Maternal, 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.

Right message, right medium, right time: powering counseling to improve maternal, infant, and young child nutrition in South Asia.

Quality counseling can positively impact maternal, infant and young child nutrition (MIYCN) behaviors linked to poor nutrition outcomes. Global guidance includes 93 recommendations on MIYCN counseling. A desk review and key informant interviews sought to assess compliance to the recommendations, reach and quality, systemic gaps and opportunities for MIYCN counseling in seven South Asian countries. Ninety-three (93) policies and guidelines, 180 counseling materials and over 50 documents were reviewed; 115 key informant interviews were conducted. Information synthesis captured eight domains. Data from national surveys were analyzed to determine MIYCN counseling reach, quality and association with nutrition behaviors. Results showed that national guidelines were inconsistent with global recommendations for seven thematic areas. Coverage of contacts points like antenatal and postnatal care (ANC, PNC) with potential to deliver MIYCN counseling was highly variable. Having at least four ANC contacts was significantly associated with consumption of 100+ iron folic acid tablets in all countries. Rates of early initiation of breastfeeding (18% Pakistan to 90% Sri Lanka) were lower than institutional delivery rates, except for Bangladesh and Sri Lanka. PNC contact within 48 h of birth was positively correlated with exclusive breastfeeding in India, Pakistan and Sri Lanka (OR 1.4, 3.1, 3.2). Health worker contacts and wealth status equally influenced child's dietary diversity in India. MIYCN services were add-on roles for community-based workers, except in India. Supervision mechanisms exist but were not focused on quality of MIYCN services. Counseling resources were predominantly paper based (>70%), had rural-focused messaging on diets and mainly targeted women. Platforms to engage men were largely missing. Health management information systems included indicators on maternal contact points in all countries but not for children. Assessing funding for MIYCN counseling was challenging as costs were subsumed across several budget line-items. The research findings can be used to (1) align country guidance with global recommendations, (2) review workforce responsibilities and capacity building with supervision, (3) assess the need for new counseling materials based on coverage of content, service providers and audience, (4) integrate MIYCN counseling indicators in information systems and (5) include MIYCN counseling services with activities and budget in country plans.

What is missing in our understanding of urban slum environments and maternal, infant and young child nutrition from publicly available data in Asia and the Pacific?

Given the recent, rapid urbanisation in Asia and the Pacific region, coupled with increases in the triple burden of malnutrition, we need to better understand maternal, infant and young child nutrition (MIYCN) for populations living in urban slum environments. This research used existing large-scale datasets to explore MIYCN indicators for those living in urban slum, compared with urban nonslum, areas. Data since 2015 from available Demographic and Health Surveys (DHS; Afghanistan, India, Indonesia, Myanmar, Pakistan and the Philippines) and Multiple Indicator Cluster Surveys (MICS; Bangladesh, Fiji, Kiribati, Mongolia, Nepal, Thailand and Tuvalu) were analysed. Most urban children in the 13 countries from the region were breastfed within 24 h of birth, with slightly higher rates for those living in slums. Conversely, almost all indicators of infant and young child malnutrition were worse for those in urban slums. For mothers living in slums, underweight prevalence and iron deficiency anaemia were higher while maternal overweight and obesity prevalence were lower. Analysis revealed disparities across countries in the wealth status of those living in slum versus nonslum areas. What is currently missing is representative sampling of households, adequate collection of data both within and across countries, and accurate representation of slum-dwellers in large-scale surveys. Given that limited data for the region show urban poor slum populations are vulnerable to poor nutrition indicators, more data are needed on the poorest urban slum populations to enable effective resource allocation to support optimal MIYCN.

Determinants of maternal, infant, and young child nutrition during the 1,000-day window of opportunity in Solomon Islands: A focused ethnographic study.

