Managing acute malnutrition in infants aged less than six months: a qualitative assessment in Niger public hospitals

Quality management of severe acute malnutrition (SAM) in infants < 6 months of age is a key strategy within the “1000 days window of opportunity”. It prevents early child death, secures optimal growth and forms a foundation for full adulthood potentials. Most studies to date on management of SAM in infants relied on informants from Non-Governmental Organizations staff or government public health officials but little is known from hospital practitioners. From June to August 2013, a qualitative appraisal of hospital practitioners’ views on the current quality of care for malnourished infants was conducted in the eight main hospitals of Niger. These eight hospitals included two National Referral Hospitals (Lamordé and Zinder) and six Regional Referral Hospitals (Poudrière, Dosso, Tahoua, Maradi, Diffa and Agadez). Authorization for the review was given by the Ministry of Health of Niger. Health workers (HW) present during surveyors’ visits were included in the study. Two (2) specific objectives were considered: 1) Determine HW perceptions and current use of the Supplemental Suckling Technique (SST) and 2) Collect HW propositions on feasibility to organize outpatient treatment of SAM in infants less than six months. Self-designed interview guide was used. Data were analysed manually and saturation in the occurrence of responses were the criteria used to retain items. The Supplemental Suckling Technique (SST), though firmly recommended by national guidelines to ensure continuation of breastfeeding and adequate nutrients intake from supplemental milks especially in a small infant, was rarely used. Main reasons advanced by staff were work overload, inadequate training, and lack of compliance from mothers. Before being discharged from hospital, mothers were counseled on continuation of treatment, follow up visits at peripheral health center (PHC) and feeding options at home. However, hospital staff had no indication whether mothers were seen at the referred PHC, nor if counseling was practiced at home. The proposed outpatient treatment model for selected cases without medical complications should relieve hospital caseloads, strengthen referral and improve breastfeeding support to mothers after discharge from hospital.Keywords: Malnutrition, infant feeding, inpatient treatment, qualitative assessment, Nige

Effectiveness of specialized nutritious foods and social and behavior change communication interventions to prevent stunting among children in Badakhshan, Afghanistan: Protocol for a quasi-experimental study

Stunting predominantly occurs during the first 1000 days of life and continues to the age of five years. We will aim to assess the effectiveness of specialized nutritious foods (SNF)and social and behavior change communication (SBCC) strategies during the first 1000 days of life to prevent stunting among children in two rural districts of Badakhshan, Afghanistan. This will be a quasi-experimental pre-post study with the control group utilizing qualitative and quantitative methods. Before launching the program, formative research will be conducted on the acceptability, appropriate use and SBCC strategies needed to support the introduction of intervention package. Repeated cross-sectional baseline and endline surveys will be conducted in both the intervention and the control districts. After the formative research and baseline household survey, an intervention focusing on the provision of SNF, targeting pregnant and lactating women and children 6-23 months, and SBCC strategies will be implemented for at least 12 months. The primary outcome will be a reduction in the prevalence of stunting among children under two years in the intervention group compared to the control group. We will aim to compare the intervention and control group between the pre- and post-intervention assessments to isolate the effect of the intervention by difference-in-differences estimates. The program monitoring and evaluation component will examine the quality of implementation, acceptability of intervention, identification of potential barriers and to learn how to enhance the program\u27s effectiveness through ongoing operational improvements. The results will be beneficial to design interventions to prevent stunting within Afghanistan and other low-middle-income countries

