Improve Infant Feeding Research Articles

Harmony in healthcare: recommended infant feeding practices and associated factors among HIV positive mothers in Eastern Ethiopian hospitals

BackgroundFor mothers identified as HIV-infected, recommended infant feeding practices must prioritize the highest likelihood of ensuring HIV-free survival for their children while preserving maternal health. Consequently, understanding the feeding status during critical infancy stages, especially under the risk of HIV, plays a crucial role in enhancing the quality of life within this specific population segment. Hence, this study was conducted to assess the magnitude and associated factors of recommended infant feeding practices and its associated factors among HIV-positive mothers in Eastern Ethiopian Hospitals.MethodsA cross-sectional study conducted in Eastern Ethiopian Hospitals from June to July 2022 included 371 mothers of infants. Participants were selected using systematic random sampling techniques. Data was collected through pre-tested structured face-to-face interviews administered by trained interviewers. Following data collection, information was cleaned and entered using Kobo tool collection software, then exported to Statistical Package for Social Sciences (SPSS) version 25 for analysis. Binary logistic regression analysis was employed to assess the strength of association between explanatory and outcome variables. Variables with a p-value < 0.25 in univariable logistic regression analysis were considered for multivariable logistic regression analysis, and statistical significance was determined at a P-value < 0.05 with a 95% confidence interval.ResultsThe magnitude of recommended feeding practice was found to be 86% (95% CI: 81.9, 89.1). HIV-positive mothers who had a child age of 0–6 months [AOR = 5.21 (95% CI: 2.54, 10.70], spontaneous vaginal delivery [AOR = 2.11 (95% CI: 1.05, 4.24], and ever provided expressed breast milk [AOR = 2.82 (95% CI: 1.33, 5.95] were significantly associated with recommended Infant feeding practice.Conclusionthe study identified a moderate level of adherence to recommended infant feeding practices among HIV-positive mothers in Eastern Ethiopian hospitals. Key factors influencing adherence included the child’s age, mode of delivery, and the provision of expressed breast milk. Target interventions to improve infant feeding practices among HIV-positive mothers, focusing on younger infants, cesarean-delivered mothers, and those not providing expressed breast milk. Strengthen counseling and education in healthcare facilities to address these significant factors and enhance adherence to recommended feeding practices.

Pengaruh Tingkat Pendidikan dan Pengetahuan Ibu terhadap Pemberian MP-ASI Dini di Puskesmas Cot Seumeureung, Kabupaten Aceh Barat

This study examines the impact of maternal education and knowledge on early complementary feeding (MP-ASI) in children aged 6-12 months at the Cot Seumeureng Health Center, Samatiga District, West Aceh Regency. Early complementary feeding, initiated before six months, can hinder optimal exclusive breastfeeding practices. This cross-sectional study involved 94 mothers of infants aged six to twelve months, with data collected through questionnaires and analyzed using the Chi Square test. Results indicate a statistically significant relationship between maternal education and early complementary feeding (p=0.001, PR=2.1), as well as between maternal knowledge and early complementary feeding (p=0.002, PR=1.8). These findings underscore the role of maternal education and knowledge in shaping early feeding practices, highlighting the importance of tailored health education programs to promote exclusive breastfeeding. The study concludes that enhanced maternal knowledge through education is crucial for improving infant feeding practices.

Alimentation infantile et changements climatiques: une opportunité prometteuse.

The method of infant feeding has consequences for the production of greenhouse gases (GHG) as well as for the risks to infants posed by climate change. Breastfeeding can reduce the carbon footprint associated with the use of commercial infant formula by nearly 50% while reducing its water footprint and waste. It is also an excellent way of coping with emergencies associated with climate change, such as water shortages, since breastfed children are better protected than those fed with formula. To ensure that the protection offered by breastfeeding can be realized, we present elements that can help decision-makers seize a promising opportunity: improve infant feeding support for women and families.

