Infant and young children's nutritional health and feeding practices in relation to flooding in Bangladesh

Bangladesh is one of the poorest developing countries in the world where infant and young children (IYC) suffer from extremely high levels of malnutrition resulting in high morbidity and mortality rates. IYC are defined here as birth to 3 years old. Due to the double burden of climate variability and urbanisation, longer and more severe floods affect people living in urban slums, with IYC being highly vulnerable. Insufficient research exists into understanding the mechanisms leading to poor nutritional child health related to flooding in urban slums. Maternal nutritional status associated with infant and child health has been established previously, but rarely in the aftermath of a flood. This study explores, 1) whether maternal nutritional status measured soon after a flood can predict the current nutritional status and the risk for future deterioration of nutritional status of their children, 2) the impact of flooding on IYC feeding practices during flooding compared to non-flooding and the coping strategies developed by caretakers in urban slums, 3) the perceptions of root causes of malnutrition including flooding for IYC living in urban slums and 4) develops a pilot study for an intervention to tackle malnutrition in IYC living in urban slums. The research uses 1) quantitative data (n=143, secondary analysis of data collected after the 1998 flood in Bangladesh) to answer the first research question, and 2) a mixed method approach of qualitative data (participant observation n=24, semi-structured interviews n=23 (18 mothers, 5 community health workers), and focus group discussions n=10) and quantitative data (household questionnaire n=23 and anthropometric measurements n=55 for IYC and n=23 for mothers and community health workers) collected in slums in Dhaka to answer the second and third research questions. A new technique is used to answer question three. This technique is based on existing methods for the building of a causal model combined with a pile sorting of photographs to understand the root causes and processes leading to malnutrition. The participants of the mixed method were mothers, pregnant women and Bangladesh Rural Advancement Committee (BRAC) community health workers living and working in the slums. The key findings are: 1) maternal nutritional status measured soon after a flood can predict the current nutritional status and the risk for future deterioration of nutritional status of their children, 2) feeding practices for IYC deteriorate during flooding in Dhaka slums, 3) the coping strategies of IYC caretakers are limited and their resilience capacity to floods is low, 4) there is a good perception of the root causes of malnutrition by participants living in Dhaka slums but feeding practices are not meeting the WHO guidelines due to barriers, limitations and poor knowledge, and 5) there is a need for a pilot project to test the feasibility of an intervention aiming at improving IYC nutritional health and feeding practices. This research deepens the understanding of coping strategies for feeding practices and perceived roots of malnutrition for IYC living in urban slums exposed to flooding. It brings evidence of the interactions between coping strategies and nutritional health in relation to flooding. It also casts new anthropological light onto the series of existing studies and previous research essentially focused on the flood event itself. As a result, the research leads to recommendations for risk reduction strategies and nutrition promotion for flood exposed populations with infants and young children

Infant and young children's nutritional health and feeding practices in relation to flooding in Bangladesh

Bangladesh is one of the poorest developing countries in the world where infant and young children (IYC) suffer from extremely high levels of malnutrition resulting in high morbidity and mortality rates. IYC are defined here as birth to 3 years old. Due to the double burden of climate variability and urbanisation, longer and more severe floods affect people living in urban slums, with IYC being highly vulnerable. Insufficient research exists into understanding the mechanisms leading to poor nutritional child health related to flooding in urban slums. Maternal nutritional status associated with infant and child health has been established previously, but rarely in the aftermath of a flood. This study explores, 1) whether maternal nutritional status measured soon after a flood can predict the current nutritional status and the risk for future deterioration of nutritional status of their children, 2) the impact of flooding on IYC feeding practices during flooding compared to non-flooding and the coping strategies developed by caretakers in urban slums, 3) the perceptions of root causes of malnutrition including flooding for IYC living in urban slums and 4) develops a pilot study for an intervention to tackle malnutrition in IYC living in urban slums. The research uses 1) quantitative data (n=143, secondary analysis of data collected after the 1998 flood in Bangladesh) to answer the first research question, and 2) a mixed method approach of qualitative data (participant observation n=24, semi-structured interviews n=23 (18 mothers, 5 community health workers), and focus group discussions n=10) and quantitative data (household questionnaire n=23 and anthropometric measurements n=55 for IYC and n=23 for mothers and community health workers) collected in slums in Dhaka to answer the second and third research questions. A new technique is used to answer question three. This technique is based on existing methods for the building of a causal model combined with a pile sorting of photographs to understand the root causes and processes leading to malnutrition. The participants of the mixed method were mothers, pregnant women and Bangladesh Rural Advancement Committee (BRAC) community health workers living and working in the slums. The key findings are: 1) maternal nutritional status measured soon after a flood can predict the current nutritional status and the risk for future deterioration of nutritional status of their children, 2) feeding practices for IYC deteriorate during flooding in Dhaka slums, 3) the coping strategies of IYC caretakers are limited and their resilience capacity to floods is low, 4) there is a good perception of the root causes of malnutrition by participants living in Dhaka slums but feeding practices are not meeting the WHO guidelines due to barriers, limitations and poor knowledge, and 5) there is a need for a pilot project to test the feasibility of an intervention aiming at improving IYC nutritional health and feeding practices. This research deepens the understanding of coping strategies for feeding practices and perceived roots of malnutrition for IYC living in urban slums exposed to flooding. It brings evidence of the interactions between coping strategies and nutritional health in relation to flooding. It also casts new anthropological light onto the series of existing studies and previous research essentially focused on the flood event itself. As a result, the research leads to recommendations for risk reduction strategies and nutrition promotion for flood exposed populations with infants and young children.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Cost effectiveness of a community based prevention and treatment of acute malnutrition programme in Mumbai slums, India

