Community-based Nutrition Interventions Research Articles

Feeding patterns of underweight children in rural Malawi given supplementary fortified spread at home

Fortified spread (FS), containing dry food particles embedded in edible fat, offers a convenient means for nutrition rehabilitation. To describe how caregivers feed FS to their undernourished children at home, and how FS use affects other feeding patterns, we conducted a longitudinal observational study in rural Malawi. Sixteen 6- to 17-month-old underweight children (weight-for-age z-score < -2.0; -3.0 < weight-for-height z-score < 0) received FS for 12 weeks. Twelve-hour observations were conducted before supplementation and during weeks 1, 4, 8 and 12 of FS use. FS was fed to children about two times per day; each serving was 15-20 g. The spread was first used mainly alone as a between-meal snack, and then became integrated into the typical complementary feeding pattern by being mixed with porridge. Introduction of FS reduced the number of plain porridge meals, but did not decrease the total number of meals or breastfeeds per day and did not change the daily mean time caregivers spent on feeding. Children accepted the FS well, but more FS was wasted when it was offered mixed with porridge than when given alone (23.6% vs. 1.2%, 95% CI for the difference 13.2% to 31.6%). FS supplementation is feasible for community-based nutrition interventions in Malawi because it easily becomes part of the feeding routine, does not replace other foods and does not take extra caregiver time. To limit wastage, caregivers should be advised to serve FS plain or to mix it with only a small quantity of porridge.

Malnutrition improvement for infants under 18 months old of Dai minority in Luxi, China

Child malnutrition and thiamine deficiency remain a matter of public concern in Dai children under 5 years old in Southwest areas of China. The aim of the present study was to understand the status and correlates of malnutrition and thiamine deficiency in Dai children under 18 months old in Yunnan, China, and to explore an effective intervention for improving their nutritional status and decreasing the prevalence of malnutrition and thiamine deficiency in Dai children. Well-trained investigators completed a baseline evaluation survey, including questionnaire survey by maternal interviews, child physical measurements, lab examination of thiamine, and group discussions in a cross-sectional study. An intervention plan was constructed by a group consisting of the city governor, government officers, maternal and child health workers, community leaders, and villagers etc. A comprehensive community-based intervention was carried out for 352 children born after July 2001 and their mothers or caregivers in half of the baseline survey villages by the end of 2003. The intervention included participatory intervention, community nutrition education, child growth monitoring and distributing thiamine to new mothers just before or after delivery. The baseline evaluation survey in 2000 indicated that the prevalence of moderate and severe protein-energy malnutrition was 19.5% for underweight, 16.4% for stunting, and 6.7% for wasting, respectively. With increasing age, the prevalence increased, peaking at 12-15 months. The prevalence of underweight in girls was higher than in boys. A total of 10.5% of children suffered from thiamine deficiency, and 5.7% of the children were insufficient in thiamine supply. Low Kaup target (<25%) was significantly associated with lack of guidance by doctors, lack of nutrition knowledge, lack of knowledge of causes of malnutrition and local culture food taboos. The status of child nutrition has been improved significantly since the intervention measure implementation. The change of prevalence of underweight children aged 6-17 months prior to and after the intervention was significant: 20.5% before and 13.7% after the intervention in infants aged 6-11 months, and 39.0% before and 26.4% after the intervention in young children aged 12-17 months. Prevalence of girls was higher than that of boys. Some women began to eat vegetables and pork from the market, which were forbidden by the culture food taboos. There is no case report of child thiamine deficiency in project villages. The prevalence of moderate and severe protein-energy malnutrition is high in Dai infants and young children. However, based on the local situation, participatory community-based comprehensive nutrition intervention effectively reduces the prevalence of child malnutrition and thiamine deficiency. It is highlighted that population nutritional intervention can produce better results with participation at a community level.

