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Grey K, Kodish SR, Namohunu SA, Losi J, Matean M, Palaniappan U, Northrup-Lyons M, Cherian A, Gwavuya S, McLean J, Erasmus W. Determinants of maternal, infant, and young child nutrition during the 1,000-day window of opportunity in Solomon Islands: A focused ethnographic study. Front Nutr 2023; 9:1082161. [PMID: 36742003 PMCID: PMC9893623 DOI: 10.3389/fnut.2022.1082161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
Introduction This focused ethnographic study used qualitative, ethnographic, and participatory methods to explore determinants of maternal, infant, and young child nutrition (MIYCN) during the first 1,000 days of life as part of efforts to address the double burden of malnutrition in Solomon Islands. Methods An iterative study design was used to first explore and then confirm findings related to food and nutrition security and social and behavioral determinants of MIYCN in urban and rural settings. The first phase included in-depth interviews, household observations, free lists, and seasonal food availability calendar workshops while the second phase included focus group discussions, pile sorts, participatory community workshops, and repeated household observations. Results and discussion We found that MIYCN is shaped by a complex interaction of factors at the macro- and micro-levels. At the macro-level, globalization of the food system, a shifting economy, and climate change are driving a shift toward a delocalized food system based on imported processed foods. This shift has contributed to a food environment that leaves Solomon Islanders vulnerable to food and nutrition insecurity, which we found to be the primary determinant of MIYCN in this context. At the micro-level, this food environment leads to household- and individual-level food decisions that often do not support adequate MIYCN. Multi-sectoral interventions that address the macro- and micro-level factors shaping this nutrition situation may help to improve MIYCN in Solomon Islands.
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Affiliation(s)
- Kelsey Grey
- Nourish Global Nutrition, Vancouver, BC, Canada,*Correspondence: Kelsey Grey,
| | - Stephen R. Kodish
- Chandlee Lab, Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, United States,Chandlee Lab, Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, United States
| | | | - Jill Losi
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | | | | | | | | | | | - Judy McLean
- Nourish Global Nutrition, Vancouver, BC, Canada
| | - Wendy Erasmus
- United Nations Children’s Fund (UNICEF) Pacific, Suva, Fiji
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Kodish SR, Matean M, Grey K, Palaniappan U, Northrup-Lyons M, Yalvigi A, Gwavuya S, Mclean J, Erasmus W. Conceptualizing multi-level determinants of infant and young child nutrition in the Republic of Marshall Islands-a socio-ecological perspective. PLOS Glob Public Health 2022; 2:e0001343. [PMID: 36962875 PMCID: PMC10022247 DOI: 10.1371/journal.pgph.0001343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
The East and Pacific region includes 14 Pacific Island Countries where, between 2000 and 2016, indicators of stunting, wasting, and micronutrient deficiencies have plateaued or worsened, while rates of overweight, obesity, and associated disease have risen. The Republic of Marshall Islands (RMI) is no exception: maternal and child nutrition indicators have not improved in decades. A study of the contemporary factors shaping the RMI nutrition situation was needed for informing policy and tailoring interventions. This formative study had an iterative design utilizing qualitative methods. An exploratory Phase 1 included 59 semi-structured interviews with community members, 86 free lists with caregivers, 8 participatory workshops, and 20 meal observations (round 1). Findings were synthesized to inform a confirmatory Phase 2 where 13 focus groups, 81 pile sorts, 15 meal observations (round 2), and 2 seasonal food availability workshops were conducted. Textual data were analyzed thematically using NVivo while cultural domain analysis was conducted in Anthropac. RMI faces interrelated challenges that contribute to a lack of nutritious and local food availability, which is compounded by high food costs relative to household incomes. A decades-long cultural transition from local to processed diets has resulted in infant and young child diets now characterized by morning meals of doughnuts, bread, and ramen with tea, coffee, or Kool-Aid and afternoon meals that include rice with canned meats (e.g., store-bought chicken, hot dogs). Individual preferences for processed food imports have increased their supply. Low maternal risk perception toward nutrition-related illnesses may further explain sub-optimal diets. Improving the RMI food environment will require approaches that align with the multi-level determinants of sub-optimal diets found in this study. As the ten-year 2013 RMI Food Security Policy soon ends, study findings may be used to inform new policy development and investments for improving the nutrition situation.
