Infancy Childhood Research Articles

Time to death and its predictors among Ethiopian under-five children: cluster-level shared frailty survival analysis using the 2019 Ethiopian mini demographic health survey

Introduction: Reducing under-five mortality to less than 25 per 1000 live births by 2030 is one of the Sustainable Development Goals introduced in 2016. However, several countries are still falling short of their targets. In Ethiopia, one out of every 19 children dies before reaching the age of five. Thus, this study aims to identify the time to death and its predictors among under-five children in Ethiopia. Methods: The data were retrieved from the 2019 Ethiopian Mini Demographic and Health Survey data set. Descriptive statistics and survival curves were applied. Shared frailty survival analysis was employed to determine the predictors of under-five mortality. Statistical significance was declared at p-value <0.05. Result: The under-five mortality rate was found to be 59 deaths per 1000 live births with an estimated mean survival time of 57.6 months (95%CI: 57.38, 57.85). A child born into a family of seven or more had an 85% lowered risk of dying (AHR = 0.15, 95% CI: 0.05, 0.44). The risk of mortality among children born in the birth order of five or above was 3 times higher (AHR = 3.00, 95%CI: 1.70, 5.21) compared to those born in the birth order of one to four. The estimated risk of death among under-five children born less than 24 months interval was 2.68 times higher (AHR=2.68, 95%CI: 1.71, 4.21). Never breastfed was also a significant predictor of under-five child death (AHR = 2.76, 95%CI: 1.46, 5.23). Conclusion: Birth order, family size, preceding birth interval, and never breastfed history were significant predictors of under-five child mortality. Health policies should focus on keeping the spirit of a continuum of care to improve the health of the child and the health of the family as a whole. Health care providers should intervene in the community to maximize optimal infant and young child feeding practices.

Prevalence of Children Aged 6 to 23 Months Who Did Not Consume Animal Milk, Formula, or Solid or Semisolid Food During the Last 24 Hours Across Low- and Middle-Income Countries

The introduction of solid or semisolid foods alongside breast milk plays a vital role in meeting nutritional requirements during early childhood, which is crucial for child growth and development. Understanding the prevalence of zero-food children (defined for research purposes as children aged 6 to 23 months who did not consume animal milk, formula, or solid or semisolid food during the last 24 hours) is essential for targeted interventions to improve feeding practices. To estimate the percentage of zero-food children in 92 low- and middle-income countries. This cross-sectional study analyzed nationally representative cross-sectional household data of children aged 6 to 23 months from the Demographic and Health Surveys and the Multiple Indicator Cluster Surveys conducted between May 20, 2010, and January 27, 2022. Data were obtained from 92 low- and middle-income countries. Standardized procedures were followed to ensure data comparability and reliability. Both percentage and number of zero-food children were estimated. The outcome studied was defined as a binary variable indicating children aged 6 to 23 months who had not been fed any animal milk, formula, or solid or semisolid foods during the 24 hours before each survey, as reported by the mother or caretaker. A sample of 276 379 children aged 6 to 23 months (mean age, 14.2 months [95% CI, 14.15-14.26 months]) in 92 low- and middle-income countries was obtained, of whom 51.4% (95% CI, 51.1%-51.8%) were boys. The estimated percentage of zero-food children was 10.4% (95% CI, 10.1%-10.7%) in the pooled sample, ranging from 0.1% (95% CI, 0%-0.6%) in Costa Rica to 21.8% (95% CI, 19.3%-24.4%) in Guinea. The prevalence of zero-food children was particularly high in West and Central Africa, where the overall prevalence was 10.5% (95% CI, 10.1%-11.0%), and in India, where the prevalence was 19.3% (95% CI, 18.9%-19.8%). India accounted for almost half of zero-food children in this study. In this cross-sectional study of 276 379 children aged 6 to 23 months, substantial disparities in the estimates of food consumption across 92 low- and middle-income countries were found. The prevalence of zero-food children underscores the need for targeted interventions to improve infant and young child feeding practices and ensure optimal nutrition during this critical period of development. The issue is particularly urgent in West and Central Africa and India.

