousands of food ingredients with myriad combinations. These complexities make dietary assessment and links to health challenging both for population sciences research and for public health policy and practice. Furthermore, most studies evaluating nutrition and health usually rely on self-report instruments prone to random and systematic measurement error. Scientific advances involve developing nutritional biomarkers and then applying these biomarkers as stand-alone nutritional exposures or for calibrating self-reports using specialized statistics.
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Affiliation(s)
- Marian L Neuhouser
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA;
| | - Ross L Prentice
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA;
| | - Lesley F Tinker
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA;
| | - Johanna W Lampe
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA;
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21
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Yazawa A, Kawachi I, Shrestha RM, Fukunaga A, Pham TTP, Nguyen CQ, Hoang DV, Phan DC, Hachiya M, Huynh DV, Le HX, Do HT, Mizoue T, Inoue Y. Parental absence during childhood and weight status in adulthood among middle-aged community dwellers in rural Vietnam. Am J Hum Biol 2023; 35:e23827. [PMID: 36345160 DOI: 10.1002/ajhb.23827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES While adverse childhood experiences (ACEs) have been shown to be associated with adulthood obesity, less is known about their association with underweight. We examined the associations between parental absence (i.e., a major component of ACEs) and both underweight and excess weight among middle-aged rural community dwellers in Vietnam, where experiences of parental absence was not uncommon during and after the Vietnam War (1955-1975). METHODS Data came from 3000 middle-aged adults who participated in the baseline survey of Khánh Hòa Cardiovascular Study. Parental absence was defined as parental absence due to death, divorce, or out-migration. Using information on the timing of such events, we categorized participants into those who experienced parental absence before the age of 3, between the ages of 3 and 15, and those without such experiences. BMI was calculated based on measured height and weight (kg/m2 ) and categorized into three groups: underweight <18.5; normal 18.5-24.9; excess weight ≥ 25. Multinomial logistic regression was then used to investigate the association between parental absence and adult weight status. RESULTS Parental absence that occurred before the age of 3 was marginally significantly associated with underweight (relative risk ratio [RRR] = 1.44, 95% confidence interval [CI] 0.95, 2.20) but not with overweight/obesity. Parental divorce was associated with overweight/obesity (RRR = 2.48, 95% CI 1.28, 4.81), but not parental absence due to migratory work. CONCLUSIONS While previous studies in Western settings focused almost exclusively on the risk of obesity in relation to exposure to ACEs, our findings point to the potential importance of considering the risk of underweight in low- and middle-income countries.
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Affiliation(s)
- Aki Yazawa
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rachana Manandhar Shrestha
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ami Fukunaga
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Thuy Thi Phuong Pham
- Department of Non-communicable Disease Control and Nutrition, Pasteur Institute in Nha Trang, Nha Trang, Vietnam
| | - Chau Que Nguyen
- Department of Non-communicable Disease Control and Nutrition, Pasteur Institute in Nha Trang, Nha Trang, Vietnam
| | - Dong Van Hoang
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Danh Cong Phan
- Department of Non-communicable Disease Control and Nutrition, Pasteur Institute in Nha Trang, Nha Trang, Vietnam
| | - Masahiko Hachiya
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Dong Van Huynh
- Khánh Hòa Center for Disease Control, Nha Trang, Vietnam
| | - Huy Xuan Le
- Pasteur Institute in Nha Trang, Nha Trang, Vietnam
| | - Hung Thai Do
- Pasteur Institute in Nha Trang, Nha Trang, Vietnam
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yosuke Inoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
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22
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Galvin L, Verissimo CK, Ambikapathi R, Gunaratna NS, Rudnicka P, Sunseri A, Jeong J, O'Malley SF, Yousafzai AK, Sando MM, Mosha D, Kumalija E, Connolly H, PrayGod G, Endyke-Doran C, Kieffer MP. Effects of engaging fathers and bundling nutrition and parenting interventions on household gender equality and women's empowerment in rural Tanzania: Results from EFFECTS, a five-arm cluster-randomized controlled trial. Soc Sci Med 2023; 324:115869. [PMID: 37023660 DOI: 10.1016/j.socscimed.2023.115869] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Advancing gender equality and women's empowerment (GE/WE) may contribute to better child nutrition and development in low-resource settings. However, few empirical studies have generated evidence on GE/WE and examined the potential of engaging men to transform gender norms and power relations in the context of nutrition and parenting programs. We tested the independent and combined effects of engaging couples and bundling nutrition and parenting interventions on GE/WE in Mara, Tanzania. EFFECTS (ClinicalTrials.gov, NCT03759821) was a cluster-randomized 2 × 2 factorial trial plus control. Eighty village clusters were randomly assigned to one of five intervention conditions: standard of care, mothers nutrition, couples nutrition, mothers bundled nutrition and parenting, or couples bundled nutrition and parenting. Between October 2018-May 2019, 960 households were enrolled with children under 18 months of age residing with their mother and father. Community health workers (CHWs) delivered a bi-weekly 24-session hybrid peer group/home visit gender-transformative behavior change program to either mothers or couples. GE/WE outcomes were analyzed as intention-to-treat and included time use, gender attitudes, social support, couples' communication frequency and quality, decision-making power, intimate partner violence (IPV), and women's dietary diversity (WDD). Data were collected from 957 to 815 mothers and 913 and 733 fathers at baseline and endline, respectively. Engaging couples compared to mothers only significantly increased paternal and maternal gender-equitable attitudes, paternal time spent on domestic chores, and maternal decision-making power. Bundling increased maternal leisure time, decreased maternal exposure to any IPV, and increased WDD over 7 days. A combination of engaging couples and bundling was most effective for paternal gender attitudes, couples communication frequency, and WDD over 24 h and 7 days. Our findings generate novel evidence that CHWs can deliver bundled nutrition and parenting interventions to couples in low-resource community settings that advance GE/WE more than nutrition interventions targeting only women.
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23
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Liu K, Zhang J, Liu S, Chen J, Zhang Y, Li W, Fu H, Fu L. Parental Stress on Children's Appearance, Body Dissatisfaction, and Eating Behaviours in Chinese Children: A Pathway Analysis. Psychol Res Behav Manag 2023; 16:363-372. [PMID: 36798874 PMCID: PMC9925390 DOI: 10.2147/prbm.s395628] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Purpose This study aimed to analyze the association pathways of parental stress on children's appearance, body dissatisfaction, and eating behaviours in Chinese children and adolescents. Patients and Methods The children aged 8-15 years were selected from 2 nine-year schools using stratified cluster random sampling. The appearance-related social stress questionnaire and the body dissatisfaction subscale of EDI-1 were used to investigate parental stress on children's appearance and body dissatisfaction, respectively. The self-administered eating frequency questionnaire was used to investigate children's eating behaviours. Results Body dissatisfaction in girls mediated associations between BMI, parental teasing, parental injustice and ignorance, parental encouragement and healthy eating behaviour: BMI → body dissatisfaction → healthy eating behaviour, parental teasing → body dissatisfaction → healthy eating behaviour, parental injustice and ignorance → body dissatisfaction → healthy eating behaviour, parental encouragement → body dissatisfaction → healthy eating behaviour. Parental injustice and ignorance directly and negatively predicted healthy eating behaviour in girls. In boys and girls, parental teasing was a direct predictor factor of unhealthy eating behaviour. Conclusion Parental teasing, parental injustice and ignorance, parental encouragement, and BMI through body dissatisfaction positively predicted healthy eating behaviour in girls, parental injustice and ignorance directly negatively predicted healthy eating behaviour in girls, and parental teasing directly positively predicted unhealthy eating behaviour in girls and boys. Therefore, parental pressure on children's appearance may pay important role in children's eating behaviours.
