Community-based Nutrition Programs Research Articles

A Theory-Based Newsletter Nutrition Education Program Reduces Nutritional Risk and Improves Dietary Intake for Congregate Meal Participants

At-risk older adults need community-based nutrition programs that improve nutritional status and practices. This 6-month study assessed the impact of the traditional Chef Charles (CC) program (Control) compared to a theory-based CC program (Treatment) on nutritional risk (NR), dietary intakes, self-efficacy (SE), food security (FS), and program satisfaction for congregate meal participants. Participants were mostly educated, single, “food secure” White females. NR change for the treatment group was significantly higher (P = 0.042) than the control group. No differences were noted for SE or FS change and program satisfaction between groups. The overall distribution classification levels of FS changed significantly (P < .001) from pre to post. Over half (n = 46, 76.7%) reported making dietary changes and the majority (n = 52, 86.7%) rated CC as good to excellent. Results suggest the theory-based CC program (treatment) is more effective in reducing NR and dietary practices than the traditional CC program (control).

Can an integrated approach reduce child vulnerability to anaemia? Evidence from three African countries.

Addressing the complex, multi-factorial causes of childhood anaemia is best done through integrated packages of interventions. We hypothesized that due to reduced child vulnerability, a “buffering” of risk associated with known causes of anaemia would be observed among children living in areas benefiting from a community-based health and nutrition program intervention. Cross-sectional data on the nutrition and health status of children 24–59 mo (N = 2405) were obtained in 2000 and 2004 from program evaluation surveys in Ghana, Malawi and Tanzania. Linear regression models estimated the association between haemoglobin and immediate, underlying and basic causes of child anaemia and variation in this association between years. Lower haemoglobin levels were observed in children assessed in 2000 compared to 2004 (difference -3.30 g/L), children from Tanzania (-9.15 g/L) and Malawi (-2.96 g/L) compared to Ghana, and the youngest (24–35 mo) compared to oldest age group (48–59 mo; -5.43 g/L). Children who were stunted, malaria positive and recently ill also had lower haemoglobin, independent of age, sex and other underlying and basic causes of anaemia. Despite ongoing morbidity, risk of lower haemoglobin decreased for children with malaria and recent illness, suggesting decreased vulnerability to their anaemia-producing effects. Stunting remained an independent and unbuffered risk factor. Reducing chronic undernutrition is required in order to further reduce child vulnerability and ensure maximum impact of anaemia control programs. Buffering the impact of child morbidity on haemoglobin levels, including malaria, may be achieved in certain settings.

Prevalence and Risk Factors of Child Malnutrition in Community Based Nutrition Program Implementing and Nonimplementing Districts from South East Amhara, Ethiopia

Background: The burden of malnutrition in Ethiopia is the second highest in sub Saharan Africa. According to the recently released Ethiopian Demographic and Health Survey report of 2011, the prevalence of child stunting, underweight and wasting were 44% st...

Quality of Community Based Nutrition of Integrated Refresher Training Provided for Health Extension Workers in Amhara Region, Northwest Ethiopia

Improving nutrition contributes to productivity, economic development, and poverty reduction by getting better cognitive development, school performance, physical work capacity, and maintaining health status by reducing morbidity and mortality. Poor nutrition perpetuate the cycle of poverty. Community-Based Nutrition (CBN) is an important component of the National Nutrition Program, designed to build upon the Health Extension Program packages to improve nutritional status of under-five children and pregnant and lactating women. As part of this program shift, CBN training modules have been shortened and incorporated into the Integrated Refresher Training (IRT). The nutrition components of Integrated Refresher Training have not been assessed so far. This study aims to assess the quality of CBN component of integrated refresher training, stakeholder perceptions on the quality of training and change in the knowledge of HEWs. Institutional based cross-sectional study with both qualitative and quantitative data collection methods was used. Four Woredas were chosen purposively from a listing of all woredas receiving IRT module II in Amhararegion from June-July 2012. Many MTs and trainees mentioned difficulty of delivering the training as designed due to shortage of time allocated. This was alsoobserved in IRT sessions where MTs used additional than allocated time. Even though most trainees said the training on CBN component was adequate to give services to the community and significant knowledge change (p&lt;0.05) was seen by participants after the training, it was observed that they failed to give all the appropriate advice related to CBN component during the field practice. Most of the HEWs reported that there was no supportive supervision for the last four months. In conclusion; the training that were given in four selected woredas of Amhara region were not quality wise and as designed. The IRT of nutrition component lack reporting and monitoring format. In all nutrition components of IRT and the allocated time for training is too short. The IRT of nutrition component is also not adequate for health extension workers to accomplish community based nutrition program. Thus, there should be additional training for the health extension workers.