Anthropometric, biochemical, dietary, morbidity and well-being assessments in women and children in Indonesia, India and Senegal: a UKRI GCRF Action Against Stunting Hub protocol paper

IntroductionChild stunting has a complex aetiology, especially in the first 1000 days of life. Nutrition interventions alone have not produced expected impacts in reducing/preventing child stunting, indicating the importance of...

SNOWBALL-THROWING METHOD EDUCATION INCREASES THE KNOWLEDGE AND ATTITUDES OF ADOLESCENTS ABOUT THE MATURATION OF MARRIAGE AGE (PUP)

Background: Maturation of Marital Age is an effort to raise the age of child marriage. The number of underage marriages results in rapid population development, high maternal and infant mortality rates, low maternal and child health, families are often not harmonious, domestic violence occurs, and is prone to divorce. The rate of child marriage in Central Sulawesi is very high, one of which is in Donggala district. Donggala Regency ranks 3rd with 196 child marriages in 2022. A contributing factor is the lack of knowledge and attitudes of adolescents about maturing marriage age. The purpose of the study was to determine the effect of snowball throwing method counseling on the management and attitudes of adolescents about the maturation of marriage age at SMKS Al-Amin Wani Method: The pre-experimental research with one group pretest-posttest design was conducted from April 14 to May 20, 2023, at SMKS Al-Amin Wani. Proportional stratified random sampling technique of 75 respondents. Analyzes data through the Wilcoxon test. Result: 31 respondents (41.3%) is 16 years old, 55 respondents (73.3%) is female. the most dominant knowledge was in a good category, 75 respondents (100%). Average increase in knowledge and attitude score of 38.00 and p-value of 0.000. Conclusion: Education on snowball throwing method can improve teenagers' knowledge and attitudes about marriage-age maturity at SMKS Al-Amin Wani.

Infant and Young Child Feeding Practice among Mothers in Rural Areas of Gazipur District, Bangladesh

A cross-sectional, descriptive study was conducted among 599 mothers who had at least one child aged 0–23-month to determine infant and young child feeding practice (IYCF) in rural areas of Bangladesh. The study was conducted between November 2019 and March 2020 in rural areas of Gazipur district. A pre-tested semi-structured questionnaire was used to collect data. Out of 599 respondents, the majority (62.93%) were in the 21-30 years age-group. Only 6.67% were illiterate and the rest of the respondents were literate with different levels of education. About one third (33.38%) of the respondents had monthly income between BDT 5001- 15000. 27% of the mothers could not give colostrum to the babies; half of them (50%) mentioned that baby could not suck well, while 43.83% mentioned being advised by the elders (not to give colostrum) and 6.17% mentioned their own illness. Pre-lacteal feeding practice was observed among 27% mothers and common pre-lacteal food was honey (61.25%), sugar water (35.63%) and animal milk (4.32%). Breastfeeding was initiated within the first hour of birth among 73.29% of mothers. 53.26% percent of mothers practice exclusive breastfeeding (EBF). Difficulties faced by mothers for EBF are insufficient secretion of breast milk (46.42%), not having knowledge about EBF (42.51%), and mother’s illness (11.07%). Most of the mothers (81.63%) gave complementary feeding in the correct time (6 months) and predominant complementary food was Khichuri (51.91%); however, most of them (60.77%) gave complementary food ≤3 times in a day. Our data suggests that the practice of IYCF was not optimum among the rural mothers. To improve this condition, it is necessary to motivate mothers through proper health education about the positive impacts of IYCF on child health. CBMJ 2024 January: vol. 13 no. 01 P: 28-34

Observational Methods in Studies of Infant and Young Child Feeding Practices in Low- and Middle-Income Countries: A Twenty-Year Retrospective Review.

