Child Nutrition Programs Research Articles

The Impact of COVID-19 on Breastfeeding Initiation and Duration in a Low-Income Population, Washington, DC.

Objective: To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on breastfeeding initiation (BFI) and duration among women enrolled in the Special Supplemental Nutrition Program for women, infants, and children (WIC) in Washington District of Columbia (DC). Materials and Methods: We used WIC program data from Washington DC to assess the pandemic's impact on BFI and duration among WIC recipients. t-Tests and unadjusted odds ratios compared breastfeeding outcomes before and during the pandemic. Multivariable logistic and linear regression models estimated the pandemic's impact on initiation and duration, respectively, while controlling for social determinants of health and other factors. Results: BFI was similar among women who gave birth before (61.4%) or during the pandemic (60.4%) (p = 0.359). However, the proportion of women who breastfed at 1 month decreased significantly from 56.1% (before pandemic) to 47.6% (during pandemic) (p < 0.0001). This pattern for duration continued at 3 and 6 months: 46.9% to 37.1% (p < 0.0001) at 3 months and 34.8% to 25.7% (p < 0.0001) at 6 months. On average, women who delivered during the pandemic breastfed 33.9 fewer days than those who delivered before (p < 0.0001). Conclusions: BFI among DC WIC recipients was similar for infants born before or during the pandemic, and determinants of initiation remained similar to previous reports (e.g., race/ethnicity, education). However, for women who initiated breastfeeding, average duration was significantly lower for infants born during the pandemic than before. Our findings suggest the importance of leveraging WIC and other breastfeeding supports to promote breastfeeding during pandemics and other emergencies.

Women empowerment and childhood stunting: evidence from rural northwest Ethiopia

BackgroundWomen are often the primary caregivers of children, and as such, their empowerment could influence the nutritional status of their children. However, the role of maternal empowerment on the nutritional status of children in Ethiopia is largely unknown.AimTo determine the association of women’s empowerment with childhood stunting in rural northwest Ethiopia.MethodsA community-based cross-sectional study was conducted among 582 mothers with children aged 6–59 months. A multistage sampling technique was used to select the study participants. Binomial logistic regression analyses were used to assess whether women’s empowerment (categorized as low, moderate and high) and its five dimensions (household decision-making, educational status, cash earnings, house/land ownership, and membership in community groups) were associated with stunting in children. Odds ratios with 95% CI were estimated, and statistical significance was declared at a p-value of < 0.05.ResultsA total of 114 (19.6%), 312 (53.6%), and 156 (26.8%) participants had low, moderate, and high empowerment levels, respectively. In addition, 255 (43.8%) mothers had children who were stunted (too short for their age). In the adjusted models, mothers with moderate empowerment (AOR 0.60, 95% CI: 0.35, 0.97) and high empowerment (AOR 0.56, 95% CI: 0.37, 0.86) had lower odds of having stunted children compared to mothers with low empowerment. Mothers who had a secondary education or higher (AOR 0.57, 95% CI: 0.35, 0.93), owned a house or land (AOR 0.64, 95% CI: 0.44, 0.94) and were members of community groups (AOR 0.54, 95% CI: 0.36, 0.80) were less likely to have stunted children.ConclusionHigh women empowerment was significantly associated with a lower likelihood of childhood stunting. The findings suggest a need to look beyond the direct causes of stunting and incorporate targeted strategies for empowering women into child nutrition programs.

Healthy School Meals for All in Utah.

The National School Lunch and School Breakfast programs reduce food insecurity and improve dietary intake. During the COVID-19 pandemic, school meals were provided to all children at no cost, regardless of income. This policy is known as Healthy School Meals For All (HSMFA). The purpose of the study was to examine the feasibility of a HSMFA policy in Utah. A mixed-methods approach was used, including qualitative interviews for policymakers, surveys for school foodservice directors, and financial modeling of Utah Child Nutrition Programs data. Analysis included a phenomenological analytic approach for qualitative data, descriptive statistics for surveys, and development of a cost model with 6 scenarios. Qualitative data revealed themes of (1) awareness; (2) responsibility; (3) perspectives on school meals; and (4) new opportunities. Most (81%) foodservice directors believed HSMFA should continue post-pandemic. HSMFA would cost $51,341,436 to $82,358,375 per year. HSMFA would result in the equitable treatment of all children regarding access to healthy school meals. Given the support of foodservice directors but the lack of political consensus, considering stepwise implementation and providing cost estimates may increase feasibility of a HSMFA policy in Utah.

