Feeding practices and growth among young children during two seasons in rural Ethiopia

BACKGROUND: The use of indices of infant and young child feeding practices to predict growth has generated inconsistent results, possibly through age and seasonal confounding. The aim of this study was to evaluate the association of a dietary diversity score (DDS) and infant and child feeding index (ICFI) with growth among young children in a repeated cross-sectional and a follow-up study in two distinct seasons in rural southwest Ethiopia. METHODS: We used a repeated cross-sectional design comparing child feeding practices to nutritional status in 6–12 month old children during harvest (HS; n = 320) and pre-harvest season (PHS; n = 312). In addition, 6–12 month old children from the HS were reassessed 6 months later during PHS. In addition to child anthropometry, child feeding practices were collected using 24-h and 7-day dietary recalls. RESULTS: The mean (±SD) length-for-age z-score (LAZ) of the 6–12 month old children was −0.77 (±1.4) and −1.0 (±1.3) in HS and PHS, respectively, while the mean (±SD) of the follow-up children in PHS was −1.0 (±1.3). The median DDS (IQR) was 2.0 (1.0, 3.0.), 2.0 (2.0, 3.0) and 3.0 (2.0, 4.0) for the children in HS, PHS and the follow-up children in PHS, respectively. The DDS in HS was positively associated with LAZ at follow-up (β = 0.16; 95% CI: 0.01, 0.30; P = 0.03) after controlling for confounding factors. ICFI and DDS were not associated with mean LAZ, weight-for-height z-score and weight-for-age z-score within season. However, the odds of being stunted when having a DDS ≤ 2 was 2.3 times (95% CI: 1.10, 4.78; P = 0.03) higher compared to a DDS > 2 child in HS and 1.7 times (95% CI: 1.04, 2.71; P = 0.04) higher for the pooled sample of 6–12 months old children in HS and PHS. CONCLUSIONS: The DDS was found to be an indicator for child stunting during the Ethiopian harvest season. The DDS can be an appropriate tool to evaluate the association of child feeding practices with child growth irrespective of season. Inclusion of other dimensions in the construction of ICFI should be considered in future analysis as we found no association with growth

Food security and health security : explaining the levels of nutrition in Pakistan

Most influential studies of malnutrition and public policy have focused on energy availability and consumption, tending to equate hunger with malnutrition. But recent studies have explored how other factors - notably infection and levels of maternal education - affect nutrition. Alderman and Garcia's study of nutrition levels in Pakistan shows that raising household food consumption, for example, has less impact on nutritional levels than raising a mother's education does. They found that educating mothers to at least the primary level tends to reduce the level of child stunting 16.5 percent, or roughly 10 times the impact achieved by increasing per capita income 10 percent. (The impact of education is not immediately realized; the diffusion of knowledge about good hygiene and child care associated with learning has a cumulative effect.) Alderman and Garcia found that in Pakistan, food security alone is not enough to improve children's nutritional status. There may be welfare justifications for various food policies, but in rural Pakistan, especially, it is equally important to improve health and reduce infection.Health Economics&Finance,Health Monitoring&Evaluation,Early Child and Children's Health,Environmental Economics&Policies,Agricultural Knowledge&Information Systems

The constraints to good child care practices in Accra

Life in urban areas presents special challenges for maternal child care practices. Data from a representative survey of households with children less than 3 years of age in Accra were used to test a number of hypothesized constraints to child care, including various maternal (education, employment, marital status, age, health, ethnic group, migration status) and household-level factors (income, calorie availability, quality of housing and asset ownership, availability of services, household size, and crowding). An age-specific child care index was created using recall data on maternal child feeding practices and use of preventive health services. A hygiene index was created from spot check observations of proxies of hygiene behaviors. Multivariate analyses showed that maternal schooling was the most consistent constraint to both the care and the hygiene index. None of the household-level characteristics were associated with the care index, but better housing quality and access to garbage collection services were associated with better hygiene. Female head of household and larger family size were associated with poorer hygiene. The programmatic implications of these findings for nutrition education and behavior change interventions in Accra are discussed. The focus is on using the information to target the right practices to be modified as well as the main constraints to their adoption.FCND ,Child care. ,Ghana. ,Maternal and infant welfare Developing countries. ,Urban health. ,

Some urban facts of life

This review of recent literature explores the challenges to urban food and nutrition security in the rapidly urbanizing developing world. The premise of the manuscript is that the causes of malnutrition and food insecurity in urban and rural areas are different due primarily to a number of phenomena that are unique to or exacerbated by urban living. These areas include (1) a greater dependence on cash income; (2) weaker informal safety nets; (3) greater labor force participation of women and its consequences for child care; (4) lifestyle changes, particularly diet and exercise patterns; (5) greater availability of public services, but questionable access by the poor; (6) greater exposure to environmental contamination; and (7) governance by a new, possibly nonexistent, set of property rights. The main focus is on identifying what is different about urban areas, so as to better frame the program and policy responses.Urbanization. ,employment ,Child care ,Malnutrition. ,Labor ,Food security. ,Nutrition ,Property rights ,