This narrative review describes the observational approaches used to study infant and young child feeding (IYCF) practices in low- and middle-income countries (LMICs) published between 2001 and 2021. Articles were included in this narrative review if they were (1) original peer-reviewed articles published in English in PubMed and Web of Science; (2) published between 1 January 2001, and 31 December 2021; (3) conducted in an LMIC; and (4) employed observations and focused on IYCF practices among children aged 6-59 months. The studies (n = 51) revealed a wide-ranging application of direct meal and full-day observations, as well as indirect spot checks, to study IYCF. The findings revealed that meal observations were typically conducted during a midday meal using precise recording approaches such as video and aimed to understand child-caregiver interactions or specialized nutritious food (SNF) usage. Conversely, full-day observations lasted between 6 and 12 h and often used a field notes-based recording approach. Behaviors occurring outside of mealtime, such as snacking or interhousehold food sharing, were also a primary focus. Finally, spot checks were conducted to indirectly assess SNF compliance during both announced and unannounced visits. This review highlights the adaptability of observations across contexts and their versatility when used as a primary data collection tool to help monitor and evaluate nutrition programs.

Minimum acceptable diet and associated factors among children aged 6–23 months in Jig-Jiga, Somali region, eastern Ethiopia, 2022

BackgroundThe minimum acceptable diet is the proportion of children aged 6–23 months who consumed the minimum meal frequency and minimum dietary diversity during the previous day or night. The minimum acceptable diet assesses both micronutrient adequacy and the quantity of food consumed during the previous day or night. Inappropriate infant and young child feeding practices during this period result in significant threats to child health through impaired cognitive development. Therefore, this study aims to assess the minimum acceptable diet and associated factors among children aged 6–23 months in Jig-Jiga, Somali region, Eastern Ethiopia.MethodsA community-based, cross-sectional study was conducted in Jig-Jiga town. A systematic random sampling technique was used to select 536 children aged 6–23 months with their mothers. Data were collected using a pre-tested, structured questionnaire. The data were entered into Epi-data 3.1. The data were cleaned and analyzed using SPSS v20. Bi-variable and multivariable logistic regression analyses were done, and model fitness was checked and tested by the Hosmer-Lemeshow goodness of fit test. The results of the adjusted odds ratio with 95% confidence intervals and P < 0.05 were considered statistically significant.ResultThe overall prevalence of a minimum acceptable diet was 47.2% (95% CI: 43.1–51.6). Occupation of fathers (AOR = 0.5, 95%CI: 0.3–0.8), child age of 6–11 months (AOR = 3.6, 95%CI: 1.7–7.7), age of the mother 15–24 years (AOR = 7.6, 95%CI: 1.5–38.146), 25–34 years (AOR = 5.56, 95%CI: 1.17–26.325), mothers who had only one under-five child (AOR = 2.1, 95%CI: 1.298–3.471), and media as a source of information (AOR = 0.16, 95%CI: 0.061–0.433) were associated with the minimum acceptable diet.ConclusionThis study showed that the prevalence of a minimum acceptable diet was low. Factors associated with a minimum acceptable diet included the father’s occupation, the child’s age, the mother’s age, having one under-five child, and the media as a source of information. Therefore, interventional strategies that focus on family planning and advocacy for infant and young child feeding are required to improve the provision of a minimum acceptable diet.

Maternal postnatal depressive symptoms and early achievement of developmental milestones in infants and young children: A meta-analysis.

Screening for social determinants of health, including maternal depression, is a recommended pediatric practice. However, the magnitude of association between maternal and child screening tools remains to be determined. The current study evaluated the association between maternal postnatal depressive symptoms and child developmental milestones, as well as moderators of these associations. A comprehensive search strategy was carried out in four databases (MEDLINE, EMBASE, APA PsycINFO, and Cochrane Central Register of Controlled Trials) from database inception to September 2022. Studies that examine postnatal depressive symptoms and associations with infant and early child (<6 years) achievement of developmental milestones were included. Data were extracted by two independent coders and a random-effects meta-analysis was used to estimate pooled effect sizes and test for moderators. A total of 38 non-overlapping studies (95,897 participants), all focused on maternal postnatal depression, met inclusion criteria. The pooled effect size for the association between postnatal depressive symptoms and early achievement of infant and child developmental milestones (N=38; r=-.12; 95% CI=-.18, -.06) was small in magnitude. Child age at maternal depression measurement was a moderator, whereby effect sizes became greater for older children. Despite small effects, maternal postnatal depressive symptoms should be included in screening during routine well-child visits to enhance child development outcomes.