This focused ethnographic study used qualitative, ethnographic, and participatory methods to explore determinants of maternal, infant, and young child nutrition (MIYCN) during the first 1,000 days of life as part of efforts to address the double burden of malnutrition in Solomon Islands. An iterative study design was used to first explore and then confirm findings related to food and nutrition security and social and behavioral determinants of MIYCN in urban and rural settings. The first phase included in-depth interviews, household observations, free lists, and seasonal food availability calendar workshops while the second phase included focus group discussions, pile sorts, participatory community workshops, and repeated household observations. We found that MIYCN is shaped by a complex interaction of factors at the macro- and micro-levels. At the macro-level, globalization of the food system, a shifting economy, and climate change are driving a shift toward a delocalized food system based on imported processed foods. This shift has contributed to a food environment that leaves Solomon Islanders vulnerable to food and nutrition insecurity, which we found to be the primary determinant of MIYCN in this context. At the micro-level, this food environment leads to household- and individual-level food decisions that often do not support adequate MIYCN. Multi-sectoral interventions that address the macro- and micro-level factors shaping this nutrition situation may help to improve MIYCN in Solomon Islands.

Effect of home visits by community health workers on complementary feeding practices among caregivers of children aged 6-23 months in 10 districts of Bangladesh.

Suboptimal complementary feeding contributes to undernutrition in children aged 6-23 months in low- and middle-income countries like Bangladesh. Multifaceted interventions have been taken to improve complementary feeding practices, but there is limited evidence about the effect of home visits by community health workers (CHWs) on complementary feeding practices of the caregivers of children. We collated data from the baseline and the corresponding follow-up survey done as part of an evaluation of Bangladesh Maternal, Infant and Young Child Nutrition (MIYCN) programme. We collected data on complementary feeding practices using a 24-h recall questionnaire. Age-appropriate dietary diversity, minimum meal frequency, and minimum acceptable diet were assessed based on recommended food consumption as per child's age. To understand the effect of CHWs' visits on complementary feeding practices, we performed Generalized Estimating Equation (GEE) procedure for dealing with correlated data and adjusted other covariates. A total of 758 and 745 caregivers of children aged 6-23 months participated in the baseline and follow-up survey, respectively. Complementary feeding practices were improved in 1 year of programme implementation; dietary diversity increased from 46 to 54%, minimum meal frequency from 82 to 91%, and minimum acceptable diet from 41 to 53%. Caregivers of children who had received the visit of CHWs in the last 12 months prior to the day of the follow-up survey were more likely (AOR 1.51; 95% CI 1.10-2.10) to maintain dietary diversity in their children's feeding practices than the caregivers who had not received a CHW visit in the last 12 months. The likelihood of maintaining a minimum acceptable diet in feeding practices was 1.57 times higher (AOR 1.57; 95% CI 1.14-2.17) among the caregivers who were exposed to the visits of the CHWs in the last 12 months compared to the caregivers who were not exposed to the CHW's visits in the last 12 months. Integration of promotional activities of complementary feeding practices into the mainstream nutrition programme can be instrumental in optimizing complementary feeding practices among the caregivers of the under-five children. However, home visits by CHWs should be prioritized in such an integrated programme.

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.

Behavioural drivers of suboptimal maternal and child feeding practices in Rwanda: An anthropological study.

At 33% of under-5s, stunting rates in Rwanda remain stubbornly high, as do figures for maternal (25% of pregnant women) and childhood anaemia (37%). Intensive communication and education campaigns have provided caregivers with high levels of knowledge about best practices in Maternal, Infant and Young Child Nutrition (MIYCN), but this is not translating into the improved diets which could contribute to reducing rates of stunting. Deploying an anthropological approach via multi-module Focused Ethnographic Studies carried out within household case studies, the research team sought to understand drivers of suboptimal feeding practices in a sample of 30 households across all of Rwanda's districts. The sample included households with pregnant women as well as children in the 6-60 month age range. Analysed against a framework of proximal and underlying causes of under-nutrition, our results reveal gaps in the knowledge-capability-practice chain resulting from decisions and prioritisations taken by caregivers and heads-of-household. Pregnant women and mothers of young children possess high levels of knowledge about feeding themselves and their young children, but this is not reflected in decision-making and prioritisation around the acquisition and feeding of animal source foods, whose consumption is low among both groups. This was found to be true even in households which own and raise livestock. Turning to policy and programmes, we argue for a move towards incentivized human capital programming focusing on the 'last mile' behaviour change which is needed to translate knowledge and capability into better dietary choices.