“It has changed my life”: unconditional cash transfers and personalized infant feeding support- a feasibility intervention trial among women living with HIV in western Kenya

BackgroundThe syndemic effects of poverty, food insecurity and living with HIV are recognized as global health priorities, including through the United Nations Sustainability Goals 1, 2 and 3. Today, women and girls account for 63% of all new HIV infections in eastern and southern Africa, including Kenya. Pregnant and postpartum women living with HIV in this setting face unique challenges including increased financial insecurity as women leave the work force to care for their newborn infants. This contributes to poverty, food scarcity and stress.MethodsTo address financial insecurity, improve infant feeding and reduce stress among mothers living with HIV in this setting, we developed a multilevel intervention, Supporting Healthy Mothers, consisting of 10 monthly unconditional cash transfers (10,000 KES, ~$75 USD/month) and personalized infant feeding support from pregnancy to 7 months postpartum. We conducted a non-randomized feasibility trial of this intervention among women engaged in HIV care in Kisumu, Kenya. From February 23, 2022 to March 23, 2022, we enrolled a total of 40 women who were 20–35 weeks pregnant—20 women to the intervention group at a public clinic, and 20 women to the control group at a similar clinic. Our aim was to assess feasibility, acceptability, and the potential impact of the intervention on food security, infant feeding and maternal mental health.ResultsAnalyzing data from all 40 participants, we found a significant reduction in food insecurity scores from baseline for the intervention group when compared to the control group at 6 weeks and 6 months postpartum (p = 0.0008 and p < 0.0001, respectively). Qualitative exit interviews with intervention group participants confirmed women felt more financially secure and had newly acquired practical knowledge and skills related to infant feeding. Women found the two intervention components highly acceptable and described an overall positive impact on wellbeing.ConclusionsThe Supporting Healthy Mothers intervention has potential to positively impact women across the perinatal period and beyond by increasing financial security and supporting women to overcome infant feeding challenges and should be assessed in larger trials.Trial registrationSupporting Healthy Mothers was registered with ClinicalTrials.gov Protocol Registration and Results System, initially published on February 1, 2022. ClinicalTrials.gov ID: NCT05219552 Protocol ID: K23MH116807.

Nurture Early for Optimal Nutrition (NEON) participatory learning and action women’s groups to improve infant feeding and practices in South Asian infants: pilot randomised trial study protocol

IntroductionFeeding practices developed in early life can impact a child’s nutrition, growth, dental health, cognitive development and lifetime risk of chronic diseases. Substantial evidence suggests ethnic health inequalities, and non-recommended...

Evaluating the Relationship Between Maternal Postpartum Depression, Infant Feeding Practices, and Infant Nutritional Status at a Maternity Hospital in Uasin Gishu County, Kenya

Postpartum depression is a major maternal mental problem that has been shown to contribute to malnutrition in infants. This cross-sectional study explores the association between maternal postpartum depression (PPD) and infant feeding practices as well as infant nutritional status among infants aged 6-14 weeks at Eldoret West Maternity Hospital (EWMH) in Uasin Gishu County, Kenya. The study involved 257 women of reproductive age with infants aged 6-14 weeks postpartum attending postnatal and maternal and child health clinics at EWMH. Data was collected using a modified Edinburgh Postnatal Depression Scale (EPDS) to screen for PPD and other questionnaires to gather sociodemographic information, feeding practices, and infant nutritional status. Multivariate logistic regression analyses were conducted to assess associations between maternal PPD, infant feeding practices, and nutritional status. The prevalence of maternal PPD was 17.5%, with 1 in 6 mothers affected. Exclusive breastfeeding was practiced by 94.6% of mothers, exceeding the national level of 60%. Mothers with PPD were more likely to practice nonexclusive breastfeeding and were 1.4, 1.8, and 1.6 times more likely to have stunted, wasted, and underweight infants respectively than mothers without PPD though the association was not statistically significant after adjusting for confounders.Maternal PPD is prevalent among mothers at EWMH and is more likely to influence infant feeding practices particularly non-exclusive breastfeeding and nutritional status. Stunting, wasting and underweight were prevalent in infants of mothers with PPD. These findings underscore the importance of integrating mental health and nutritional support services for mothers and infants in maternal healthcare settings. Early identification and intervention for maternal PPD can help improve infant feeding practices and nutritional outcomes, promoting the well-being of both mothers and their infants.

The impact and implementation of an mHealth intervention to improve infant and young child feeding in Senegal: IIMAANJE protocol for a cluster randomized control trial.