Creating a child feeding index using the demographic and health surveys

Data from the Demographic and Health Surveys (DHS) for five Latin American countries (seven data sets) were used to explore the feasibility of creating a composite feeding index and to examine the association between feeding practices and child height-for-age (HAZ). Urban/rural differences were also examined...The data sets used were Bolivia, 1994 and 1998; Colombia, 1995; Guatemala, 1995 and 1999; Nicaragua, 1998; and Peru, 1996...This work shows that the data available in DHS data sets can be used for a variety of purposes, including to (1) describe and study the distribution of specific feeding practices by geographic area, or other characteristics of interest such as maternal schooling or household socioeconomic status; (2) create a child feeding index to quantify and illustrate associations between child feeding practices and child outcomes, thereby serving as an advocacy tool; and (3) identify practices and vulnerable groups that could be targeted by programs and policies to improve child feeding practices and overall child health and nutrition. In sum, greater use of the DHS data on child feeding practices should be promoted for research and analysis, as a source of guidance on program design and planning, and for advocacy.FCND ,Demography Latin America. ,Surveys Statistical methods. ,Health status indicators. ,Bolivia. ,Colombia. ,Guatemala. ,Nicaragua. ,Peru. ,Child Feeding. ,Children Growth. ,

Effective food and nutrition policy responses to HIV/AIDS

The impact of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) on people's lives and on development is staggering. Millions have died and livelihoods have been devastated, particularly in Sub-Saharan Africa. Agriculture and natural resources are important components of such livelihoods. And the nutritional status of those infected and affected plays a large part in determining their current welfare and their ability to further develop their livelihoods towards activities that help to mitigate the impacts of AIDS and prevent the spread of HIV. This paper first reviews the potential pathways through which HIV/AIDS affects assets and institutions generally and then the specific impacts on agriculture, natural resource management, food security, and nutrition. The review addresses the question of how the public sector can and should respond to these challenges. The focus is primarily on mitigation, though the authors note that effective mitigation can also serve as a very cost-effective form of prevention. As labor becomes depleted, new cultivation technologies and varieties need to be developed that do not rely so much on labor, yet allow crops to remain drought resistant and nutritious.Sustainable livelihoods. ,HIV/AIDS ,Africa, Sub-Saharan. ,Nutritional status. ,Crops and soil Management. ,HIV/AIDS ,Nutritional status. ,

No. 07: Rapid Urbanization and the Nutrition Transition in Southern Africa

The nutrition transition, including the presence of malnutrition and obesity in poor urban populations (the so-called ‘double burden’ of disease), is occurring in Southern Africa in the context of massive rural-urban migration and rapid urbanization. This seemingly contradictory situation poses one of the major threats to public health in the developing world, and impacts the poor – and therefore the most food insecure – to the greatest extent. This paper reviews the state of knowledge about food insecurity and the nutrition transition in the urban areas of Southern Africa drawing on existing studies and new research conducted by AFSUN. The paper lays out an agenda for future research on nutrition environments and discusses the implications of undernutrition and overnutrition for urban policy making on health and food security in the region

AIDS and food security: essays

AIDS (Disease), Food security., HIV/AIDS Africa., Africa, Sub-Saharan., Epidemics., Food security Developing countries., Food supply., Malnutrition Prevention., Agriculture., Nutrition policies. ,

Why Should 5000 Children Die in India Every Day? Major Causes and Managerial Challenges

Globally, more than 10 million children under 5 years of age, die every year (20 children per minute), most from preventable causes, and almost all in poor countries. Major causes of child death include neonatal disorders (death within 28 days of birth), diarrhea, pneumonia, and measles. Malnutrition accounts for almost 35 % of childhood diseases. India alone accounts for almost 5000 child deaths under 5 years old (U5) every day. India.s child heath indicators are poor even compared with our Asian neighbors, namely Malaysia, Sri Lanka, Thailand, Vietnam, China, Nepal and Bangladesh. Within India, the states of Bihar, Madhya Pradesh, Orissa, Rajasthan and Uttar Pradesh account for almost 60 % of all child deaths India.s neonatal mortality, which accounts for almost 50 % of U5 deaths, is one of the highest in the world. India launched the Universal Immunization Program in 1985, but the status of full immunization in India has reached only 43.5 % by 2005-06. India started the Integrated Child Development Scheme (ICDS) in 1975 to provide supplementary nutrition to children, but 50 % of our children are still malnourished; nearly double that of Sub-Saharan Africa. The WHO/UNICEF training program on Integrated Management of Neonatal and Childhood Illnesses, known as IMNCI, started in India a few years ago, but the progress is very slow. What is unfortunate is the fact that most of these deaths are preventable through proven interventions: preventive interventions and/or treatment interventions, but the management of childhood illnesses is very poor. In this working paper, we bring out the nature and magnitude of child deaths in India (Chapter 1) and then share with you in Chapters 2, 3 and 4 our observations on the management of some of national programs of the government of India such as The Universal Immunization Program (UIP) The Integrated Child Development Scheme (ICDS) The Integrated Management of Neonatal and Child Illnesses (IMNCI) In the final chapter (Chapter 5), we highlight certain managerial challenges to satisfactorily address the child mortality and morbidity in our country.