Educación alimentaria y nutricional para reducir la obesidad en escolares de Panamá: protocolo de estudio

Overweight in school-age children represents a growing public health problem in Panama. The objective is to develop and validate an intervention program in food and nutrition education (FNE) against overweight and obesity in school-age children in Panama from the perspective of an intersectoral public policy in health and education. The intervention is based on behavior changes under the socio-ecological model that favors the adoption of healthier dietary practices and lifestyles. This is a study in 768 school-age children of quasi-experimental, pre-test and post-test, prospective and non-controlled design, in public education institutions in three districts of Panama West Province: La Chorrera, Capira and Chame. Five schools were selected, the Victoria D’Spinay and La Herradura schools in the District of La Chorrera, the Hernando Bárcenas school in the District of Capira and the El Espavé and Berta Elida Fernández schools in the Chame District. The protocol was registered in the international test platform No. ISRCTN28920505. Sociodemographic, anthropometric, nutritional and food data will be obtained; of food security; and of knowledge, attitude, perception and behavior on food and healthy lifestyles from March to December 2019 during the implementation of the intersectoral program called "Healthy Schools" of the Ministry of Health and the Ministry of Education of Panama. The data will be described and compared using parametric and non-parametric statistics. The study protocol was reviewed and approved by the Bioethics Committee of the University of Panama (Ref CBUP/Nº075/2019), registered in the General Directorate of Health (DIGESA) of the Ministry of Health (Nº 881). Signed informed consent will be requested from the guardians and assent for each participating child. The results of the study will be widely disseminated in peer-reviewed journals and in health and nutrition congresses.El sobrepeso en escolares representa un creciente problema de salud pública en Panamá. El objetivo es desarrollar y validar un programa de intervención en educación alimentaria y nutricional (EAN) contra el sobrepeso y la obesidad en escolares de Panamá bajo la perspectiva de una política pública intersectorial de salud y educación. La intervención se basa en el cambio de conducta bajo el modelo socio-ecológico que favorezca la adopción de comportamientos alimentarios y de estilos de vida más saludables. Se trata de un estudio en 768 escolares de diseño cuasi experimental, pre-post intervención, prospectivo y sin grupo control, de tipo observacional explicativo en instituciones de educación básica general del sector público en tres Distritos de Panamá Oeste: La Chorrera, Capira y Chame. Se seleccionaron 5 escuelas, la escuela Victoria DˈSpinay y La Herradura en el Distrito de La Chorrera, la escuela Hernando Bárcenas en el Distrito de Capira y las escuelas El Espavé y Berta Elida Fernández en el Distrito de Chame. El protocolo fue registrado en la plataforma internacional de ensayos Nº ISRCTN28920505. Se obtendrán datos sociodemográficos, antropométricos, nutricionales y alimentarios; de seguridad alimentaria; y de conocimiento, actitud, percepción y comportamiento sobre alimentación y estilos de vida saludables de marzo a diciembre de 2019 durante la implementación del programa intersectorial denominado “Escuelas Saludables” del Ministerio de Salud y del Ministerio de Educación de Panamá. Se describirán y compararán los datos utilizando estadística paramétrica y no paramétrica. El protocolo de estudio fue revisado y aprobado por el Comité de Bioética de la Universidad de Panamá (Ref. CBUP/Nº075/2019), registrado en la Dirección General de Salud (DIGESA) del MINSA (Nº 881). Se solicitará consentimiento informado firmado por parte de los acudientes y asentimiento por cada niño participante. Los resultados del estudio serán difundidos ampliamente en revistas indexadas de revisión de pares y en congresos de salud y nutrición.Número de registro de protocolo: ISRCTN28920505

Impacts of casinos on key pathways to health: qualitative findings from American Indian gaming communities in California