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Affiliation(s)
- Keke Liu
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, People’s Republic of China
| | - Juan Zhang
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, People’s Republic of China
| | - Songhui Liu
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, People’s Republic of China
| | - Jiaoyan Chen
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, People’s Republic of China
| | - Ya Zhang
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, People’s Republic of China
| | - Wenxiu Li
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, People’s Republic of China
| | - Han Fu
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, People’s Republic of China
| | - Lianguo Fu
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, People’s Republic of China,Correspondence: Lianguo Fu, Tel +86-13195529639, Fax +86-5523175215, Email
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24
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Dulal S, Saville NM, Merom D, Giri K, Prost A. Exploring the feasibility of integrating health, nutrition and stimulation interventions for children under three years in Nepal's health system: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001398. [PMID: 37115747 PMCID: PMC10146516 DOI: 10.1371/journal.pgph.0001398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Community-based primary care settings are a potential entry point for delivering Early Childhood Development (ECD) interventions in Nepal. Past studies have suggested that integrating stimulation with nutrition interventions is an effective way to deliver multiple benefits for children, but there is limited knowledge of how to do this in Nepal. We conducted a qualitative study in Nepal's Dhanusha district to explore how stimulation interventions for early learning could be integrated into existing health and nutrition programmes within the public health system. Between March and April 2021, we completed semi-structured interviews with caregivers (n = 18), health service providers (n = 4), district (n = 1) and national stakeholders (n = 4), as well as policymakers (n = 3). We also carried out focus group discussions with Female Community Health Volunteers (FCHVs) (n = 2) and health facility operation and management committee members (n = 2). We analysed data using the framework method. Respondents were positive about introducing stimulation interventions into maternal and child health and nutrition services. They thought that using health system structures would help in the implementation of integrated interventions. Respondents also highlighted that local governments play a lead role in decision-making but must be supported by provincial and national governments and external agencies. Key factors impeding the integration of stimulation into national programmes included a lack of intersectoral collaboration, poor health worker competency, increased workload for FCHVs, financial constraints, a lack of prioritisation of ECD and inadequate capacity in local governments. Key barriers influencing the uptake of intervention by community members included lack of knowledge about stimulation, caregivers' limited time, lack of paternal engagement, poverty, religious or caste discrimination, and social restrictions for newlywed women and young mothers. There is an urgent need for an effective coordination mechanism between ministries and within all three tiers of government to support the integration and implementation of scalable ECD interventions in rural Nepal.
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Affiliation(s)
- Sophiya Dulal
- Western Sydney University, School of Health Sciences, Sydney, Australia
| | | | - Dafna Merom
- Western Sydney University, School of Health Sciences, Sydney, Australia
| | - Kalpana Giri
- Health Research and Development Forum, Kathmandu, Nepal
| | - Audrey Prost
- UCL Institute for Global Health, London, United Kingdom
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25
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Serván-Mori E, Ramírez-Baca MI, Fuentes-Rivera E, García-Martínez A, Quezada-Sánchez AD, Del Carmen Hernández-Chávez M, Olvera-Flores F, Pineda-Pérez D, Zelocuatecatl-Aguilar A, Orozco-Núñez E, Schnaas L. Predictors of maternal knowledge on early childhood development in highly marginalized communities in Mexico: Implications for public policy. Acta Psychol (Amst) 2022; 230:103743. [PMID: 36130413 DOI: 10.1016/j.actpsy.2022.103743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 08/23/2022] [Accepted: 09/09/2022] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Efforts to identify the predictors of maternal knowledge on Early Child Development (ECD) have proven inconclusive thus far, particularly with respect to socially deprived contexts in Low- and Middle-Income Countries (LMICs). We quantified the extent of ECD knowledge among mothers who were the primary caregivers of 0-38-month-old infants in marginalized communities in Mexico. We also explored the characteristics of the children, both individually and with regard to their households, given the influence of these factors on childhood development. METHODS We analyzed primary data obtained through a questionnaire administered to mothers who were the primary caregivers of 1045 girls and boys 0-38 months of age. The instrument was specifically designed for our study in order to explore the knowledge of participants about physical, neurological and psycho-affective development during childhood. We performed fractional regression analysis to assess the predictors of ECD knowledge. RESULTS The mean score of maternal ECD knowledge increased with their age and schooling as well as with their levels of cognitive ability and self-esteem. Irrespective of age at first birth, mean knowledge was relatively high for women with high school education and low for women with elementary or no formal education, a gradient with respect to age at fist birth was more marked among women with middle school education. ECD knowledge scores increased among mothers from households enjoying higher socioeconomic levels and from households with health insurance. Scores were lower for indigenous households regardless of their participation in social programs. CONCLUSION Public policies on ECD should promote programs that are not only adapted to specific contexts, but also designed to improve shared child-rearing, early childhood care and as well as psycho-emotional education skills as a pathway to healthier ECD. The participation of families and communities in sensitive childhood care should form part of multisectoral programs involving education, health and wellbeing.
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Affiliation(s)
- Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Martín I Ramírez-Baca
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Evelyn Fuentes-Rivera
- Center for Demographic, Urban and Environmental Studies, College of Mexico A.C., Mexico City, Mexico
| | - Angélica García-Martínez
- Lucy Family Institute for Data and Society, University of Notre Dame, Notre Dame, IN, United States of America
| | - Amado D Quezada-Sánchez
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | | | | | | | - Emanuel Orozco-Núñez
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Lourdes Schnaas
- Department of Developmental Neurobiology, National Institute of Perinatology Isidro Espinosa de los Reyes, Mexico City, Mexico
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26
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Sullivan EF, Xie W, Conte S, Richards JE, Shama T, Haque R, Petri WA, Nelson CA. Neural correlates of inhibitory control and associations with cognitive outcomes in Bangladeshi children exposed to early adversities. Dev Sci 2022; 25:e13245. [PMID: 35192240 PMCID: PMC9393202 DOI: 10.1111/desc.13245] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/19/2021] [Accepted: 02/04/2022] [Indexed: 12/15/2022]
Abstract
There is strong support for the view that children growing up in low-income homes typically evince poorer performance on tests of inhibitory control compared to those growing up in higher income homes. Unfortunately, the vast majority of the work documenting this association has been conducted in high-income countries. It is not yet known whether the mechanisms found to mediate this association would generalize to children in low- and middle-income countries, where the risks of exposure to extreme poverty and a wide range of both biological and psychosocial hazards may be greater. We examined relations among early adversity, neural correlates of inhibitory control, and cognitive outcomes in 154 5-year-old children living in Dhaka, Bangladesh, an area with a high prevalence of poverty. Participants completed a go/no-go task assessing inhibitory control and their behavioral and event-related potential responses were assessed. Cortical source analysis was performed. We collected measures of poverty, malnutrition, maternal mental health, psychosocial adversity, and cognitive skills. Supporting studies in high-income countries, children in this sample exhibited a longer N2 latency and higher P3 amplitude to the no-go versus go condition. Unexpectedly, children had a more pronounced N2 amplitude during go trials than no-go trials. The N2 latency was related to their behavioral accuracy on the go/no-go task. The P3 mean amplitude, behavioral accuracy, and reaction time during the task were all associated with intelligence-quotient (IQ) scores. Children who experienced higher levels of psychosocial adversity had lower accuracy on the task and lower IQ scores.
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Affiliation(s)
- Eileen F Sullivan
- Labs of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children's Hospital, Boston, USA.,Harvard Graduate School of Education, Cambridge, USA
| | - Wanze Xie
- School of Psychological and Cognitive Sciences, Peking University, Beijing, China.,PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Stefania Conte
- Department of Psychology, University of South Carolina, Columbia, USA
| | - John E Richards
- Department of Psychology, University of South Carolina, Columbia, USA
| | | | | | - William A Petri
- Infectious Diseases & International Health, University of Virginia, Charlottesville, USA
| | - Charles A Nelson
- Labs of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children's Hospital, Boston, USA.,Harvard Graduate School of Education, Cambridge, USA.,Harvard Medical School, Boston, USA
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27
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Siswati T, Iskandar S, Pramestuti N, Raharjo J, Rubaya AK, Wiratama BS. Impact of an Integrative Nutrition Package through Home Visit on Maternal and Children Outcome: Finding from Locus Stunting in Yogyakarta, Indonesia. Nutrients 2022; 14:nu14163448. [PMID: 36014954 PMCID: PMC9416237 DOI: 10.3390/nu14163448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Stunting has been a public health problem in several developing countries including Indonesia. One of the strategies to reduce stunting was family assistance. This study was aimed to estimate the effect of family assistance by using an integrative nutrition package through home visits on the growth and development of stunted children. Method: This was an experimental study using pre-test post-test with control group design, conducted in Yogyakarta, Indonesia, on March to May 2022. The intervention group was provided an integrative nutrition package (INP) including maternal education, behavioral change through home visit, as well as monitoring children’s outcome, while the control group was asked to read and follow child care procedure in the maternal and child health (MCH) book as a standard procedure. Both groups were visited by trained health volunteers and had a complementary feeding (CF) package weekly for four weeks. The outcomes of this study were the maternal outcome (knowledge and behavior on children’s growth monitoring (CGM), children’s development monitoring (CDM), and infant/young children feeding (IYCF) as well as children’s outcomes, including body weight (BW), body height (BH), and child score development (CSD). This study used generalized estimating equation (GEE) to estimate the differences in differences (DID) of the impact of intervention compared with control group and compared among three different times (baseline, fourth, and eighth week). Results: There were 60 stunted children under five years in this study, i.e., 30 in intervention group and 30 in control group. From the GEE analysis, it was found that the regression adjusted DID showed statistically significant increase of all outcomes including children’s development score (CDS). The adjusted DID effect (95% CI) on 8th week for children’s weight, height, and development score were 0.31 (0.25–0.37), 0.41 (0.13–0.68), and −0.40 (−0.59–(−0.21)), respectively, among the intervention group. Conclusions: INP through home visit successfully increased maternal and children’s outcomes compared witsh standard procedure. The effect of intervention was found to be consistently significant in the fourth and eighth weeks after intervention. We recommend the local government to apply INP through home visit especially in high-prevalence stunting areas.