Reduction of anaemia.

Reduction of anaemia.

Comparison of the Estimated Cost-Effectiveness of Preventive and Therapeutic Zinc Supplementation Strategies for Reducing Child Morbidity and Mortality in Sub-Saharan Africa

Zinc supplementation of young children in lower-income countries reduces morbidity from diarrhea and pneumonia and all-cause mortality, but the most cost-effective approach for distributing zinc supplements is unknown. To examine the potential impact of four possible strategies for delivering zinc supplements on disease prevention and deaths averted among children 6 to 59 months of age in sub-Saharan Africa. We analyzed different zinc supplementation strategies to assess their likely impact on morbidity and mortality of preschool children in sub-Saharan Africa and to estimate their possible costs. Preventive zinc supplementation reduces diarrhea incidence by 27% among children 12 to 59 months of age, pneumonia incidence by 21% among children 6 to 59 months of age, and all-cause mortality by 18% among children 12 to 59 months of age. The likely average total program costs of zinc supplementation programs were estimated from the outlays of existing service delivery platforms, such as child health days, community-based nutrition programs, and clinic-based treatment of diarrhea, assuming different levels of coverage and target age ranges of children. We found that the average total costs per life saved ranged from approximately US$462 to US$3,111, and the most cost-effective interventions were weekly or intermittent preventive zinc supplementation, because of the possibility of high coverage and fewer supplements required. Empirical data from zinc supplementation programs will be needed to confirm these estimates.

Thailand nutrition in transition: situation and challenges of maternal and child nutrition.

Double burden of malnutrition (DBMN), the coexistence of under- and overnutrition in the same population, is an emerging public health concern in developing countries, including Thailand. This paper aims to review the maternal and child nutrition situation and trends as the country moved from a low-income to a middle-income country, using data from large scale national surveys. Protein-energy malnutrition and micronutrient deficiencies predominantly affected mothers and children prior to the 1980s. The situation greatly improved during the 1980s- 1990s, with the implementation of multi-sectoral policies and programs focusing on poverty alleviation and primary health care. Economic development, improved access to health services and effective community-based nutrition programs contributed to these positive trends. However, the prevalence of low birth weight remained at 8- 10%, while stunting and underweight declined to about 10% by the 1990s, with small change thereafter. The prevalence of anemia among pregnant women and children decreased by half and vitamin A deficiency is no longer a public health problem. Iodine deficiency, especially during pregnancy is still a major concern. As the country progressed in terms of economic and social development, overnutrition among women and children affected all socio-economic levels. Changes in lifestyles, food access and eating patterns are observed both in urban and rural areas. Although efforts have been made to address these challenges, harmonized policy and strategic programs that address DBMN in the complex social and economic environment are urgently needed. Early life undernutrition should be considered along with measures to address obesity and chronic diseases in children.

A State-Level Examination of the Association Between Home and Community-Based Services and Rates of Nursing Home Residency with Special Attention to Nutrition Programs

Federal food and nutrition programs implemented by the Administration on Aging and funded by the Older Americans Act (OAA) seek to enable older adults to remain in their homes and communities through a comprehensive, coordinated, and cost-effective array of services. We hypothesized that expenditures devoted to nutrition programs for home and community-based nutrition services were inversely related to changes in state-level rates of institutionalization for older adults from one year to the next, such that states that spend more money per capita on community-based nutrition programs would have smaller increases or greater decreases in rates of institutionalization, controlling for expenditures on other home and community-based services. We found, however, that there was not an effect of OAA Nutrition Services on the change in rates of nursing home residency. We noted, though, that states that direct a greater proportion of their long-term care expenditures to home and community-based services appear to have more reduction in their rates of nursing home residency. Further longitudinal work at the state and individual levels is warranted.