Food Supply Adequacy in the Lower Mississippi Delta

Objective To assess food supply adequacy within 3 food store types in the Lower Mississippi Delta. Design Regional food store survey to determine availability and quality of 102 food items in 62 supermarkets, 77 small/medium stores, and 86 convenience stores. Setting Lower Mississippi Delta region of the United States. Participants 225 food stores in 18 counties. Main Outcome Measures Percentage of Thrifty Food Plan (TFP) food items available and quality ratings of 6 food sections across store types. Results On average, supermarkets carried 96% of the items that compose the TFP. Mean percentage of TFP carried in small/medium stores was 50%. Convenience stores carried 28% of the TFP items. Supermarkets had higher overall quality ratings and quality ratings for fresh and frozen foods compared to small/medium and convenience stores ( P < .01). Implications for Research and Practice Although supermarkets carried a large percentage of items surveyed, the number of supermarkets in this region is limited. Community residents with limited transportation to reach supermarkets may experience limited food supply adequacy. Therefore, community-based nutrition interventions should include partnerships with small/medium food retailers while trying to impact residents’ food choices within those stores.

Fighting cancer with fitness: Dietary outcomes of a randomized, controlled lifestyle change intervention in healthy African–American women

Objectives. This study tested the efficacy of an 8-week, culturally targeted community-based nutrition and physical activity promotion intervention, Fight Cancer with Fitness! (FCF). Methods. A randomized, controlled trial was conducted in a black-owned commercial gym in a sample of 366 predominantly overweight or obese, healthy African–American women. Results. Dietary quality as indexed by fruit and vegetable intake improved significantly in the intervention group compared to the control group at 12-month follow-up, and proportion of calories consumed as fat decreased in both groups. Conclusions. This individually targeted cancer prevention intervention produced beneficial effects on dietary quality that were sustained for at least 12 months.

Stunting among young black children and the socio-economic and health status of their mothers/caregivers in poor areas of rural Limpopo and urban Gauteng – the NutriGro Study

Objectives. To determine the prevalence and immediate and underlying causes of stunting in black children aged 12 - 24 months living in rural and urban South Africa.Design. A cross-sectional survey.Setting. Two poor rural villages in Limpopo and two poor urban informal settlement areas in Atteridgeville, Gauteng.Population. All households with mothers/caregivers (M/Cs) of children aged 12 - 24 months in the selected areas. All households meeting the inclusion criteria in the urban areas ( N = 380) and in the two rural villages ( N = 156) were included in the sample.Methods. Trained interviewers collected data using a standardised socio-demographic questionnaire. Heights and weights of M/Cs and their children were measured. Stunting was defined as a z-score less than -2 for height for age. Body mass index (BMI) values were calculated for the M/C. Data were analysed using a stepwise logistical regression analysis.Results. A stunting rate of 18% was documented in the rural areas, with a difference of 8% between the two villages, and 19% in the urban areas. Statistically significant associations were found between low birth weight and stunting ( p = 0.0073). Households with stunted children were significantly larger than households with non-stunted children ( p = 0.0156). Stunted children were introduced to solid foods significantly earlier than nonstunted children ( p = 0.0415).Conclusions and recommendations. Similar prevalences of stunting were found in the urban and rural areas. Of the multifactorial causes of stunting, low birth weight, early complementary feeding and large household size were significantly associated with stunting. The data collected during this phase of the NutriGro Study will be the focus for all future community-based nutrition interventions.

Peer Educators' Perceptions of Training for and Implementing a Community-Based Nutrition Intervention for Older Adults

This study aimed to evaluate the use of peer educators in nutrition interventions with older people. A sample of 22 people aged 60+ were recruited and trained using an accredited course for Community Nutrition Assistants which included basic nutrition and group skills. They were paid to work as peer educators in a 20-week food club intervention which ran in 13 sheltered accommodation schemes for older people in northeast England. Clubs ran for 2 hours each week and included food preparation, food tasting and sharing information and ideas about food and health. This paper reports key findings from qualitative interviews with peer educators on their perspectives on their motivation to participate, their training and their implementation of the food club intervention. It discusses some of the issues involved in the training and use of peer educators and presents lessons learned, particularly the need to target training, according to prior experience and skills.

