Conceptual framework of food systems for children and adolescents

Transforming food systems is essential to ensuring nutritious, safe, affordable, and sustainable diets for all, including children and adolescents. This paper proposes a new conceptual framework (the ‘Innocenti Frame­ work’) to better articulate how the diets of children and adolescents are shaped by food systems. The framework is comprised of a set of food system drivers, determinants (namely, food supply chains, external food environ­ ments, personal food environments, and behaviors of caregivers, children and adolescents), influencers, and interactions, which together determine children’s and adolescents’ diets. The conceptual framework conceptu­ alizes the dynamic linkages between the elements of food systems, and highlights the importance of continuously shaping food systems to deliver nutritious, safe, affordable, and sustainable diets to children and adolescents

The Role of Child Health Days in the Attainment of Global Deworming Coverage Targets among Preschool-Age Children.

BACKGROUND:Global deworming programs aim to reach 75% of at-risk preschool-age children (pre-SAC) by 2020. The 2013 global pre-SAC deworming coverage initially published by the World Health Organization (WHO) was 23.9%, but this estimate inadequately captured deworming delivered through Child Health Day (CHD) platforms. OBJECTIVE:To update global and regional coverage estimates of pre-SAC deworming in 2013 by supplementing data from the WHO Preventive Chemotherapy and Transmission Control (PCT) databank with national CHD data. METHODS:UNICEF country offices (n = 82) were mailed a questionnaire in July 2014 to report on official national biannual CHD deworming coverage as part of the global vitamin A supplementation coverage reporting mechanism. Coverage data obtained were validated and considered for inclusion in the PCT databank in a collaboration between UNICEF and WHO. Descriptive statistical analyses were conducted to update the number of pre-SAC reached and the number of treatments delivered. RESULTS:Of the 47 countries that responded to the UNICEF pre-SAC deworming questionnaire, 73 data points from 39 countries were considered for inclusion into the WHO PCT databank. Of these, 21 new data points were from 12 countries were newly integrated into the WHO database. With this integration, deworming coverage among pre-SAC increased to 49.1%, representing an increase in the number of children reached and treatments administered from 63.7 million to 130.7 million and 94.7 million to 234.8 million, respectively. The updated databank comprised 98 mass deworming activities conducted in 55 countries, in which 80.4% of the global pre-SAC population requiring deworming reside. In all, 57 countries requiring deworming were not yet represented in the database. CONCLUSIONS:With the inclusion of CHD data, global deworming programs are on track to achieving global pre-SAC coverage targets. However, further efforts are needed to improve pre-SAC coverage reporting as well as to sustain and expand deworming delivery through CHDs and other platforms

Annual pre-SAC global coverage and data gaps¹, 2013.

<p>Proportion of global pre-SAC population requiring deworming and treated and the global data gap for the years (2010–2013). pre-SAC, preschool-age children. ¹Data gap is proportion of pre-SAC population requiring deworming for the countries not responding. ²Initial Database, WHO Preventive Chemotherapy and Transmission Control Databank as of January 15^th 2015, Updated Database ³WHO Preventive Chemotherapy and Transmission Control Databank as of April 15^th 2015</p

Number of deworming treatments administered among preschool-age children in the World Health Organization Preventive Chemotherapy and Transmission Control Databank, 2013.

<p>¹ WHO Regions</p><p>² Initial Database, WHO Preventive Chemotherapy and Transmission Control Databank as of January 15^th 2015</p><p>³Updated Database, WHO Preventive Chemotherapy and Transmission Control Databank as of April 15^th 2015</p><p>Number of deworming treatments administered among preschool-age children in the World Health Organization Preventive Chemotherapy and Transmission Control Databank, 2013.</p

Proportion of total treatments by Anthelminthic, 2013 (updated database).

<p>Updated Database, WHO Preventive Chemotherapy and Transmission Control Databank as of April 15^th 2015.</p

Global coverage of deworming among preschool-age children in the World Health Organization Preventive Chemotherapy and Transmission Control Databank, 2013.