Cost-effectiveness of the community-based management of severe acute malnutrition by community health workers in southern Bangladesh

This study assessed the cost-effectiveness of adding the community-based management of severe acute malnutrition (CMAM) to a community-based health and nutrition programme delivered by community health workers (CHWs) in southern Bangladesh. The cost-effectiveness of this model of treatment for severe acute malnutrition (SAM) was compared with the cost-effectiveness of the 'standard of care' for SAM (i.e. inpatient treatment), augmented with community surveillance by CHWs to detect cases, in a neighbouring area. An activity-based cost model was used, and a societal perspective taken, to include all costs incurred in the programme by providers and participants for the management of SAM in both areas. Cost data were coupled with programme effectiveness data. The community-based strategy cost US$26 per disability-adjusted life year (DALY) averted, compared with US$1344 per DALY averted for inpatient treatment. The average cost to participant households for their child to recover from SAM in community treatment was one-sixth that of inpatient treatment. These results suggest that this model of treatment for SAM is highly cost-effective and that CHWs, given adequate supervision and training, can be employed effectively to expand access to treatment for SAM in Bangladesh.

Opportunities for Improving Maternal Nutrition and Birth Outcomes: Synthesis of Country Experiences

Undernutrition in women in poor countries remains prevalent and affects maternal, neonatal and child health (MNCH) outcomes. Improving MNCH outcomes requires better policies and programs that enhance women's nutrition. The studies aimed to better understand awareness, perceptions, barriers to intervention, and policy and program priorities and approaches, through different platforms, addressing three related priority problems: anemia, intra-uterine growth retardation (IUGR), and maternal thinness and stunting (including incomplete growth with early pregnancy). Results of a global literature review on program effectiveness, and from case studies in Ethiopia, India, and Nigeria, were synthesized. Anemia can be reduced by iron-folate supplementation, but all aspects for successful implementation, from priority to resources to local capacity, require strengthening. For IUGR, additional interventions, offood supplementation or cash transfers, may be required for impact, plus measures to combat early pregnancy. Breaking the intergenerational cycle of women's undernutrition may also be helped by child nutrition programs. Potential interventions exist and need to be built on: iron-folate and multiple micronutrient supplementation, food fortification (including iodized salt),food supplementation and/or cash transfer programs, combatting early pregnancy, infant and young child nutrition. Potential platforms are: the health system especially antenatal care, community-based nutrition programs (presently usually child-oriented but can be extended to women), child health days, safety net programs, especially cash transfer and conditional cash transfer programs. Making these more effective requires system development and organization, capacity and training, technical guidelines and operational research, and advocacy (who takes the lead?), information, monitoring and evaluation.

Quality of care for severe acute malnutrition delivered by community health workers in southern Bangladesh

This study assessed the quality of care provided by community health workers (CHWs) in managing cases of severe acute malnutrition (SAM) according to a treatment algorithm. A mixed methods approach was employed to provide perspectives on different aspects of quality of care, including technical competence and acceptability to caretakers. CHWs screened children at community level using a mid-upper arm circumference measurement, and treated cases without medical complications. Fifty-five case management observations were conducted using a quality of care checklist, with 89.1% (95% confidence interval: 77.8-95.9%) of CHWs achieving 90% error-free case management or higher. Caretakers perceived CHWs' services as acceptable and valuable, with doorstep delivery of services promoting early presentation in this remote area of Bangladesh. Integration of the treatment of SAM into community-based health and nutrition programs appears to be feasible and effective. In this setting, well-trained and supervised CHWs were able to effectively manage cases of SAM. These findings suggest the feasibility of further decentralization of treatment from current delivery models for community-based management of acute malnutrition.

Beliefs regarding diet during childhood illness

Background:Fifty percent to 70% of the burden of childhood diarrhea and respiratory infections is attributable to undernutrition. It is compounded by food restriction during illness due to false beliefs, leading to a vicious cycle of malnutrition and infection. In the long run, it decreases the child's productivity, which is an obstacle to sustainable socioeconomic development.Objectives:To assess the dietary practices during different illnesses, to study the role of education, culture and religion in feeding an ill child and to create awareness against detrimental practices.Materials and Methods:A cross-sectional study was undertaken among 126 caregivers of ill children using an open-ended pretested questionnaire. Statistical package for social sciences software was used for data analysis. Simple proportions, percentages and Chi-square were used.Results:Caregivers believed that a child must be fed less during illness. Educational status did not play a role in maintaining beliefs, but elders and religion did. Doctors too were responsible for unwanted dietary restrictions. Media did not have an impact in spreading nutrition messages. Decreased breast feeds, initiating bottle feeds, feeding diluted milk and reducing complementary feeds during illness was widely practiced. Calorie intake during illness was very less and statistically significant. Firmly rooted beliefs about “hot” and “cold” foods lead to restriction of food available at home.Conclusions:Healthy feeding practices were few, and inappropriate ones predominant. Dietary education was overlooked. While planning community-based nutrition programs, firmly rooted beliefs should be kept in mind. Involving the elderly caregivers and mothers actively along with the health workers is the need of the hour.