Contemporary definitions of infant growth failure and neurodevelopmental and behavioral outcomes in extremely premature infants at two years of age

BackgroundAssociations of 2-year neurodevelopmental and behavioral outcomes with growth trajectories of preterm infants are unknown.MethodsThis secondary analysis of a preterm cohort examined in-hospital and discharge to 2-year changes in anthropometric z-scores. Two-year follow-up included Bayley Scales of Infant Development (BSID-III) and Child Behavior Checklist.ResultsAmong 590 infants, adjusted in-hospital growth was not associated with any BSID-III subscale. Occipitofrontal circumference (OFC) growth failure (GF) in-hospital was associated with increased adjusted odds of attention problems (aOR 1.65 [1.03, 2.65]), aggressive behavior (aOR 2.34 [1.12, 4.89]), and attention-deficit-hyperactivity symptoms (aOR 1.86 [1.05, 3.30]). Infants with OFC GF at 2 years had lower adjusted BSID-III language scores (−4.0 [−8.0, −0.1]), increased odds of attention problems (aOR 2.29 [1.11, 4.74]), aggressive behavior (aOR 3.09 [1.00, 9.56]), and externalizing problems (aOR 3.01 [1.07, 8.45]) compared to normal OFC growth cohort.ConclusionInfants with OFC GF are at risk for neurodevelopmental and behavioral impairment.Clinical trial registrationThis study is a secondary analysis of pre-existing data from the PENUT Trial Registration: NCT01378273.

Bridging the evidence-to-action gap: enhancing alignment of national nutrition strategies in Cambodia, Laos, and Vietnam with global and regional recommendations.

Nutrition policies are critical frameworks for tackling the triple burden of malnutrition, including undernutrition (i.e., stunting and wasting), overweight, and hidden hunger (i.e., micronutrient deficiencies). We examined (1) the alignment of recent National Nutrition Strategies and Action Plans (NNS) in Cambodia, Laos, and Vietnam with recent global and regional recommendations and standards with a focus on maternal, infant, and young child nutrition and (2) changes compared to the previous NNS. We extracted information regarding the context, objectives, interventions, indicators, strategies, and coordination mechanisms from the most recent NNSs in Cambodia (2019-2023), Laos (2021-2025), and Vietnam (2021-2030). Recent NNSs aimed to reduce malnutrition among priority populations and described program development, monitoring, and evaluation plans for the following interventions: breastfeeding promotion, improved complementary feeding, dietary diversity, safe water, food security, nutritional/health campaigns, strategies for vulnerable groups, and strengthening of policies related to food and nutrition. Direct interventions to improve women's general nutrition (outside of pregnancy) and adolescent nutrition were not the focus of any NNSs. Although some indicators (e.g., wasting and exclusive breastfeeding) were covered in all recent NNSs, other indicators (e.g., low birth weight and childhood overweight and obesity) were inconsistently incorporated. In comparison to the previous NNS, the following interventions were discontinued in three countries: dietary counseling, maintaining physical activity, monitoring weight gain during pregnancy, maternal micronutrient supplementation, and nutrition and HIV. Despite similarities in structure and content, the recent NNSs of Cambodia, Laos, and Vietnam do not consistently align with global and regional recommendations. Variations in the types of interventions and indicators included may reflect a shift in priorities, attention, or resources. In conclusion, the NNSs of Cambodia, Laos, and Vietnam exhibit both structural and content similarities; however, certain interventions and indicators vary across countries and differ from global and regional recommendations. Enhancing alignment while prioritizing country-specific needs, optimizing coordination, ensuring policy efficacy, and updating nutrition strategy data for cross-country comparisons and knowledge exchange is critical to ensure progress on reducing malnutrition in the region.