Strengthening Maternal, Infant, and Young Child Nutrition Training and Counseling in Ghana: A Community-Based Approach

ABSTRACTBackgroundEvidence-based maternal, infant, and young child nutrition (MIYCN) counseling provides caregivers essential nutrition education to optimize infant and young child feeding practices and subsequently improve child growth and development. Effective integration of responsive feeding (RF) into current MIYCN training requires working with priority communities.ObjectivesStudy objectives were to 1) assess MIYCN knowledge and practices among Ghanaian caregivers, 2) identify factors influencing RF/responsive parenting (RP) among Ghanaian caregivers, 3) identify barriers and facilitators influencing MIYCN training and counseling among Ghanaian health care providers, and 4) document recommendations for integrating an RF curriculum into the existing MIYCN training.MethodsThis was a qualitative study, conducted within the Central Region of Ghana, based on 1) 6 focus groups with caregivers of young children (<36 mo; n = 44) and 2) in-depth interviews with health care providers (n = 14). Focus group transcripts were coded independently, consensus was reached, and a final codebook developed. The same coding process and thematic analysis were applied to the in-depth interviews.ResultsCaregivers identified 3 domains influencing the primary outcome of RF/RP knowledge and practices and the secondary outcome of MIYCN: 1) health care provider counseling; 2) support from family, friends, and community members; and 3) food safety knowledge and practice. Providers identified barriers to MIYCN provider training as well as caregiver counseling which included limited access to financial and counseling resources and limited qualified staff to deliver infant and young child feeding counseling. Identified facilitators included availability of funding and counseling staff with adequate resources. Health care providers strongly endorsed integrating an RF curriculum into MIYCN training and counseling along with providing RF training and distribution of RF materials/tools to facilities.ConclusionsHealth care providers directly influenced RF/RP practices through MIYCN counseling. Strengthening MIYCN counseling through the integration of an RF curriculum into MIYCN training is desired by the community.

Expanding Integrated Competency-Focused Health Worker Curricula for Maternal Infant and Young Child Nutrition

Maternal, infant, and young child nutrition (MIYCN) is important for health, survival, productivity, and development. Knowledgeable, skilled health workers are vital to provide quality care, improve health outcomes, and meet global nutrition targets. When nutrition is not adequately addressed in pre-service curricula, health workers may not be equipped with the knowledge, skills and confidence required to deliver nutrition services and accurate information free of commercial influence. Curriculum review, revision, and competency structuring provides an opportunity to benchmark course topics and content to global standards, to increase focus on learner outcomes, and to facilitate mutual recognition of qualifications across countries and regions. This paper discusses a multistage process to map an existing curriculum, analyse expected competencies, and recognize broader factors when developing a competency-focused curriculum in pre-service education that includes MIYCN. Examples of tools are provided which can be used for review and discussion of curricula and competency at local and national level and to integrate skills such as communication and counselling.

Data Use Aids Adaptation and Continuation of Maternal, Infant and Young Child Nutrition (MIYCN) Services in Urban Health Facilities in Bangladesh During the COVID-19 Pandemic

ObjectivesThe COVID-19 pandemic disrupted health services worldwide. Alive and Thrive (A&T) is testing MIYCN integration into non-governmental organizations’ (NGOs) health services in eight facilities in Dhaka. We aimed to develop a data-driven urban MIYCN intervention pathway adapted to continue delivering nutrition services during COVID-19. MethodsA&T used its learnings from previous interventions and formative research to design an urban MIYCN intervention with a social and behavior change strategy set to improve nutrition practices. Mixed monitoring data were used to track the intervention elements capacity building, demand creation, service delivery, and supervision; and COVID-19 situation domains lockdown, restrictions, guidelines, staff turnover, contextual and behavior changes, adaptations, and budget implications. COVID-19 studies as well as external value chain, market, and food security reports were used. Monthly monitoring data were used to identify and validate potential adaptations. ResultsIntervention adaptations and adoption of government requirements for nutrition services allowed MIYCN services to continue during the pandemic; recurrent users reached seven or more counseling sessions. The intervention incorporated virtual capacity building; MIYCN counseling, supervision, and demand creation for services via mobile phones; and community mobilization via satellite clinics and referrers. The use of monitoring data allowed documenting the intervention pathway with some original intervention components pre-pandemic, and other components delivered after adapting to restrictions during lockdown and after lockdown was lifted. Adaptations were based on national and global requirements and on social and individual behaviors during the pandemic (e.g., fearful mothers not coming to facilities). ConclusionsData use elucidated how to deliver urban MIYCN services and adapt amidst the ongoing pandemic. NGOs providing government-aligned health services can potentially address the urban gap, and advance nutrition services and improved practices during crisis. Documenting an evidence-based intervention pathway visualizing adaptations will guide the endline study to maximize learnings for the MIYCN community in Bangladesh and globally. Funding SourcesBill & Melinda Gates Foundation through Alive & Thrive FHI Solutions.