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Affiliation(s)
- Tri Siswati
- Department of Nutrition, Politeknik Kesehatan Kemenkes Yogyakarta, Tata Bumi No. 3, Banyuraden, Gamping, Sleman, Yogyakarta 55293, Indonesia
- Pusat Unggulan Iptek Inovasi Teknologi Terapan Kesehatan Masyarakat, Politeknik Kesehatan Kemenkes Yogyakarta, Tata Bumi No. 3, Banyuraden, Gamping, Sleman, Yogyakarta 55293, Indonesia
- Correspondence:
| | - Slamet Iskandar
- Department of Nutrition, Politeknik Kesehatan Kemenkes Yogyakarta, Tata Bumi No. 3, Banyuraden, Gamping, Sleman, Yogyakarta 55293, Indonesia
- Pusat Unggulan Iptek Inovasi Teknologi Terapan Kesehatan Masyarakat, Politeknik Kesehatan Kemenkes Yogyakarta, Tata Bumi No. 3, Banyuraden, Gamping, Sleman, Yogyakarta 55293, Indonesia
| | - Nova Pramestuti
- Balai Litbang Kesehatan Banjarnegara, Selamanik No. 16 A, Banjarnegara 53415, Indonesia
| | - Jarohman Raharjo
- Balai Litbang Kesehatan Banjarnegara, Selamanik No. 16 A, Banjarnegara 53415, Indonesia
| | - Agus Kharmayana Rubaya
- Pusat Unggulan Iptek Inovasi Teknologi Terapan Kesehatan Masyarakat, Politeknik Kesehatan Kemenkes Yogyakarta, Tata Bumi No. 3, Banyuraden, Gamping, Sleman, Yogyakarta 55293, Indonesia
- Department of Environmental Health, Politeknik Kesehatan Kemenkes Yogyakarta, Tata Bumi No. 3, Banyuraden, Gamping, Sleman, Yogyakarta 55293, Indonesia
| | - Bayu Satria Wiratama
- Department of Epidemiology, Biostatistics and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
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28
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Bein A, Fadel CW, Swenor B, Cao W, Powers RK, Camacho DM, Naziripour A, Parsons A, LoGrande N, Sharma S, Kim S, Jalili-Firoozinezhad S, Grant J, Breault DT, Iqbal J, Ali A, Denson LA, Moore SR, Prantil-Baun R, Goyal G, Ingber DE. Nutritional deficiency in an intestine-on-a-chip recapitulates injury hallmarks associated with environmental enteric dysfunction. Nat Biomed Eng 2022; 6:1236-1247. [PMID: 35739419 DOI: 10.1038/s41551-022-00899-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/12/2022] [Indexed: 01/03/2023]
Abstract
Environmental enteric dysfunction (EED)-a chronic inflammatory condition of the intestine-is characterized by villus blunting, compromised intestinal barrier function and reduced nutrient absorption. Here we show that essential genotypic and phenotypic features of EED-associated intestinal injury can be reconstituted in a human intestine-on-a-chip lined by organoid-derived intestinal epithelial cells from patients with EED and cultured in nutrient-deficient medium lacking niacinamide and tryptophan. Exposure of the organ chip to such nutritional deficiencies resulted in congruent changes in six of the top ten upregulated genes that were comparable to changes seen in samples from patients with EED. Chips lined with healthy epithelium or with EED epithelium exposed to nutritional deficiencies resulted in severe villus blunting and barrier dysfunction, and in the impairment of fatty acid uptake and amino acid transport; and the chips with EED epithelium exhibited heightened secretion of inflammatory cytokines. The organ-chip model of EED-associated intestinal injury may facilitate the analysis of the molecular, genetic and nutritional bases of the disease and the testing of candidate therapeutics for it.
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Affiliation(s)
- Amir Bein
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA.,Quris Technologies, Boston, MA, USA
| | - Cicely W Fadel
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Division of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ben Swenor
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Wuji Cao
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Rani K Powers
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA.,Pluto Biosciences, Inc., Golden, CO, USA
| | - Diogo M Camacho
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA.,Rheos Medicines, Cambridge, MA, USA
| | - Arash Naziripour
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Andrew Parsons
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Nina LoGrande
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Sanjay Sharma
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Seongmin Kim
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Sasan Jalili-Firoozinezhad
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA.,Department of Bioengineering and iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Jennifer Grant
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - David T Breault
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.,Harvard Stem Cell Institute, Harvard University, Boston, MA, USA
| | - Junaid Iqbal
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Asad Ali
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Lee A Denson
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sean R Moore
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Virginia, Charlottesville, VA, USA
| | - Rachelle Prantil-Baun
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Girija Goyal
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Donald E Ingber
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA. .,Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA. .,Vascular Biology Program and Department of Surgery, Harvard Medical School and Boston Children's Hospital, Boston, MA, USA.
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Leonkiewicz M, Wawrzyniak A. The relationship between rigorous perception of one's own body and self, unhealthy eating behavior and a high risk of anorexic readiness: a predictor of eating disorders in the group of female ballet dancers and artistic gymnasts at the beginning of their career. J Eat Disord 2022; 10:48. [PMID: 35410315 PMCID: PMC8996514 DOI: 10.1186/s40337-022-00574-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 04/01/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A group that is particularly exposed to eating disorders are young sportswomen who practice aesthetic disciplines, for whom it is important to keep a slim figure. Hence, the purpose of the study was to present the assessment of perception of one's own body and self as well as nutritional behavior in the group of ballet dancers and artistic gymnasts (BGA, n = 60) aged 10-12 against the background of the peer group (K, n = 60) and to determine the relationship between the studied elements, as well as anorexic readiness risk assessment to help diagnose premorbid stage of eating disorders with full symptoms. METHODS Anthropometric measurements (height, body weight) and the assessment of adipose tissue were performed. Using a questionnaire, data on physical activity, perception of one's own body and self, and selected eating behaviors were collected. RESULTS Underweight was observed in nearly half of the girls from the BGA group and the content of adipose tissue was significantly lower. Girls from the BGA group were characterized by overestimation of body size (p = 0.032), the need to improve their appearance/body (p = 0.025) and wanting to be the best in many areas of life (p = 0.002) significantly more often than in the K group. Moreover, they significantly more often limited the consumption of fats and carbohydrates (p = 0.044) and felt angry with themselves after too large of a meal (p = 0.050). It was shown that unhealthy eating behavior in the BGA group was significantly associated with rigorous self-perception (r = 0.42; p < 0.001). Students from the BGA group were more often exposed to a higher risk of anorexic readiness (p = 0.001). In a detailed analysis, it was found that eating behaviors, such as fasting, limiting the consumption of fats and carbohydrates, and avoiding eating under stress, were associated with feelings of dissatisfaction with oneself, the belief that appearance is extremely important in achieving life success and the need to improve appearance. CONCLUSION The obtained research results can be used as a source of information for specialists (including dietitians and psychologists), for the preparation of educational and repair programs in the group of ballet dancers or artistic gymnasts aged 10-12, including nutritional education and psychological care.
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Affiliation(s)
- Magdalena Leonkiewicz
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), Warsaw, Poland.