An economic evaluation of strategies to ensure safer drinking water in the homes of families with young children in select United States locations

IntroductionIn the United States, safe, accessible drinking water is not equitable due to source water contamination, unreliable water treatment, or hazardous plumbing infrastructure. Drinking water free of lead, nitrates, and arsenic is vital for infant and young children’s health. MethodsResearchers conducted a study combining single-case study review methods and economic evaluation for 6 US policies or programs. Researchers used case-study findings, activity-based costing, publicly available US population data, and existing literature to create 5-year cost projections (2020–2024) for strategies to address lead, nitrates, or arsenic in drinking water from private wells or community water systems for families with low incomes and young children aged 0–5y. Researchers estimated the number of households reached and the costs by activity and payer of implementing each policy or program using case-specific geographic location and eligibility criteria. ResultsThe total number of households reached varied from 295 to 135,000 depending on water source, population of focus, and geographic location. Focused strategies reached higher proportions of families with low incomes and young children. Community water system and state-wide strategies had the broadest reach. The total annual program cost per household that received information about their water quality ranged from $75 to $2,780. Of this cost, the portion paid by the household varied from $0.12 to $1,590, not including mitigation. ConclusionsThese findings can inform local decisions about policies and programs in communities seeking to increase awareness and access to safer drinking water, particularly in homes of families with low incomes and young children.

Aplicação do índice de alimentação de lactentes e crianças pequenas e avaliação de sua relação com o estado nutricional de crianças de 6 a 24 meses

ABSTRACT Objective To evaluate the complementary feeding practices of mothers in infant and child nutrition using Infant and Young Child Feeding Indicator and Infant and Child Feeding Index and to determine their relationship with nutritional status. Methods Study data were collected through an online questionnaire administered to 141 parents on healthy 6-24 month infants/children. Complementary feeding practices for infants/children were evaluated in line with the Infant and Child Feeding Index and Infant and Young Child Feeding Indicator. In the evaluation of growth, weight for age z-scores, length for age z-scores, and weight for length z-scores of infants/children were calculated with the World Health Organization Anthro program. Results 74.5% of 141 infants and children (71 boys, 70 girls) evaluated in the study are breastfed. The prevalence of stunting, wasted, and underweight was determined as 6.4%, 0.7%, and 4.3%, respectively. When evaluated using Infant and Young Child Feeding Indicator, it was determined that 82.3% of children met the minimum meal frequency, 80.9% met the minimum dietary diversity, and 67.4% met the minimum acceptable diet. Regarding Infant and Child Feeding Index evaluations of the children, while there was no difference between 9-11 and 12-24 month age groups, the mean Infant and Child Feeding Index score in the 6-8 month group was significantly lower than the other age groups (p=0.000). The Infant and Child Feeding Index scores used to evaluate complementary feeding practices in our study were found to be high in most infants/children. No clear relationship was found between stunting and minimum acceptable diet, minimum dietary diversity or minimum meal frequency, which are indicators of both Infant and Child Feeding Index scores and World Health Organization, Infant and Young Child Feeding Indicator. Conclusion The Infant and Child Feeding Index scores used to evaluate complementary feeding practices in our study were high in most infants/children. In addition, the high rates of MMF, minimum dietary diversity, and minimum acceptable diet coverage in evaluating infants/children in terms of World Health Organization indicators show that they have appropriate complementary feeding practices. However, study found no clear relationship between stunting and minimum acceptable diet, minimum dietary diversity or MMF, which are indicators of both Infant and Child Feeding Index I scores and WHO Infant and Young Child Feeding Indicator. It was concluded that World Health Organization Infant and Young Child Feeding Indicator indicators may be better than length for age z-scores in the weight for length z-scores explanation.

Animal source food consumption practice and factors associated among infant and young children from selected rural districts in Ethiopia: A cross-sectional study.

