Infant And Young Child Nutrition Research Articles

Changing maternal, infantand young child nutrition practices through social and behaviour change interventions implemented at scale: Lessons learned from Alive & Thrive.

Alive & Thrive (A&T) is an initiative designed to advance the implementation of maternal, infantand young child nutrition (MIYCN) social and behaviour change (SBC) at a large scale. The aims of this research were to: (1) describe A&T's SBC implementation processes and their impact based on a review of programme documents and peer-reviewed publications and (2) gather lessons learned from key informant interviews (N = 23) with A&T staff and stakeholders in Bangladesh, Burkina Faso, Ethiopia, India, Nigeriaand Vietnam. A&T's SBC approach used interpersonal communication, community mobilizationand mass media to address knowledge gaps, strengthen self-efficacyand shift social norms. The initiative used data for designand evaluation and facilitated scale and sustainability through close collaboration with governments and other stakeholders. A&T's approach increased exclusive breastfeeding, minimum meal frequency of childrenand use of iron and folic acid tablets by pregnant women, but had mixed impacts on early initiation of breastfeeding and maternal and child dietary diversity. Multiple SBC channels and frequent contacts strengthened the impact of SBC on MIYCN practices. Lessons learned included: using existing large-scale platforms for interpersonal communication, improving counselling skills of health workers, delivering timely tailored messages, engaging key influencers to take specific actions, using research to address underlying behavioural concerns and maximize mass media reach and frequency, using simple memorable messagesand employing additional channels to reach low media coverage areas. A&T developed and implemented at-scale MIYCN SBC in multiple countries, providing lessons learned about intervention strategies, engagement of influencersand mass media campaign development, which governments and other implementers can adapt and replicate.

Knowledge and practices of selected infant and young child nutrition (IYCN) practices among lactating mothers residing in urban slums of Vadodara, Gujarat

Age appropriate optimal Infant and young child nutrition is one of the a main strategy to improve under nutrition in children. Sub optimal Infant and Young Child Nutrition (IYCN) practices need to be strengthen in rural, tribal and urban mothers.The present study was planned to assess the Knowledge and practices of lactating mothers on selected Infant and Young Child Nutrition (IYCN) practice This study was conducted from November 2022 to February 2023. There were 34 UHC (Urban Health Centre) in the area of Urban Vadodara. One UHC was selected purposively. Informed verbal and written consent were obtained from hundred mothers before data collection. Knowledge and practices on selected IYCN practices was collected using pre tested semi structured questionnaire. Total 100 mothers were interviewed. 60% mothers were having knowledge regarding early initiation of breastfeeding but only 53% followed the correct practices. 61% of mothers were having knowledge regarding colostrum but only 58% followed correct practice. 82% mothers reported to have knowledge regarding pre lacteal but only 73% were following the correct practice. 60% knew that infant should be breastfed exclusively for 6 months but only 44% followed correct practices.Infant and Young Child nutrition (IYCN) practices were foundto be suboptimal. There is a need to sensitize young mothers for timely and optimal IYCN practices through various counselling strategies in government programmes.

Engaging men in maternal, infantand young child nutrition in rural Tanzania: Outcomes from a cluster randomized control trial and qualitative study.

There is growing recognition that engaging men in maternal, infantand young child nutrition (MIYCN) interventions can benefit child health and disrupt harmful gender norms. We conducted a cluster-randomized controlled trial in Tanzania, which engaged men and women in behaviour change via mobile messaging (short message service [SMS])and traditional interpersonal communication (IPC), separately and in combination. Here, we evaluate intervention effects on individual-level men's MIYCN knowledge and discuss barriers to male engagement. Eligible clusters were dispensary catchment areas with >3000 residents. Forty clusters were stratified by population size and randomly allocated to the four study arms, with 10 clusters per arm. Data on knowledge and intervention exposure were collected from 1394 men through baseline and endline surveys (March-April 2018 and July-September 2019). A process evaluation conducted partway through the 15-18-month intervention period included focus group discussionsand interviews. Data were analysed for key trends and themes using Stata and ATLAS.ti software. Male participants in the short message service + interpersonal communication(SMS + IPC) group reported higher exposure to IPC discussions than IPC-only men (43.8% and 21.9%, respectively). Knowledge scores increased significantly across all three intervention groups, with the greatest impact in the SMS + IPC group. Qualitative findings indicated that the main barriers to male participation were a lack of interest in health/nutrition and perceptions that these topics were a woman's responsibility. Other challenges included meeting logistics, prioritizing income-earning activitiesand insufficient efforts to engage men. The use of a combined approach fusing IPC with SMS is promising, yet countering gender norms and encouraging stronger male engagement may require additional strategies.