The Impact of a Community-Based Activity and Nutrition Program for Children

There is consensus that community-wide integration of programs targeting pediatric obesity prevention is needed. The present article describes the growth, acceptability, and impact of a school- and community-based kids' marathon program targeting physical activity and nutrition. Youth in the program are encouraged to incrementally walk/run/jog a marathon and improve their diet through nutrition challenges. Participants track mileage and healthy eating over approximately 6 months, and complete a final marathon mile at the program's culminating event. Across 21 schools, 404 students between kindergarten and 8th grade reported on their experiences in the program. Also, 19 school coordinators rated their perceptions of the program's impact. While the data is preliminary and retrospective, it indicates that participants are highly engaged and that the program has potential to improve physical activity and other healthy lifestyle behaviors in many children. Strengths of the program, implications for obesity prevention, and future directions are also discussed.

Capacity-building and Participatory Research Development of a Community-based Nutrition and Exercise Lifestyle Intervention Program (NELIP) for Pregnant and Postpartum Aboriginal Women:Information Gathered from Talking Circles.

Objectives were to gather information from Talking Circles of Aboriginal women who participated in a maternal Nutrition and Exercise Lifestyle Intervention Program (NELIP) to identify strategies to bring NELIP into the community. Twelve First Nations women participated. Several main themes were identified regarding health: balance, knowledge/education and time management. Benefits of the NELIP were improvement in health, stamina, stress, and a healthy baby, no gestational diabetes and a successful home birth, with social support as an important contributing factor for success. Suggestions for improvement for the NELIP included group walking, and incorporating more traditional foods into the meal plan. The information gathered is the first step in determining strategies using participatory research and capacity-building to develop a community-based NELIP for pregnant Aboriginal women.

Revisiting the Concept of Growth Monitoring and its Possible Role in Community-Based Nutrition Programs

Community-based growth monitoring (GM) and growth monitoring and promotion (GMP) have been implemented worldwide. The literature provides controversial messages regarding their effectiveness. Numerous countries have GM as their main community-based activity and need guidance for future programming. The notion of GM is usually clear, but the follow-up actions include a range of activities and interventions, all under the heading of "promotion." We suggested definitions, objectives, and outcomes of the GM and GMP. By providing some clarity on these conceptual issues we attempted to provide a basis for consensus building and development of recommendations on when this activity should be promoted or discouraged. We reviewed basic concepts and global experience of GM and GMP using publications about GM and GMP, UNICEF country reports and other publications, field observations, and reports of recent expert consultations. Realistic added benefits are suggested as compared with general counseling that could also be delivered outside the GM session. We provide a narrow definition of "promotion" in GMP, in which actions are tailored to the results of monitoring, as well as suggest quality implementation criteria. GM, even if complemented by a promotional package, can have only a limited impact if it is not part of a comprehensive program. GMP cannot be viewed as a competitor to highly effective interventions, but may serve as a possible platform for their delivery. The decision to build community-based programs on a GMP platform should be based on consideration of benefits, feasibility of quality implementation, and capacity of human resources.