Behavior change communication (BCC) strategies have the potential to improve infant feeding and nutrition outcomes among infants and young children in low- and middle-income countries. More recently, there has been a shift toward the adoption of mHealth interventions-the use of mobile phones to transmit health-related information or direct care-to promote recommended BCC strategies among the caregivers of infants and young children. In Senegal, most infants and young children are not fed according to recommended practices leading to a high prevalence of undernutrition and micronutrient deficiencies. The aims of this cluster randomized control trial, using an effectiveness-implementation (type 1) hybrid design, were to: (1) determine the impact of an mHealth IYCF intervention on IYCF practices and nutrition outcomes; and (2) examine the implementation, costs, and opportunities for scaling up the mHealth messaging intervention. The trial was conducted in three regions in Senegal (Thies, Fatick, Diourbel) with 488 mother, father and children (6-23 months) triads. The intervention included 8 scripted messages, that underwent cognitive testing prior to the intervention implementation, and 8 unscripted messages from positive deviants. One voice message and one text message were sent each week to members of our experimental group for a 16-week period. The impact of the intervention was assessed through a household survey, 24-h dietary recall, and hemoglobin measurements before and after the intervention implementation. The primary outcomes were minimal acceptable diet (MAD) and anemia. We also included a total of 54 participants in nine focus groups held with mothers and fathers and semi-structured interviews with Badienou Gox (i.e., community health workers) (n = 6) and national partners and program implementers (n = 6) to examine the intervention implementation process. The study was registered prior to data collection on Clinicaltrials.gov (Identifier: NCT05374837).

Clustering of Child Nutrition Status using Hierarchical Agglomerative Clustering Algorithm in Bekasi City

Clustering infant nutrition based on weight, height, and age is a data analysis method used to group infant nutritional status based on these characteristics. The research on clustering infant nutrition aims to analyze whether there are still many infants in the area with insufficient or excessive nutrition, and to identify groups of infants requiring special attention regarding their nutritional intake. In the analysis of infant nutrition clustering, data on weight, height, and age of infants are collected and then grouped based on similarities in body height and weight at certain ages. The method used in this research is hierarchical clustering, which can help in grouping the data. Clustering analysis can help understand how infants' feeding patterns vary based on their weight, height, and age. The results of research on clustering infant nutrition based on weight, height, and age can provide valuable insights for nutrition experts, pediatricians, and community health workers in developing appropriate intervention programs to improve infant feeding patterns and meet their nutritional needs. Additionally, the results of clustering infant nutrition can also be used to identify groups of infants requiring special attention regarding their nutritional needs, thus minimizing the risk of malnutrition and unhealthy growth in infants.

Perceptions of Adolescent Mothers on Feeding and Nutrition of their Children aged 0-3 Years in Rural Bangladesh

Proper feeding practices at an early age are the key to improving a child’s overall health and achieving developmental milestones. In Bangladesh, a large portion of rural girls become mothers before the age of 18. Past records show that most interventions are designed to improve infant and young child feeding practices targeting older mothers. That is why, this study has been designed with an aim to explore the perceptions and practices of infant and young children feeding among rural Bangladeshi mothers aged &lt;19 years old. Data was collected through in-depth interviews and group discussions with a total of 40 adolescent mothers who have children aged 0-3 years. Data has revealed that the majority of the mothers hold very limited knowledge of nutrition and child nutrition but those who are educationally a bit ahead hold a little better knowledge. Participants are aware of breastfeeding but they all misinterpret the term ‘exclusive breastfeeding’ with other liquid food. It has also emerged that most of the mothers know the ideal timing of starting complementary feeding but very few of them actually understand what to feed children. In spite of having misconceptions and superstation rural adolescent mothers practice responsive feeding instead of force-feeding. No gender discrimination has been found regarding child feeding. The findings of the study pinpointed that mothers are unable to practice proper infant and child feeding due to a lack of knowledge and limited affordability. Educating girls &amp; young mothers and improving financial security could be an effective way to promote improved infant feeding practices.

The Baby Bites Text Messaging Project with randomized controlled trial: texting to improve infant feeding practices.

