Maternal nutrition: how is Eastern and Southern Africa faring and what needs to be done?

Background: The progress in key maternal health indicators in the Eastern and Southern Africa Region (ESAR) over the past two decades has been slow. Objective: This paper analyzed available information on nutrition programs and nutrition-specific interventions targeting maternal nutrition in the ESAR and proposes steps to improve maternal nutrition in this region. Methods: Search was conducted in relevant databases. Meta-analysis was done where there was sufficient data, while data from the nutrition programs was abstracted for objectives, settings, beneficiaries, stakeholders, impact of interventions and barriers encountered during implementation. Results: Findings from our review suggest that multiple nutrition programs are in place in the ESAR; including programs that directly address nutrition indicators and those that integrate corresponding sectors like agriculture, health, education, and water and sanitation. However, their scale and depth differ considerably. These programs have been implemented by a diverse range of players including respective government ministries, international agencies, non government organisations and the private sector in the region. Most of these programs are clustered in a few countries like Kenya, Uganda and Ethiopia while others e.g. Comoros, Somalia and Swaziland have only had a limited number of initiatives. Conclusion: These programs have been associated with some improvements in overall maternal health and nutritional indicators; however these are insufficient to significantly contribute to the progress in the region. Efforts should be prioritized in countries with the greatest burden of maternal undernutrition and associated risk factors with a focus on existing promising interventions to improve maternal nutrition

Characteristics and birth outcomes of pregnant adolescents compared to older women: An analysis of individual level data from 140,000 mothers from 20 RCTs

BACKGROUND: Adolescence is a critical period of maturation when nutrient needs are high, especially among adolescents entering pregnancy. Using individual-level data from 140,000 participants, we examined socioeconomic, nutrition, and pregnancy and birth outcomes for adolescent mothers (10–19 years) compared to older mothers in low and middle-income countries. METHODS: This study was conducted between March 16, 2018 and May 25, 2021. Data were obtained from 20 randomised controlled trials of micronutrient supplementation in pregnancy. Stratified analyses were conducted by age (10–14 years, 15–17 years, 18–19 years, 20–29 years, 30–39 years, 40+ years) and geographical region (Africa, Asia). Crude and confounder-adjusted means, prevalence and relative risks of pregnancy, nutrition and birth outcomes were estimated using multivariable linear and log-binomial regression models with 95% confidence intervals. FINDINGS: Adolescent mothers comprised 31.6% of our data. Preterm birth, small-for-gestational age (SGA), low birthweight (LBW) and newborn mortality followed a U-shaped trend in which prevalence was highest among the youngest mothers (10–14 years) and then reduced gradually, but increased again for older mothers (40+ years). When compared to mothers aged 20–29 years, there was a 23% increased risk of preterm birth, a 60% increased risk of perinatal mortality, a 63% increased risk of neonatal mortality, a 28% increased risk of LBW, and a 22% increased risk of SGA among mothers 10–14 years. Mothers 40+ years experienced a 22% increased risk of preterm birth and a 103% increased risk of stillbirth when compared to the 20–29 year group. INTERPRETATION: The youngest and oldest mothers suffer most from adverse pregnancy and birth outcomes. Policy and programming agendas should consider both biological and socioeconomic/environmental factors when targeting these populations. FUNDING: Bill and Melinda Gates Foundation (Grant No: OP1137750)