GAMBARAN STATUS GIZI ANAK USIA 0-6 TAHUN DI DESA HARIMAU TANDANG KECAMATAN PEMULUTAN SELATAN KABUPATEN OGAN ILIR

Masalah gizi seperti gizi kurang dan stunting pada anak usia dibawah 5 tahun dapat berpengaruh terhadap morbiditas maupun mortalitas, dalam jangka pendek dapat meningkatkan resiko penyakit infeksi seperti diare, campak, saluran pernafasan, dan malaria, yang berakibat pada terganggunya proses pertumbuhan. Penelitian ini bertujuan untuk melihat gambaran status gizi anak usia 0-6 tahun di Desa Harimau Tandang Kecamatan Pemulutan Selatan, Kabupaten Ogan Ilir tahun 2022. Penelitian yang dilakukan di Desa Harimau tandang bersifat deskriptif dengan menggunakan desain penelitian kuantitatif.Teknik pengambilan sampel dengan cara purposive sampling sebanyak 40 responden. Pengumpulan data melalui observasi dan wawancara oleh peneliti dengan menggunakan kuesioner berisikan data gizi dan food recal 24 jam. Data status gizi merujuk pada WHO-Antro. Data yang didapat dari penelitian dianalisis dengan analisis univariat untuk mendeskripsikan masing masing variabel penelitian. Dari hasil penelitian didapat hasil bahwa usia responden mayoritas berusia > 25 tahun (90%),  pendidikan responden (70%), serta pekerjaan responden menenun (80%), gizi kurang dan stunting (5%) dan berisiko gizi lebih (2,5%) di desa Harimau Tandang. Dari hasil pengukuran IMT/U, TB/U, dan BB/U didapat kesimpulan terdapat 2 anak yang memiliki status gizi kurang dan stunting serta 1 anak yang memiliki resiko gizi lebih di Desa Harimau Tandang

Effectiveness of a normative nutrition intervention (diet, physical activity and breastfeeding) on maternal nutrition and offspring growth: the Chilean maternal and infant nutrition cohort study (CHiMINCs).

BACKGROUND: Maternal obesity before and during pregnancy predicts maternal and infant risks of obesity and its associated metabolic conditions. Dietary and physical activity recommendations during pregnancy as well as weight monitoring are currently available in the Chilean primary health care system. However some of these recommendations are not updated and most of them are poorly implemented. We seek to assess the effectiveness of an intervention that enhances the implementation of updated nutrition health care standards (diet, physical activity, and breastfeeding promotion) during pregnancy on maternal weight gain and infant growth. METHODS: DESIGN & SETTING: Cluster randomized controlled trial. The cluster units will be 12 primary health care centers from two counties (La Florida and Puente Alto) from the South-East Area of Santiago randomly allocated to: 1) enhanced nutrition health care standards (intervention group) or 2) routine care (control group). PARTICIPANTS: Women seeking prenatal care before 15 weeks of gestation, residing within a catchment area of selected health centers, and who express that they are not planning to change residence will be invited to participate in the study. Pregnant women classified as high risk according to the Chilean norms (i.e age 40 years, multiple gestation, pre-gestational medical conditions, previous pregnancy-related issues) and/or underweight will be excluded. INTERVENTION: Pregnant women who attend intervened health care centers starting at their first prenatal visit will receive advice regarding optimal weight gain during pregnancy and diet and physical activity counseling-support. Pregnant women who attend control health clinics will receive routine antenatal care according to national guidelines. We plan to recruit 200 women in each health center. Assuming a 20% loss to follow up, we expect to include 960 women per arm. MAIN OUTCOME MEASURES: 1) Achievement of adequate weight gain based on IOM 2009 recommendations and adequate glycaemic control at 24-28 weeks of pregnancy according to ADA 2011, and 2) healthy infant growth during the first year of age based on WHO standards. DISCUSSION: We expect that the intervention will benefit the participants in achieving adequate weight gain & metabolic control during pregnancy as well as adequate infant growth as a result of an increased impact of standard nutrition and health care practices. Gathered information should contribute to a better understanding of how to develop effective interventions to halt the maternal obesity epidemic and its associated co-morbidities in the Chilean population. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01916603

Utilisation, equity and determinants of full antenatal care in India: analysis from the National Family Health Survey 4

