Infant and young child feeding practices and child linear growth in Nepal : regression-decomposition analysis of national survey data, 1996–2016

Suboptimal infant and young child feeding (IYCF) practices have profound implications on child survival, health, growth, and development. First, our study analysed trends in 18 IYCF indicators and height-for-age z-score (HAZ) and stunting prevalence across Nepal's Family Health Survey 1996 and four rounds of Nepal Demographic and Health Surveys from 2001-2016. Second, we constructed multivariable regression models and decomposed the contribution of optimal IYCF practices on HAZ and stunting prevalence over the 1996-2016 period. Our findings indicate that most age-appropriate IYCF practices and child linear growth outcomes improved over the past two decades. At present, according to the World Health Organization's tool for national assessment of IYCF practices, duration of breastfeeding is rated very good, early initiation of breastfeeding and exclusive breastfeeding (EBF) are rated good, whereas minimal bottle-feeding and introduction of solid, semi-solid or soft foods are rated fair. Our study also reports that a paucity of age-appropriate IYCF practices-in particular complementary feeding-are significantly associated with increased HAZ and decreased probability of stunting (p < .05). Moreover, age-appropriate IYCF practices-in isolation-made modest statistical contributions to the rapid and sustained reduction in age-specific child linear growth faltering from 1996-2016. Nevertheless, our findings indicate that comprehensive multisectoral nutrition strategies-integrating and advocating optimal IYCF-are critical to further accelerate the progress against child linear growth faltering. Furthermore, specific focus is needed to improve IYCF practices that have shown no significant development over the past two decades in Nepal: EBF, minimum acceptable diet, and minimal bottle-feeding

Drivers of under-five stunting trend in 14 low- and middle-income countries since the turn of the millennium : a multilevel pooled analysis of 50 demographic and health surveys

Background: Understanding the drivers contributing to the decreasing trend in stunting is paramount to meeting the World Health Assembly's global target of 40% stunting reduction by 2025. Methods: We pooled data from 50 Demographic and Health Surveys since 2000 in 14 countries to examine the relationships between the stunting trend and potential factors at distal, intermediate, and proximal levels. A multilevel pooled trend analysis was used to estimate the association between the change in potential drivers at a country level and stunting probability for an individual child while adjusting for time trends and child-level covariates. A four-level mixed-effects linear probability regression model was fitted, accounting for the clustering of data by sampling clusters, survey-rounds, and countries. Results: Stunting followed a decreasing trend in all countries at an average annual rate of 1.04 percentage points. Among the distal factors assessed, a decrease in the Gini coefficient, an improvement in women's decision-making, and an increase in urbanization were significantly associated with a lower probability of stunting within a country. Improvements in households' access to improved sanitation facilities and drinking water sources, and children's access to basic vaccinations were the important intermediate service-related drivers, whereas improvements in early initiation of breastfeeding and a decrease in the prevalence of low birthweight were the important proximal drivers. Conclusions: The results reinforce the need for a combination of nutrition-sensitive and -specific interventions to tackle the problem of stunting. The identified drivers help to guide global efforts to further accelerate stunting reduction and monitor progress against chronic childhood undernutrition

Elucidating the sustained decline in under‐three child linear growth faltering in Nepal, 1996-2016

Childhood linear growth faltering remains a major public health concern in Nepal. Nevertheless, over the past 20 years, Nepal sustained one of the most rapid reductions in the prevalence of stunting worldwide. First, our study analysed the trends in height-for-age z-score (HAZ), stunting prevalence, and available nutrition-sensitive and nutrition-specific determinants of linear growth faltering in under-three children across Nepal's Family Health Survey 1996 and Nepal's Demographic and Health Surveys 2001, 2006, 2001, and 2016. Second, we constructed pooled multivariable linear regression models and decomposed the contributions of our time-variant determinants on the predicted changes in HAZ and stunting over the past two decades. Our findings indicate substantial improvements in HAZ (38.5%) and reductions in stunting (-42.6%) and severe stunting prevalence (-63.9%) in Nepalese children aged 0-35 months. We also report that the increment in HAZ, across the 1996-2016 period, was significantly associated (confounder-adjustedp< .05) with household asset index, maternal and paternal years of education, maternal body mass index and height, basic child vaccinations, preceding birth interval, childbirth in a medical facility, and prenatal doctor visits. Furthermore, our quantitative decomposition of HAZ identified advances in utilisation of health care and related services (31.7% of predicted change), household wealth accumulation (25%), parental education (21.7%), and maternal nutrition (8.3%) as key drivers of the long-term and sustained progress against child linear growth deficits. Our research reiterates the multifactorial nature of chronic child undernutrition and the need for coherent multisectoral nutrition-sensitive and nutrition-specific strategies at national scale to further improve linear growth in Nepal

The contribution of Thai fisheries to sustainable seafood consumption : national trends and future projections