University-level nutrition training in West Africa:cost and financing issues

BackgroundThere is a serious shortage of skilled nutrition professionals in West Africa. Investing in nutrition training is one of the strategies for strengthening the human resource base in nutrition. However, little is known about how nutrition training in the region is financed and the levels of tuition fees charged. The purpose of this study was to provide a comprehensive assessment about the levels of tuition fees charged for nutrition training in the West Africa region and to determine to what extent this is of reach to the average student. MethodologyThe data for this study were obtained from 74 nutrition degree programs operating in nine West African countries in 2013 through semi-structured interviews during on-site visits or through self-administered questionnaires. They included the age of the programs, school ownership, tuition fees, financial assistance, and main sources of funding. Tuition fees (in 2013 US$) were expressed per program to enable uniformity and comparability. Simple descriptive and bivariate analyses were performed. ResultsResults from 74 nutrition training programs in nine countries showed a wide variation in tuition fees within and between countries. The tuition fees for bachelor's, master's, and doctoral programs, respectively, ranged from 372 to 4,325 (mean: 2,353); 162 to 7,678 (mean: 2,232); and 369 to 5,600 (mean: 2,208). The tuition fees were significantly higher (p<0.05) in private institutions than in public institutions (mean: US$3,079 vs. US$2,029 for bachelor's programs; US$5,118 vs. US$1,820 for master's programs; and US$3,076 vs. US$1,815 for doctoral programs). The difference in the tuition fees between Francophone and Anglophone countries was not statistically significant (mean: US$2,570 vs. US$2,216 for bachelor's programs; US$2,417 vs. US$2,147 for master's programs; US$3,285 vs. US$2,055 for doctoral programs). In most countries, the tuition fees appeared to be out of reach of the average student. Recent master's programs appeared to charge higher fees than older ones. We found a significant negative correlation between tuition fees and the age of the program, after controlling for school ownership (r=−0.33, p<0.001). ConclusionsOur findings underscore the urgent need for national governments in the region to establish benchmarks and regulate nutrition training costs. In a region where the average annual gross national income (GNI) per capita is barely 890$, the rising cost of tuition fees is likely to hinder access of students from poor background to nutrition training. Governments should institute financing mechanisms such as scholarships, public–private partnerships, credit facilities, and donor funding to facilitate access to tertiary-level nutrition training in the region

Upper arm length along with mid-upper arm circumference to enhance wasting prevalence estimation and diagnosis: sensitivity and specificity in 6–59-months-old children

Objective To evaluate the added value of the use of upper arm length (UAL) along with mid-upper arm circumference (MUAC) to diagnose and estimate the prevalence of wasting in comparison to current WHO standard and other MUAC-based methods.Design UAL and usual anthropometric measurements were collected during a national cross-sectional nutritional survey. Children were classified into three upper arm length groups (UALGs): UALG1, UALG2 and UALG3 according to the following UAL limits: ≤150, 151–180 and ≥181 mm, respectively. Receiver operating characteristic curves were used to determine the best MUAC cut-off for each group using weight-for-height Z-score (WHZ) as a reference standard. Wasting prevalence, sensitivity and specificity of all diagnostic methods were compared.Setting This study was conducted in Mauritania.Participants National representative sample of children from 6 to 59 months old.Results In total, 12 590 children were included in the study. Wasting prevalence was 16.1%, 5.0% and 12.5% when diagnosed by WHZ &lt;−2, MUAC &lt;125 mm and MUAC–UALG methods, respectively. Using the MUAC–UALG method increased the sensitivity for wasting diagnosis from 17.98% with MUAC &lt;125 mm to 39.43% with MUAC–UALG. The specificity decreased from 97.49% with MUAC &lt;125 mm to 92.71% with MUAC–UALG. With MUAC–height Z score and MUAC &lt;138 mm, sensitivity was 26.04% and 69.76% and specificity were 97.40% and 75.64% respectively.Conclusion This alternative method using MUAC tape to measure UAL increases the wasting diagnosis accuracy and allows for a better estimation of wasting prevalence. This method could be used as a potential alternative method for quick surveys in emergency settings such as Corona virus disease 2019 context

Towards improving child feeding practices for optimal nutrition outcomes in Burkina Faso

Background: Infant and young child feeding (IYCF) practices are a critical factor in improving child nutrition. Methods: This study was conducted to document the promotion of optimal child feeding practices in the North and Central Plateau regions in Burkina Faso. Data were collected through a review of available program data, field visits and interviews with key stakeholders involved in the process. Results: A participatory approach was used to promote feeding practices in the two target regions. Interventions were delivered both at community level and through the health system. A mother-focused life cycle approach was used to deliver IYCF interventions at community level. The use of a participatory approach to scale up IYCF interventions fostered ownership and sustainability of the program. The development of a number of monitoring tools allowed the generation of real-time data about the program. In less than two years, the program reached 38,307 pregnant women and 63,955 mothers of children under two years of age with IYCF services in the Central Plateau region and 33,500 pregnant women and 67,200 mothers of children under two years of age in the North region. Despite this, much remains to be done to develop a full-fledged multi-sectoral system for addressing stunting in the two regions. Conclusion: Our data indicate that IYCF interventions were successfully developed and improved in two regions of Burkina Faso. Efforts should be made to accelerate the implementation of a comprehensive multi-sectoral package for addressing stunting in the two regions and also in the other regions of Burkina Fas