Background: Three decades ago, casino gaming on sovereign American Indian lands was legalized with differential economic and social implications. While casinos have improved the incomes of tribal communities, there have been both positive and negative findings in relation to health impacts. We sought to understand the perceived pathways by which casinos impact individual and community health through voices of the community. Methods: We conducted semi-structured, interviews with tribal leaders (n =12) and tribal members (n =24) from tribal communities (n = 23) representing different regions of California. We inductively analyzed textual data drawing from Grounded Theory, first using line-by-line coding to identify analytic categories from emergent themes in consideration of the study objective. Then, focused codes were applied to identify salient themes, which we represented through exemplar quotes and an overall conceptual framework. Data were managed and coded using Dedoose software. Results: American Indian-owned casinos are perceived to influence the health of tribal communities through three pathways: 1) improving the tribal economy 2) altering the built environment, and 3) disrupting the the social landscape. Forming these pathways are a series of interrelated health determinants. Improvement of the tribal economy, through both job creation for tribal members and improved tribal cash flow, was perceived by participants to both influence health. Specifically, improved cash flow has resulted in new wellness programs, community centers, places for recreation, and improved social services. Higher disposable incomes have led to better financial stability, increased access to healthy food, and more opportunities for physical activity. Yet, higher disposable incomes were perceived to also contribute to negative health behaviors, most notably increased drug and alcohol abuse. Casinos were also perceived to alter built environments, resulting in increased availability and access to unhealthy food. And to a lesser extent, they were perceived to disrupt the social landscape of communities with impacts on tribal community value systems. Conclusions: Casino environments improve economic conditions of tribal communities, but present important social and public health challenges. Policy makers at federal, state, and tribal levels should consider the perceptions of tribal members and leaders when determining policies in light of casino development

Educación alimentaria y nutricional para reducir la obesidad en escolares de Panamá: protocolo de estudio

Overweight in school-age children represents a growing public health problem in Panama. The objective is to develop and validate an intervention program in food and nutrition education (FNE) against overweight and obesity in school-age children in Panama from the perspective of an intersectoral public policy in health and education. The intervention is based on behavior changes under the socio-ecological model that favors the adoption of healthier dietary practices and lifestyles. This is a study in 768 school-age children of quasi-experimental, pre-test and post-test, prospective and non-controlled design, in public education institutions in three districts of Panama West Province: La Chorrera, Capira and Chame. Five schools were selected, the Victoria D’Spinay and La Herradura schools in the District of La Chorrera, the Hernando Bárcenas school in the District of Capira and the El Espavé and Berta Elida Fernández schools in the Chame District. The protocol was registered in the international test platform No. ISRCTN28920505. Sociodemographic, anthropometric, nutritional and food data will be obtained; of food security; and of knowledge, attitude, perception and behavior on food and healthy lifestyles from March to December 2019 during the implementation of the intersectoral program called "Healthy Schools" of the Ministry of Health and the Ministry of Education of Panama. The data will be described and compared using parametric and non-parametric statistics. The study protocol was reviewed and approved by the Bioethics Committee of the University of Panama (Ref CBUP/Nº075/2019), registered in the General Directorate of Health (DIGESA) of the Ministry of Health (Nº 881). Signed informed consent will be requested from the guardians and assent for each participating child. The results of the study will be widely disseminated in peer-reviewed journals and in health and nutrition congresses.El sobrepeso en escolares representa un creciente problema de salud pública en Panamá. El objetivo es desarrollar y validar un programa de intervención en educación alimentaria y nutricional (EAN) contra el sobrepeso y la obesidad en escolares de Panamá bajo la perspectiva de una política pública intersectorial de salud y educación. La intervención se basa en el cambio de conducta bajo el modelo socio-ecológico que favorezca la adopción de comportamientos alimentarios y de estilos de vida más saludables. Se trata de un estudio en 768 escolares de diseño cuasi experimental, pre-post intervención, prospectivo y sin grupo control, de tipo observacional explicativo en instituciones de educación básica general del sector público en tres Distritos de Panamá Oeste: La Chorrera, Capira y Chame. Se seleccionaron 5 escuelas, la escuela Victoria DˈSpinay y La Herradura en el Distrito de La Chorrera, la escuela Hernando Bárcenas en el Distrito de Capira y las escuelas El Espavé y Berta Elida Fernández en el Distrito de Chame. El protocolo fue registrado en la plataforma internacional de ensayos Nº ISRCTN28920505. Se obtendrán datos sociodemográficos, antropométricos, nutricionales y alimentarios; de seguridad alimentaria; y de conocimiento, actitud, percepción y comportamiento sobre alimentación y estilos de vida saludables de marzo a diciembre de 2019 durante la implementación del programa intersectorial denominado “Escuelas Saludables” del Ministerio de Salud y del Ministerio de Educación de Panamá. Se describirán y compararán los datos utilizando estadística paramétrica y no paramétrica. El protocolo de estudio fue revisado y aprobado por el Comité de Bioética de la Universidad de Panamá (Ref. CBUP/Nº075/2019), registrado en la Dirección General de Salud (DIGESA) del MINSA (Nº 881). Se solicitará consentimiento informado firmado por parte de los acudientes y asentimiento por cada niño participante. Los resultados del estudio serán difundidos ampliamente en revistas indexadas de revisión de pares y en congresos de salud y nutrición.Número de registro de protocolo: ISRCTN28920505