Sustainably feeding a growing human population is one of the greatest food system challenges of the 21st century. Seafood plays a vital role in supporting human wellbeing, by providing bioavailable and nutrient-dense animal-source food. In Thailand, seafood demand is increasing, and wild capture fishery yields have plateaued, due to oceanic ecosystem degradation and fishery stock exploitation. In this study, we investigated the supply trend of fishery products and subsequent seafood-derived nutrient availability over the last decade. In addition, we explored the possibility of predicting seafood availability and consumption levels, including adherence to Thailand’s national food guide and global dietary recommendations for sustainable seafood consumption. Our findings indicate that, at national-level, fishery products supplied between 19% and 35% of the Thai populations recommended dietary protein intake, 4–6% of calcium, 6–11% of iron, and 2–4% of zinc from 1995 to 2015. Nevertheless, our research also reports that if Thailand’s wild-caught seafood production were to decrease by 13%, as is highly likely, by 2030, the country might face a per capita supply deficit of fish and shellfish to meet healthy and sustainable dietary recommendations (28–30 g/day), let alone the current Thai average intake (32 g/day). Although a 1% per year increase in aquaculture production might bridge this supply gap, policymakers and relevant fishery stakeholders must consider the long-term environmental impacts of such an approach in Thailand

Treatment protocols and management of retained fetal membranes in cattle by rural practitioners in Belgium

Retained fetal membranes (RFM) is a frequent postpartum disorder in cattle causing considerable economic losses, and a common indication for antibiotic (AB) administration. There is controversy with regard to the treatment of RFM, and scientific recommendations are often in conflict with current legislation on AB use and practical routines in the field. The aim of this study was to assess the therapeutic approaches of RFM by Belgian rural veterinarians. A digital survey was sent to 468 Belgian veterinarians; 149 complete questionnaires (Wallonia: 78; Flanders: 71) were obtained. Survey questions captured socio-demographic characteristics, case definition, therapeutic approaches and treatment options for RFM. Questions on treatment were duplicated for dairy and beef cattle. When confronted with dairy cows suffering from RFM without fever, 35.6 % of vets do not treat with AB, while the majority administers AB, either intrauterine (47.6 %), systemically (10.7 %) or both (6.1 %). Dairy cows with RFM and fever receive a systemic (33.5 %), intrauterine (2.7 %) or combined (61.8 %) AB treatment. For a beef cow with RFM without fever, 21.5 % of vets prefer no AB treatment, while others prefer an intrauterine (24.2 %), systemic (24.8 %), combined (29.5 %) AB treatment. Beef cows with RFM and fever receive AB from the large majority of vets, by systemic (34.9 %) or combined (56.3 %) administration. In case of a parenteral treatment, benzylpenicillin, amoxicillin and ampicillin are by far the most frequently used molecules; only a minority of vets use cephalosporins. Manual placental removal is attempted by 93.9 % of the respondents. These results demonstrate that there is room for improvement when considering the treatment protocols of RFM. Many veterinarians use AB in RFM cows not presenting symptoms of general illness, or administer intrauterine AB in cows with or without clinical signs of illness. Concerning the molecules of choice, practical routines are largely in line with national AB recommendations. Beef cows suffering from RFM are treated more rigorously than dairy cows, regardless of their rectal temperature

Minimum dietary diversity for women of reproductive age (MDD-W) data collection : validity of the list-based and open recall methods as compared to weighed food record

Minimum dietary diversity for women of reproductive age (MDD-W) was validated as a population-level proxy of micronutrient adequacy, with indicator data collection proposed as either list-based or open recall. No study has assessed the validity of these two non-quantitative proxy methods against weighed food records (WFR). We assessed the measurement agreement of list-based and open recall methods as compared to WFR (i.e., reference method of individual quantitative dietary assessment) for achieving MDD-W and an ordinal food group diversity score. Applying a non-inferiority design, data were collected from non-pregnant women of reproductive age in Cambodia (n = 430), Ethiopia (n = 431), and Zambia (n = 476). For the pooled sample (n = 1337), proportions achieving MDD-W from both proxy methods were compared to WFR proportion by McNemar’s chi-square tests, Cohen’s kappa, and receiver operating characteristic (ROC) analysis. Ordinal food group diversity (0–10) was compared by Wilcoxon matched-pairs signed-rank tests, intraclass correlation coefficients (ICC), and weighted kappa. MDD-W food groups that were most frequently misreported (i.e., type I and II errors) by the proxy methods were determined. Our findings indicate statistically significant differences in proportions achieving MDD-W, ordinal food group diversity scores, and ROC curves between both proxy methods and WFR (p < 0.001). List-based and open recall methods overreported women achieving MDD-W by 16 and 10 percentage points, respectively, as compared to WFR (proportion achieving MDD-W: 30%). ICC values between list-based or open recall and WFR were 0.50 and 0.55, respectively. Simple and weighted kappa values both indicated moderate agreement between list-based or open recall against WFR. Food groups most likely to be misreported using proxy methods were beans and peas, dark green leafy vegetables, vitamin A-rich fruit and vegetables, and other fruits. Our study provides statistical evidence for overreporting of both list-based and open recall methods for assessing prevalence of MDD-W or ordinal food group diversity score in women of reproductive age in low- and middle-income countries. Operationalizing MDD-W through qualitative recall methods should consider potential trade-offs between accuracy and simplicity