Four years after implementation of a national micronutrient powder program in Kyrgyzstan, prevalence of iron deficiency and iron deficiency anemia is lower, but prevalence of vitamin A deficiency is higher.

In 2009, the Ministry of Health of Kyrgyzstan launched a national Infant and Young Child Nutrition (IYCN) program which included point-of-use fortification of foods with micronutrient powders (MNP) containing iron, vitamin A, and other micronutrients. Caretakers of children aged 6-23 months were given 30 sachets of MNP every 2 months. Micronutrient surveys were conducted in 2009 and 2013. The objective of the study was to compare the prevalence of anemia and deficiencies of iron and vitamin A among children aged 6-29 months prior to the MNP program (2009) with those after full implementation (2013). Cross-sectional national surveys were conducted in 2009 (n = 666) and 2013 (n = 2150). Capillary blood samples were collected to measure hemoglobin, iron (ferritin and soluble transferrin receptor [sTfR]) and vitamin A (retinol binding protein [RBP]) status, and inflammation status (C-reactive protein [CRP] and α-1-acid glycoprotein [AGP]). Ferritin, sTfR, and RBP were adjusted for inflammation; hemoglobin was adjusted for altitude. The prevalence of anemia was non-significantly lower in 2013 compared to 2009 (32.7% vs. 39.0%, p = 0.076). Prevalence of inflammation-adjusted iron deficiency (54.8% vs. 74.2%, p<0.001) and iron deficiency anemia (IDA, 25.5% vs. 35.1%, p = 0.003) were lower and the prevalence of inflammation-adjusted vitamin A deficiency was higher (4.3% vs. 2.0%, p = 0.013) in 2013 compared to 2009. Four years after the initiation of a national Infant and Young Child Nutrition program including the introduction of point-of-use fortification with MNP, the prevalence of iron deficiency and IDA is lower, but the prevalence of vitamin A deficiency is higher.

What does an enabling environment for infant and young child nutrition look like at implementation level? Perspectives from a multi-stakeholder process in the Breede Valley Sub-District, Western Cape, South Africa

BackgroundBreede Valley is a sub-district of the Cape Winelands district, Western Cape Province, South Africa. The administrative capital of the district is situated in the semi-rural town Worcester. Findings of a baseline survey in Worcester revealed poor infant feeding practices and childhood under- and overnutrition, with particular concern over high levels of stunting and low dietary diversity. Maternal overweight and obesity was high. These characteristics made the site suitable to study multi-sectoral arrangements for infant and young child nutrition (IYCN). The purpose of this study was to explore elements of an enabling environment with key stakeholders aimed at improving IYCN at implementation level.MethodsFocus group discussions and interviews were conducted with representatives from two vulnerable communities; local and district government; higher education institutions; business; and the media in the Breede Valley. Audio recordings were transcribed and data were analysed with the Atlas.TI software programme.ResultsThe participants viewed knowledge and evidence about the first 1000 days of life as important to address IYCN. The impact of early, optimal nutrition on health and intellectual development resonated with them. The IYCN narrative in the Breede Valley could therefore be framed around nutrition’s development impact in a well-structured advocacy campaign. Participants felt that capacity and resources were constrained by many competing agendas spreading public resources thinly, leaving limited scope for promotion and prevention activities. “People” were viewed as a resource, and building partnerships and relationships, could bridge some shortfalls in capacity. Conversations about politics and governance elicited strong opinions about what should be done through direct intervention, policy formulation and legislation. A lead government agency could not be identified for taking the IYCN agenda forward, due to its complexity. Participants proposed it should be referred to a local, informal, inter-governmental body where directors and senior managers meet to address issues of cross-cutting importance.ConclusionThe study illustrated that knowledge and evidence; politics and governance; and capacity and resources, elements of the international definition of an enabling environment, also apply at implementation level. In addition, our findings indicated that a people-centred approach is critical in shaping the enabling environment at this level.

Behavior change communication activities improve infant and young child nutrition knowledge and practice of neighboring non-participants in a cluster-randomized trial in rural Bangladesh.