Relative impacts of a virtual cooking and nutrition program for children and families

Relative impacts of a virtual cooking and nutrition program for children and families

Portable digital devices for paediatric height and length measurement: A scoping review and target product profile matching analysis.

Routine anthropometry of children, including length/height measurement, is an essential component of paediatric clinical assessments. UNICEF has called for the accelerated development of novel, digital height/length measurement devices to improve child nutrition and growth surveillance programs. This scoping review aimed to identify all digital, portable height/length measurement devices in the literature or otherwise available internationally. We also assessed identified devices against the UNICEF Target Product Profile (TPP) to identify those of highest potential for clinical and public health use. We searched four databases (Medline, Embase, CINAHL and Global Health) and the grey literature between 1st January 1992 and 2nd February 2023. We looked for studies or reports on portable, digital devices for height or length measurement in children up to 18 years old. Citations were screened independently by two reviewers, with data extraction and quality assessment performed in duplicate and disagreements resolved. Devices were evaluated and scored against the 34 criteria of the UNICEF TPP. Twenty studies describing twelve height/length measurement devices were identified, most of which used prospective validation designs. Additional devices were found in the grey literature, but these did not report key performance data so were not included. Across the twelve devices, only 10 of 34 UNICEF criteria on average could be fully assessed. Six met UNICEF's ideal accuracy standard and one device met the minimum accuracy standard. The Leica DistoD2 device scored highest (41%), followed by Autoanthro in a controlled environment (33%) and GLM30 (32%). These devices may be high potential for further assessment and development, though further research is required. While 12 portable, digital devices exist for child height/length measurement, insufficient data are available to fully assess whether they meet the industry's needs. Although some devices show promise, further research is needed to test the validity of these devices in varying contexts, and continued development and commercialization will be important to improve reliability and precision of these devices for widespread use.

The Silent Victims of the Pandemic: Children During the Coronavirus Disease 2019 Crisis.

The coronavirus disease-19 pandemic has adversely affected children's health since its inception. Apart from the mortality and morbidity due to infection, child health monitoring, vaccination, and nutrition programs, especially in newborns and young children, have been disrupted. Measures such as school closures and curfews to prevent the spread of infection brought along many physical and mental health problems by causing disruption of education, social isolation, and closure of children at home. The possible long-term effects of the delayed implementation of the Sustainable Development Goals in Health have also deeply affected children, who are the most vulnerable victims of the coronavirus disease-19 pandemic.

Determinan Stunting Balita di Wilayah Kerja Puskesmas Moutong, Kabupaten Parigi Moutong, Sulawesi Tengah

Introduction: The causes of stunting are maternal nutritional status, non-exclusive breastfeeding, low birth weight, and family income. This study aims to analyze the determinants of stunting among toddlers at Moutong Health Center in 2020. The research method used was cross-sectional. The study was conducted from March 3 to March 21, 2020, at Moutong Health Center, Parigi Moutong, Central Sulawesi. The data used in this study were secondary data from 2020. The sample size consisted of 222 toddler respondents. Simple random sampling technique was employed. Data analysis was performed using chi-square test and odds ratio. The results of the study showed that the highest prevalence of stunting was found among pregnant women with low nutritional status (61.1%), non-exclusive breastfeeding (59.6%), low birth weight (55.9%), and low family income (68.2%). Chi-square test indicated that all variables had significant values (&lt;0.05). Multivariate analysis showed an odds ratio of 4.5 for low birth weight and stunting. In conclusion, this study found that low birth weight had a 4.5 times higher risk of stunting. It is recommended that healthcare professionals conduct education, prevention, and early detection of stunting, monitor the provision of maternal and child nutrition programs to pregnant women and toddlers, and provide assistance to low-income families or those who are unable to afford proper nutrition.