| | - Agata Wawrzyniak
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), Warsaw, Poland
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Lee B, Kwon CY, Lee SH, Chang GT. Herbal Medicine for the Treatment of Anorexia in Children: A Systematic Review and Meta-Analysis. Front Pharmacol 2022; 13:839668. [PMID: 35431933 PMCID: PMC9012502 DOI: 10.3389/fphar.2022.839668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/18/2022] [Indexed: 01/09/2023] Open
Abstract
Background: Anorexia is a common obstacle to adequate nutrition in childhood, a critical period for physical growth. East Asian traditional medicine treatment modalities including herbal medicine (HM) a re considered an attractive therapeutic option, especially in East Asian countries. The purpose of this systematic review was to comprehensively examine the efficacy and safety of HM for anorexia in children. Methods: A total of 12 electronic databases from their inception date to June 2021 were searched for randomized controlled trials (RCTs) assessing the efficacy of HM for the treatment of anorexia in children. The primary outcome was an improvement in anorexia clinical symptoms after treatment. In this meta-analysis, continuous and binary outcomes were assessed, and the data are presented as the mean difference or standardized mean difference and risk ratio (RR) with their 95% confidence intervals (CIs). The risk of bias and quality of evidence were assessed using the Cochrane Collaboration’s risk of bias tool and Grading of Recommendations, Assessment, Development, and Evaluations tool. Results: A total of 205 RCTs were included. A comparison of HM with placebo revealed that the total effective rate based on anorexia symptom improvement was significantly higher in the HM group (RR 1.58, 95% CI 1.34, 1.85). In comparison with controls, HM as monotherapy or adjunctive therapy to dietary supplements or conventional medications led to significant improvements in anorexia symptoms, body measurements, levels of blood biomarkers related to gastrointestinal function, and nutrition indices, with a lower recurrence rate of anorexia. No serious adverse events related to HM were reported. The risk of bias of the included studies was generally unclear, and the quality of evidence was generally low to moderate. Conclusion: Our study showed that HM could improve clinical symptoms, some anthropometric outcomes, and some biological markers related to appetite and growth in children with anorexia. However, considering the high risk of bias of the included studies and the heterogeneity of the HMs used, future research should focus on the use of standardized HMs and the implementation of methodologically robust clinical trials. Systematic Review Registration: https://www.crd.york.ac.uk/prosperodisplay_record.php?ID=CRD42021274376, identifier CRD42021274376
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Affiliation(s)
- Boram Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-eui University College of Korean Medicine, Busan, South Korea
| | - Sun Haeng Lee
- Department of Korean Pediatrics, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Gyu Tae Chang
- Department of Korean Pediatrics, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- *Correspondence: Gyu Tae Chang,
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31
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Brown JM, Franco-Arellano B, Froome H, Siddiqi A, Mahmood A, Arcand J. The Content, Quality, and Behavior Change Techniques in Nutrition-Themed Mobile Apps for Children in Canada: App Review and Evaluation Study. JMIR Mhealth Uhealth 2022; 10:e31537. [PMID: 35171100 PMCID: PMC8892278 DOI: 10.2196/31537] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/04/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Children increasingly use mobile apps. Strategies to increase child engagement with apps include the use of gamification and images that incite fun and interaction, such as food. However, the foods and beverages that children are exposed to while using apps are unknown and may vary by app type. OBJECTIVE The aim of this study is to identify the app content (ie, types of foods and beverages) included in nutrition-themed apps intended for children, to assess the use of game-like features, and to examine app characteristics such as overall quality and behavior change techniques (BCTs). METHODS This analysis used a cross-sectional database of nutrition-themed apps intended for children (≤12 years), collected between May 2018 and June 2019 from the Apple App Store and Google Play Store (n=259). Apps were classified into four types: food games or nongames that included didactic nutrition guides, habit trackers, and other. Food and beverages were identified in apps and classified into 16 food categories, as recommended (8/16, 50%) and as not recommended (8/16, 50%) by dietary guidelines, and quantified by app type. Binomial logistic regression assessed whether game apps were associated with foods and beverages not recommended by guidelines. App quality, overall and by subscales, was determined using the Mobile App Rating Scale. The BCT Taxonomy was used to classify the different behavioral techniques that were identified in a subsample of apps (124/259, 47.9%). RESULTS A total of 259 apps displayed a median of 6 (IQR 3) foods and beverages. Moreover, 62.5% (162/259) of apps were classified as food games, 27.4% (71/259) as didactic nutrition guides, 6.6% (17/259) as habit trackers, and 3.5% (9/259) as other. Most apps (198/259, 76.4%) displayed at least one food or beverage that was not recommended by the dietary guidelines. Food game apps were almost 3 times more likely to display food and beverages not recommended by the guidelines compared with nongame apps (β=2.8; P<.001). The overall app quality was moderate, with a median Mobile App Rating Scale score of 3.6 (IQR 0.7). Functionality was the subscale with the highest score (median 4, IQR 0.3). Nutrition guides were more likely to be educational and contain informative content on healthy eating (score 3.7), compared with the other app types, although they also scored significantly lower in engagement (score 2.3). Most apps (105/124, 84.7%) displayed at least one BCT, with the most common BCT being information about health consequences. CONCLUSIONS Findings suggest nutrition-themed apps intended for children displayed food and beverage content not recommended by dietary guidelines, with gaming apps more likely to display not recommended foods than their nongame counterparts. Many apps have a moderate app quality, and the use of consequences (instead of rewards) was the most common BCT.
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Affiliation(s)
| | | | - Hannah Froome
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Amina Siddiqi
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Amina Mahmood
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - JoAnne Arcand
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
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32
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Wilujeng AP, Indriani N, Trianita D, Munif B, Yanuar A, Putri NS, Mawarni EE. Determinants of Infant Growth and Development Based on the Health Promotion Model. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The quality of future generations is largely determined by the growth and development of toddlers. All parents want their children to grow and develop optimally.
AIM: The purpose of this study was to identify the determinants of growth and development of infants aged 3–12 months based on the Health Promotion Model (HPM).
METHODS: The study used a cross-sectional study design, which was conducted at the Banyuwangi District Health Center. Respondents in this study were mothers who had infants aged 3–12 months as many as 217. The sampling technique used was random sampling. The independent variables using the components of the HPM theory are mother’s motivation, infant’s gestational age, perceived benefit, perceived barrier, perceived self-efficacy, and activity-related affect. The dependent variable is growth and development. Growth assessment is obtained from the BB/U value and compared with the z-score table. Developmental assessment was done using Pre-screening Development Questionnaire. The relationship between each independent variable and the dependent variable was analyzed using the Chi-square test. Determinants of growth and development of children under five were analyzed using multiple logistic regression.
RESULTS: The results of the independent variable logistic regression test with growth showed that the variable with p < 0.05 was the mother’s perceived self-efficacy with p = 0.013. While the independent variable logistic regression test with development showed that the variable with p < 0.05 was the mother’s perceived barrier with a p = 0.000.
CONCLUSION: Based on the HPM approach, it was found that the determinant of infant growth was the mother’s perceived self-efficacy, while the determinant of infant development was the mother’s perceived barrier. The growth and development of toddlers can be achieved optimally through efforts to increase the mother’s perceived self-efficacy and reduce the mother’s perceived barrier.
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Nepfumbada G, Dzinamarira T, Mashamba-Thompson TP. Development of an acceptable indigenous food diet for Pedi children under five years in early childhood development centers in rural Limpopo, South Africa. Arch Public Health 2021; 79:217. [PMID: 34844652 PMCID: PMC8630854 DOI: 10.1186/s13690-021-00743-9] [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: 05/27/2021] [Accepted: 11/21/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The use of indigenous food (IF) such as green leafy vegetables and fruits in rural communities has been the primary source of their diet despite being replaced by food high in sugar and fats. South Africans are over-reliant on maize and should diversify their diets to include more indigenous fruits and vegetables to improve nutrition. Early Childhood Development (ECD) centers positively influence healthy eating among children under five years. This study aimed for ECD stakeholders to co-create an IF diet for children under five in ECD centers. METHOD A sequential explanatory mixed-method design was employed. We conducted focus group discussions with stakeholders using the community-based participatory research (CBPR) approach and the nominal group technique ranking method to develop children's acceptable indigenous food diet. Data were analyzed using both qualitative and quantitative methods. We employed a thematic approach to analyze data using a Consolidated Framework for Implementation Research (intervention characteristics, inner setting, outer setting, individuals involved in implementation, and the implementation process. We used statistical analysis to analyze quantitative data collected through surveys. RESULTS Participants developed an IF diet. Participants were six ECD stakeholders (ECD managers, social workers, and dieticians) aged 34-52. Participants identified and voted for Ditokomane, Oranges, Mabele soft porridge, Dithotse, and Dinawa as components of an IF that are suitable and acceptable for children under five years as an IF diet appropriate and adequate for children under five years ECD centers will implement. CONCLUSION Implementation of the developed IF diet can be considered an intervention towards achieving the United Nations Sustainable Development Goal 2 to end hunger, achieve food security and improve nutrition and sustainable agriculture. The study suggests that the IF diet could scale up the use of IF to fulfill dietary requirements for children under five years and preserve indigenous knowledge.
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Affiliation(s)
- Gundo Nepfumbada
- University of KwaZulu-Natal - Howard College Campus, Durban, South Africa.