ObjectiveTo examine the impact on infant and young child nutrition knowledge and practice of mothers who were neighbors of mothers participating in a nutrition Behavior Change Communication (BCC) intervention in rural Bangladesh.MethodsWe analyzed data from 300 mothers whose neighbor participated in a nutrition BCC intervention and 600 mothers whose neighbor participated in an intervention that did not include BCC. We constructed measures capturing mothers’ knowledge of infant and young child nutrition (IYCN) and measures of food consumption by children 6-24m. The effect on these outcomes of exposure to a neighbor receiving a nutrition BCC intervention was estimated using ordinary least squares and probit regressions. The study was registered with ClinicalTrials.gov (Study ID: NCT02237144).ResultsHaving a neighboring mother participate in a nutrition BCC intervention increased non-participant mothers’ IYCN knowledge by 0.17 SD (translating to 0.3 more correct answers). They were 14.1 percentage points more likely to feed their 6-24m children legumes and nuts; 11.6 percentage points more likely to feed these children vitamin A rich fruits and vegetables; and 10.0 percentage points more likely to feed these children eggs. Children of non-participant mothers who had a neighboring mother participate in a nutrition BCC intervention were 13.8 percentage points more likely to meet World Health Organization (WHO) guidelines for minimum diet diversity, 11.9 percentage points more likely to meet WHO guidelines for minimum acceptable diet, and 10.3 percentage points more likely to meet WHO guidelines for minimum meal frequency for children who continue to be breastfed after age 6m. Children aged 0-6m of non-participant mothers who are neighbors of mothers receiving BCC were 7.1 percentage points less likely to have ever consumed water-based liquids.ConclusionsStudies of nutrition BCC that do not account for information spillovers to non-participants may underestimate its benefits in terms of IYCN knowledge and practice.

Adolescent girls' infant and young child nutrition knowledge levels and sources differ among rural and urban samples in Bangladesh.

In many low‐income countries, girls marry early and have children very soon after marriage. Although conveying infant and young child nutrition (IYCN) knowledge to adolescent girls in time is important to ensure the well‐being of their children, little is known about the best ways to convey these messages. This study examines the extent of, and sources from which adolescent girls derive IYCN knowledge in order to inform the design of programmes that convey such information. Data on adolescent girls aged 12–18 was collected in 2013 in 140 clusters of villages in rural areas (n = 436), and 70 clusters of slums in urban areas (n = 345) in Bangladesh. Data were analysed using multivariable Poisson regression models. In both the urban and rural samples, girls' schooling is positively and significantly associated with IYCN knowledge (P < 0.01 and P < 0.10, respectively). IYCN knowledge of adolescent girls' mothers is also associated with adolescents' IYCN knowledge in both urban and rural samples, but the magnitude of association in the urban sample is only half that of the rural sample (P < 0.01 and P < 0.10, respectively). In Bangladesh, efforts to improve knowledge regarding IYCN are typically focused on mothers of young children. Only some of this knowledge is passed onto adolescent girls living in the same household. As other messaging efforts directed towards mothers have only small, or no association with adolescent girls' knowledge of IYCN, improving adolescent girls' IYCN knowledge may require information and messaging specifically directed towards them. © 2016 John Wiley & Sons Ltd

Commentary: Getting to Compliance. Multisector dialogue, collaboration and the International Code of Marketing of Breast Milk Substitutes