Impacts of Covid-19 School Closures on School Food Service Revenue: Analysis of Public Local Education Agencies in Maryland.

The public health policies and school closures in response to the Covid-19 pandemic have created disruptions in school meal programs. Research is needed to understand the changes in school food service revenue before and during the initial Covid-19-related school shutdowns. A longitudinal cohort study examining federal and state reimbursements as well as sales revenues for all public local education agencies (LEAs) in Maryland from school years (SY) 2018-2019 and 2019-2020 was conducted. Monthly changes in federal and state reimbursements for Child Nutrition Programs, including the National School Lunch Program (NSLP), School Breakfast Program (SBP), Summer Food Service Program (SFSP), and Child and Adult Care Food Program (CACFP) were examined. In the SY 2018-2019, the total revenues from federal and state reimbursements for SBP, NSLP, SFSP, and at-risk CACFP were $272.9million; in comparison, for the SY 2019-2020, the total revenues were $241.8million (11.4% reduction from SY 2018-2019). On average, the school shutdown (during March to June 2020) was associated with a $450,385 (p-value < .01) reduction in federal and state reimbursements per LEA-month (41% reduction). The school shutdown during the Covid-19 pandemic was associated with a statistically significant reduction in school food service revenues across Maryland's public LEAs.

Interdisciplinary feeding clinic during the coronavirus disease 2019 pandemic: Implementing telehealth and social determinants of health screening.

Interdisciplinary feeding clinic during the coronavirus disease 2019 pandemic: Implementing telehealth and social determinants of health screening.

Learning from the Implementation of the Child Nutrition Program: A Mixed Methods Evaluation of Process.

Nutrition and feeding interventions are important for children's growth and development. Holt International's Child Nutrition Program (CNP) is a child nutrition and feeding intervention. This study aims to describe and explore the implementation of CNP in Mongolia and the Philippines using mixed methods including qualitative and quantitative data analysis. The analysis framework was guided by the WHO's Monitoring the Building Blocks of Health Systems. Key informant interviews (KIIs) were conducted, transcribed, translated and coded. Knowledge, Attitude and Practice Surveys (KAPS) and pre-/post-tests from routine program audit data were analyzed. Analysis of nutrition (Mongolia: 95% CI: 7.5-16.6 (p = &lt; 0.0001), Philippines: 95% CI: 7.6-15.7 (p= &lt; 0.0001)) and feeding (Mongolia: 95% CI: 11.7-23.9 (p = &lt; 0.0001), Philippines: 95% CI: 6.6-16.9 (p = &lt; 0.0001)) tests indicate improvement post-training in both countries. KAPS indicate changes in desired practices from pre-training to post-training. Thematic analysis of KIIs highlight essential components for program implementation and effectiveness, including strong leadership, buy-in, secure funding, reliable supply chains, training and adequate staffing. This evaluation of program implementation highlights successful strategies and challenges in implementing CNP to improve the health of children in Mongolia and the Philippines. Lessons learned from the implementation of CNP can inform growth of the program, scaling strategies and provide insights for similar interventions.

Health Care as a Partner in Federal Nutrition Programs: Call for Advocacy.

Health Care as a Partner in Federal Nutrition Programs: Call for Advocacy.

Child stunting and associated risk factors in selected food-insecure areas in Rwanda: an analytical cross-sectional study