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34
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Tang MN, Adolphe S, Rogers SR, Frank DA. Failure to Thrive or Growth Faltering: Medical, Developmental/Behavioral, Nutritional, and Social Dimensions. Pediatr Rev 2021; 42:590-603. [PMID: 34725219 DOI: 10.1542/pir.2020-001883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Margot N Tang
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
| | - Soukaina Adolphe
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
| | | | - Deborah A Frank
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
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35
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Dulal S, Prost A, Karki S, Saville N, Merom D. Characteristics and effects of integrated nutrition and stimulation interventions to improve the nutritional status and development of children under 5 years of age: a systematic review and meta-analysis. BMJ Glob Health 2021; 6:bmjgh-2020-003872. [PMID: 34321232 PMCID: PMC8319976 DOI: 10.1136/bmjgh-2020-003872] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 06/29/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Around 250 million children in low-income and middle-income countries are at risk of not fulfilling their developmental potential. There is a need to update syntheses investigating the effects of combined nutrition and stimulation interventions on children’s growth and development and identify intervention characteristics associated with positive effects. Methods We did a systematic review to: (1) understand the effects of integrated nutrition and stimulation interventions versus (i) usual care and (ii) standalone nutrition or stimulation interventions, on the growth and development of children under five; (2) explore intervention characteristics (delivery strategies, behaviour change techniques, intensity and personnel) associated with positive effects. We searched eight databases for studies published from inception to 16 November 2020. Eligible studies were randomised and non-randomised controlled trials of integrated nutrition and stimulation interventions examining growth and developmental outcomes. We performed meta-analyses for length-for-age/height-for-age, weight-for-age and weight-for-length/weight-for-height Z scores and cognitive, motor and language development scores, and subgroup analyses by intervention characteristics. We conducted random-effects metaregression to assess potential subgroup differences in outcomes by intervention characteristics. Results Twenty trials were included in the meta-analysis. Pooled effect sizes showed significant benefits of integrated interventions on developmental outcomes compared with usual care and standalone nutrition interventions (I2 >75%) but not on growth outcomes. Moreover, integrated interventions have non-significant effects on developmental outcomes compared with standalone stimulation interventions. Integrated interventions showed greater effects on cognitive (p=0.039) and language (p=0.040) outcomes for undernourished children compared with adequately nourished children. The effects of integrated interventions on developmental outcomes did not differ by intervention characteristics. Conclusion Integrated interventions have greater benefits for children’s development than usual care or standalone nutrition interventions, especially in settings with high levels of undernutrition. Future studies should use standardised reporting of implementation processes to identify intervention characteristics linked to positive effects.
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Affiliation(s)
- Sophiya Dulal
- School of Health Sciences, Western Sydney University, Penrith South, New South Wales, Australia
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | - Surendra Karki
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,Research and Development, Australian Red Cross Lifeblood New South Wales and Australian Capital Territory, Alexandria, New South Wales, Australia
| | - Naomi Saville
- Institute for Global Health, University College London, London, UK
| | - Dafna Merom
- School of Health Sciences, Western Sydney University, Penrith South, New South Wales, Australia
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Ramponi F, Tafesse W, Griffin S. Economic evaluation of interventions to address undernutrition: a systematic review. Health Policy Plan 2021; 36:533-541. [PMID: 33280036 PMCID: PMC8128006 DOI: 10.1093/heapol/czaa149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 12/28/2022] Open
Abstract
Strategies to address undernutrition in low- and middle-income countries (LMICs) include various interventions implemented through different sectors of the economy. Our aim is to provide an overview of published economic evaluations of such interventions and to compare and contrast evaluations of interventions in different areas. We reviewed economic evaluations of nutrition interventions in LMICs published since 2015 and/or included in the Tufts Global registry or Disease Control Priorities 3rd edition. We categorized the studies by intervention type (preventive; therapeutic; fortification; delivery platforms), nutritional deficiency addressed and characteristics of the economic evaluation (e.g. type of model, costs and outcomes included). Of the 62 economic evaluations identified, 56 (90%) were cost-effectiveness analyses. Twenty-two (36%) evaluations investigated fortification and 23 (37%) preventive interventions. Forty-three percent of the evaluations of preventive interventions did not include a model, whereas most of fortification strategies used the same reference model. We identified different trends in cost categories and inclusion of health and non-health outcomes across evaluations in the four different topic areas. To illustrate the implications of such trends for decision-making, we compared a set of studies evaluating alternative strategies to combat zinc deficiency. We showed that the use of ‘off-the-shelf’ models and tools can potentially conceal what outcomes and costs and value judgements are used. Comparing interventions across different areas is fundamental to assist decision-makers in developing their nutrition strategy. Systematic differences in the economic evaluations of interventions delivered within and outside the health sector can undermine the ability to prioritize alternative nutrition strategies.
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Affiliation(s)
- Francesco Ramponi
- Centre for Health Economics, Alcuin A Block, University of York ,York YO10 5DD, UK
| | - Wiktoria Tafesse
- Centre for Health Economics, Alcuin A Block, University of York ,York YO10 5DD, UK
| | - Susan Griffin
- Centre for Health Economics, Alcuin A Block, University of York ,York YO10 5DD, UK
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37
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Windiani IGAT, Agustini NKW, Adnyana IGANS, Soetjiningsih S, Murti NLSP. The Association Between Nutritional Status and Risk of Developmental Disorder in Children in Denpasar Bali Indonesia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Preschool age is an important period for growth and development. Malnutrition that occurs during this period can have negative impacts on growth, cognitive development, and academic performance in children.
AIM: The objective of the study is to know the association between nutritional status and the risk of developmental disorder in preschool children in Denpasar.
METHODS: An observational analytic study with a cross-sectional design and cluster sampling method was conducted on children under 5 years old who attended Early Childhood Education in Denpasar Bali in 2019.
RESULTS: From 468 samples, the median age was 5 years old (range, 1–5), the majority of children were well-nourished (52.6%), and caretaken by parents (82.9%). Child development was prescreened using an Indonesian child development pre-screening questionnaire/Kuesioner Pra Skrining Perkembangan (KPSP) that had 75% sensitivity, 99.16% specificity, 85.71% positive predictive value,and 98.33% negative predictive value compared to Capute Scale test as a gold standard. It showed that the majority of participants had an appropriate developmental stage (91.3%), followed by doubtful (5.3%) and possible deviations (3.4%). The results of the bivariate analysis showed that malnutrition was significantly related to the risk of developmental delay (PR 2; confidence interval [CI] 95%, 1.05-3.97). The result of multivariate analysis for variables that were considered to be significant as a risk for developmental disorder showed that malnutrition was related to the possibility of developmental disorder (PR 2; CI 95%, 1.04–3.95). Caretakers other than parents and lack of physical activity were not significantly related to the risk of developmental disorder.
CONCLUSION: Malnutrition was found to be significantly associated with the risk of developmental disorder in preschool children. Further prospective study by standard assessment tools is required to evaluate the association between nutritional status and developmental level in children.
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Huma ZE, Gillani A, Shafique F, Rashid A, Mahjabeen B, Javed H, Wang D, Rahman A, Hamdani SU. Evaluating the impact of a common elements-based intervention to improve maternal psychological well-being and mother-infant interaction in rural Pakistan: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e047609. [PMID: 34233989 PMCID: PMC8264893 DOI: 10.1136/bmjopen-2020-047609] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/21/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Millions of children in low resource settings are at high risk of poor development due to factors such as under nutrition, inadequate stimulation and maternal depression. Evidence-based interventions to address these risk factors exist, but often as a separate and overlapping package. The current study aims to evaluate the effectiveness of a common elements-based intervention to improve mother-infant interaction at 12 months post-partum. METHOD AND ANALYSIS A two-arm, single-blinded, individual randomised controlled trial is being carried out in the community settings of the rural subdistrict of Gujar Khan in Rawalpindi, Pakistan. 250 pregnant women in third trimester with distress (Self-Reporting Questionnaire, cut-off score >9) have been randomised on 1:1 allocation ratio into intervention (n=125) and treatment-as-usual arms (n=125). The participants in the intervention arm will receive 15 individual sessions of intervention on a monthly basis by non-specialist facilitators. The intervention involves components of early stimulation, learning through play, responsive feeding, guided discovery using pictures, behavioural activation and problem solving. The primary outcome is caregiver-infant interaction at 12 months postpartum. The secondary outcomes include maternal psychological well-being, quality of life, social support and empowerment. Infant secondary outcomes include growth, nutrition and development. The data will be collected at baseline, 6 and 12 months postpartum. A qualitative process evaluation will be conducted to inform the feasibility of intervention delivery. ETHICS Ethics approval for the present study was obtained from the Human Development Research Foundation Institutional Review Board, Islamabad Pakistan. DISSEMINATION If proven effective, the study will contribute to scale-up care for maternal and child mental health in low resource settings, globally. The findings of the present study will be published in peer-reviewed journals and presented at conferences and community forums. TRIAL REGISTRATION NUMBER NCT04252807.