Assessment of Maternal Infant and Young Child Nutrition (MIYCN) Knowledge and Practices Among Obstetricians and Pediatricians in Private Health Facilities in India

Objectivesi) To assess current MIYCN knowledge and practices among obstetricians and pediatricians in private facilities ii) To identify bottlenecks to adopting evidence- based MIYCN guidelines in private facilities MethodsThe study used an observational cross-sectional design and mixed methods for an online self-administered survey with 360 pediatricians and 99 obstetricians (members of the Indian Academy of Pediatrics and Federation of Obstetric and Gynaecological Societies of India). The study included onsite interviews with 55 obstetricians and 59 pediatricians selected randomly during assessments in 114 private health facilities where they provided services across 3 purposefully selected cities in each of the 5 states (Uttar Pradesh, Bihar, Gujrat, Maharashtra and Karnataka). States were purposefully selected for high burden of undernutrition and high number of private practitioners. ResultsHalf of obstetricians knew the recommended dosage of iron supplementation during pregnancy, while 42% knew recommendations postpartum. Knowledge around weight gain during pregnancy and dietary requirements was limited. 75% of providers reported delayed initiation of breastfeeding in C-section deliveries. Over 90% of pediatricians knew about exclusive breastfeeding; but 40% of obstetricians and 11% of pediatricians had prescribed breastmilk substitutes. Only one third of pediatricians understood the importance of dietary diversity in complementary feeding. 70% of facilities had no maternal nutrition protocols. Roadblocks to optimal practices were lack of training and of evidence-based protocols, as well as non- recruitment of lactation counselors and dieticians. Half of the obstetricians and pediatricians reported ever being trained on MIYCN. ConclusionsFindings reveal a need to improve private obstetricians and pediatricians’ knowledge on MIYCN and prioritize nutrition in medical associations’ continuing education. Data support calls to action to institutionalize the integration of MIYCN into MNCH service protocols in private health facilities. Funding SourcesBill & Melinda Gates Foundation through Alive & Thrive FHI Solutions.

Household food insecurity and unimproved toilet facilities associate with child morbidity: evidence from a cross-sectional study in Bangladesh

BackgroundDespite recent progress in rural economic development and food production, the prevalence of household food insecurity (FI) and use of unimproved toilet facilities are widespread in Bangladesh. Evidence regarding the consequencs of household FI and poor sanitation on child morbidity is scarce. This study aimed to understand the association of FI and unimproved toilet facility with morbidity status of under-5 children in Bangladesh.MethodsWe used data from a cross-sectional survey that was conducted as part of an evaluation of the Maternal, Infant and Young Child Nutrition (MIYCN) Program in 9 districts of Bangladesh. The study population included children aged 6–59 months and their caregivers, identified using a two-stage cluster-sampling procedure. Child morbidity status was the outcome variable, and household FI status and type of toilet used were considered the main exposure variables in this study. We performed logistic regression, calculated adjusted odds ratios (AOR) to assess the association of child morbidity with household FI and unimproved toilet facility after adjusting for potential confounders.ResultsA total of 1,728 households were eligible for this analysis. About 23% of the households were food-insecure, and a large number of households had improved toilet facilities (93.4%). In the multivariable logistic regression model, we found that children in food-insecure households with unimproved toilet facility had 5.88 (AOR: 5.88; 95% CI 2.52, 13.70) times more chance, of being morbid compared to the children of food-secure households with improved toilet facility. A similar association of FI and toilet facilities with each of the morbidity components was observed, including diarrhea (AOR:3.6; 95% CI 1.79, 7.89), fever (AOR:3.47; 95% CI 1.72, 6.99), difficult or fast breathing with cough (AOR:3.88; 95% CI 1.99, 7.59), and difficult or fast breathing with blocked or running nose (AOR:1.29; 95% CI 0.56, 2.95).ConclusionsOur study shows that household FI and unimproved toilet facility jointly have more deteriorative effects on child morbidity than either of these conditions alone. Therefore, it is recommended to consider these two critical factors while designing a public health intervention for reducing morbidity among under-five children.