Effect of balanced energy-protein supplementation during pregnancy and lactation on birth outcomes and infant growth in rural Burkina Faso: study protocol for a randomised controlled trial

Introduction: Adequate nutrition during pregnancy is crucial to both mother and child. Maternal malnutrition can be the cause of stillbirth or lead to poor birth outcomes such as preterm delivery and small-for-gestational-age newborns. There is a probable positive effect of providing pregnant women a balanced energy-protein (BEP) food supplement, but more evidence is needed. The MIcronutriments pour la SAnte de la Mere et de l'Enfant (MISAME) III project aims to improve birth outcomes and infant growth by testing a BEP supplement during pregnancy and lactation in rural Burkina Faso. This paper describes the study protocol. Methods and analysis: MISAME-III is a four-arm individually randomised efficacy trial implemented in six rural health centre catchments areas in the district of Hounde. Eligible pregnant women, aged between 15 and 40 years old and living in the study areas, will be enrolled. Women will be randomly assigned to one of the four study groups: (1) prenatal intervention only, (2) postnatal intervention only, (3) prenatal and postnatal intervention or (4) no prenatal or postnatal intervention. The intervention group will receive the BEP supplement and iron/folic acid (IFA) tablets, while the control group will only receive the IFA tablets following the national health protocol. Consumption will be supervised by trained village women on a daily basis by means of home visits. The primary outcomes are small-for-gestational age at birth and length-for-age z-score at 6 months of age. Secondary outcomes will be measured at birth and during the first 6 months of the infants' life. Women will be enrolled from October 2019 until the total sample size is reached. Ethics and dissemination: MISAME-III has been reviewed and approved by the University Hospital of Ghent and the ethics committee of Centre Muraz, Burkina Faso. Informed consent will be obtained. Results will be published in relevant journals and shared with other researchers and public health institutions

Can common dietary assessment methods be better designed to capture the nutritional contribution of neglected, forest, and wild foods to diets?

Food systems are the primary cause of biodiversity loss globally. Biodiversity and specifically, the role that wild, forest and neglected and underutilised species (NUS) foods might play in diet quality is gaining increased attention. The narrow focus on producing affordable staples for dietary energy has contributed to largely homogenous and unhealthy diets. To date, evidence to quantify the nutritional contribution of these biodiverse foods is limited. A scoping review was conducted to document the methods used to quantify the contribution of wild, forest and NUS foods. We found 37 relevant articles from 22 different countries, mainly from Africa (45%), the Americas (19%), and Asia (10%). There were 114 different classifications used for the foods, 73% of these were specifically related to wild or forest foods. Most dietary assessments were completed using a single day qualitative or quantitative 24 h open recall (n = 23), or a food frequency questionnaire (n = 12). There were 18 different diet related indicators used, mainly nutrient adequacy (n = 9) and dietary diversity scores (n = 9). Often, no specific nutritionally validated diet metric was used. There were 16 studies that presented results (semi) quantitatively to measure the contribution of wild, forest or NUS foods to dietary intakes. Of these, 38% were aggregated together with broader classifications of ‘traditional’ or ‘local’ foods, without definitions provided meaning it was not possible to determine if or to what extend wild, forest of NUS foods were included (or not). In almost all studies there was insufficient detail on the magnitude of the associations between wild, forest or NUS foods and dietary energy or nutrient intakes or the (qualitative) diet recall methodologies that were used inhibited the quantification of the contribution of these foods to diets. A set of six recommendations are put forward to strengthen the evidence on the contribution of wild, NUS, and forest foods to human diets

Food biodiversity : quantifying the unquantifiable in human diets

Dietary diversity is an established public health principle, and its measurement is essential for studies of diet quality and food security. However, conventional between food group scores fail to capture the nutritional variability and ecosystem services delivered by dietary richness and dissimilarity within food groups, or the relative distribution (i.e., evenness or moderation) of e.g., species or varieties across whole diets. Summarizing food biodiversity in an all-encompassing index is problematic. Therefore, various diversity indices have been proposed in ecology, yet these require methodological adaption for integration in dietary assessments. In this narrative review, we summarize the key conceptual issues underlying the measurement of food biodiversity at an edible species level, assess the ecological diversity indices previously applied to food consumption and food supply data, discuss their relative suitability, and potential amendments for use in (quantitative) dietary intake studies. Ecological diversity indices are often used without justification through the lens of nutrition. To illustrate: (i) dietary species richness fails to account for the distribution of foods across the diet or their functional traits; (ii) evenness indices, such as the Gini-Simpson index, require widely accepted relative abundance units (e.g., kcal, g, cups) and evidence-based moderation weighting factors; and (iii) functional dissimilarity indices are constructed based on an arbitrary selection of distance measures, cutoff criteria, and number of phylogenetic, nutritional, and morphological traits. Disregard for these limitations can lead to counterintuitive results and ambiguous or incorrect conclusions about the food biodiversity within diets or food systems. To ensure comparability and robustness of future research, we advocate food biodiversity indices that: (i) satisfy key axioms; (ii) can be extended to account for disparity between edible species; and (iii) are used in combination, rather than in isolation