Rapid weight gain and overweight in infancy are associated with childhood obesity. Thus, effective, accessible interventions to promote healthy infant feeding practices to prevent early obesity are essential. This mixed-methods study involved diverse parents of infants in an urban, low-income pediatric clinic. Qualitative interviews explored parental attitudes towards feeding, early obesity, and communication with the pediatrician. A pilot, randomized controlled trial (RCT) informed by feedback provided by clinic parents compared text messages delivered for 12 months promoting healthy feeding practices to usual care to prevent early pediatric obesity. A computer-generated randomization schedule with balanced distribution for sex was used to place infants into groups. Weight-for-length percentiles and z-scores and feeding practices were measured at 0-2 weeks (baseline), 2-4 months, 6-9 months, and 12 months. Interviews were recorded, transcribed, and coded using thematic analysis. Weight for length percentile, Weight for length z scores, and feeding practices were compared between groups using repeated measures mixed analysis of variance (ANOVA). Participants in the interviews were 15 parents of infants less than 1 month old. RCT participants were 38 parents of newborns (17 control; 21 intervention). Most parents in the qualitative evaluation viewed breastfeeding positively but also discussed barriers. Most also wanted practical information regarding infant feeding. There were no differences in weight-for-length percentile (F=0.52; P=0.60) or z-scores (F=0.7922; P=0.79), breastfeeding persistence χ2[1] =1.45, P=0.23, or age of introduction of solids in the intervention (statistical analysis not possible due to low counts) compared to the control group; however, low response to surveys limited the study's power. Text messaging has potential to extend the healthcare provider's communication beyond clinic. However, texting interventions should be flexible to mitigate barriers such as loss of phone service and challenges customizing messages to parent needs.

Perceptions of Human Milk Banks as a Response to the US Infant Formula Shortage: A Mixed Methods Study of US Mothers

Human donor milk from established milk banks is the safest alternative to mother’s own milk. The current study examined US mothers’ perceptions of human milk banks as a response to the ongoing infant formula shortage in the United States. A cross-sectional study with closed and open-ended items was administered through nine Facebook groups, and a final sample of 863 responses was retained in the study. We used descriptive and inferential statistics for statistical analysis, and content and thematic analyses were conducted on open-ended responses. In our sample, 77.4% of respondents perceived human milk banking as a feasible response to the formula shortage crisis. Marital status, education, religion, and willingness to donate milk were associated with respondent perceptions of milk banking as a response to the formula shortage. US mothers’ concerns around the accessibility of milk banks and the cost of human milk were the primary reasons accounting for the hesitancy toward milk banking as a response to the infant formula shortage crisis. The study findings indicate support for milk banking as a potential ‘temporary’ solution to the formula shortage and reveal that milk banking is a tool that is currently being underutilized. It is imperative that stakeholders address the challenges identified by the current study to improve infant feeding and health.

Developing a community facilitator-led participatory learning and action women's group intervention to improve infant feeding, care and dental hygiene practices in South Asian infants: NEON programme.

The Nurture Early for Optimal Nutrition (NEON) study is a multiphase project that aims to optimize feeding, care and dental hygiene practices in South Asian children &lt;2 years in East London, United Kingdom. The multiphase project uses a participatory learning and action (PLA) approach facilitated by a multilingual community facilitator. In this paper, we elaborate on the process and results of the Intervention Development Phase in the context of the wider NEON programme. Qualitative community-based participatory intervention codevelopment and adaptation. Community centres in East London and online (Zoom) meetings and workshops. In total, 32 participants registered to participate in the Intervention Development Phase. Four Intervention Development workshops were held, attended by 25, 17, 20and 20 participants, respectively. Collaboratively, a culturally sensitive NEON intervention package was developed consisting of (1) PLA group facilitator manual, (2) picture cards detailing recommended and nonrecommended feeding, care and dental hygiene practices with facilitators/barriers to uptake as well as solutions to address these, (3) healthy infant cultural recipes, (4) participatory Community Asset Maps and(5) list of resources and services supporting infant feeding, care and dental hygiene practices. The Intervention Development Phase of the NEON programme demonstrates the value of a collaborative approach between researchers, community facilitators and the target population when developing public health interventions. We recommend that interventions to promote infant feeding, care and dental hygiene practices should be codeveloped with communities. Recognizing and taking into account both social and cultural norms may be of particular value for infants from ethnically diverse communities to develop interventions that are both effective in and accepted by these communities. Considerable efforts were placed on Patient/Participant and Public Involvement and Engagement. Five community facilitators were identified, each of which represented one ethnic/language group: (i) Bangladeshi/Bengali and Sylheti, (ii) Pakistani/Urdu, (iii) Indian/Gujrati, (iv) Indian/Punjabi and(v) Sri Lankan/Tamil. The community facilitators were engaged in every step of the study, from the initial drafting of the protocol and study design to the Intervention Development and refinement of the NEON toolkit, as well as the publication and dissemination of the study findings. More specifically, their role in the Intervention Development Phase of the NEON programme was to: 1. Support the development of the study protocol, information sheets and ethics application. 2. Ensure any documents intended for community members are clear, appropriate and sensitively worded. 3. Develop strategies to troubleshoot any logistical challenges of project delivery, for example, recruitment shortfalls. 4. Contribute to the writing of academic papers, in particular reviewing and revising drafts. 5. Develop plain language summaries and assist in dissemination activities, for example, updates on relevant websites. 6. Contribute to the development of the NEON intervention toolkit and recruitment of the community members. 7. Attend and contribute to Intervention Development workshops, ensuring the participant's voices were the focus of the discussion and workshop outcomes.