Participatory Nutrition Capacity Assessment and Capacity Development in Six Regions of Ethiopia

Abstract Objectives The multi-faceted causes of malnutrition make capacity development in nutrition complex. Defining capacity development actions requires an understanding of the landscape actors utilize to address the determinants. Thus, six regional health bureaus (RHB) in Ethiopia, in collaboration with Alive &amp; Thrive (A&amp;T), conducted participatory capacity assessments to identify capacity strengths and gaps, and co-developed appropriate maternal, infant, and young child nutrition (MIYCN) capacity development plans linked to achieving targets outlined in the national nutrition program. Methods From April to June 2019, 143 nutrition practitioners in six regions of Ethiopia conducted rapid participatory assessments of their respective regional capacity. They used an adapted assessment tool based on WHO's six system building blocks, and a four-level scoring guide to identify MIYCN capacity strengths and gaps on 87 statements of excellence. Validated by RHB's leadership, the assessors and A&amp;T co-developed region-specific MIYCN capacity development plans for areas rated ‘poor’ and ‘fair’. Results An aggregate assessment score for six regions revealed presence of adequate MIYCN implementation capacity – excellent (25.3%), moderate capacity with basic ones in place or in use – good (37.9%), low capacity needing attention – ‘fair’ (23.6%), and no capacity or critical capacity limitation needing urgent attention – ‘poor’ (9.4%). Using a prioritization matrix, MIYCN-focused performance strengthening plans were designed, tailored to each region's context. Beginning in July 2019, the six RHBs incorporated key MIYCN improvement action items targeted towards ‘poor’ and ‘fair’ performance areas with relevant indicators into their annual plans, budget structure, and M&amp;E framework. A&amp;T and other partners provided technical assistance and coordinated their efforts with RHBs to spirally build regional MIYCN implementation capacities. Conclusions The participatory capacity assessment served to establish a baseline of existing MIYCN implementation capability; and create a strong and shared commitment within the health sector identifying areas for improvement that can be addressed by the government, with little or no external assistance. Funding Sources The Bill &amp; Melinda Gates Foundation.

Nutrition Information Systems in Ethiopia: Strengths and Challenges

Abstract Objectives The success of a nutrition program heavily relies on availability of information for measuring changes in nutrition outcomes and tracking progress in the implementation of nutrition-specific and nutrition-sensitive interventions. This study examined the nutrition information systems that capture nutrition-specific and nutrition-sensitive data in the context of the second National Nutrition Program (NNP II) implemented by the Government of Ethiopia since 2013 with particular focus on maternal, infant, and young child nutrition (MIYCN). Methods Conducted at both national and regional levels, the study employed a cross-sectional study design pursuing a qualitative data collection method. In-depth interviews were conducted with 134 participants selected from 70 national and regional institutions including ministerial and regional offices of selected sectors, special programs and non-governmental organizations. In each organization, NNP II focal persons and Monitoring and Evaluation or Health Management Information system (HMIS) focal persons were purposively selected for interviews. In addition, desk reviews constituted secondary data. The data was thematically analysed using ATLAS.ti version 8. Results The study revealed that the individual sectors and nutrition programs have information systems that capture nutrition data, either alone or as part of systems gathering data on multiple programs and interventions. The findings also show that, except for the health sector, the nutrition information systems in three NNP signatory sectors (education, women children and youth and water irrigation &amp; energy) are in their infancy and are not collecting nutrition-sensitive indicators as required by the NNP II. Important indicators on critical nutrition interventions are lacking in the HMIS. Health workers and managers needed much more information than what the systems currently provide. Conclusions Except the HMIS, the nutrition information systems in place are sub-national and program specific, thus cannot complement the HMIS. Besides, some key MIYCN indicators are missing from the HMIS. Currently, there is no single unified functional national nutrition information system in Ethiopia to inform the NNP II. Funding Sources The Bill &amp; Melinda Gates Foundation.