Children are recommended to consume animal source foods (ASF) as part of diversified diets. However, ASF consumption practice of infant and young children (IYC) is less studied and contributing factors are not exhaustively identified. Therefore, the purpose of this study is to assess consumption of ASF and identify associated factors among 6-23 months old IYC from selected rural districts in Ethiopia. A cross-sectional study was conducted in a total of 606 IYC from selected rural districts of Oromia and Sidama regional states in Ethiopia. A two-stage sampling technique was used to select participants. Data were collected using interviewer-administered questionnaire. Frequencies, percentages and mean scores with standard deviations were generated to describe participants and report univariate outcomes. Consumption of ASF was assessed using a 24-hour dietary recall. Logistic regression analysis was applied to identify contributing factors contributed to IYC's ASF consumption practice. Dairy, eggs and meat were consumed by 41.2%, 16.4% and 2.3% of IYC, respectively. Household food security increased odds of dairy [AOR = 1.66 (95%CI: 1.16 2.38), P = 0.006], eggs [AOR = 2.15 (95%CI: 1.33, 3.49), P = 0.002] and meat [AOR = 5.08 (95%CI: 1.09, 23.71), P = 0.039] consumption. Cow [AOR = 1.86 (95%CI: 1.28, 2.70), P = 0.001], donkey [AOR = 1.83 (95%CI: 1.08, 3.11), P = 0.024] and chicken [AOR = 1.53 (95%CI: 1.05, 2.22), P = 0.027] ownership increased the odds of dairy consumption. Grades 5-8 [AOR = 1.74 (95%CI: 1.06, 2.86), P = 0.028] or ≥9 [AOR = 2.96 (95%CI: 1.62, 5.42), P <0.001] maternal educational achievements were also associated with better dairy consumption. Children from households that owned chicken [AOR = 3.20 (95%CI: 1.97, 5.19), P <0.001] or produce root crops [AOR = 1.67 (95%CI: 1.05, 2.66), P = 0.031] were with increased odds to consume eggs. Low proportion of children consumed ASF. Household food security, livestock ownership, household income, root crop production and maternal education contributed to ASF consumption. Nutrition sensitive agricultural extension activities aided by nutrition education should be considered and evaluated for their effect on IYC's ASF consumption practice.

Infant and young child feeding practices among mothers in the pilot Micronutrient Powder Initiative in four geographically and ethnically diverse districts in Ghana.

In Ghana, breastfeeding and complementary feeding counselling have been used as a nutritional intervention to promote optimal Infant and Young Child Feeding (IYCF) and nutrition. This study examined IYCF practices in four geographically and ethnically diverse districts (Ho West, Tain, Talensi and Tolon). A qualitative study involving key informant interviews (KIIs) and focus group discussions (FGDs) was conducted between November and December 2019 among women who participated in a pilot micronutrient powder intervention for children 6-23 months of age. The KIIs and FGDs were audio-taped, transcribed verbatim, and analyzed thematically using NVivo 10. Three themes emerging from the KIIs and FGDs were: level of adherence to IYCF recommendations among mothers and caregivers; IYCF recommendations perceived as the hardest to follow; and perceived motivators, facilitators, and barriers to IYCF practices. Mothers in the four districts generally followed the eight IYCF recommendations. Mothers in the Tolon district demonstrated adherence to IYCF practices, often citing the need for early initiation of breastfeeding, timely introduction of complementary feeding, and feeding children aged 9-23 months 3 times daily in addition to breastfeeding. In contrast, mothers in other districts faced challenges that hindered adherence. Giving children 4 or more food groups and timely introduction of complementary feeding were perceived as the hardest practices to follow. The main facilitators of IYCF practices include midwives and frontline nurses teaching mothers how to breastfeed, and midwives ensuring mothers initiate breastfeeding immediately after delivery. The main barriers to IYCF practices identified were insufficient breastmilk; mothers-in-law giving water to children before six months; resumption of work; and lack of financial means. Mothers in the Ho West district reported more barriers to IYCF practices, followed by mothers in the Tain, Talensi, and Tolon districts. Health practitioners, stakeholders, and policymakers should design targeted interventions that address the contextual barriers to improve IYCF practices in the various districts.

Estimating minimum dietary diversity for children aged 6-23 months: a comparison of agreement and cost of two recall methods in Cambodia and Zambia.

To compare the agreement and cost of two recall methods for estimating children's minimum dietary diversity (MDD). We assessed child's dietary intake on two consecutive days: an observation on day one, followed by two recall methods (list-based recall and multiple-pass recall) administered in random order by different enumerators at two different times on day two. We compared the estimated MDD prevalence using survey-weighted linear probability models following a two one-sided test equivalence testing approach. We also estimated the cost-effectiveness of the two methods. Cambodia (Kampong Thom, Siem Reap, Battambang, and Pursat provinces) and Zambia (Chipata, Katete, Lundazi, Nyimba, and Petauke districts). Children aged 6-23 months: 636 in Cambodia and 608 in Zambia. MDD estimations from both recall methods were equivalent to the observation in Cambodia but not in Zambia. Both methods were equivalent to the observation in capturing most food groups. Both methods were highly sensitive although the multiple-pass method accurately classified a higher proportion of children meeting MDD than the list-based method in both countries. Both methods were highly specific in Cambodia but moderately so in Zambia. Cost-effectiveness was better for the list-based recall method in both countries. The two recall methods estimated MDD and most other infant and young child feeding indicators equivalently in Cambodia but not in Zambia, compared to the observation. The list-based method produced slightly more accurate estimates of MDD at the population level, took less time to administer and was less costly to implement.