P088 A Feasibility Trial of an Asynchronous Web-based Infant Feeding Course for Child and Adult Care Food Program Providers

<h3>Background</h3> The Child and Adult Care Food Program (CACFP) provides meals and snacks to children at eligible, participating locations. Previous nutrition interventions for providers presented improved knowledge of CACFP nutrition standards, behavioral intentions, and confidence about feeding practice. However, few studies focusing on infant feeding for providers have been reported. <h3>Objective</h3> To describe the development and implementation of an asynchronous virtual training course aiming to improve infant feeding practices of providers and report program outcomes. <h3>Study Design, Settings, Participants</h3> This study was a single group, pretest-posttest quasi-experimental design. A three-module course was developed and implemented through a partnership between the State Department of Education and an Extension system. Each module consisted of 2-3 sessions and was offered through the Canvas platform. Providers completed pre-survey (n = 51) and/or post-survey (n = 57), respectively. Participants (n = 32) who completed both were included for analysis. <h3>Measurable Outcome/Analysis</h3> Self-confidence and knowledge related to infant feeding were measured. Recommended changes were assessed qualitatively. Descriptive statistics and a marginal homogeneity test were used for analysis. <h3>Results</h3> Approximately 37% of participants were teachers and 24% were center directors or owners. After the course, participants' self-confidence significantly improved (<i>P</i> <0.001). In particular, they became very confident in describing breast milk storage (<i>P =</i> 0.001), when a child should switch from a bottle to a cup (<i>P =</i> < 0.001), and when a baby is ready to start eating solid foods (<i>P =</i> < 0.001). Also, participants significantly improved knowledge of infant feeding (<i>P</i> < 0.001). Qualitative responses emphasized the importance of educating staff to feed in response to hunger cues, rather than at set times. The participants mentioned that providing refresher training, and posting signage about breast milk and formula feeding and storage guidelines in classrooms would be beneficial. Constant communication with families was perceived to be important as well. <h3>Conclusions</h3> An asynchronous virtual training course implemented through an Extension was feasible and effective for improving self-efficacy and knowledge related to infant feeding. It also has potential for program sustainability. <h3>Funding</h3> USDA; US Department of Agriculture Child and Adult Care Food Program Meal Service Training Grant through the Maryland State Department of Education.

The impact of a direct to beneficiary mobile communication program on reproductive and child health outcomes: a randomised controlled trial in India

BackgroundDirect-to-beneficiary communication mobile programmes are among the few examples of digital health programmes to have scaled widely in low-resource settings. Yet, evidence on their impact at scale is limited. This...

Influences on Infant Feeding Practices: An Ecological Perspective

Nutrition in infancy contributes to a significant portion on the notion of the importance of nutrition during the first 1000 days of life. A vast pool of literature exists on the importance of nutrition during this phase of life with future diseases, obesity and mental health. However, despite the availability of many guidelines and policies revolving around infant feeding practices, adherence to it remains poor. This review explains factors that influence infant feeding practices from an ecological point of view. A Bronfenbrenner ecological model was used to argue the influence and interaction of various ecological factors on infant feeding practices. The review highlights that the way these factors affect infant feeding differs according to populations and settings. This review suggests the need for more robust and population sensitive interventions to improve infant feeding practices globally.