A comprehensive mapping of the current capacity for human nutrition training in Cameroon

Background There is consensus among stakeholders in Cameroon on the need to develop and strengthen human resource capacity for nutrition. This study was conducted to provide a comprehensive mapping of the current capacity for tertiary-level human nutrition training in Cameroon. Design Participating institutions included university-level institutions offering dedicated nutrition degree programs or other programs in which nutrition courses were taught. A semi-structured questionnaire administered during in-person interviews was used to collect data on existing programs and content of training curricula. Nutrition curricula were reviewed against the following criteria: intended objectives, coverage of nutrition topics, and teaching methods. Results In total, five nutrition degree programs (four undergraduate programs and one master's program) were identified. Three additional programs were about to be launched at the time of data collection. We did not find any doctorate degree programs in nutrition. All the undergraduate programs only had little focus on public health nutrition whereas the master's program in our sample offered a good coverage of all dimensions of human nutrition including basic and applied nutrition. The predominant teaching method was didactic lecture in all the programs. We did not find any formal documentation outlining the competencies that students were expected to gain upon completion of these programs. Nutrition courses in agricultural and health schools were limited in terms of contact hours and scope. Public health nutrition was not covered in any of the health professional schools surveyed. We found no institution offering in-service nutrition training at the time of the study. Conclusions Based on our findings, we recommend that nutrition training programs in Cameroon be redesigned to make them more responsive to the public health needs of the country

Integration of Nutrition into the Training Curricula of the Matourkou Agricultural Centre in Burkina Faso

Background: There is heightened interest in strengthening the linkages between agriculture and nutrition so that agriculture education systems become more nutrition-sensitive. This study was conducted to document the process of integrating nutrition into the training curricula of the Matourkou Agriculture Training Centre (CAP/Matourkou) in Burkina Faso. It also aimed to identify the challenges as well as the opportunities related to this mainstreaming process. Methods: Data were collected between August and October 2015. The nutrition content of the curricula was evaluated against the following criteria: i) Scope of the nutrition topics covered; ii) Method of integration of nutrition in the revised curricula; and iii) Method of delivery of nutrition instruction. A written test was conducted to assess the extent to which the process had contributed to improving students’ knowledge in nutrition. Only students in the agricultural engineering program took the test. Focus group discussions and semi-structured interviews were also conducted to evaluate the perceptions of key stakeholders about the process. The discussions were guided by the SWOT (Strengths, Weaknesses, Opportunities and Threats) analytical framework. Results: An iterative and multi-stakeholder process was used by CAP/Matourkou to integrate nutrition into its existing curricula. Nutrition mainstreaming occurred at two levels: i) Vertical integration through which stand-alone nutrition courses were added to the curriculum for agricultural engineers, higher level technicians and agricultural agents; and ii) Longitudinal integration where nutrition was embedded into relevant agriculture-specific subjects (13 subjects in the curriculum for agricultural engineers, 3 for higher level technicians, and 2 for agricultural agents). This resulted in a short-term improvement in students’ knowledge in nutrition. Students who received nutrition instruction under the revised curricula scored significantly higher than those that did not (mean score: 53.2±10.0 vs. 45.7±10.8, P<0.01). However, the vast majority of them (77.1%) scored around the average or below (<60%) for the test, indicating the need for increased training and exposure to nutrition. The most frequently reported strengths were the use of a structured approach and ownership of the process by CAP/ Matourkou. Lack of internal communication about the process, insufficient training of faculty members in nutrition, and lack of nutrition courses emphasizing practical skills emerged as the major weaknesses. Conclusions: Our data indicate that nutrition was effectively mainstreamed into the training curricula of CAP/Matourkou in Burkina Faso. However, efforts should be made to expand students’ knowledge in nutrition. It is important to expose them to nutrition courses that emphasize practical skills. Opportunities should also be created for faculty members to upgrade their capacity to teach nutrition-sensitive courses. Key technical partners, such as UNICEF, FAO and other international organizations, should continue to provide a multi-level support to the process. This will ensure the sustainability of the approach and make the training programs offered by CAP/Matourkou more nutrition-sensitive