Promoting responsive care and early learning practices among caregivers of children 0-23 months in the Kyrgyz Republic: findings from integrating a counselling intervention with nutrition services.

To assess changes in caregiver practices for young children after integrating the Responsive Care and Early Learning (RCEL) Addendum package into nutrition services after 10 months of implementation. We measured changes in RCEL practices through a pre- and post-intervention assessment comprising a household survey and observations. To implement the intervention, we trained health service staff and community volunteers to deliver RCEL counselling to caregivers of children 0-23 months of age through existing community and facility-level platforms. Jalal-Abad and Batken regions in the Kyrgyz Republic. Caregivers of children aged 0-23 months at baseline. We found statistically significant increases in RCEL practices, availability of early learning opportunities in the home, decreases in parenting stress and improvements in complementary feeding practices after the intervention implementation period. Findings show that delivery of RCEL counselling using the RCEL Addendum was associated with improved responsive care practices and early learning opportunities. We also found that integration of RCEL with infant and young child feeding counselling did not disrupt nutrition service delivery or negatively affect complementary feeding outcomes, but rather suggest synergistic benefits. Given the importance of providing holistic care to support optimal early childhood development, these findings provide new evidence on how to strengthen the delivery of nurturing care services in the Kyrgyz Republic.

Linking infant and young child feeding practices to Z-scores: Unraveling the impact on childhood stunting and wasting

Abstract Introduction: Poor infant feeding practices predispose children to nutritional disorders which may persist into early childhood with life-long consequences. We aimed to find out prevalence of malnutrition among children aged less than six years and to assess infant and young children feeding practices and their impact on malnutrition. Methods: An analytic cross-sectional study was conducted between March 2021 and May 2022 among children up to six years of age registered in the Anganwadi centers of Rajkot district. Using the formula n = Z 2 pq/e 2, a sample size of 504 was estimated, including 10% nonresponders. Samples were drawn using a multistage simple random sampling method. The z scores related to the anthropometric measurements were estimated using the World Health Organization Anthro 2011 software. We reported prevalence of different types of malnutrition and infant and young child feeding practices. A logistic regression was used to identify significant factors for stunting and wasting (P &lt; 0.05). Results: The mean age of the children was 32.43 months (SD 18.7 months). The prevalence of stunting and wasting was found 36.7% and 30.5%, respectively. The prevalence of prelacteal feeding practices was 72.8%. Less than one-fourth (21.4%) of children were exclusively breastfed and 77.9% of the children received complementary feeding at appropriate age. The binary logistic regression model showed that stunted growth was strongly associated with exclusive breastfeeding and complementary foods’ introduction at the appropriate age. Conclusion: As compared to national, state, and district averages, the prevalence of wasting was remarkably higher among children included in the study. In addition, the study underscores the disturbingly high prevalence of prelacteal feeding practices, which can have a detrimental effect on the health of newborns.

Changing maternal and child nutrition practices through integrating social and behavior change interventions in community-based self-help and support groups: literature review from Bangladesh, India, and Vietnam.