Feeding Patterns, Mother-Child Dietary Diversity and Prevalence of Malnutrition Among Under-Five Children in Lebanon: A Cross-Sectional Study Based on Retrospective Recall

BackgroundDespite demonstrated benefits, most countries fall short of meeting international targets for breastfeeding patterns, optimal complementary feeding, mother-children's quality diet, and malnutrition among under-five children.RationaleSince mothers usually play the most vital role in the healthcare of their children, research is needed to illuminate maternal factors that might promote a child's health and nutritional status.AimThe purpose of this study is to retrospectively (1) examine the under-five children's (0–59 months) feeding habits including exclusive breastfeeding, exclusive bottle feeding, continued breastfeeding, and complementary feedings, (2) investigate the mother-child's dietary diversity, and (3) identify any factors that cause less optimal nutrition due to a lack of food diversity in children aged 6 to 59 months. Moreover, (4) the prevalence of wasting, stunting, underweight, and overweight in the under-five offspring living in households located in the main two provinces in Lebanon (Beirut and Mount Lebanon) was determined.MethodsThe data for this analysis were collected from a representative sample of 384 households [384 mothers (21–49 years old) and children (0–59 months)] between February 2019 and June 2019. A questionnaire was used to inquire mothers of children ages 0–23 months about exclusive breastfeeding (EBF), continuous breastfeeding (CBF), exclusive bottle feeding (EBOT), mixed feeding (MF), and complementary feeding patterns. Moreover, additional questions regarding dietary diversity were asked to mothers of children aged 6 to 59 months. This score was calculated based on the 24 h recall of the mother and her child's consumption of 7 food groups, during the 24 h prior to the survey. Moreover, stunting, wasting, overweight, and underweight were calculated using the z-score for height-for-age (HAZ), weight-for-height (WHZ), and weight-for-age (WAZ), respectively. Binary logistic regression was used to explore the dietary diversity among children (ages 6–59 months) adjusting for covariates at maternal and household levels.ResultsAround 44% of children (0–59 months) had normal body weight. In addition, 9.3% were underweight (WAZ < -2SD to −3SD), 6.5% were at risk of being overweight, 24.45% were overweight, 9.3% were stunted (HAZ < -2SD to −3SD), and 6.25% (WHZ < -2SD to −3SD) were wasted. In total, among under-five children, the prevalence of EBF at 40 d and 6 months was 27 and 30%, respectively. The prevalence of CBF was 23%. Around 60% of mothers breastfed their offspring between 0 and 6 months and half of them introduced infant formula at earlier stages between 0–6 months. Furthermore, 78.4% of mothers introduced food to their children between 4 and 6 months (of which 40% before 6 months) and 62.5% of them introduced sugary drinks before 6 months. As for dietary diversity (DD), one out of two mothers and one out of three children (ages 6–59 months) had a low DD score (DDS) (46 and 32%, respectively). The children's and mother's DD were strongly found to be correlated (p-value = 0.034). Regression analysis showed that children's DD increased around 2 times [AOR = 1.7; 95% CI (1.042–2.914)] in context of high maternal DDS, and about 12 times [AOR = 11.7; 95% CI (1.2–111)] when a member of the highest-income households.ConclusionsOur findings demonstrated low rates of EBF and CBF, high prevalence of EBOT, and early introduction of complementary foods among children ages 0–59 months. Furthermore, for children ages 6–59 months, there was poor mother-child dietary diversity and a high prevalence of overweight and stunted children in the main two Lebanese provinces. This suggests the alarming need for continuous nutrition intervention to improve infant feeding patterns and dietary diversity to reduce the malnutrition rates.

The Shishu Pushti Trial-Extended Peer Counseling for Improving Feeding Practices and Reducing Undernutrition in Children Aged 0-48 Months in Urban Bangladesh: Protocol for a Cluster-Randomized Controlled Trial.