A Prospective Study Measuring the Effect of an Interactive Educational Program on Overweight and Obesity among School-Aged Children

Being overweight or obese is a public health problem. This work evaluated a food and nutrition education (FNE) intervention to reduce overweight status among schoolchildren in four schools in the West Panama Province. This was a quasi-experimental before-and-after study that implemented a 34-week FNE intervention through workshops with didactic material to 403 children between 8 and 13 years old. A knowledge and attitude survey was used as an evaluation tool before and after the FNE intervention. The prevalence of excess weight (40%) did not reduce after the intervention. The zBMI at the beginning was 0.57 (1.29) for girls and 0.70 (1.36) for boys, and at the final evaluation was 0.57 (1.28) for girls and 0.67 (1.33) for boys. No significant differences were observed between the point of evaluation and sex. No differences were reported in the median level of attitude, although higher levels of knowledge were reported in students of both sexes. The FNE in schoolchildren can be effective in acquiring knowledge and maintaining a positive attitude towards food, but more research is needed to address nutritional status. Although the intervention had no impact on nutritional status, the FNE facilitated the adoption of skills and competencies in schoolchildren. The success of the implementation of the study highlighted the feasibility of replicating the FNE interventions on a larger scale to contribute positively to the multi-level and sectoral public policy Study Without Hunger in Panama

Acceptability and Utilization of Three Nutritional Supplements during Pregnancy: Findings from a Longitudinal, Mixed-Methods Study in Niger

Nutritional status in pregnancy is a key determinant of birth outcomes. In low-income countries, maternal diets are often limited, and daily nutrient supplements are recommended to fill nutrient gaps. As a result, it is important to understand the factors influencing acceptability and utilization of nutrient supplements in these settings. Qualitative data (individual interviews and focus group discussions with pregnant women, household members, and study staff) and quantitative data (unannounced household spot checks) were collected in 24 villages in the Maradi region of south-central Niger. Each village was randomly assigned to one of three study arms, with pregnant women receiving either iron and folic acid (IFA) supplements, multiple micronutrient (MMN) supplements, or medium-quantity lipid-based nutrient supplements (MQ-LNS) for daily consumption during pregnancy. Data were collected longitudinally to capture changes in perspective as women progressed through their pregnancy. Participants accepted all three supplement types, and perceived a wide range of health benefits attributed to supplement consumption. However, several important barriers to appropriate consumption were reported, and rumors about the supplements leading to childbirth complications also decreased utilization. The household spot checks suggested that IFA had the highest level of correct consumption. Overall, despite a stated high level of acceptance and enthusiasm for the supplements among participants and their household members, certain fears, side effects, and organoleptic factors led to decreased utilization. The effectiveness of future programs to improve maternal nutritional status through supplementation may be improved by understanding perceived barriers and facilitating factors among participants and tailoring communication efforts appropriately

A comparison of observed feeding practices of infants and young children aged 6–23 months to national responsive feeding recommendations in Sri Lanka

Abstract To describe the extent to which Sri Lankan caregivers follow current national responsive feeding recommendations and the factors limiting and enabling those behaviours. Study design. This ethnographic substudy was conducted using a four‐phase, mixed methods formative research design across rural, estate and urban sectors of Sri Lanka. Data collection methods. Data were collected using direct meal observations and semistructured interviews. Participants including infants and young children aged 6–23 months (n = 72), community leaders (n = 10), caregivers (n = 58) and community members (n = 37) were purposefully sampled to participate in this study. Data analysis. Observational data were summarized using descriptive statistics while textual data were analysed thematically using Dedoose. Findings were then interpreted vis‐à‐vis six national responsive feeding recommendations. During observed feeding episodes, caregivers were responsive to nearly all food requests (87.2% [34/39]) made by infants and young children. Many caregivers (61.1% [44/72]) also positively encouraged their infant and young child during feeding. Despite some responsive feeding practices being observed, 36.1% (22/61) of caregivers across sectors used forceful feeding practices if their infant or young child refused to eat. Interviews data indicated that force‐feeding practices were used because caregivers wanted their infants and young children to maintain adequate weight gain for fear of reprimand from Public Health Midwives. Despite overall high caregiver knowledge of national responsive feeding recommendations in Sri Lanka, direct observations revealed suboptimal responsive feeding practices, suggesting that other factors in the knowledge‐behaviour gap may need to be addressed

Correction: Implications of the Ebola virus disease outbreak in Guinea: Qualitative findings to inform future health and nutrition-related responses.