Introductionstunting rates among the under-five children are generally high in Rwanda. They are unexpectedly lower than the national average stunting rate in some districts where poverty rates are the highest in the country. This study aimed to ascertain the key factors that protect children from stunting in these poorest areas, where stunting rates are lower than expected.Methodswe analysed cross-sectional data from 2019/2020 Rwanda Demographic and Health Survey (RDHS) for 477 under-five children from Karongi, Rulindo, Nyanza, and Gisagara districts. Univariate and bivariate statistical analyses were used to find out the factors to retain for multivariable analysis. We obtained the key risk factors of child stunting through a multivariable binary logistic regression analysis.Resultsthe child stunting rate in the study districts was 30 percent, which is three percent lower than the national average rate. Child stunting was negatively associated with a birth weight of at least 2.5 kg (AOR = 0.393, 95% CI: 0.180 - 0.856), a high household economic status (AOR = 0.506, 95%CI: 0.273 - 0.937), urban residence (AOR = 0.467; 95% CI: 0.222 - 0.984), and health insurance coverage (AOR = 0.418; 95% CI: 0.228 -0.767). Children aged one year and above, as well as female-headed households, were associated with at least three times and two times greater odds of child stunting than children aged below 12 months and those from male-headed households respectively.Conclusionthe nutritional performance of children in the study districts is substantially driven by the high uptake of health insurance, which fosters increased access to healthcare services. To address child-stunting gaps in low-income areas in Rwanda, child nutrition programs should improve the utilization of healthcare services, and leverage the potential high effect of nutrition education, especially during pregnancy and lactation.

Maternal mental health and child nutritional status in an urban slum in Bangladesh: A cross-sectional study

Poor mental health may diminish a mother’s capacity to adequately care for her child, resulting in a negative impact on the child’s nutrition. This study aims to determine the association between maternal mental health and child nutritional status in a poor urban population in Bangladesh. We carried out a cross-sectional study among 264 mother-child pairs in an urban slum area of Bangladesh. The Self-Reporting Questionnaire-20 (SRQ-20) was used to assess maternal mental health. An SRQ-20 score ≥7 was considered a common mental disorder (CMD). Anthropometric measurements were performed to assess nutritional status of the children. The prevalence of maternal CMD was 46.2%. Maternal CMD was associated with poorer child feeding practice (p<0.001), poorer hygiene practice (p<0.001), poorer preventive care service use (p = 0.016), and suffering from diarrheal diseases (p = 0.049). The prevalence of stunting, wasting and underweight in children was 44.3%, 18.2% and 33.7%, respectively. A poorer child feeding practice was associated with wasting (p = 0.004) and underweight (p<0.001) but not with stunting. Poorer hygiene practices and suffering from diarrheal diseases were associated with stunting and underweight, but not with wasting. In multivariable analysis, maternal CMD was associated with child wasting (adjusted odds ratio, aOR = 2.25, 95% CI = 1.15–4.43). The association between maternal CMD and child underweight found in the bivariate analysis was attenuated and no longer statistically significant after multivariable analysis (aOR = 1.77, 95% CI = 0.94–3.33). No statistically significant association was observed between maternal CMD and stunting in this study (aOR = 1.46, 95% CI = 0.84–2.54). Maternal mental health affects nutritional status of the children where child feeding practice, hygiene practice and preventive care use might play a role. Interventions to address maternal mental health in child nutrition programs might improve child nutritional status.

Opportunities to increase whole grain intake within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Abstract Background: In 2017, the National Academies of Science, Engineering, and Medicine, at the request of the United States Department of Agriculture Food and Nutrition Service (USDA FNS), published an expert report proposing updates to food packages for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Recommendations included adoption of the “whole grain‐rich” criteria instead of the whole grain health claim to classify whole grain breakfast cereals, and further, that all breakfast cereals be whole grain‐rich. Aims &amp; Methods: To discuss the advantages and implications of these recommendations, the Cereal &amp; Grains Association, in partnership with General Mills, Inc., convened an expert roundtable in April 2022. Results &amp; Discussion: The roundtable agreed increasing whole grain intake among WIC participants is critical and adoption of the whole grain‐rich criteria aligns with the 2020 Dietary Guidelines for Americans and child nutrition programs. However, potential challenges in requiring all cereals to be whole grain‐rich, including cost, and consumer choices based on taste and cultural preferences were noted and potential solutions discussed. Conclusion: Considering the public health need to increase whole grain intake, USDA FNS should increase the provision of whole grain in WIC food packages, while also considering the preferences of WIC participants and food costs.