Objectives: We examined the utilisation, equity and determinants of full antenatal care (ANC), defined as 4 or more antenatal visits, at least one tetanus toxoid (TT) injection and consumption of iron folic acid (IFA) for a minimum of 100 days, in India. Methods: We analysed a sample of 190,898 women from India’s National Family Health Survey 4. Concentration curves and concentration index were used to assess equity in full ANC utilisation. Multivariable logistic regression model was used to examine the factors associated with full ANC utilisation. Results: In India, 21% of pregnant women utilised full ANC, ranging from 2.3–65.9% across states. Overall, 51.6% had 4 or more ANC visits, 30.8% consumed IFA for atleast 100 days, and 91.1% had one or more doses of tetanus toxoid. Full ANC utilisation was inequitable across place of residence, caste and maternal education. Registration of pregnancy, utilisation of government’s Integrated Child Development Services (ICDS) and health insurance coverage were associated with higher odds of full ANC utilisation. Lower maternal education, lower wealth quintile(s), lack of father’s participation during antenatal visits, higher birth order, teenage and unintended pregnancy were associated with lower odds of full ANC utilisation. Conclusions: Full ANC utilisation in India was inadequate and inequitable. Although half of the women did not receive the minimum recommended ANC visits, the utilisation of TT immunisation was almost universal. The positive association of full ANC with ICDS utilisation and child’s father involvement may be leveraged for increasing the uptake of full ANC. Strategies to address the socio-demographic factors associated with low and inequitable utilisation of full ANC are imperative for strengthening India’s maternal health program.publishedVersio

Risk factors for undernutrition in children under five years of age in Tenom, Sabah, Malaysia

ABSTRACT Undernutrition is the result of complex interplay of factors such as household food security, childcare, feeding practices, nutrition and sanitation. Therefore, this study aimed to determine the prevalence of stunting, wasting, underweight based on WHO child growth standards 2006 and undernutrition based on Composite Index Anthropometric Failure (CIAF) and its association with the biological, behavioural, socio-economic and physical environment factors among children under-5 years. This was a cross sectional study involving children aged between 6 and 59 months recruited through stratified random sampling from the Tenom district. Sociodemographic background was obtained from mothers via a questionnaire. Height and weight measurements were measured using standardised instrument. The height-for-age, weight-for-age and BMI-for-age were classified according to the WHO Child Growth Standard 2006. Bivariate analysis and multivariate logistic regression analysis were conducted. The prevalence of undernutrition based on CIAF was 42.3%, underweight 34.7%, stunting 33.3% and wasting 10.0%. After adjusting for all confounders, childhood undernutrition was significantly associated with unimproved sanitation (adjusted OR 2.98, 95% CI: 1.082 to 8.225) and frequent illness (adjusted OR 2.07, 95% CI: 1.015 to 3.274). These findings support the association of biological and physical environmental factors with the nutritional status of children under-5 years old

Determinants of Stunting among Children Aged 6-23 Months of Age in Pastoral Community, Afar Region, Ethiopia: Unmatched Case-Control Study

Background: Globally, stunting is a public health concern, more of in developing counties, including Ethiopia. Once occurred, in the first two years of life, it is irreversible and has long-lasting harmful consequences. Exploring the determinants has pivotal importance for evidence-based interventions. Therefore, the rationale of this study was to identify determinants of stunting among children aged 6-23 months in the pastoralist community, Afar region, Ethiopia.Method: A community-based unmatched case-control study was conducted among 381 (cases=126, controls 255) study participants from February 15/2017 to March 30/2017. Cases and controls were identified consecutively using the world health organization growth monitoring chart.Data was collected by interviewer-administered questionnaires and anthropometric measurements. Statistical significance was declared at p-value < 0.05 in the final multivariable logistic regression model.Result: Maternal education (AOR:0.34, 95% CI: 0.16, 0.77), maternal under-nutrition (AOR:2.91, 95% CI:1.51, 5.60), number of under-five children within the household (AOR:2.66, 95% CI: 1.38, 5.10), latrine ownership (AOR:0.28, 95% CI:0.15, 0.55), minimum Dietary Diversity score of children (AOR:0.41, 95% CI:0.22, 0.75), child age (AOR:1.76, 95% CI:1.01, 3.09), colostrum intake (AOR:3.03, 95%CI:1.62, 5.66), and exclusively breastfeed for the first six months (AOR:3.20, 95% CI:1.72,5.95) were found to be determinants of stunting.Conclusion: This study found that determinants of childhood stunting are multifactorial. Maternal, household and child-related characteristics are associated with childhood stunting. Therefore, to improve childhood nutritional status, inter-sectoral collaboration and commitment are vital