Implementing Care Groups for improved maternal and child nutrition: Critical factors for success from the Amalima program in rural Zimbabwe

Over the last decade Zimbabwe has made noteworthy progress in reducing both underweight and wasting in children under the age of five years, however one in four children in Zimbabwe is stunted. The rate in the decline of the number of children stunted still falls short of meeting the World Health Assembly target, and it goes without saying that effective, innovative community-based strategies are required by the government and development partners to accelerate the rate of stunting reduction. This paper presents experiences from using the Care Group approach for promoting improved maternal, infant and young child nutrition (MIYCN) and care based on lessons from the Amalima program, a seven-year United States Agency for International Development (USAID) Office of Food for Peace intervention. The Amalima program has been promoting Care Groups as a community and family centred approach to improve maternal and child nutrition in Zimbabwe. Care Groups are an innovative community-based strategy that has been rolled out as part of the Amalima program activities in four food and nutrition insecure districts in Zimbabwe. The final programme evaluation suggested the program succeeded in increasing the exclusive breastfeeding rate and reducing levels of nutritional stunting among children under two years. In the present discussion paper, we present the key lessons learned and strategies we believe may have contributed to making Care Group implementation effective; we highlight the modifications that we made in Care Group implementation to ensure a context appropriate approach; and we discuss how Care Groups can be integrated into the Ministry of Health and Child Care structure. The critical factors for successful Care Group implementation have been grouped into five broad categories: conduct formative research; ensure context specific approaches &amp; adaptive management; leverage on social capital and cohesion; invest in human capital; prioritise quality assurance &amp; reviews.

Systematic Review of Behavioral Interventions to Increase Family Support for Maternal and Child Nutrition in Low- and Middle-Income Countries

Abstract Objectives To examine the scope and impact of behavioral interventions to increase family support for maternal, infant, and young child nutrition (MIYCN) practices in low- and middle-income countries (LMICs). Despite the recognized influence of fathers, grandmothers, and other family members, we lack a comprehensive review of how interventions engage them and how engagement impacts MIYCN. Methods We first conducted a scoping review to identify family-focused interventions and then a mixed methods review to assess impacts. We systematically searched PubMed, Scopus, Web of Science, Global Health, and CINAHL for peer-reviewed studies of behavioral interventions to increase family support for MIYCN. We screened 5733 abstracts and evaluated 142 full-text articles. Quantitative and qualitative results were examined independently. (PROSPERO ID# CRD42018090273) Results The scoping review of intervention approaches included 48 studies; the mixed methods systematic review assessing impact included 16 comparative quantitative studies and 13 qualitative studies. A wide range of approaches were used to engage family members to support MIYCN, including multi-channel strategies with community outreach. Most comparative research relied on direct counseling and focused on breastfeeding in first 6 months, primarily engaging fathers (9) or, less often, grandmothers (2) or both (2). Most (10/13) found positive impacts on exclusive breastfeeding rates and some associated practices and on family members’ awareness and support to mothers. The 3 studies on maternal nutrition, complementary feeding, or multiple MIYCN indicators also suggested benefits of engaging family members. Qualitative themes included improved nutrition behaviors, enhanced relationships, and challenges due to social norms. Conclusions Interventions engaging family members in LMICs can increase awareness, build support for MIYCN, and improve practices. While many positive outcomes were reported, more rigorous study designs testing causal relationships, and implementation research to elucidate pathways and identify factors shaping effectiveness, are needed. Important gaps include research on interventions that support maternal nutrition and complementary feeding, include nutrition-sensitive activities, and utilize gender transformative approaches. Funding Sources USAID.

The Role of the Opinion Leader Research Process in Informing Policy Making for Improved Nutrition: Experience and Lessons Learned in Southeast Asia.