Public health impact of community-based nutrition and lifestyle interventions

Community-based interventions have increasingly received attention since researchers and public health professionals have come to acknowledge the importance of an environment that makes the healthy choice the easy choice. All stakeholders including the target community are involved to achieve changes in legislation, in people's social and physical context, and in individual characteristics that support healthy diets and other lifestyles. Some early large-scale community-based heart health interventions showed promising results. The Stanford Five City Project, for example, showed net improvements in knowledge of coronary heart disease risk factors of approximately 12%. Net declines in smoking prevalence (14%), cholesterol (2%), and systolic (3%) and diastolic (5%) blood pressure were also observed. Most later studies did not replicate these findings and it was therefore suggested that community-based interventions, which require substantial commitment and resources, may be less effective than approaches targeting high-risk groups. We present the rationale and theories for community-based interventions, and then elaborate on the methodological challenges in the design and the outcome and process evaluation of community-based interventions. We provide an overview of some of the evidence on the effectiveness of community-based heart health interventions and conclude with the perspectives for community-based interventions in future research and practice.

Monetary incentives in primary health care and effects on use and coverage of preventive health care interventions in rural Honduras: cluster randomised trial

Scaling-up of effective preventive interventions in child and maternal health is constrained in many developing countries by lack of demand. In Latin America, some governments have been trying to increase demand for health interventions by making direct payments to poor households contingent on them keeping up-to-date with preventive health services. We undertook a public health programme effectiveness trial in Honduras to assess this approach, contrasting it with a direct transfer of resources to local health teams. 70 municipalities were selected because they had the country's highest prevalence of malnutrition. They were allocated at random to four groups: money to households; resources to local health teams combined with a community-based nutrition intervention; both packages; and neither. Evaluation surveys of about 5600 households were undertaken at baseline and roughly 2 years later. Pregnant women and mothers of children younger than 3 years old were asked about use of health services (primary outcome) and coverage of interventions such as immunisation and growth monitoring (secondary outcome). Reports were supplemented with data from children's health cards and government service utilisation data. Analysis was by mixed effects regression, accounting for the municipality-level randomisation. The household-level intervention had a large impact (15-20 percentage points; p<0.01) on the reported coverage of antenatal care and well-child check-ups. Childhood immunisation series could thus be started more opportunely, and the coverage of growth monitoring was markedly increased (15-21 percentage points; p<0.01. Measles and tetanus toxoid immunisation were not affected. The transfer of resources to local health teams could not be implemented properly because of legal complications. Conditional payments to households increase the use and coverage of preventive health care interventions.

Prevalence and Predictors of Underweight, Stunting, and Wasting among Children Aged 5 and Under in Western Kenya

The health and nutritional status of children aged 5 and under was assessed in three villages in Siaya District of western Kenya. A cross-sectional survey was conducted among 121 adults and 175 children during July 2002. Primary caretakers were interviewed during home visits to assess agricultural and sanitation resources, child feeding practices, and the nutritional status of their children aged 5 years and under. Through anthropometry, the prevalence of underweight, stunting and wasting were determined: 30 per cent were underweight, 47 per cent were stunted, and 7 per cent were wasted. Predictors of undernutrition were analysed using logistic regression controlling for age, sex, and SES, and four major findings emerged. First, children in their second year of life were more likely to be underweight and stunted. Second, children who were introduced to foods early had an increased risk of being underweight. Third, up-to-date vaccinations were protective against stunting, while reports of having upper respiratory infections or other illness in the past month predicted underweight. Finally, living with non-biological parents significantly increased risk of stunting. Emphasis should be placed on current immunization, prolonging exclusive breastfeeding, and improving access to nutrient-rich foods among adopted children and their families via community-based nutrition interventions.