Children in slums are at high risk of acute malnutrition and death. Cost-effectiveness of community-based management of severe acute malnutrition programmes has been demonstrated previously, but there is limited evidence in the context of urban slums where programme cost structure is likely to vary tremendously. This study assessed the cost-utility of adding a community based prevention and treatment for acute malnutrition intervention to Government of India Integrated Child Development Services (ICDS) standard care for children in Mumbai slums. The intervention is delivered by community health workers in collaboration with ICDS Anganwadi community health workers. The analysis used a decision tree model to compare the costs and effects of the two options: standard ICDS services with the intervention and prevention versus standard ICDS services alone. The model used outcome and cost data from the Society for Nutrition, Education & Health Action’s Child Health and Nutrition programme in Mumbai slums, which delivered services to 12,362 children over one year from 2013 to 2014. An activity-based cost model was used, with calculated costs based on programme financial records and key informant interviews. Cost data were coupled with programme effectiveness data to estimate disability adjusted life years (DALYs) averted. The community based prevention and treatment programme averted 15,016 DALYs (95% Uncertainty Interval [UI]: 12,246–17,843) at an estimated cost of $23 per DALY averted (95%UI:19–28) and was thus highly cost-effective. This study shows that ICDS Anganwadi community health workers can work efficiently with community health workers to increase the prevention and treatment coverage in slums in India and can lead to policy recommendations at the state, and potentially the national level, to promote such programmes in Indian slums as a cost-effective approach to tackling moderate and severe acute malnutrition

How does poverty affect children's nutritional status in Nairobi slums? A qualitative study of the root causes of undernutrition

Children in slums are at high risk of undernutrition, which has long-term negative consequences on their physical growth and cognitive development. Severe undernutrition can lead to the child's death. The present paper aimed to understand the causes of undernutrition in children as perceived by various groups of community members in Nairobi slums, Kenya. Analysis of ten focus group discussions and ten individual interviews with key informants. The main topic discussed was the root causes of child undernutrition in the slums. The focus group discussions and key informant interviews were recorded and transcribed verbatim. The transcripts were coded in NVivo by extracting concepts and using a constant comparison of data across the different categories of respondents to draw out themes to enable a thematic analysis. Two slum communities in Nairobi, Kenya. Women of childbearing age, community health workers, elders, leaders and other knowledgeable people in the two slum communities (n 90). Participants demonstrated an understanding of undernutrition in children. Findings inform target criteria at community and household level that can be used to identify children at risk of undernutrition. To tackle the immediate and underlying causes of undernutrition, interventions recommended should aim to: (i) improve maternal health and nutrition; (ii) promote optimal infant and young children feeding practices; (iii) support mothers in their working role; (iv) increase access to family planning; (v) improve water, sanitation and hygiene (WASH); (vi) address alcohol problems at all levels; and (vii) address street food issues with infant feeding counselling

Social value of a nutritional counselling and support program for breastfeeding in urban poor settings, Nairobi

Background: In Kenya, poor maternal nutrition, suboptimal infant and young child feeding practices and high levels of malnutrition have been shown among the urban poor. An intervention aimed at promoting optimal maternal infant and young child nutrition (MIYCN) practices in urban poor settings in Nairobi, Kenya was implemented. The intervention involved home-based counselling of pregnant and breastfeeding women and mothers of young children by community health volunteers (CHVs) on optimal MIYCN practices. This study assesses the social impact of the intervention using a Social Return on Investment (SROI) approach. Methods: Data collection was based on SROI methods and used a mixed methods approach (focus group discussions, key informant interviews, in-depth interviews, quantitative stakeholder surveys, and revealed preference approach for outcomes using value games). Results: The SROI analysis revealed that the MIYCN intervention was assessed to be highly effective and created social value, particularly for mothers and their children. Positive changes that participants experienced included mothers being more confident in child care and children and mothers being healthier. Overall, the intervention had a negative social impact on daycare centers and on health care providers, by putting too much pressure on them to provide care without providing extra support. The study calculated that, after accounting for discounting factors, the input ($USD 419,716) generated$USD 8 million of social value at the end of the project. The net present value created by the project was estimated at $USD 29.5 million.$USD 1 invested in the project was estimated to bring USD$71 (sensitivity analysis: USD$ 34-136) of social value for the stakeholders. Conclusion: The MIYCN intervention showed an important social impact in which mothers and children benefited the most. The intervention resulted in better perceived health of mothers and children and increased confidence of mothers to provide care for their children, while it resulted in negative impacts for day care center owners and health care providers