ABSTRACTOpinion leader research (OLR) has been widely used in public health to identify influential persons or organizations to affect health care practice, inform policy-making processes, and help shape communication strategies. We used OLR to gather information related to barriers and possible solutions to guide strategic engagement for strengthening policy making for improved maternal, infant, and young child nutrition (MIYCN) practices in 5 Southeast Asian countries—Cambodia, Laos, Indonesia, Timor-Leste, and Thailand. In most countries, MIYCN policies and policymaker interest exist, but effective implementation and/or enforcement of current policies is weak. This article aims to share our experience in and lessons learned from using OLR as an advocacy tool: It helped identify opinion leaders with interest and influence to affect nutrition-related policies, it raised opinion leaders’ interest in MIYCN, and it identified themes that would help generate political priority setting. Based on our experience, we recommend OLR as a strategic activity for informing and generating support for MIYCN policy-making processes.

Mixed-Methods Systematic Review of Behavioral Interventions in Low- and Middle-Income Countries to Increase Family Support for Maternal, Infant, and Young Child Nutrition during the First 1000 Days.

ABSTRACTFathers, grandmothers, and other family members’ influence on maternal, infant, and young child nutrition (MIYCN) is widely recognized, yet synthesis of the effectiveness of engaging them to improve nutrition practices during the first 1000 d is lacking. We examined the impact of behavioral interventions to engage family members in MIYCN in low- and middle-income countries through a mixed-methods systematic review. We screened 5733 abstracts and included 35 peer-reviewed articles on 25 studies (16 with quantitative and 13 with qualitative data). Most quantitative studies focused on early breastfeeding, primarily engaging fathers or, less often, grandmothers. Most found positive impacts on exclusive breastfeeding rates and family members’ knowledge and support. The few quantitative studies on complementary feeding, maternal nutrition, and multiple outcomes also suggested benefits. Qualitative themes included improved nutrition behaviors, enhanced relationships, and challenges due to social norms. Interventions engaging family members can increase awareness and build support for MIYCN, but more rigorous study designs are needed. This systematic review is registered at PROSPERO as CRD42018090273, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=90273.

Perspectives on maternal, infant, and young child nutrition and family planning: Considerations for rollout of integrated services in Mara and Kagera, Tanzania.

In Lake Zone, Tanzania, low contraceptive prevalence, closely spaced births, and child stunting are common. Synergies exist between postpartum family planning (PPFP) and maternal, infant, and young child nutrition (MIYCN), yet health services are often provided in silos. This qualitative formative research study aimed to identify barriers and facilitating factors for optimal nutrition and PPFP practices in Mara and Kagera, Tanzania. Results informed the program design of an integrated nutrition and family planning (FP) implementation approach. The study involved in‐depth interviews with mothers of infants under 1 year (n = 24), grandmothers (n = 12), health providers (n = 6), and traditional birth attendants (n = 12), and 14 focus group discussions with community health workers, fathers, and community leaders. Findings reveal that breastfeeding initiation was often delayed, and prelacteal feeding was common. Respondents linked insufficient breast milk to inadequate maternal nutrition—in terms of the quality of the diet and small quantities of food consumed by mothers. Breast milk insufficiency was addressed through early introduction of foods and liquids. Mothers believed that breastfeeding prevents pregnancy, regardless of the frequency or duration of breastfeeding, yet were generally not aware of the lactational amenorrhea method (LAM) of FP. Joint decision‐making on FP was viewed as important, and women often discussed it with their partner. Future programming should address misconceptions about return to fecundity1 knowledge gaps and concerns about FP methods including LAM; and perceptions regarding insufficient breast milk and early introduction of foods which are impediments to optimal MIYCN and FP practices.

The power of counseling: Changing maternal, infant, and young child nutrition and family planning practices in Dhamar, Yemen

We conducted a study to determine current maternal, infant, and young child nutrition (MIYCN) and family planning (FP) practices and how practices can be improved with counseling. The study consisted of qualitative methods. Mothers and couples were able to attempt and adopt new practices after only one counseling visit, except consuming meat daily due to cost, and adopting contraception, which was challenging due to health system constraints. Most appreciated receiving information, reported positive experiences, and said they would continue practices. It is possible to improve these practices through counseling, although some systems factors should be addressed.