Amélioration de la gestion d’un programme de suivi de la croissance à base communautaire des enfants en milieu rural au Rwanda

Background In order to improve the management of a community based nutrition program in the catchment area of Ruli District Hospital in Rwanda, we carried out a nutrition survey to determine the risk factors for childhood malnutrition in the area. Identifying the groups of children at risk of malnutrition and their risk factors allows the community nutrition workers to target the children who require close monitoring, and assists in the development of key messages for educational nutrition training. Methods The prevalence of the three forms of malnutrition was estimated by using the Z-scores height for age, weight for age and weight for height with NCHS/OMS/2000 reference. Logistic regression was performed to identify the risk factors for malnutrition. Results Our findings show that children from 12–35 months of age are at greatest risk of malnutrition. Risk factors for wasting include: low monthly income of the household, concurrent illness of the child and a household that does not practice breeding. Risk factors for underweight include: child being greater than 12 months of age, mother of the child being pregnant and history of malnutrition in the household. Finally, risk factors for stunting include the absence of a mosquito net in the household, an insufficient number of working adults in the household, the child being greater than 12 months of age and a household managed by a man alone or by an orphan. Conclusion Community based growth monitoring must focus its attention on the children from nine to 35 months of age. Children less than nine months of age are generally followed by the health centers through the immunization program, and the older children are generally followed in the child minder schools that need to be promoted in all the cells. Community messages must focus on the identified risk factors of malnutrition, and a positive deviance approach must be introduced in the entire zone.

Measuring the Impact of Nutrition Education and Physical Activity on Older Adults Participating in Government Sponsored Programs

A longitudinal, four-year study (2004–2007) with a cohort of 139 older adults (majority women;71%) was conducted to examine the impact of community-based nutrition and physical activity programs on health outcome measures. Demographic and anthropometric data were collected and nutrition screening was performed. Blood pressure, serum cholesterol and glucose levels, and pulse rate were also measured. The blood pressure, both mean systolic and diastolic, 141(± 19.0)/79.3 ± 9.7 (2004) vs. 127.8 ± 10.9/73.8 ± 10.2 mm Hg (2007), were improved (p < 0.05) in women. There were also improvements (p < 0.05 in both men and women) in pulse rate between 2004 and 2007. There is no doubt that nutrition education and exercise programs together enhanced the overall health and well being of these older adults. However, our findings emphasize the need for further systematic study and for appropriate biometric assessments to evaluate the full impact of nutrition education and physical activity interventions in older adults.

Evaluation of Six Community-Based Physical Activity and Nutrition Programs

Evaluation of Six Community-Based Physical Activity and Nutrition Programs

Community based approaches to prevent and control malnutrition.

Community based nutrition programmes (CBNP) are increasingly being seen as a key turning point in implementation strategies leading to food and nutrition improvement as a sound basis for socio-economic development. In order to be effective and successful, CBNP require a constellation of methods and services planned from the community along with policy support for effective implementation, reaching the unreachable and empowering those at the grass roots. These also need to be guided and monitored using a set of indicators such as essential minimum needs indicators specific to the community's needs. The community based approach has also been embraced at the global level with the Millennium Development Goals, advocating achieving a set of eight goals ranging from reducing poverty and hunger to improving educational opportunities for all children and forming stronger global partnerships for development. Lessons learned from CBNP in Asia show that in order to be effective, the programmes must be adopted at national level and implemented at community level. National level leadership and commitment to sound nutrition improvement policies and goals, must be combined with basic services, mass mobilization, people empowerment and actions at community level.

Utilization of Positive Deviance Analysis in Evaluating Community-Based Nutrition Programs: An Application to the Dular Program in Bihar, India

Positive deviance is increasingly employed in international development activities to permit the utilization of proven local solutions. Including positive deviance methods in evaluation analysis, particularly in places like Bihar, India, where the rates of child underweight hover at 55%, can help identify project activities and household characteristics that affect key outcomes. These can, in turn, inform decision-making regarding the intensification of particularly promising activities. To apply positive deviance analysis to the Dular program in Bihar, a community-based nutrition program that seeks to improve the impact of India's Integrated Child Development Services on young children. In order to assure that desired program outcomes were not dependent on higher economic status, the analysis isolated a subset of program beneficiaries--the poorest children with the best nutritional outcomes--and examined the behavioral and project factors that may have brought about positive results in this subgroup. The data for this analysis were drawn from a 2005 program evaluation with a sample of 1,560 children. The analysis found that positive deviant children with normal nutritional status in the poorest 50% of Dular households were introduced to complementary food almost 2 months earlier (7.18 vs. 9.02 months of age) than severely malnourished children, were more than twice as likely to use soap for handwashing after defecation (25.0% vs. 11.8%), and were more than seven times as likely to have literate mothers (25.0% vs. 3.5%). The analysis suggests that programmatic efforts relating to these activities have been particularly effective and may well deserve increased investment.