Age-Appropriate Feeding Practices in Cambodia and the Possible Influence on the Growth of the Children:A Longitudinal Study

Age-appropriate feeding practice (ADF) during early childhood are vital for optimal nutrition. This longitudinal study determined the effect of selected risk factors and ADF, as described by the National Nutritional Recommendations, on linear and ponderal growth of children below 24 months of age. Weight and length measures were used to calculate z-scores of anthropometric measures by WHO standards. The prevalence of stunting increased from 13.2% to 32.4% over time, while prevalence of wasting remained stable (14.5%). At first visit, 43% of children of all ages complied with ADF criteria, a proportion which decreased to 7.1% in follow-up. The quality of feeding practices for children above 12 months of age was the poorest, where at the last visit, only 6% complied with the criteria for ADF. The linear mixed-effect models found the association between ADF and ponderal growth to be significant (weight-for-height estimate: 0.05 SD). In Cambodia, Ratanakiri province, ADF was the second largest determinant for ponderal growth. We recommend province specific public health actions. For children above 6 months, the quantity of food given needs to be increased, followed by the meal frequency. Mothers’ educational level, improved sanitation, and drinking water quality were among strongest predictors of a child’s growth

Agriculture, Food Systems, and Nutrition: Meeting the Challenge

Malnutrition is a global challenge with huge social and economic costs; nearly every country faces a public health challenge, whether from undernutrition, overweight/obesity, and/or micronutrient deficiencies. Malnutrition is a multisectoral, multi-level problem that results from the complex interplay between household and individual decision-making, agri-food, health, and environmental systems that determine access to services and resources, and related policy processes. This paper reviews the theory and recent qualitative evidence (particularly from 2010 to 2016) in the public health and nutrition literature, on the role that agriculture plays in improving nutrition, how food systems are changing rapidly due to globalization, trade liberalization, and urbanization, and the implications this has for nutrition globally. The paper ends by summarizing recommendations that emerge from this research related to (i) knowledge, evidence, and communications, (ii) politics, governance, and policy, and (iii) capacity, leadership, and financing

Agricultural research for nutrition outcomes – rethinking the agenda

Agriculture and food are assumed to be critical determinants of stunting and micronutrient deficiency. However, agriculture research for development has not translated as expected into better nutrition outcomes. We argue that to do so, agriculture research needs to be fundamentally changed, from the current emphasis on supply-side production and productivity goals to understanding consumption and addressing factors that can improve diet quality. Some of the research will be to improve the efficiency of supply for more nutritious foods. Other research will need to focus on factors that promote diet quality rather than focus on food security goals through stocks of staple cereals. Because of its importance in low-income, high-burden countries, agriculture can also contribute more effectively to multisectoral nutrition-sensitive development strategies and programs. Critical roles for agricultural research in multisectoral actions will be better metrics, indicators and research studies for diet quality and better evaluation methods – both randomized trials for specific interventions and contribution analysis through theories of change for more complex multisectoral system interventions to prevent stunting and micronutrient deficiencies. To achieve improvements in nutrition outcomes at scale, researchers must engage in new partnerships. In food systems, these partnerships must include more disciplines from agriculture and food science through economics and social science to business and delivery science. Food system researchers will also need to engage more with value chain actors and policy makers. Current efforts to improve nutrition outcomes at scale are severely hampered by data and evidence gaps that prevent better decisions and faster learning