Characteristics and birth outcomes of pregnant adolescents compared to older women : An analysis of individual level data from 140,000 mothers from 20 RCTs

Background: Adolescence is a critical period of maturation when nutrient needs are high, especially among adolescents entering pregnancy. Using individual-level data from 140,000 participants, we examined socioeconomic, nutrition, and pregnancy and birth outcomes for adolescent mothers (10–19 years) compared to older mothers in low and middle-income countries. Methods: This study was conducted between March 16, 2018 and May 25, 2021. Data were obtained from 20 randomised controlled trials of micronutrient supplementation in pregnancy. Stratified analyses were conducted by age (10–14 years, 15–17 years, 18–19 years, 20–29 years, 30–39 years, 40+ years) and geographical region (Africa, Asia). Crude and confounder-adjusted means, prevalence and relative risks of pregnancy, nutrition and birth outcomes were estimated using multivariable linear and log-binomial regression models with 95% confidence intervals. Findings: Adolescent mothers comprised 31.6% of our data. Preterm birth, small-for-gestational age (SGA), low birthweight (LBW) and newborn mortality followed a U-shaped trend in which prevalence was highest among the youngest mothers (10–14 years) and then reduced gradually, but increased again for older mothers (40+ years). When compared to mothers aged 20–29 years, there was a 23% increased risk of preterm birth, a 60% increased risk of perinatal mortality, a 63% increased risk of neonatal mortality, a 28% increased risk of LBW, and a 22% increased risk of SGA among mothers 10–14 years. Mothers 40+ years experienced a 22% increased risk of preterm birth and a 103% increased risk of stillbirth when compared to the 20–29 year group. Interpretation: The youngest and oldest mothers suffer most from adverse pregnancy and birth outcomes. Policy and programming agendas should consider both biological and socioeconomic/environmental factors when targeting these populations. Funding: Bill and Melinda Gates Foundation (Grant No: OP1137750).publishedVersionPeer reviewe

Characteristics and birth outcomes of pregnant adolescents compared to older women: An analysis of individual level data from 140,000 mothers from 20 RCTs.

BackgroundAdolescence is a critical period of maturation when nutrient needs are high, especially among adolescents entering pregnancy. Using individual-level data from 140,000 participants, we examined socioeconomic, nutrition, and pregnancy and birth outcomes for adolescent mothers (10-19 years) compared to older mothers in low and middle-income countries.MethodsThis study was conducted between March 16, 2018 and May 25, 2021. Data were obtained from 20 randomised controlled trials of micronutrient supplementation in pregnancy. Stratified analyses were conducted by age (10-14 years, 15-17 years, 18-19 years, 20-29 years, 30-39 years, 40+ years) and geographical region (Africa, Asia). Crude and confounder-adjusted means, prevalence and relative risks of pregnancy, nutrition and birth outcomes were estimated using multivariable linear and log-binomial regression models with 95% confidence intervals.FindingsAdolescent mothers comprised 31.6% of our data. Preterm birth, small-for-gestational age (SGA), low birthweight (LBW) and newborn mortality followed a U-shaped trend in which prevalence was highest among the youngest mothers (10-14 years) and then reduced gradually, but increased again for older mothers (40+ years). When compared to mothers aged 20-29 years, there was a 23% increased risk of preterm birth, a 60% increased risk of perinatal mortality, a 63% increased risk of neonatal mortality, a 28% increased risk of LBW, and a 22% increased risk of SGA among mothers 10-14 years. Mothers 40+ years experienced a 22% increased risk of preterm birth and a 103% increased risk of stillbirth when compared to the 20-29 year group.InterpretationThe youngest and oldest mothers suffer most from adverse pregnancy and birth outcomes. Policy and programming agendas should consider both biological and socioeconomic/environmental factors when targeting these populations.FundingBill and Melinda Gates Foundation (Grant No: OP1137750)