Self-help groups (SHGs) and Support Groups (SGs) are increasingly recognized as effective mechanisms for improving maternal and young child nutrition due to their decentralized, community-based structures. While numerous studies have evaluated the outcomes and impact of SHGs and SGs on nutrition practices, there remains a gap in the literature. To address this, we conducted a literature review to examine the role of SHGs and SGs in improving health and nutrition outcomes, focusing on marginalized women, especially pregnant and lactating women (PLW), in India, Bangladesh, and Vietnam, with an emphasis on programs supported by the international non-governmental initiative, Alive & Thrive. We conducted a literature review to assess various models, summarizing findings from 34 documents, including research studies, evaluation reports, program materials, strategies, annual reports, work plans, and toolkits. Relevant information from these documents was extracted using predetermined forms. In India, the models used SHGs with 10-20 women, federated into larger village and district organizations. Bangladesh and Vietnam SGs have similar structures but with local leaders and committees playing key roles. In all three countries, interventions aimed to improve health and nutrition practices through social behavior change (SBC) interventions, including peer-to-peer learning, interpersonal communication, home visits, and community meetings. Outcomes of the interventions showed that SHG members had increased knowledge of breastfeeding, complementary feeding, and improved dietary diversity compared to non-SHG participants. Interventions helped improve infant and young child feeding practices. Common challenges included sustaining the SHGs, ensuring adequate participation, socio-cultural barriers, and logistical difficulties in reaching PLW in remote areas. Limited time for health topics during SHG meetings and the dissolution of older SHGs were also significant issues. SHG and SG models demonstrate success in improving health and nutrition outcomes but face challenges in scale, sustainability, and participation. Integrating nutrition-focused SBC interventions into SHGs and SGs requires significant capacity building for technical and counseling skills. Ensuring comprehensive coverage and robust quality assessment during community-based rollouts is essential. To sustain these interventions, it is crucial to prevent group dissolution, allow time for maturation, and secure strong stakeholder engagement and political support.

Risk Factors of Postpartum Depression Among Korean Women: An Analysis Based on the Korean Pregnancy Outcome Study (KPOS).

Postpartum depression (PPD) can negatively affect infant well-being and child development. Although the frequency and risk factors of PPD symptoms might vary depending on the country and culture, there is limited research on these risk factors among Korean women. This study aimed to elucidate the potential risk factors of PPD throughout pregnancy to help improve PPD screening and prevention in Korean women. The pregnant women at 12 gestational weeks (GW) were enrolled from two obstetric specialized hospitals from March 2013 to November 2017. A questionnaire survey was administered at 12 GW, 24 GW, 36 GW, and 4 weeks postpartum. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale, and PPD was defined as a score of ≥ 10. PPD was prevalent in 16.3% (410/2,512) of the participants. Depressive feeling at 12 GW and postpartum factors of stress, relationship with children, depressive feeling, fear, sadness, and neonatal intensive care unit admission of baby were significantly associated with a higher risk of PPD. Meanwhile, high postpartum quality of life and marital satisfaction at postpartum period were significantly associated with a lower risk of PPD. We developed a model for predicting PPD using factors as mentioned above and it had an area under the curve of 0.871. Depressive feeling at 12 GW and postpartum stress, fear, sadness, relationship with children, low quality of life, and low marital satisfaction increased the risk of PPD. A risk model that comprises significant factors can effectively predict PPD and can be helpful for its prevention and appropriate treatment.

Characterisation of complementary feeding practice and locally available climate-resilient crops for complementary food among agro-pastoralists of Ethiopia: a qualitative study.

The current study aims to characterise the complementary feeding practice and identify locally available climate-resilient crops that can be used for complementary feeding among agro-pastoralists in Ethiopia. A phenomenological study in Benna-Tsemay district, comprising focused group discussions, key informant interviews, and household observations, was conducted. A pretested guide was used to capture information regarding types of complementary food, lists of food items, and ingredients included in their complementary formulation. A thematic analysis for emerging points of discussion was carried out. Three major themes, including infant and young child feeding practices, food items included in complementary food, and their consumption frequencies, as well as the incorporation of climate-resilient crops into complementary foods as coping mechanisms, emerged. Breastfeeding was common and regarded as essential. Gruel and porridge from grains, roots, and tubers were regular parts of complementary foods in the study area. Moringa and sorghum were dominantly identified as climate-resilient crops regularly grown and used in complementary foods. Growing these crops was regarded as a coping strategy for drought and seasonal constraints. The district is one of the most drought-prone areas in Ethiopia, compromising the quality of complementary food. Unlike the World Health Organization recommendation, the grains, roots, and tubers-based diet formed the basis of complementary food lacking flesh foods, eggs, pulses, and other fruits and vegetables. Thus, it is recommended to improve complementary food quality through value-addition using locally accessible crops.