Ensuring exclusive breastfeeding for the first 6 months of an infant’s life with ongoing breastfeeding to 2 years of age could decrease child deaths by 13%. The inappropriate marketing of infant formula and breast milk substitutes can present a challenge to meeting this critical goal, which is why, in 1981, the World Health Organization (WHO) adopted the International Code of Marketing of Breast Milk Substitutes (the Code). The Code remains today an important yet deeply divisive piece of international policy intended to prevent inappropriate marketing and promote breastfeeding globally. In his paper in this issue of the Journal of Public Health, Stewart Forsyth argues that the Code has instead had the opposite effect because it has driven a wedge between the various sectors needed to dialogue and collaborate to promote breastfeeding. This criticism could also be heard in the hallways at the 65th World Health Assembly in Geneva this past May, and it reflects more broadly, the general atmosphere of mistrust between stakeholders in the infant and young child nutrition (IYCN) community. As a way forward, Forsyth proposes a Memorandum of Understanding (MOU) to be established between key agencies to set out common understandings, express a convergence of will between the parties and indicate an intended mutual line of action. The proposal is a good one. What is missing, however, are the concrete steps to convince various actors from the public and private sectors to actually come together to discuss challenges and build trust. From our program, Singh et al. proposed a set of shared principles of ethics for IYCN in the developing world—derived from relevant existing laws, trade regimes, international codes and international goals—from which stakeholders may be able to begin dialogue around establishing an operational framework for cooperation, collaboration and oversight. In addition, Singer et al. have suggested that stakeholders in IYCN explore a multi-stakeholder initiative, somewhat analogous to the Ethical Trading Initiative, which was established to address sweatshop violations in the international labour industry. There is a need to explore how these and other proposals may complement and strengthen one another and be implemented in practice. There is also a need for key leadership to initiate the process of building the trust necessary to implement them. For example, the WHO along with other key international agencies could act as a neutral arbitrator to negotiate the terms of an MOU between stakeholders, incorporating conflict of interest guidelines and the set of shared ethical principles for IYCN. The negative impact of the lack of dialogue between stakeholders in the IYCN community, specifically over the Code, should not be underestimated—of particular concern is that despite these deep divisions and perceived ineffectiveness of the Code, some stakeholder groups continue to hold that it ought to be extended to include complementary foods in addition to breast milk substitutes. Such a move will only further exacerbate international efforts to tackle infant and young child undernutrition. The various proposals mentioned here recognize the complex nature of these relationships and offer key agencies and stakeholders opportunities to begin dialogue that can lead to solutions collectively addressing the lack of Code compliance, establish partnerships, prioritize IYCN globally and ultimately save children’s lives.

Effects of a large-scale micronutrient powder and young child feeding education program on the micronutrient status of children 6–24 months of age in the Kyrgyz Republic

To combat iron and other micronutrient deficiencies, the Ministry of Health of the Kyrgyz Republic launched a regional Infant and Young Child Nutrition (IYCN) program in 2009, which included promotion of home fortification with micronutrient powder (MNP) containing iron (12.5 mg elemental iron), vitamin A (300 μg) and other micronutrients. Every 2 months children aged 6-24 months were provided 30 sachets to be taken on a flexible schedule. The objective was to assess biochemical indicators of iron and vitamin A status among children aged 6-24 months at the baseline and follow-up surveys. Cross-sectional representative cluster surveys were conducted in 2008 (n=571 children) and 2010 (n=541). Data collected included measurement of hemoglobin, serum ferritin, soluble transferrin receptor (sTfR), retinol-binding protein, C-reactive protein (CRP) and α1-glycoprotein acid (AGP). Among all children, declines were observed in the prevalence of: anemia, 50.6% versus 43.8% (P=0.05); total iron deficiency (either low ferritin or high sTfR), 77.3% versus 63.7% (P<0.01); and iron deficiency anemia, 45.5% versus 33.4% (P<0.01). Among children without inflammation as measured by CRP and AGP, similar declines were observed, but only declines in total iron deficiency and iron deficiency anemia reached statistical significance. Among all children and those without inflammation, the prevalence of vitamin A deficiency remained the same. One year after the introduction of home fortification with MNP, within a larger IYCN program, the prevalence of anemia, iron deficiency and iron deficiency anemia declined, but vitamin A deficiency remained unchanged.

Situational analysis of infant and young child nutrition activities in the Sahel – executive summary

Several international agencies and non-governmental organizations joined forces in 2007 to support an initiative to ‘Reposition children’s right to adequate nutrition in the Sahel’. The overarching goal articulated by these organizations was to achieve optimal feeding of 80% of children 0–24 months based on relevant and internationally agreed-upon childfeeding indicators. An early activity of the working group for this infant and young child nutrition (IYCN) initiative was to carry out a situational analysis to evaluate IYCN activities being conducted in six Sahelian countries of West and Central Africa, namely, Burkina Faso, Chad, Mali, Mauritania, Niger and Senegal (1–6). The objectives of this analysis were to compile, analyse and interpret available information on infant and child feeding, and the nutrition and health situation of children <2 years of age in the six target countries. This information was used to determine: (i) whether national IYCN policies and activities match international IYCN recommendations; (ii) where IYCN-related activities have been successful, and why; and (iii) how international agencies can assist in filling gaps to speed progress in improving the feeding practices and nutritional status of infants and young children in the region.