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Affiliation(s)
- Zill-E- Huma
- Implementation Science, Human Development Research Foundation, Islamabad, Punjab, Pakistan
- Department of Primary Care and Mental Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Ayella Gillani
- Implementation Science, Human Development Research Foundation, Islamabad, Punjab, Pakistan
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Fakhira Shafique
- Implementation Science, Human Development Research Foundation, Islamabad, Punjab, Pakistan
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Alina Rashid
- Implementation Science, Human Development Research Foundation, Islamabad, Punjab, Pakistan
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Bushra Mahjabeen
- Implementation Science, Human Development Research Foundation, Islamabad, Punjab, Pakistan
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Hashim Javed
- Implementation Science, Human Development Research Foundation, Islamabad, Punjab, Pakistan
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Atif Rahman
- Department of Primary Care and Mental Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
| | - Syed Usman Hamdani
- Implementation Science, Human Development Research Foundation, Islamabad, Punjab, Pakistan
- Department of Primary Care and Mental Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
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Black MM, Fernandez-Rao S, Nair KM, Balakrishna N, Tilton N, Radhakrishna KV, Ravinder P, Harding KB, Reinhart G, Yimgang DP, Hurley KM. A Randomized Multiple Micronutrient Powder Point-of-Use Fortification Trial Implemented in Indian Preschools Increases Expressive Language and Reduces Anemia and Iron Deficiency. J Nutr 2021; 151:2029-2042. [PMID: 33880548 PMCID: PMC8245888 DOI: 10.1093/jn/nxab066] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/01/2020] [Accepted: 02/22/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Anemia is a global public health problem that undermines childhood development. India provides government-sponsored integrated nutrition/child development preschools. OBJECTIVES This double-masked, cluster-randomized controlled trial examines whether point-of-use multiple micronutrient powder (MNP) compared with placebo fortification of preschool meals impacts child development and whether effects vary by preschool quality (primary outcome) and biomarkers of anemia and micronutrients (secondary outcomes). We also measured growth and morbidity. METHODS We randomly assigned 22 preschools in rural India to receive MNP/placebo fortification. We administered baseline and endline blood sampling and measures of childhood development (Mullen Scales of Early Learning, inhibitory control, social-emotional), anthropometry, and morbidity to preschoolers (aged 29-49 mo). Preschools added MNP/placebo to meals 6 d/wk for 8 mo. We conducted linear mixed-effects regression models accounting for preschool clustering and repeated measures. We evaluated child development, examining effects in high- compared with low-quality preschools using the Early Childhood Environment Rating Scale-Revised and the Home Observation for the Measurement of the Environment Inventory, modified for preschools. RESULTS At baseline, mean age ± SD was 36.6 ± 5.7 mo, with 47.8% anemic, 41.9% stunted, and 20.0% wasted. Baseline expressive/receptive language scores were higher in high-quality compared with low-quality preschools (P = 0.02 and P = 0.03, respectively). At endline (91% retention, n = 293/321), we found MNP compared with placebo effects in expressive language (Cohen's standardized effect d = 0.4), inhibitory control (d = 0.2), and social-emotional (d = 0.3) in low-quality, not high-quality, preschools. MNP had significantly greater reduction of anemia and iron deficiency compared with placebo (37% compared with 13.5% and 41% compared with 1.2%, respectively). There were no effects on growth or morbidity. CONCLUSIONS Providing multiple micronutrient-fortified meals in government-sponsored preschools is feasible; reduced anemia and iron deficiency; and, in low-quality preschools, increased preschoolers' expressive language and inhibitory control and reduced developmental disparities. Improving overall preschool quality by incorporating multiple components of nurturing care (responsive care, learning, and nutrition) may be necessary to enhance preschoolers' development. This trial was registered at clinicaltrials.gov as NCT01660958.
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Affiliation(s)
- Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
- RTI International, Research Triangle Park, NC, USA
| | - Sylvia Fernandez-Rao
- Department of Behavioral Science, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - Krishnapillai Madhavan Nair
- Department of Micronutrient Research, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - Nagalla Balakrishna
- Department of Biostatistics, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - Nicholas Tilton
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Punjal Ravinder
- Department of Micronutrient Research, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | | | - Gregory Reinhart
- The Mathile Institute for the Advancement of Human Nutrition, Dayton, OH, USA
| | - Doris P Yimgang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kristen M Hurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Froome HM, Townson C, Rhodes S, Franco-Arellano B, LeSage A, Savaglio R, Brown JM, Hughes J, Kapralos B, Arcand J. The Effectiveness of the Foodbot Factory Mobile Serious Game on Increasing Nutrition Knowledge in Children. Nutrients 2020; 12:E3413. [PMID: 33172094 PMCID: PMC7694779 DOI: 10.3390/nu12113413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 12/26/2022] Open
Abstract
The interactive and engaging nature of serious games (i.e., video games designed for educational purposes) enables deeper learning and facilitates behavior change; however, most do not specifically support the dissemination of national dietary guidelines, and there are limited data on their impact on child nutrition knowledge. The Foodbot Factory serious game mobile application was developed to support school children in learning about Canada's Food Guide; however, its impacts on nutrition knowledge have not been evaluated. The objective of this study was to determine if Foodbot Factory effectively improves children's knowledge of Canada's Food Guide, compared to a control group (control app). This study was a single-blinded, parallel, randomized controlled pilot study conducted among children ages 8-10 years attending Ontario Tech University day camps. Compared to the control group (n = 34), children who used Foodbot Factory (n = 39) had significant increases in overall nutrition knowledge (10.3 ± 2.9 to 13.5 ± 3.8 versus 10.2 ± 3.1 to 10.4 ± 3.2, p < 0.001), and in Vegetables and Fruits (p < 0.001), Protein Foods (p < 0.001), and Whole Grain Foods (p = 0.040) sub-scores. No significant difference in knowledge was observed in the Drinks sub-score. Foodbot Factory has the potential to be an effective educational tool to support children in learning about nutrition.
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Affiliation(s)
- Hannah M. Froome
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, Canada; (H.M.F.); (C.T.); (B.F.-A.); (J.M.B.)
| | - Carly Townson
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, Canada; (H.M.F.); (C.T.); (B.F.-A.); (J.M.B.)
| | - Sheila Rhodes
- Faculty of Education, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, Canada; (S.R.); (A.L.); (J.H.)
| | - Beatriz Franco-Arellano
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, Canada; (H.M.F.); (C.T.); (B.F.-A.); (J.M.B.)
| | - Ann LeSage
- Faculty of Education, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, Canada; (S.R.); (A.L.); (J.H.)
| | - Rob Savaglio
- Faculty of Business and Information Technology, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, Canada; (R.S.); (B.K.)
| | - Jacqueline Marie Brown
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, Canada; (H.M.F.); (C.T.); (B.F.-A.); (J.M.B.)
| | - Janette Hughes
- Faculty of Education, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, Canada; (S.R.); (A.L.); (J.H.)
| | - Bill Kapralos
- Faculty of Business and Information Technology, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, Canada; (R.S.); (B.K.)
| | - JoAnne Arcand
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, Canada; (H.M.F.); (C.T.); (B.F.-A.); (J.M.B.)
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Social Determinants of Health and the Role of Routine Pediatric Care in a Medically Complex Toddler. J Dev Behav Pediatr 2020; 41:583-585. [PMID: 32649593 DOI: 10.1097/dbp.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CASE Late on a Friday afternoon, a new family presents to your practice for urgent care. They come with their youngest child Mai, a 2-year-old girl, who, although born in the United States at 36 weeks gestation, has resided in Laos with her grandparents for the past 16 months. Your triage nurse tells you that she has a fever and was found to have profound anemia while at the WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) office earlier today.On walking into the room, you describe Mai as "listless" and "sickly." Her vitals were notable for fever (102°F), tachycardia (140 beats per minute), and tachypnea (35 breaths per minute). On physical examination, she was grunting with a systolic ejection murmur and without hepatosplenomegaly. Laboratory test results revealed hemoglobin of 2.2 g/dL, hematocrit of 12%, mean corpuscular volume of 50 fL, red cell distribution width of 27%, reticulocyte count of 3%, ferritin of <2 ng/mL, iron of 15 μg/dL, total iron binding count of 420 μg/dL, white blood cell count of 13.5 K/μL, and platelets of 605 K/μL. Her evaluation was consistent with severe iron deficiency anemia (IDA), which was further supported by reported restrictive diet and excessive cow milk intake of 35 ounces daily. She was admitted to the Pediatric Intensive Care Unit in high-output cardiac failure and was slowly transfused with 15 mL/kg of packed red blood cells over 2 days with careful monitoring. Once stabilized, she was transferred to the inpatient floor for further nutritional evaluation and supplementation. Additional workup, including hemoglobin electrophoresis, fecal occult blood test, celiac studies, and stool parasite testing were normal. The clinical picture was consistent with a viral infection in the setting of profound IDA and malnutrition.Although her clinical status had improved, she remained inpatient for nutritional optimization. Her height was at the 54th percentile (z-score: 0.11), weight was at the first percentile (z-score: -2.25), and body mass index was below the first percentile (z-score: -3.18), diagnostic of severe protein-calorie malnutrition. She was evaluated by an interdisciplinary growth and nutrition team, received multivitamin and mineral supplements, and was monitored for refeeding syndrome. She was noted to be "difficult to engage," "resistant to new faces," and made little progress on expanding her dietary choices. Concerns about a possible diagnosis of autism spectrum disorder were raised by her treating team. What would you do next? REFERENCE 1. Bouma S. Diagnosing pediatric malnutrition: paradigm shifts of etiology-related definitions and appraisal of the indicators. Nutr Clin Pract. 2017;32:52-67.