Rapid review of factors influencing dietary behaviors in Fiji

IntroductionIn Fiji, multiple burdens of malnutrition including undernutrition, overweight/obesity, and micronutrient deficiencies coexist at the individual, household, and population levels. The diets of children, adolescents, and adults are generally unhealthy. The objective of this review was to understand how the dietary behaviors of children, adolescents, and women in Fiji are influenced by individual, social, and food environment factors.MethodsThis rapid review was conducted to synthesize existing evidence, identify research gaps in the evidence base, and make recommendations for future research. The Cochrane Rapid Reviews Methods and the updated guideline for reporting systematic reviews were used. The search strategy for this rapid review was based on the Population Context Outcome [P(E)CO] framework, including search terms for population (children, adolescents, and adults), context (Fiji), and outcome (dietary behaviors). Searches were conducted in PubMed, Scopus, PsycINFO, and Google Scholar.ResultsThe 22 studies included in this review identified different factors influencing dietary behaviors in Fiji. Individual preferences for processed and imported foods, especially of younger generations, and social dynamics, especially gender norms and social pressure, to serve meat and overeat appeared to be prominent in driving dietary habits. The ongoing nutrition transition has led to increasing availability and affordability of ultra-processed and fast foods, especially in urban areas. Concerns about food safety and contamination and climate change and its effect on local food production also appear to influence dietary choices.DiscussionThis review identified different dynamics influencing dietary behaviors, but also research gaps especially with regard to the food environment, calling for an integrated approach to address these factors more systemically

The Population Structure of Glossina palpalis gambiensis from Island and Continental Locations in Coastal Guinea

Guinea is the country with the highest prevalence of sleeping sickness in West Africa, and we undertook a population genetics analysis there of the most dangerous tsetse fly species of West Africa, Glossina palpalis gambiensis. Our aims were to estimate effective population size and the degree of isolation between coastal sites on the mainland of Guinea (including Dubréka, a highly prevalent sleeping sickness focus) and Loos Islands in order to get the most possible accurate vision of feasibility and sustainability of anti-tsetse strategies of these sites. We found very low migration rates of tsetse between sites except between those situated in the Dubréka area, which seems to contain a widely distributed panmictic tsetse population (i.e. a population where mating occurs at random). Effective population sizes on Loos islands estimated with various techniques all converged to surprisingly small values. These values might be explained by a recent decrease in tsetse numbers on Kassa Island due to bauxite mining activities. But on the other sites, other explanations have to be found, including possible variance in reproductive success. Our genetic results suggest that different control strategies should be advised on the mainland (reduction in tsetse densities, no elimination) compared to the islands (total elimination feasible). This approach could be extended to many areas where vector control of Human and Animal Trypanosomoses is contemplated

Contrasting Population Structures of Two Vectors of African Trypanosomoses in Burkina Faso: Consequences for Control

Tsetse flies are insects that transmit trypanosomes to humans (sleeping sickness) and animals (nagana). Controlling these vectors is a very efficient way to control these diseases. In Burkina Faso, a tsetse eradication campaign is presently targeting the northern part of the Mouhoun River Basin. To attain this objective, the approach has to be area-wide, i.e. the control effort targets an entire pest population within a circumscribed area. To assess the level of this isolation, we studied the genetic structure of Glossina palpalis gambiensis and Glossina tachinoides populations in the target area and in the adjacent river basins of the Comoé, the Niger and the Sissili River Basins. Our results suggest an absence of strong genetic isolation of the target populations. We therefore recommend establishing permanent buffer zones between the Mouhoun and the other river basin(s) to prevent reinvasion. This kind of study may be extended to other areas on other tsetse species

An ultraconserved Hox–Pbx responsive element resides in the coding sequence of Hoxa2 and is active in rhombomere 4

The Hoxa2 gene has a fundamental role in vertebrate craniofacial and hindbrain patterning. Segmental control of Hoxa2 expression is crucial to its function and several studies have highlighted transcriptional regulatory elements governing its activity in distinct rhombomeres. Here, we identify a putative Hox–Pbx responsive cis-regulatory sequence, which resides in the coding sequence of Hoxa2 and is an important component of Hoxa2 regulation in rhombomere (r) 4. By using cell transfection and chromatin immunoprecipitation (ChIP) assays, we show that this regulatory sequence is responsive to paralogue group 1 and 2 Hox proteins and to their Pbx co-factors. Importantly, we also show that the Hox–Pbx element cooperates with a previously reported Hoxa2 r4 intronic enhancer and that its integrity is required to drive specific reporter gene expression in r4 upon electroporation in the chick embryo hindbrain. Thus, both intronic as well as exonic regulatory sequences are involved in Hoxa2 segmental regulation in the developing r4. Finally, we found that the Hox–Pbx exonic element is embedded in a larger 205-bp long ultraconserved genomic element (UCE) shared by all vertebrate genomes. In this respect, our data further support the idea that extreme conservation of UCE sequences may be the result of multiple superposed functional and evolutionary constraints