Situational analysis of infant and young child nutrition policies and programmatic activities in Burkina Faso

AbstractProgress towards reducing mortality and malnutrition among children &lt; 5 years of age has been less than needed to achieve related Millennium Development Goals. Therefore, several international agencies joined to ‘Reposition children's right to adequate nutrition in the Sahel’, starting with an analysis of current activities related to infant and young child nutrition (IYCN). The objectives of the present paper are to compare relevant national policies, training materials, programmes, and monitoring and evaluation activities with internationally accepted IYCN recommendations. These findings are available to assist countries in identifying inconsistencies and filling gaps in current programming. Between August and November 2008, key informants responsible for conducting IYCN‐related activities in Burkina Faso were interviewed, and 153 documents were examined on the following themes: optimal breastfeeding and complementary feeding practices, prevention of micronutrient deficiencies, screening and treatment of acute malnutrition, prevention of mother‐to‐child transmission of HIV, food security and hygienic practices. National policy documents addressed nearly all of the key IYCN topics, specifically or generally. Formative research has identified some local barriers and beliefs related to general breastfeeding and complementary feeding practices, and other formative research addressed about half of the IYCN topics included in this review. However, there was little evidence that this formative research was being utilized in developing training materials and designing programme interventions. Nevertheless, the training materials that were reviewed do provide specific guidance for nearly all of the key IYCN topics. Although many of the IYCN programmes are intended for national coverage, we could only confirm with available reports that programme coverage extended to certain regions. Some programme monitoring and evaluation were conducted, but few of these provided information on whether the specific IYCN programme components were implemented as designed. Most surveys that were identified reported on general nutrition status indicators, but did not provide the detail necessary for programme impact evaluations. The policy framework is well established for optimal IYCN practices, but greater resources and capacity building are needed to: (i) conduct necessary research and adapt training materials and programme protocols to local needs; (ii) improve, carry out, and document monitoring and evaluation that highlight effective and ineffective programme components; and (iii) apply these findings in developing, expanding, and improving effective programmes.

Situational analysis of infant and young child nutrition policies and programmatic activities in Senegal.

Progress towards reducing mortality and malnutrition among children <5 years of age has been less than needed to achieve related Millennium Development Goals (MDGs). Therefore, several international agencies joined to 'Reposition children's right to adequate nutrition in the Sahel', starting with an analysis of current activities related to infant and young child nutrition (IYCN). The main objectives of the situational analysis are to compile, analyse and interpret available information on infant and child feeding and the nutrition situation of children <2 years of age in Senegal, as one of the six targeted countries. These findings will be used to assist in identifying inconsistencies and filling gaps in current programming. Between August and December 2008, key informants responsible for conducting IYCN-related activities in Senegal were interviewed, and 157 documents were examined on the following themes: optimal breastfeeding and complementary feeding practices, prevention of micronutrient deficiencies, prevention of mother-to-child transmission of HIV, management of acute malnutrition, food security and hygienic practices. Nearly all of the key IYCN topics were addressed, specifically or generally, in national policy documents. Senegal reported substantial improvements since the 1990s towards reducing infant and young child mortality and underweight, and increasing exclusive breastfeeding among infants <6 months of age (34%). Senegal is one of the few countries in the region that is nearly on track for reaching related MDGs. Notable activities that may have played a role include: (1) vitamin A supplementation was expanded to nearly semi-annual national campaigns starting in 1994; (2) the Ministry of Health partnered with several national and international agencies to scale up child survival activities under the umbrella of the Basic Support for Institutionalizing Child Survival (1994-2006); (3) a national nutrition division was developed to support a national nutrition strengthening programme; (4) the national nutrition counsel was organized to coordinate nutritional activities across various organizations and governmental sectors, involving representatives from health, agriculture and surveillance; and (5) an integrated communications programme was developed to support harmonized behaviour change communication tools for the health and nutrition sectors. Along with these activities, a number of programme evaluations were conducted to ensure that programmes obtain desired results. Although useful, these evaluations were not rigorous enough to identify effective programmes that contributed to the mentioned reductions in the prevalence of underweight and mortality, and increases in exclusive breastfeeding. The policy and programme framework is well established for support of optimal IYCN practices in Senegal. Despite the recent improvements in infant and young child nutritional status indicators, there is still much to do. Greater resources and continued capacity building are needed to: (1) conduct necessary research for adapting training materials and programme protocols to programmatic needs; (2) improve and carry out monitoring and evaluation that identify effective programme components; and (3) apply these findings in developing, expanding and improving effective programmes.