[This corrects the article DOI: 10.1371/journal.pone.0202468.]

A Livelihood Intervention to Reduce the Stigma of HIV in Rural Kenya: Longitudinal Qualitative Study.

The scale-up of effective treatment has partially reduced the stigma attached to HIV, but HIV still remains highly stigmatized throughout sub-Saharan Africa. Most studies of anti-HIV stigma interventions have employed psycho-educational strategies such as information provision, counseling, and testimonials, but these have had varying degrees of success. Theory suggests that livelihood interventions could potentially reduce stigma by weakening the instrumental and symbolic associations between HIV and premature morbidity, economic incapacity, and death, but this hypothesis has not been directly examined. We conducted a longitudinal qualitative study among 54 persons with HIV participating in a 12-month randomized controlled trial of a livelihood intervention in rural Kenya. Our study design permitted assessment of changes over time in the perspectives of treatment-arm participants (N = 45), as well as an understanding of the experiences of control arm participants (N = 9, interviewed only at follow-up). Initially, participants felt ashamed of their seropositivity and were socially isolated (internalized stigma). They also described how others in the community discriminated against them, labeled them as being "already dead," and deemed them useless and unworthy of social investment (perceived and enacted stigma). At follow-up, participants in the treatment arm described less stigma and voiced positive changes in confidence and self-esteem. Concurrently, they observed that other community members perceived them as active, economically productive, and contributing citizens. None of these changes were noted by participants in the control arm, who described ongoing and continued stigma. In summary, our findings suggest a theory of stigma reduction: livelihood interventions may reduce internalized stigma among persons with HIV and also, by targeting core drivers of negative attitudes toward persons with HIV, positively change attitudes toward persons with HIV held by others. Further research is needed to formally test these hypotheses, assess the extent to which these changes endure over the long term, and determine whether this class of interventions can be implemented at scale

Changes in Health and Antiretroviral Adherence Among HIV-Infected Adults in Kenya: Qualitative Longitudinal Findings from a Livelihood Intervention.

This longitudinal qualitative study sought to understand how and why a livelihood intervention affected the health and health behaviors of HIV-infected Kenyan adults. The intervention included a microfinance loan, agricultural and financial training, and a human-powered water pump. In-depth interviews were conducted at two time points with intervention and control participants and program staff. We double coded interviews (n = 117) and used thematic content analysis of transcripts following an integrative inductive-deductive approach. Intervention participants described improvements in HIV health, including increased CD4 counts and energy, improved viral suppression, and fewer HIV-related symptoms. Better health was linked to improved clinic attendance and ART adherence through several mechanisms: (1) reductions in food insecurity and abject hunger; (2) improved financial stability; (3) improved productivity which enhanced social support; (4) better control over work situations; and, (5) renewed desire to prioritize their own health. Livelihood interventions may improve health by influencing upstream determinants of health behavior including food security and poverty

Critical review of indicators, metrics, methods, and tools for monitoring and evaluation of biofortification programs at scale

Sound monitoring and evaluation (M&E) systems are needed to inform effective biofortification program management and implementation. Despite the existence of M&E frameworks for biofortification programs, the use of indicators, metrics, methods, and tools (IMMT) are currently not harmonized, rendering the tracking of biofortification programs difficult. We aimed to compile IMMT for M&E of existing biofortification programs and recommend a sub-set of high-level indicators (HLI) for a harmonized global M&E framework. We conducted (1) a mapping review to compile IMMT for M&E biofortification programs; (2) semi-structured interviews (SSIs) with biofortification programming experts (and other relevant stakeholders) to contextualize findings from step 1; and (3) compiled a generic biofortification program Theory of Change (ToC) to use it as an analytical framework for selecting the HLI. This study revealed diversity in seed systems and crop value chains across countries and crops, resulting in differences in M&E frameworks. Yet, sufficient commonalities between implementation pathways emerged. A set of 17 HLI for tracking critical results along the biofortification implementation pathway represented in the ToC is recommended for a harmonized global M&E framework. Further research is needed to test, revise, and develop mechanisms to harmonize the M&E framework across programs, institutions, and countries