Gender-common and gender-specific determinants of child dietary diversity in eight Asia Pacific countries

BackgroundOptimal child feeding practices contribute to reducing child undernutrition in low- and middle-income countries. Minimum dietary diversity (MDD) is a key indicator of complementary feeding quality for children aged 6-23 months. We aimed to examine the gender-common and gender-specific factors associated with the failure to meet MDD in eight Asia Pacific countries.MethodsThe study used data of children aged 6-23 months from the Demographic and Health Surveys (DHS) conducted in Afghanistan (n = 8410), Bangladesh (n = 2371), Nepal (n = 1478), Pakistan (n = 3490), Cambodia (n = 2182), Indonesia (n = 5133), Myanmar (n = 1379), and Timor-Leste (n = 2115). A total of 41 household, maternal, and child-level variables were examined for association with MDD using univariate and multivariable logistic regressions. All analyses accounted for the survey design and sampling weights.ResultsBeing aged 6-11 months, not receiving Vitamin A supplementation, low maternal education, belonging to a low wealth quintile, and having two or more young children in the household were factors related to the failure to meet MDD among both male and female children. Mothers’ not watching TV or not being exposed to media at least once a week, delivery at home, young age, and engagement to non-agricultural work were only significant risk factors among female children. Non-professional delivery assistance, unsafe disposal of children’s stool, tolerant attitudes towards domestic violence, and rural residence were significant factors only among male children.ConclusionsIt is possible that male and female children in the region may consume food in various ways, because the factors for meeting MDD are not the same for different genders of children. It is advised to enhance dietary diversity in child nutrition programmes through gender-specific activities.

Repeated Cross-Sectional Surveys of Registered Dietitian Nutritionists Demonstrate Rapid Practice Changes to Address Food Insecurity During the Coronavirus Disease 2019 Pandemic

Repeated Cross-Sectional Surveys of Registered Dietitian Nutritionists Demonstrate Rapid Practice Changes to Address Food Insecurity During the Coronavirus Disease 2019 Pandemic

A Call for Theory to Guide Equity-Focused Federal Child Nutrition Program Policy Responses and Recovery Efforts in Times of Public Health Crisis.

A Call for Theory to Guide Equity-Focused Federal Child Nutrition Program Policy Responses and Recovery Efforts in Times of Public Health Crisis.

P055 ‘Silver Lining’: Encouraging Outcomes and Perceived Best Practices for Child Nutrition Directors During COVID-19 Pandemic

P055 ‘Silver Lining’: Encouraging Outcomes and Perceived Best Practices for Child Nutrition Directors During COVID-19 Pandemic

Strengthening Food and Nutrition Security to Promote Public Health in the United States: A Position Paper From the American College of Physicians.

Food insecurity functions as a social driver of health, directly negatively impacting health status and outcomes, which can further negatively impact employment and income and increase medical expenditures-all of which exacerbates food insecurity. Progress in meaningfully reducing the food-insecurity rate has stalled in recent years. Although rates have decreased since their peak during the Great Recession, these gains have been reversed by the economic implications of the COVID-19 pandemic. As the federal government is the largest provider of food assistance, there is much potential in better leveraging nutrition assistance programs like the Supplemental Nutrition Assistance Program (SNAP) and the Child Nutrition Programs to increase access to healthful foods and improve public health. However, these programs face many funding challenges and internal shortcomings that create uncertainties and prevent maximal effect. Physicians and other medical professionals also have a role in improving nutritional health by screening for food insecurity and serving as connectors between patients, community organizations, and government services. Governments and payers must support these efforts by providing sufficient resources to practices to fulfill this role. In this position paper, the American College of Physicians (ACP) offers several policy recommendations to strengthen the federal food-insecurity response and empower physicians and other medical professionals to better address those social drivers of health occurring beyond the office doors.

Impact of Child Nutrition Programs Offered in Schools on Daily Nutrition and Dietary Quality

Impact of Child Nutrition Programs Offered in Schools on Daily Nutrition and Dietary Quality