Situational analysis of infant and young child nutrition policies and programmatic activities in Niger

Due to limited progress towards reducing mortality and malnutrition among children <5 years of age, an alliance of international agencies joined to 'Reposition children's right to adequate nutrition in the Sahel,' starting with a situational analysis of current activities related to infant and young child nutrition (IYCN). The main objectives of this analysis are to compile, analyse, and interpret available information on infant and child feeding and the nutrition situation of children <2 years of age in Niger, as one of the six targeted countries. Between August and November 2008, key informants responsible for conducting IYCN-related activities in Niger were interviewed, and 90 documents were examined on: optimal breastfeeding and complementary feeding practices, prevention of micronutrient deficiencies, prevention of mother-to-child transmission of HIV, management of acute malnutrition, food security, and hygienic practices. The results reported are limited by the availability of documents for review. Mortality rates are on track to reaching the Millennium Development Goal to reduce mortality among young children by two-thirds by 2015, but there has been no change in undernutrition, and total mortality rates are still high among young children. Nearly all of the key IYCN topics were addressed, specifically or generally, in national policy documents, training materials, and programmes. A national nutrition council meets regularly to coordinate programme activities nationally. Many of the IYCN-related programmes are intended for national coverage, but few reach this coverage. Monitoring and impact evaluations were conducted on some programmes, but few of these reported on whether the specific IYCN components of the programme were implemented as designed or compared outcomes with non-intervention sites. Human resources have been identified as inadequate to fully carry out nutrition programmes in Niger. Due to these limitations, we could not confirm whether the lack of progress in reducing malnutrition was due to ineffective or inadequately implemented programmes, though both of these were likely contributors. The policy framework is well established for the promotion of optimal IYCN practices, but greater resources and capacity building are needed to: (i) increase human capacities to carry out nutrition programmes; (ii) expand and track the implementation of evidence-based programmes nationally; (iii) improve and carry out monitoring and evaluation that identify effective and ineffective programmes; and (iv) apply these findings in developing, expanding, and improving effective programmes.

Situational analysis of infant and young child nutrition policies and programmatic activities in Mali

Progress towards reducing mortality and malnutrition among children <5 years of age has been less than needed to achieve related Millennium Development Goals. Therefore, several international agencies joined to 'Reposition children's right to adequate nutrition in the Sahel', starting with a situational analysis of current activities related to infant and young child nutrition (IYCN). The main objectives of the situational analysis are to compile, analyse and interpret available information on infant and young child feeding, and the nutrition situation of children <2 years of age in Mali, as one of the six targeted countries. Between June and September 2008, key informants responsible for conducting IYCN-related activities in Mali were interviewed, and 117 documents were examined on the following themes: optimal breastfeeding and complementary feeding practices, prevention of micronutrient deficiencies, screening and management of acute malnutrition, prevention of mother-to-child transmission of HIV, food security, and hygienic practices. Most of the key IYCN topics were addressed in national policies, training materials, and programme documents. Information on the national coverage and impact of these programmes is generally not available. Exclusive breastfeeding (<6 months) has increased in Mali, but no studies identified the contributors to this increase. Despite improvements in breastfeeding practices, optimal infant, and young child feeding is still practiced among too few young children in Mali. Several research articles were identified, but few of these were linked to programme development. Some programme monitoring and evaluation reports were available, but few of these were rigorous enough to identify whether IYCN-specific programme components were implemented as designed or were achieving desired outcomes. Therefore, we could not confirm which programmes contributed to reported improvements. Monitoring of programmes managing malnutrition identified gaps in human and institutional capacities to fully carry out intended interventions and the government has recognized the overall lack of adequate numbers of health care providers to carry out necessary programmes in Mali, of which nutrition programmes are a part. The policy and programme framework is well established for support of optimal IYCN practices, but greater resources and capacity building are needed to: (i) conduct necessary research to adapt training materials and programme protocols to programmatic needs; (ii) implement rigorous monitoring and evaluation that identify effective programme components; and (iii) apply these findings in developing, expanding, and improving effective programmes.

Situational analysis of infant and young child nutrition policies and programmatic activities in the Islamic Republic of Mauritania