Randomized Controlled Community-Based Nutrition and Exercise Intervention Improves Glycemia and Cardiovascular Risk Factors in Type 2 Diabetic Patients in Rural Costa Rica

The prevalence of type 2 diabetes, especially in developing countries, has grown over the past decades. We performed a controlled clinical study to determine whether a community-based, group-centered public health intervention addressing nutrition and exercise can ameliorate glycemic control and associated cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica. A total of 75 adults with type 2 diabetes, mean age 59 years, were randomly assigned to the intervention group or the control group. All participants received basic diabetes education. The subjects in the intervention group participated in 11 weekly nutrition classes (90 min each session). Subjects for whom exercise was deemed safe also participated in triweekly walking groups (60 min each session). Glycosylated hemoglobin, fasting plasma glucose, total cholesterol, triglycerides, HDL and LDL cholesterol, height, weight, BMI, and blood pressure were measured at baseline and the end of the study (after 12 weeks). The intervention group lost 1.0 +/- 2.2 kg compared with a weight gain in the control group of 0.4 +/- 2.3 kg (P = 0.028). Fasting plasma glucose decreased 19 +/- 55 mg/dl in the intervention group and increased 16 +/- 78 mg/dl in the control group (P = 0.048). Glycosylated hemoglobin decreased 1.8 +/- 2.3% in the intervention group and 0.4 +/- 2.3% in the control group (P = 0.028). Glycemic control of type 2 diabetic patients can be improved through community-based, group-centered public health interventions addressing nutrition and exercise. This pilot study provides an economically feasible model for programs that aim to improve the health status of people with type 2 diabetes.

Applying a Not-for-Profit Outcomes Assessment Model to Community-Based Nutrition Interventions

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Strategies and Practices in Community—Based Campaigns Promoting Nutrition and Physical Activity

The strategies and practices employed in 50 community-based nutrition and physical activity interventions are reviewed from the perspective of a four-stage social marketing model. Goals and objectives established at the research and planning stage were infrequently grounded in data and theory. At the strategy design stage, concept/message pretesting was uncommon. Most campaigns disseminated material products through several channels and activities. At the implementation stage, community members were regularly enlisted as collaborators and a majority of campaigns identified sustainability as a long-term goal. In the evaluation stage, summative research was most often based on quasi-experimental methods. Self-reported knowledge and behavior effects were often assessed; morbidity and mortality campaign effects were rarely considered. Suggestions are offered for improving the design and execution of future interventions.

Community-based nutritional intervention for reducing malnutrition among children under 5 years of age in the Islamic Republic of Iran

A project was conducted in a rural area in September 1994 with the aim of decreasing the incidence of protein-energy malnutrition among children under 5 years, by nutritional intervention through the primary health care system. An initial situation analysis revealed the region's resources and causes of malnutrition. Practical instruction on feeding methods, deworming, environmental sanitation, the promotion of home-grown vegetables and reinforcement of the growth monitoring programme were chosen as the routes for intervention. All indices were reassessed in the region after 1 year. Results showed that nutritional awareness had grown among mothers, and that the incidence of malnutrition had dropped from 6.5% to 1.8%, as measured against the weight-for-height index.

Dietary fat patterns in urban African American women.

The purpose of this study was to describe the scope of fatty food preferences of urban African American women and to examine factors associated with the selection of high fat foods. A volunteer sample of urban African American women church-goers were invited for dietary and risk factor screening at health fairs held following Sunday services. A standardized instrument, the Fat Intake Scale (FIS), was administered primarily by dietitians to estimate dietary fat intake and usual food choices. A sum score of 25 or more is thought to be associated with higher fat and cholesterol intake. As a validation of the FIS, a 24-hour recall was administered to a subsample. Sociodemographics, smoking status and comorbidity were assessed by self-report. Body weight, height, and total blood serum cholesterol were assessed using standardized measurement techniques. In the 521 participating women, 61% were classified as obese based on national reference norms for body mass index (BMI). More than 81% had an FIS of 25 or greater. On multiple logistic regression analysis, significant predictors of a higher fat diet (FIS > or = 25) included age greater than 45 years, obesity, and the absence of comorbidity. These findings suggest that there are independent predictors of selection of a diet high in fat. This has implications for planning and targeting community-based nutrition interventions for African American women who exhibit among the highest rates of obesity in the U.S. and who suffer an excess burden of obesity-related diseases.