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Kiebalo T, Holotka J, Habura I, Pawlaczyk K. Nutritional Status in Peritoneal Dialysis: Nutritional Guidelines, Adequacy and the Management of Malnutrition. Nutrients 2020; 12:E1715. [PMID: 32521626 PMCID: PMC7352713 DOI: 10.3390/nu12061715] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/30/2020] [Accepted: 06/04/2020] [Indexed: 12/11/2022] Open
Abstract
The positive impact of nutritional status on the health and treatment adequacy of peritoneal dialyzed patients has been well established. Protein intake is an important factor used to stratify malnutrition, with inadequate intake leading to protein-energy wasting during the course of therapy. In this review, we discuss the recommendations made by nephrological societies regarding nutrition in this population of dialysis patients. Special attention is given to the intake of protein, and recommendations on the intake of micronutrients are also discussed. Furthermore, factors that may impair nutritional intake and balance are discussed, with mention of the innovative strategies utilized to combat them. In light of inconsistent recommendations that vary between each respective society, as well as a general lack of concise information, it is our intention to call for further research regarding nutritional recommendations in peritoneal dialysis (PD), as well as to advocate for clear and accessible information for patients.
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Affiliation(s)
- Thomas Kiebalo
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (T.K.); (J.H.)
| | - Jacqueline Holotka
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (T.K.); (J.H.)
| | - Ireneusz Habura
- Department of Nephrology, University Hospital of Karol Marcinkowski in Zielona Gora, 65-046 Zielona Gora, Poland;
| | - Krzysztof Pawlaczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (T.K.); (J.H.)
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Ordway MR, Sadler LS, Jeon S, O'Connell M, Banasiak N, Fenick AM, Crowley AA, Canapari C, Redeker NS. Sleep health in young children living with socioeconomic adversity. Res Nurs Health 2020; 43:329-340. [PMID: 32306413 DOI: 10.1002/nur.22023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/22/2020] [Accepted: 03/29/2020] [Indexed: 12/19/2022]
Abstract
Racially and ethnically diverse young children who live with socioeconomic adversity are at high risk for sleep deficiency, but few behavioral sleep interventions (BSIs) are tailored to their needs. To support the future development of a feasible, acceptable, and culturally relevant sleep intervention, we conducted a community-engaged, mixed-methods study with 40 low-income, racially, and ethnically diverse parents to describe sleep characteristics, sleep habits, and parental sleep knowledge of their 6-36-month-old children and to examine the associations between children's sleep characteristics and sleep habits. This report presents quantitative data from this mixed-methods study. We measured objective (actigraphy) and parent-reported sleep (Brief Infant Sleep Questionnaire) characteristics, sleep habits at bedtime, sleep onset, and during night awakenings, parental sleep knowledge, psychological function (Brief Symptom Inventory), and parenting stress (Parenting Stress Index). Children had low sleep duration (537.2 ± 54.7 nighttime and 111.2 ± 29.8 nap minutes), late bedtimes (22:36 ± 1.5 hr), and high bedtime variability (mean squared successive difference = 3.68 ± 4.31 hr) based on actigraphy. Parental knowledge about sleep recommendations was limited. Sleep habits before bedtime, at sleep onset, and during night awakenings were varied. Sixty-five percent of parents reported co-sleeping. Feeding near bedtime or during the night was associated with later bedtimes, more fragmented sleep, and increased bedtime variability. These findings suggest the need for BSIs to support earlier bedtimes and improve sleep duration and continuity by addressing modifiable behaviors. Tailored BSIs that consider socioecological influences on the development of sleep habits are needed.
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Affiliation(s)
| | - Lois S Sadler
- Yale Child Study Center, Yale University School of Nursing, West Haven, Connecticut
| | | | | | | | - Ada M Fenick
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | | | - Craig Canapari
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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Yaya S, Uthman OA, Kunnuji M, Navaneetham K, Akinyemi JO, Kananura RM, Adjiwanou V, Adetokunboh O, Bishwajit G. Does economic growth reduce childhood stunting? A multicountry analysis of 89 Demographic and Health Surveys in sub-Saharan Africa. BMJ Glob Health 2020; 5:e002042. [PMID: 32133174 PMCID: PMC7042587 DOI: 10.1136/bmjgh-2019-002042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/29/2019] [Accepted: 01/06/2020] [Indexed: 12/18/2022] Open
Abstract
Background There is mixed evidence and lack of consensus on the impact of economic development on stunting, and likewise there is a dearth of empirical studies on this relationship in the case of sub-Saharan Africa. Thus, this paper examines whether economic growth is associated with childhood stunting in low-income and middle-income sub-Saharan African countries. Methods We analysed data from 89 Demographic and Health Surveys conducted between 1987 and 2016 available as of October 2018 using multivariable multilevel logistic regression models to show the association between gross domestic product (GDP) per capita and stunting. We adjusted the models for child's age, survey year, child's sex, birth order and country random effect, and presented adjusted and unadjusted ORs. Results We included data from 490 526 children. We found that the prevalence of stunting decreased with increasing GDP per capita (correlation coefficient=-0.606, p<0.0001). In the unadjusted model for full sample, for every US$1000 increase in GDP per capita, the odds of stunting decreased by 23% (OR=0.77, 95% CI 0.76 to 0.78). The magnitude of the association between GDP per capita and stunting was stronger among children in the richest quintile. After adjustment was made, the association was not significant among children from the poorest quintile. However, the magnitude of the association was more pronounced among children from low-income countries, such that, in the model adjusted for child's age, survey year, child's sex, birth order and country random effect, the association between GDP per capita and stunting remained statistically significant; for every US$1000 increase in GDP per capita, the odds of stunting decreased by 12% (OR=0.88, 95% CI 0.87 to 0.90). Conclusion There was no significant association between economic growth and child nutritional status. The prevalence of stunting decreased with increasing GDP per capita. This was more pronounced among children from the richest quintile. The magnitude of the association was higher among children from low-income countries, suggesting that households in the poorest quintile were typically the least likely to benefit from economic gains. The findings could serve as a building block needed to modify current policy as per child nutrition-related programmes in Africa.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada.,The George Institute for Global Health, The University of Oxford, Oxford, United Kingdom
| | - Olalekan A Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Michael Kunnuji
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Kannan Navaneetham
- Department of Population Studies, University of Botswana, Gaborone, Botswana
| | | | - Rornald Muhumuza Kananura
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Visseho Adjiwanou
- Département de Sociologie, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Olatunji Adetokunboh
- The South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
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Myszkowska-Ryciak J, Harton A. Eating Healthy, Growing Healthy: Outcome Evaluation of the Nutrition Education Program Optimizing the Nutritional Value of Preschool Menus, Poland. Nutrients 2019; 11:E2438. [PMID: 31614948 PMCID: PMC6835571 DOI: 10.3390/nu11102438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 09/24/2019] [Accepted: 10/09/2019] [Indexed: 12/13/2022] Open
Abstract
Staff education can improve the quality of nutrition in childcare centers, but an objective assessment of the change is necessary to assess its effectiveness. This study evaluated the effectiveness of the multicomponent educational program for improving the nutritional value of preschools menus in Poland measured by the change in nutrients content before (baseline) and 3-6 months after education (post-baseline). A sample of 10 daily menus and inventory reports reflecting foods and beverages served in 231 full-board government-sponsored preschools was analyzed twice: at baseline and post-baseline (in total 4620 inventory reports). The changes in 1. the supply of nutrients per 1 child per day; 2. the nutrient-to-energy ratio of menus; 3. the number of preschools serving menus consistent with the healthy diet recommendations, were assessed. Education resulted in favorable changes in the supply of energy, fat and saturated fatty acids. The nutrient-to-energy ratio for vitamins A, B1, B2, B6, C, folate and minerals Calcium, copper, iron, magnesium, phosphorus, potassium and zinc increased significantly. The percentage of preschools implementing the recommendations for energy, share of fat, saturated fatty acids and sucrose as well as calcium, iron and potassium increased significantly. However, no beneficial effects of education on the content of iodine, potassium, vitamin D and folate were observed. This study indicates the potentially beneficial effect of education in optimizing the quality of the menu in preschools. However, the magnitude of change is still not sufficient to meet the nutritional standards for deficient nutrients.
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Affiliation(s)
- Joanna Myszkowska-Ryciak
- Department of Dietetics, Faculty of Human Nutrition, Warsaw University of Life Sciences (WULS), 159C Nowoursynowska Str, 02-776 Warsaw, Poland.
| | - Anna Harton
- Department of Dietetics, Faculty of Human Nutrition, Warsaw University of Life Sciences (WULS), 159C Nowoursynowska Str, 02-776 Warsaw, Poland.