Progress towards reducing mortality and malnutrition among children <5 years of age has been less than needed to achieve related Millennium Development Goals (MDGs), so several international agencies joined to 'reposition children's right to adequate nutrition in the Sahel', starting with an analysis of current activities related to infant and young child nutrition (IYCN). The main objectives of the situational analysis are to compile, analyse, and interpret available information on infant and child feeding, and the nutrition and health situation of children <2 years of age in Mauritania as one of the six target countries (Burkina Faso, Chad, Mali, Mauritania, Niger, Senegal). These findings are available to assist countries in identifying inconsistencies and filling gaps in current programming. Between August and November of 2008, key informants responsible for conducting IYCN-related activities in Mauritania were interviewed, and 46 documents were examined on the following themes: optimal breastfeeding and complementary feeding practices, prevention of micronutrient deficiencies, prevention of mother-to-child transmission of human immunodeficiency virus (HIV), management of acute malnutrition, food security, and hygienic practices. Mauritania is on track to reaching the MDG of halving undernutrition among children <5 years of age by 2015. National policy documents, training guides, and programmes address nearly all of the key IYCN topics, specifically or generally. Exceptions are the use of zinc supplements in diarrhoea treatment, prevention of zinc deficiency, and dietary guidelines for preventing mother-to-child transmission of HIV. Substantial infrastructure capacity building was also recently implemented in nutritionally high-risk regions, and increases were reported in exclusive breastfeeding rates among children <6 months. The recent National Behaviour Change Communication Strategy is intended to address the needs of adapting programme activities to local needs. Despite these noteworthy accomplishments, the prevalence of acute malnutrition remains high, mortality rates did not decrease as malnutrition rates decreased, the overall prevalence of desirable nutrition-related practices is low, and human resources are reportedly insufficient to carry out all nutrition-related programme activities. Very little nutrition research has been conducted in Mauritania, and key informants identified gaps in adapting international programmes to local needs. Monitoring and evaluation reports have not been rigorous enough to identify which programme activities were implemented as designed or whether programmes were effective at improving nutritional and health status of young children. Therefore, we could not confirm which programmes might have been responsible for the reported improvements, or if other population-wide changes contributed to these changes. The policy framework is supportive of optimal IYCN practices, but greater resources and capacity building are needed to (i) support activities to adapt training materials and programme protocols to fit local needs, (ii) expand and track the implementation of evidence-based programmes nationally, (iii) improve and carry out monitoring and evaluation that identify effective and ineffective programmes, and (iv) apply these findings in developing, disseminating, and improving effective programmes.

Situational analysis of infant and young child nutrition policies and programmatic activities in Chad

Progress towards reducing mortality and malnutrition among children <5 years of age has been less than needed to achieve related Millennium Development Goals (MDGs). Therefore, several international agencies joined to 'reposition children's right to adequate nutrition in the Sahel', starting with an analysis of current activities related to infant and young child nutrition (IYCN). The main objectives of the situational analysis are to compile, analyse, and interpret available information on infant and child feeding, and the nutrition situation of children <2 years of age in Chad, as one of the six targeted countries. These findings are available to assist in identifying inconsistencies and filling gaps in current programming. Between June and October of 2008, key informants responsible for IYCN-related activities in Chad were interviewed, and 53 documents were examined on the following themes: the promotion of optimal breastfeeding and complementary feeding practices, prevention of micronutrient deficiencies, management of acute malnutrition, prevention of mother-to-child transmission of human immunodeficiency virus (HIV), food security, and promotion of good hygienic practices. Chad is not on track to reaching the MDGs of reducing mortality by two-thirds and malnutrition by half among children <5 years of age between 1990 and 2015. Most of the key IYCN topics were addressed in a national policy to combat malnutrition and micronutrient deficiencies. No national nutrition policy was yet ratified in Chad, so the target of many documents reviewed was the malnourished child. Researchers have identified some barriers to optimal feeding practices. However, the majority of these surveys were small scale, so they do not necessarily provide information relevant to the general population. Expanded surveys would be needed for developing evidence-based educational messages targeted to local needs. Reviewed training materials and related programmes being implemented in Chad provide specific guidance for nearly all of the key IYCN topics, except for appropriate feeding choices for the prevention of mother-to-child transmission of HIV. Some of the programmes were intended for national coverage, but we could not confirm whether these programmes were actually implemented nationally. Monitoring and evaluation reports were available for some small-scale programmes, but few of these evaluated whether IYCN-specific programme components were implemented as designed and none evaluated whether participants adopted the promoted feeding practices. Establishment of the policy and programme framework has commenced for improving IYCN practices. Formative research is needed to guide the development of evidence-based training materials and programmes to address the nutritional needs of infants and children. Once more directed programmes are established, there is a further need for rigorous monitoring and evaluation to ensure that training is adequate, programmes are implemented as designed, and effective programmes are identified for expansion nationally. Evaluations are also needed to determine where human and institutional capacity building is needed to carry out these activities as they are implemented. National and international support will be required to complete these enhancements, and thus improve the health and nutritional status of infants and young children in Chad.