<p>pre-SAC, preschool-age children.</p><p>¹ WHO Regions</p><p>² Initial Database, WHO Preventive Chemotherapy and Transmission Control Databank as of January 15^th 2015</p><p>³Updated Database, WHO Preventive Chemotherapy and Transmission Control Databank as of April 15^th 2015</p><p>⁴Proportion of pre-SAC population requiring deworming that received treatment</p><p>Global coverage of deworming among preschool-age children in the World Health Organization Preventive Chemotherapy and Transmission Control Databank, 2013.</p

Global gaps in deworming coverage reporting in the World Health Organization Preventive Chemotherapy and Transmission Control Databank, 2013.

<p>Pre-SAC, preschool-age children.</p><p>¹ WHO Regions</p><p>² Initial Database, WHO Preventive Chemotherapy and Transmission Control Databank as of January 15^th 2015</p><p>³ Updated Database, WHO Preventive Chemotherapy and Transmission Control Databank as of April 15^th 2015</p><p>⁴ Proportion of pre-SAC population requiring deworming for the countries not responding</p><p>Global gaps in deworming coverage reporting in the World Health Organization Preventive Chemotherapy and Transmission Control Databank, 2013.</p

Small vulnerable newborns—big potential for impact

Despite major achievements in child survival, the burden of neonatal mortality has remained high and even increased in some countries since 1990. Currently, most neonatal deaths are attributable to being born preterm, small for gestational age (SGA), or with low birthweight (LBW). Besides neonatal mortality, these conditions are associated with stillbirth and multiple morbidities, with short-term and long-term adverse consequences for the newborn, their families, and society, resulting in a major loss of human capital. Prevention of preterm birth, SGA, and LBW is thus critical for global child health and broader societal development. Progress has, however, been slow, largely because of the global community’s failure to agree on the definition and magnitude of newborn vulnerability and best ways to address it, to frame the problem attractively, and to build a broad coalition of actors and a suitable governance structure to implement a change. We propose a new definition and a conceptual framework, bringing preterm birth, SGA, and LBW together under a broader umbrella term of the small vulnerable newborn (SVN). Adoption of the framework and the unified definition can facilitate improved problem definition and improved programming for SVN prevention. Interventions aiming at SVN prevention would result in a healthier start for live-born infants, while also reducing the number of stillbirths, improving maternal health, and contributing to a positive economic and social development in the society

Study protocol for UNICEF and WHO estimates of global, regional, and national low birthweight prevalence for 2000 to 2020.

BACKGROUND: Reducing low birthweight (LBW, weight at birth less than 2,500g) prevalence by at least 30% between 2012 and 2025 is a target endorsed by the World Health Assembly that can contribute to achieving Sustainable Development Goal 2 (Zero Hunger) by 2030. The 2019 LBW estimates indicated a global prevalence of 14.6% (20.5 million newborns) in 2015. We aim to develop updated LBW estimates at global, regional, and national levels for up to 202 countries for the period of 2000 to 2020. METHODS: Two types of sources for LBW data will be sought: national administrative data and population-based surveys. Administrative data will be searched for countries with a facility birth rate ≥80% and included when birthweight data account for ≥80% of UN estimated live births for that country and year. Surveys with birthweight data published since release of the 2019 edition of the LBW estimates will be adjusted using the standard methodology applied for the previous estimates. Risk of bias assessments will be undertaken. Covariates will be selected based on a conceptual framework of plausible associations with LBW, covariate time-series data quality, collinearity between covariates and correlations with LBW. National LBW prevalence will be estimated using a Bayesian multilevel-mixed regression model, then aggregated to derive regional and global estimates through population-weighted averages. CONCLUSION: Whilst availability of LBW data has increased, especially with more facility births, gaps remain in the quantity and quality of data, particularly in low-and middle-income countries. Challenges include high percentages of missing data, lack of adherence to reporting standards, inaccurate measurement, and data heaping. Updated LBW estimates are important to highlight the global burden of LBW, track progress towards nutrition targets, and inform investments in programmes. Reliable, nationally representative data are key, alongside investments to improve the measurement and recording of an accurate birthweight for every baby