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Affiliation(s)
- Stephen R Kodish
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, United States of America
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Maryam Matean
- Nourish Global Nutrition, Vancouver, British Columbia, Canada
| | - Kelsey Grey
- Nourish Global Nutrition, Vancouver, British Columbia, Canada
| | | | | | - Akshata Yalvigi
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, United States of America
| | | | - Judy Mclean
- Nourish Global Nutrition, Vancouver, British Columbia, Canada
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Kodish SR, Grey K, Matean M, Palaniappan U, Gwavuya S, Gomez C, Iuta T, Timeon E, Northrup-Lyons M, McLean J, Erasmus W. Socio-Ecological Factors That Influence Infant and Young Child Nutrition in Kiribati: A Biocultural Perspective. Nutrients 2019; 11:nu11061330. [PMID: 31200550 PMCID: PMC6627610 DOI: 10.3390/nu11061330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 11/16/2022] Open
Abstract
This study sought to elucidate the multi-level factors that influence behaviors underlying high childhood stunting and widespread micronutrient deficiencies in Kiribati. This two-phase formative research study had an emergent and iterative design using the socio-ecological model as the guiding theoretical framework. Phase 1 was exploratory while phase 2 was confirmatory. In phase 1, in-depth interviews, free lists, seasonal food availability calendar workshops, and household observations were conducted. In phase 2, focus group discussions, pile sorts, participatory workshops, and repeat observations of the same households were completed. Textual data were analyzed using NVivo software; ethnographic data were analyzed with Anthropac software for cultural domain analysis. We found a combination of interrelated structural, community, interpersonal, and individual-level factors contributing to the early child nutrition situation in Kiribati. Despite widespread knowledge of nutritious young child foods among community members, households make dietary decisions based not only on food availability and access, but also longstanding traditions and social norms. Diarrheal disease is the most salient young child illness, attributable to unsanitary environments and sub-optimal water, sanitation, and hygiene behaviors. This research underscores the importance of a multi-pronged approach to most effectively address the interrelated policy, community, interpersonal, and individual-level determinants of infant and young child nutrition in Kiribati.
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Affiliation(s)
- Stephen R Kodish
- Departments of Nutritional Sciences and Biobehavioral Health, Pennsylvania State University, University Park, PA 16802, USA.
- Nourish Global Nutrition, Vancouver, BC V6H 4A7, Canada.
| | - Kelsey Grey
- Nourish Global Nutrition, Vancouver, BC V6H 4A7, Canada.
| | - Maryam Matean
- Nourish Global Nutrition, Vancouver, BC V6H 4A7, Canada.
| | | | | | - Caitlin Gomez
- Nourish Global Nutrition, Vancouver, BC V6H 4A7, Canada.
| | | | - Eretii Timeon
- Ministry of Health and Medical Services, Bikenibau, Republic of Kiribati.
| | | | - Judy McLean
- Nourish Global Nutrition, Vancouver, BC V6H 4A7, Canada.
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McLean J, Northrup-Lyons M, Reid RJ, Smith L, Ho K, Mucumbitsi A, Kayumba J, Omwega A, McDonald C, Schauer C, Zlotkin S. From evidence to national scale: An implementation framework for micronutrient powders in Rwanda. Matern Child Nutr 2018; 15:e12752. [PMID: 30426670 DOI: 10.1111/mcn.12752] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 09/07/2018] [Accepted: 11/01/2018] [Indexed: 11/30/2022]
Abstract
Micronutrient powders (MNP) are an efficacious intervention in terms of reducing anaemia among young children, yet challenges remain regarding implementation at scale. Research that can guide effective implementation of nutrition interventions and facilitate integration into existing health care platforms is needed. This paper seeks to advance the implementation science knowledge base by presenting our multiphased strategy and findings for scaling-up MNP in Rwanda. The multiphased implementation strategy, spanning a 5-year period (2011-2016), included (a) a feasibility study involving formative research, (b) a 30-day trial of improved practices (n = 60 households), (c) a 12-month pilot that included an effectiveness study (n = 1,066 caregiver/child pairs), and (d) a staggered approach to national scale-up. At the end of Phase 4, the programme had been implemented in 19 of Rwanda's 30 districts with the scale-up in the final 11 districts completed in the following year. The caregivers of over 270,000 eligible children 6-23 months of age received a box of 30 MNP sachets in the final 3-month assessment period, representing a coverage rate of 87%. Initial problems with the supply chain and distribution and ongoing challenges to monitoring and reporting have been the largest obstacles. Continued success will be dependent on adequate resources for capacity development, refresher training, and responsive monitoring. Rwanda is one of the first countries to successfully scale-up home fortification subnationally with MNP. Lessons learned have implications for other countries.
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Affiliation(s)
- Judy McLean
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martina Northrup-Lyons
- School of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert J Reid
- Munk School of Global Affairs & Public Policy, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Smith
- School of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathy Ho
- School of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexis Mucumbitsi
- Nutrition and Hygiene Department in National Early Childhood Care and Development Program, Ministry of Health, Kigali, Rwanda
| | | | | | | | - Claudia Schauer
- Centre for Global Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stanley Zlotkin
- Centre for Global Health, Hospital for Sick Children, Toronto, Ontario, Canada
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