Accelerating improvements in nutritional and health status of young children in the Sahel region of Sub‐Saharan Africa: review of international guidelines on infant and young child feeding and nutrition

The United Nations Convention on the Rights of the Child holds governments responsible to ensure children's right to the highest attainable standard of health by providing breastfeeding support, and access to nutritious foods, appropriate health care, and clean drinking water. International experts have identified key child care practices and programmatic activities that are proven to be effective at reducing infant and young child undernutrition, morbidity, and mortality. Nevertheless, progress towards reducing the prevalence of undernutrition has been sporadic across countries of the Sahel sub-region of Sub-Saharan Africa. In view of this uneven progress, a working group of international agencies was convened to 'Reposition children's right to adequate nutrition in the Sahel.' The first step towards this goal was to organize a situational analysis of the legislative, research, and programmatic activities related to infant and young child nutrition (IYCN) in six countries of the sub-region: Burkina Faso, Chad, Mali, Mauritania, Niger, and Senegal. The purposes of this introductory paper are to review current information concerning the nutritional and health status of infants and young children in the Sahel and to summarize international guidelines on optimal IYCN practices. These guidelines were used in completing the above-mentioned situational analyses and encompass specific recommendations on: (i) breastfeeding (introduction within the first hour after birth, exclusivity to 6 months, continuation to at least 24 months); (ii) complementary feeding (introduction at 6 months, use of nutrient dense foods, adequate frequency and consistency, and responsive feeding); (iii) prevention and/or treatment of micronutrient deficiencies (vitamin A, zinc, iron and anaemia, and iodine); (iv) prevention and/or treatment of acute malnutrition; (v) feeding practices adapted to the maternal situation to reduce mother-to-child transmission of HIV; (vi) activities to ensure food security; and (vii) the promotion of hygienic practices concerning food preparation and storage and environmental sanitation. The following papers in this issue will present results of the situational analyses for the individual countries.

Situational analysis of infant and young child nutrition (IYCN) activities in six countries of the African Sahel demonstrates that most IYCN policies, and related training materials &amp; programs, are consistent with international guidelines, but substantial gaps exist in program coverage and effective monitoring &amp; evaluation (M&amp;E)

Background &amp; objectivesDue to limited or no progress toward reducing &lt;5 mortality and malnutrition, an alliance of international agencies joined to “Reposition children's right to adequate nutrition in the Sahel”, starting with an analysis of IYCN activities: national policies, training materials, programs, and M&amp;E, compared with international recommendations.MethodsKey informants conducting IYCN‐related activities in Burkina Faso, Chad, Mali, Mauritania, Niger &amp; Senegal were interviewed, and &gt;500 documents were reviewed &amp; compared with internationally recommended policies on: optimal breastfeeding &amp; complementary feeding (CF) practices, prevention of micronutrient deficiencies, prevention of mother‐to‐child transmission of HIV (PMTCT), management of acute malnutrition (AM), &amp; food security.ResultsMost IYCN policies &amp; related training materials are consistent with international guidelines. Neglected topics include specific CF recommendations, zinc in diarrhea management, PMTCT &amp; screening for AM. Programs target high‐risk populations, but few reach national coverage or are adapted to research into local barriers &amp; beliefs. Most M&amp;E activities do not permit identification of effective program components.ConclusionsThe IYCN foundation is set, but greater resources &amp; capacity building are needed to enhance &amp; expand program activities and M&amp;E.Support: FAO, HKI, MI, UNICEF, WFP

Integrating Maternal, Infant, and Young Child Nutrition: Report on the Ten Year Strategy Infant and Young Child Nutrition (IYCN) Working Group October 2008 Workshop

Members of the Infant and Young Child Nutrition (IYCN) Working Group of the Ten Year Strategy for the Reduction of Vitamin and Mineral Deficiencies and several guests and speakers participated in a workshop in Geneva on 10 October 2008. The workshop had two broad objectives. The first objective was to review the evidence base for maternal and IYCN actions and explore how to integrate action throughout the window of opportunity from the prenatal period through the first 2 years of life. The second objective was to discuss the development of the Maternal, Infant, and Young Child Nutrition (MIYCN) Network in relation to the IYCN Working Group's role and structure. The speakers identified a spectrum of efforts needed to improve maternal, infant, and young child nutrition. The group decided to continue discussion on initiating a structure for an MIYCN Network to enhance collaboration.