Components of the Working Well Trial Intervention Associated With Adoption of Healthful Diets

This report examines whether variability in the type and amount of the nutrition intervention in a worksite-based intervention could explain dietary outcomes. Data are from 55 intervention worksites in the Working Well Trial, a randomized controlled trial of worksite-based health promotion. The components of the nutrition intervention were kickoff event, direct education, interactive activities (e.g., food sampling), contests, printed information picked up by employees, and materials distributed to employees. We measured delivery of the nutrition intervention (i.e., dose) by determining the amount of workforce participation in each intervention component. Diet outcomes were changes in intakes of fat, fiber, and servings of fruits and vegetables (reported on food frequency questionnaires). All variables were aggregated to the worksite level. We correlated the dose variables with indices of receipt of the intervention and with the dietary outcomes. Contests were associated with employee awareness of and participation in the nutrition intervention (r = 0.49 and 0.28, respectively), and interactive activities were associated with intervention participation (r = 0.43). Contests were associated with increased fiber intake and fruit and vegetable consumption (r = 0.36 and 0.31, respectively), and direct education was associated with fruit and vegetable consumption (r = 0.38). All the above correlation coefficients were statistically significant (P < .05). Intervention dose was not associated with changes in fat intake. It appears that longer, interactive intervention efforts (contests and classes) resulted in more positive outcomes than did one-time activities (such as the kickoffs) or more passive efforts (use of printed materials). There is a need for studies designed to test worksite- and community-based nutrition intervention methods.

Demographic Predictors of Nutritional Risk in Elderly Persons

This study examined aspects of nutritional risk among community-dwelling elders (N = 240) to identify age cohort differences in nutritional risk. It was hypothesized that advanced age, female gender, minority status, low income, and low socioeconomic status would increase nutritional risk. Chi-square analyses identified demographic differences in the Nutritional Risk Index Compared to octogenarians (n = 86) and sexagenarians (n = 79), centenarians (n = 75) were at nutritional risk for oral and bowel problems. Compared to Whites (n = 171), Blacks (n = 69) were at nutritional risk from illnesses that interfered with eating and appetite, from oral problems, and from weight changes. For the total sample, advanced age was associated with increased nutritional risk. Cohort analyses revealed, however, that age was an inverse predictor of nutritional risk among centenarians; Black centenarians were at greater nutritional risk than White centenarians. Community-based nutrition screening and intervention programs must target the oldest-old and minority elders

Apparent dietary intake in remote Aboriginal communities

Apparent per capita food and nutrient intake in six remote Australian Aboriginal communities using the 'store-turnover' method is described. The method is based on the analysis of community-store food invoices. The face validity of the method supports the notion that, under the unique circumstances of remote Aboriginal communities, the turnover of foodstuffs from the community store is a useful measure of apparent dietary intake for the community as a whole. In all Aboriginal communities studied, the apparent intake of energy, sugars and fat was excessive, while the apparent intake of dietary fibre and several nutrients, including folic acid, was low. White sugar, flour, bread and meat provided in excess of 50 per cent of the apparent total energy intake. Of the apparent high fat intake, fatty meats contributed nearly 40 per cent in northern coastal communities and over 60 per cent in central desert communities. Sixty per cent of the apparent high intake of sugars was derived from sugar per se in both regions. Compared with national Australian apparent consumption data, intakes of sugar, white flour and sweetened carbonated beverages were much higher in Aboriginal communities, and intakes of wholemeal bread, fruit and vegetables were much lower. Results of the store-turnover method have important implications for community-based nutrition intervention programs.

Household and Preschooler Vitamin A Consumption in Southwestern Kenya

This study examined the effects of an income-generating policy to expand the commercialization of subsistence agriculture in southwestern Kenya on household and preschooler macro- and micronutrient consumption. A representative sample of 617 household was included, and all preschoolers under the age of 6 y (1677) residing in these households were included in the study. Results of this analysis indicate that although increases in household income do result in improved household level vitamin A consumption, increases in household income are not significantly associated with the intake of dietary vitamin A by preschoolers. The analysis suggests that although increases in household income have some very positive effects on household food security and household micronutrient consumption, other community-based health, sanitation and nutrition interventions are needed to address the dietary needs of individuals within the household.