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Luo R, Emmers D, Warrinnier N, Rozelle S, Sylvia S. Using community health workers to deliver a scalable integrated parenting program in rural China: A cluster-randomized controlled trial. Soc Sci Med 2019; 239:112545. [PMID: 31568997 DOI: 10.1016/j.socscimed.2019.112545] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/26/2019] [Accepted: 09/07/2019] [Indexed: 12/17/2022]
Abstract
Inadequate care during early childhood can lead to long-term deficits in skill development. Parenting programs are promising tools for improving parenting practices and opportunities for healthy development. We implemented a non-masked cluster-randomized controlled trial in rural China in order to assess the effectiveness of an integrated home-visitation program that includes both psychosocial stimulation and health promotion at fostering development and health outcomes of infants and toddlers in rural China. All 6-18 month-old children of two rural townships and their main caregiver were enrolled. Villages were stratified by township and randomly assigned to intervention or control. Specifically, in September 2015 we assigned 43 clusters to treatment (21 villages, 222 caregiver-child dyads) or control (22 villages, 227 caregiver-child dyads). In the intervention group, community health workers delivered education and training on how to provide young children with psychosocial stimulation and health care (henceforth psychosocial stimulation and health promotion) during bi-weekly home visits over the period of one year. The control group received no home visits. Primary outcomes include measures of child development (i.e. the Bayley Scales of Infant and Toddler Development, third edition-or Bayley-III) and health (i.e. measures of morbidity, nutrition, and growth). Secondary outcomes are measures of parenting practices. Intention-to-treat (ITT) effects show that the intervention led to an improvement of 0·24 standard deviations (SD) [95% CI 0·04 SD-0·44 SD] in cognitive development and to a reduction of 8·1 [95% CI 3·8-12·4] percentage points in the risk of diarrheal illness. In addition, we find positive effects on parenting practices mirroring these results. We conclude that an integrated psychosocial stimulation and health promotion program improves development and health outcomes of infants and toddlers (6-30 month-old children) in rural China. Because of low incremental costs of adding program components (that is, adding health promotion to psychosocial stimulation programs), integrated programs may be cost-effective.
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Affiliation(s)
- Renfu Luo
- China Centre for Agricultural Policy (CCAP), School of Advanced Agricultural Sciences (SAAS), Peking University (PKU), Beijing, China
| | | | | | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, USA
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.
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Edmond KM, Strobel NA, Adams C, McAullay D. Effect of early childhood development interventions implemented by primary care providers commencing in the neonatal period to improve cognitive outcomes in children aged 0-23 months: protocol for a systematic review and meta-analysis. Syst Rev 2019; 8:224. [PMID: 31470911 PMCID: PMC6716939 DOI: 10.1186/s13643-019-1142-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 08/15/2019] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Impacts of early childhood development (ECD) interventions (such as fostering attachment and responsiveness through communication, play and stimulation) are well known. Globally, there is increasing recognition of the importance of the 'golden' minutes, hours and days after birth for infant health and development. However, only one systematic review has examined ECD interventions implemented in the neonatal period (0-27 days), and this review only assessed interventions implemented by specialised providers. Primary care providers have many potential contacts with mothers and infants throughout the neonatal period. However, it is unclear how many research studies or programmes have examined the effectiveness of ECD interventions commencing in the neonatal period and which methods were used. To date, there has been no systematic review of the effect of ECD interventions delivered by primary care providers commencing in the neonatal period. METHODS Our overall aim is to conduct a systematic review of the effect of ECD interventions implemented by primary care providers in the neonatal period. We will assess effects by timing and number ('dose') of contacts with primary care providers. Subgroup assessment will include effects in disadvantaged infants such as those born with low birth weight and to mothers with mental health disorders. We will also assess effects in low- and high-income countries and by type of care provider. The primary outcome is cognitive status in children aged 0-23 months as measured using standardised scales. Secondary outcomes include other child neurodevelopment domains (speech, language, fine motor, gross motor, social, emotional, behaviour, executive functioning, adaptive functioning) in children aged 0-23 months. Effects on maternal mental health will also be assessed between 0-23 months postpartum. Databases such as MEDLINE (OVID), PsycINFO (OVID), EMBASE (OVID), CINAHL, Cochrane Library, WHO databases and reference lists of papers will be searched for relevant articles. Only randomised controlled trials will be included. A narrative synthesis for all outcomes will be reported. Meta-analyses will be performed where exposures and outcomes are sufficiently homogeneous. Guidelines for PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) will be followed. DISCUSSION This review appears to be the first to be conducted in this area. The findings will be an important resource for policymakers, primary care providers and researchers who work with young infants in primary care settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019122021.
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Affiliation(s)
- Karen M. Edmond
- Medical School, Division of Paediatrics, University of Western Australia, Perth, Australia
| | - Natalie A. Strobel
- Medical School, Division of Paediatrics, University of Western Australia, Perth, Australia
| | - Claire Adams
- Medical School, Division of Paediatrics, University of Western Australia, Perth, Australia
| | - Dan McAullay
- Medical School, Division of Paediatrics, University of Western Australia, Perth, Australia
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Abey NO, Ebuehi OAT, Imaga NOA. Neurodevelopment and Cognitive Impairment in Parents and Progeny of Perinatal Dietary Protein Deficiency Models. Front Neurosci 2019; 13:826. [PMID: 31551668 PMCID: PMC6736561 DOI: 10.3389/fnins.2019.00826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/24/2019] [Indexed: 12/26/2022] Open
Abstract
There is an absolute dependence of the concept of development on supply of adequately balanced nutrients especially during the perinatal age which is critical to development. Therefore, an upgraded nutrition is specially required during gestation and lactation, as this is the critical period of neurodevelopment. This study sought to investigate the effect of protein deficiency during gestation (F0) and lactation through to adolescence on neurological functions of subsequent (F1 and F2) generations, establishing the possible consequential mechanistic association. Rats in four groups were fed different rations of protein diets (PD) as formulated: 21% PD, 10% PD, 5% PD and control diet (standard rat chow, containing 16-18% protein), from adolescent through to gestation and lactation, next generations were weaned to the maternal diet group. Neurobehavioral studies (which include; Surface righting reflex, Negative geotaxis, Learning and Memory tests), brain oxidative stress and quantification of serotonin and dopamine levels in the brain were conducted. Result shows significantly altered neurobehavior, reflected in the reduction of reflex response and postural reaction score at P ≤ 0.05. There was also a transgenerational cognitive impairment of brain function in the F-generations, following perinatal protein malnutrition as shown in the Y-maze result, measuring spatial memory and Morris water maze result (cognition), providing a background for the observed sensorimotor response. The significant increase in dopamine level, decrease in the antioxidant capacity of the protein deficient brain groups are consistent with significantly altered serotonin system, critical to neurodevelopment and functional activities of learning and memory. Therefore, persistent early life protein deficiency mediates dysfunction in neurodevelopment and this involves life-long changes in key neurotransmitters and the brain redox status underlying the neurobehavioral display.
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Affiliation(s)
- Nosarieme O. Abey
- Department of Biochemistry, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
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Das JK, Salam RA. Addressing childhood undernutrition and development through education and lipid-based supplements. Lancet Glob Health 2019; 7:e1160-e1161. [PMID: 31401992 DOI: 10.1016/s2214-109x(19)30341-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 07/17/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Jai K Das
- Division of Women and Child Health, Aga Khan University, Karachi 74800, Pakistan.
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
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Yousafzai AK, Rasheed MA, Siyal S. Integration of parenting and nutrition interventions in a community health program in Pakistan: an implementation evaluation. Ann N Y Acad Sci 2019; 1419:160-178. [PMID: 29791730 DOI: 10.1111/nyas.13649] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 01/29/2018] [Accepted: 02/05/2018] [Indexed: 12/27/2022]
Abstract
Policy and program implementers require evidence on whether integrated psychosocial stimulation and nutrition interventions can be effectively delivered at-scale, how, and at what cost? To address some of these issues, a comprehensive evaluation of implementation was designed for a trial in Pakistan that integrated psychosocial stimulation and nutrition interventions in a community health service. The first objective was to describe, analyze, and assess the quality and accuracy of the implementation of the interventions. The second objective was to identify barriers and facilitators for uptake of interventions. A mixed-methods evaluation of implementation processes was conducted. Interventions were accepted by the community and health providers and there was evidence for behavior change uptake of the care for early childhood care recommendations. The new interventions did not dilute delivery of routine services. However, fidelity and quality required supportive supervision and active use of monitoring data, which would require attention in scale-up.
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Affiliation(s)
- Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Muneera A Rasheed
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Saima Siyal
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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