BackgroundThe aim of this study is to assess if peer counseling of women improves breastfeeding, complementary feeding practices, and child growth, and thus reduces the prevalence of undernutrition in children up to 4 years of age.ObjectiveLack of exclusive breastfeeding and inappropriate complementary feeding are critical factors in reducing child undernutrition, morbidity, and mortality. There are reported trials of peer counseling to improve breastfeeding; however, they did not examine the efficacy of peer counseling to improve complementary feeding or the long-term impacts on child growth and development.MethodsThis study has used a community-based, cluster-randomized controlled trial with a superiority design and 2 parallel treatment arms. It is assessing the impact of peer counseling, starting in late pregnancy up to 1 year after delivery, on child feeding practices, growth, and development with follow-up until 48 months of age. The study site was Mirpur, a densely populated area in Dhaka. Using satellite maps and geographic information system mapping, we constructed 36 clusters with an average population of 5000 people. We recruited pregnant women in the third trimester aged 16-40 years, with no more than 3 living children. Trained peer counselors visited women at home twice before delivery, 4 times in the first month, monthly from 2 to 6 months, and again at 9 and 12 months. Trained research assistants collected anthropometric measurements. The primary outcome will be differences in child stunting and mean length for age at 6, 12, 15, and 18 months. Secondary outcomes will be differences in the percentage of women exclusively breastfeeding in the mean duration of any breastfeeding and in the percentage of children at 6 and 9 months of age who receive solid, semisolid, or soft foods; and the percentage of children consuming foods from 4 or more food groups at 9, 12, 15, and 18 months. We will assess the mean cognitive function scores from the Ages and Stages Questionnaire (9 and 18 months) and Bayley tests (24 and 36 months).ResultsWe identified 65,535 people in mapped residences, from which we defined 36 clusters and randomly allocated them equally to intervention or control groups stratified by cluster socioeconomic status. From July 2011 to May 2013, we identified 1056 pregnant women and 993 births in the intervention group and 994 pregnancies and 890 births in the control group. At 18 months, 692 children remained in the intervention group and 551 in the control group. From January 2015 to February 2017, we conducted the long-term follow-up of the cohort. We have now completed the data collection and processing and have started analyses.ConclusionsThis study will help fill the evidence gap about the short- and long-term impact of peer counseling on improving infant feeding, preventing childhood undernutrition, and enhancing child cognitive development.Trial RegistrationClinicalTrials.gov NCT01333995; https://clinicaltrials.gov/ct2/show/NCT01333995International Registered Report Identifier (IRRID)DERR1-10.2196/31475

Prevalence, risk factors and short-term consequences of adverse birth outcomes in Zimbabwean pregnant women: a secondary analysis of a cluster-randomized trial.

Globally, 15 million children are born preterm each year and 10.7 million are born at term but with low birthweight (<2500 g). The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) cluster-randomized trial enrolled 5280 pregnant women between 22 November 2012 and27 March 2015 to test the impact of improved water supply, sanitation and hygiene, and improved infant feeding, on child growth and anaemia. We conducted a secondary analysis to estimate the prevalence and risk factors of miscarriage, stillbirth, preterm birth, size small for gestational age (SGA), low birthweight (LBW), perinatal mortality, and neonatal mortality, and to estimate the effects of adverse birth outcomes on infant survival and growth. The prevalence of adverse birth outcomes was: miscarriage: 5.0%[95% confidence interval (CI), 4.4, 5.7]; stillbirth:2.3% (95% CI 1.9, 2.7);preterm birth: 18.2% (95% CI 16.9, 19.5); SGA: 16.1% (95% CI 15.0, 17.3); LBW: 9.8% (95% CI 9.0, 10.7); andneonatal mortality:31.4/1000 live births (95% CI 26.7, 36.5). Modifiable risk factors included maternal HIV infection, anaemia, lack of antenatal care and non-institutional delivery. Preterm infants had higher neonatal mortality [risk ratio (RR): 6.1 (95% CI 4.0, 9.2)], post-neonatal infant mortality [hazard ratio (HR): 2.1 (95% CI 1.1, 4.1)] and stunting at 18 months of age [RR: 1.5 (95% CI 1.4, 1.7)] than term infants; 56% of stillbirths and 57% of neonatal deaths were among preterm births. Neonatal mortality and stillbirth are high in Zimbabwe and appear to be driven by high preterm birth. Interventions for primary prevention of preterm birth and strengthenedmanagement of preterm labour and ill and small neonates are required to reduce neonatal mortality in Zimbabwe and other African countries with similar profiles.

Infant feeding, growth monitoring and the double burden of malnutrition among children aged 6 months and their mothers in KwaZulu-Natal, South Africa.

South Africa has a documented high prevalence of stunting and increasing obesity in children as well as obesity in adults. The double burden of malnutrition, which can be on an individual‐, household‐ or population level, has implications for both health and the economic development of a community and country. This paper describes a large‐scale survey (N = 774) of infant feeding, growth monitoring and anthropometry among mother and child pairs aged 6 months of age in KwaZulu‐Natal (KZN), South Africa, conducted between January and August 2017. Among children, a large increase in the prevalence of stunting and obesity was seen between birth and 6 months of age increasing from 9.3% to 21.7% and 4.0% to 21.0%, respectively. 32.1% of the mothers were overweight [body mass index (BMI): 25.0–29.9] and 28.4% had obesity grade 1 (BMI: 30–<40). Although most mothers (93%; 563/605) initiated breastfeeding, the introduction of other foods started early with 17.6% (56/319) of the mothers having started giving other fluids or food to their child within the first month. At 6 months 70.6% (427/605) children were still breastfed and 23.5% were exclusively breastfed. In addition, we found that length measurements were done less frequently than weight measurements between birth and 6 months, on average 2.2 (SD: 1.3) versus 5.8 (SD: 1.5) times. Moreover, there is a need for improvement of health worker training and understanding regarding anthropometric measurements when assessing malnutrition in children in the clinics. Early detection and improved infant feeding practices are key in preventing both stunting and obesity in children.

Improving infant feeding, care, and dental hygiene practices in South Asian infants aged younger than 2 years in east London through women's group participatory learning and action cycles (NEON): a behaviour intervention trial

BackgroundFeeding practices developed during the first 1000 days of life can affect growth, development, and lifetime risk of nutrition related and dental-related diseases. In the UK, barriers to recommended complementary feeding practices among South Asian caregivers include food access, bicultural issues, and inconsistent advice from health professionals and community members. We aimed to improve infant feeding, care, and dental hygiene practices among South Asian communities in East London boroughs by co-developing a culturally sensitive intervention and adapting the WHO-recommended women's group Participatory Learning and Action (PLA) cycles. MethodsWe developed an intervention package, in collaboration with multilingual community facilitators, community members, and stakeholders from the local health and social care system (ie, health visitors, dieticians, dentists, children's centres, and local authorities), that consisted of: PLA group facilitator manual, picture cards of recommended or non-recommended feeding practices, healthy recipes book, community asset map, and list of local resources and activities. We conducted monthly intervention development meetings with South Asian community facilitators (n=10) and workshops with South Asian community members (n=25). The inclusion criteria were pregnant women, mothers or female carers for infants younger than 2 years, backgrounds from Indian Gujarati or Punjabi, Sri Lankan, Bangladeshi, or Pakistani backgrounds, and living in the London Boroughs of Tower Hamlets, Newham, or Waltham Forest. The community was involved at three levels: researchers assisting in recruitment and data collection, meeting and workshop facilitators, and intervention developers. The primary outcome was to codevelop the intervention toolkit. This study has obtained ethical approval from the UCL Research Ethics Committee (identifier 17269/001). Community members have agreed to participate and given audio or video consent before their participation in the workshops. Verbal consent was witnessed and formally recorded. FindingsBetween Feb 1, 2020, and Nov 30, 2020, we held eight intervention development meetings in community centres and online. Between Dec 1, 2020, and Feb 28, 2021, four workshops took place online using Zoom. Participants contributed valuable input for intervention development on content, activities, photographs, cultural recipes, artistic design, objectives, schedule, and location. We were able to develop the intervention toolkit with positive perceptions from the community facilitators and community members. InterpretationWe developed a culturally sensitive approach in partnership with health and social care practitioners to address public health issues in a resource-poor ethnically diverse community. Greater use of community assets aligns with the NHS 10-Year Forward Plan. FundingNational Institute for Health Research (reference NIHR300020).