Nutrition-sensitive Interventions Research Articles

Intervensi Sosial Sebagai Strategi Komunikasi Dalam Menurunkan Stunting di Sidoarjo Jawa Timur

The stunting rate decreased by 2.8%, which was 21.6% in 2022 compared to 24.4% in 2021. The decline is a positive development, but it is still above the threshold set by the World Health Organization (WHO) which should not exceed 20%. This shows that the problem of stunting in Indonesia still requires serious attention. The purpose of the study was to understand social intervention as one of the communication strategies in reducing stunting rates in Sidoarjo Regency. Interventions in communication for social and behavioral change include various methods such as interpersonal communication, the utilization of mass media, and community mobilization and its social aspects. Qualitative research approach with constructivism paradigm. The data collection method was an in-depth interview with 4 resource persons, namely a public relations officer of the Sidoarjo Regency Health Office and three mothers who were the target audience for reducing stunting rates. The results showed that efforts to reduce stunting were carried out through two social interventions, namely specific nutrition interventions to address direct causes and nutrition-sensitive interventions to address indirect causes. Social interventions are carried out in a convergent manner with an emphasis on handling the causes of nutritional problems. Social and behavioral change communication approaches are used to raise awareness about stunting so as to encourage pregnant women and stunted children to improve nutrition and behave healthily.

Prenatal ochratoxin A exposure, birth outcomes and infant growth in rural Burkina Faso: A human biomonitoring sub-study from the MISAME-III trial

Mycotoxin exposure during pregnancy has been associated with adverse birth outcomes and poor infant growth in low- and middle-income countries. We assessed multiple biomarkers and metabolites of exposure to mycotoxins during pregnancy and their associations with birth outcomes and infant growth in 305 pregnant participants, between 30 and 34 completed weeks of gestation, in rural Burkina Faso. In this study, whole blood microsamples were analyzed for mycotoxin concentrations using ultra-performance liquid chromatography coupled to tandem mass spectrometry. Unadjusted and adjusted associations between mycotoxin exposure, and birth outcomes and infant growth at 6 months were estimated using linear regression models for continuous outcomes and linear probability models with robust variance estimation for binary outcomes. Infant growth trajectories from birth to 6 months were compared by exposure status using mixed-effects models with random intercept for the individual infant and random slope for the infant's age. Ochratoxin A (OTA) exposure was detected in 50.8 % of the study participants, with aflatoxin G1, aflatoxin M1, cyclopiazonic acid, deoxynivalenol and T-2-toxin being detected in the range of 0.33 % and 2.31 % of the population. We found no statistically significant (p ≥ 0.05) associations between OTA exposure, and birth outcomes and infant growth. Despite this, the findings indicate a significant presence of ochratoxin A among pregnant participants. Public health policies and nutrition-sensitive interventions must ensure that OTA exposure is reduced in Burkina Faso.

Low birth weight, household socio-economic status, water and sanitation are associated with stunting and wasting among children aged 6-23 months: Results from a national survey in Ghana.

Stunting and wasting are key public health problems in Ghana that are significantly linked with mortality and morbidity risk among children. However, information on their associated factors using nationally representative data is scanty in Ghana. This study investigated the influence of Infant and Young Child Feeding (IYCF) indicators, socio-demographic and economic related factors, and water and sanitation on stunting and wasting, using nationally representative data in Ghana. This is a secondary data analysis of the most recent (2017/2018) Ghana Multi-Indicator Cluster Survey (MICS) datasets. The multi-indicator cluster survey is a national cross-sectional household survey with rich data on women of reproductive age and children under the age of five. The survey used a two-stage sampling method in the selection of respondents and a computer-assisted personal interviewing technique to administer structured questionnaires from October 2017 to January 2018. The present study involved 2529 mother-child pairs, with their children aged 6 to 23 months. We used the Complex Sample procedures in SPSS, adjusting for clustering and stratification effects. In a bivariate logistic regression, variables with P-values ≤ 0.05 were included in a backward multivariate logistic regression to identify the significant factors associated with stunting and wasting. The mean age of children was 14.32 ± 0.14 months, with slightly more being males (50.4%). About 12% and 16% of the children were wasted and stunted, respectively. There were 39.4%, 25.9%, and 13.7% of children who, respectively, satisfied the minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). None of the IYCF indicators was significantly associated with stunting or wasting in the multivariate analysis but low socio-economic status, low birth weight, being a male child and unimproved toilet facilities were significantly associated with both wasting and stunting. Our findings suggest that aside from the pre-natal period, in certain contexts, household factors such as low socio-economic status and poor water and sanitation, may be stronger predictors of undernutrition. A combination of nutrition-specific and nutrition-sensitive interventions including the pre-natal period to simultaneously address the multiple determinants of undernutrition need strengthening.

Suboptimal child healthcare practices and the development of multiple infectious diseases in children aged 24-59 months.

Infections continue to be a major cause of death among children under the age of five worldwide. This study aimed to identify the factors associated with the development of multiple infectious diseases in children aged 24-59 months in Indonesia. Data from the 2018 Basic Health Research conducted by the Ministry of Health, Republic of Indonesia, were used. Information from 39,948 children aged 24-59 months was analyzed. The outcome variable was the development of multiple infectious diseases, that is, acute respiratory infections, pneumonia, pulmonary tuberculosis, diarrhea, and hepatitis, in the month before the survey. Factors significantly associated with multiple types of infectious diseases were examined using logistic regression. The study found that 76.6% of children aged 24 to 59 months in Indonesia had at least one type of infectious disease. The likelihood of developing multiple types of infectious diseases increased in children whose parents did not practice appropriate handwashing with soap and running water [adjusted odds ratio (aOR) = 1.16, p < 0.001], those who received supplemental food (aOR = 1.38, p < 0.001), those with poor nutritional status (aOR = 1.12, p < 0.001), and those living in urban areas (aOR = 1.07, p = 0.045). Improving caregivers' awareness of adequate child healthcare practices, in addition to nutrition-sensitive and specific interventions to improve children's nutritional status, is required to prevent children from contracting multiple types of infectious diseases.

Investigating market-based opportunities for the provision of nutritious and safe diets to prevent childhood stunting: a UKRI-GCRF action against stunting hub protocol paper

BackgroundInadequate access to affordable, safe, desirable and convenient nutrient-dense food is one of the underlying causes of child stunting. While targeted nutrition-sensitive interventions (eg, backyard ‘nutri-gardens’) may increase dietary diversity...

The effect of nutrition-specific and nutrition-sensitive interventions on the double burden of malnutrition in low-income and middle-income countries: a systematic review

Low-income and middle-income countries (LMICs) experiencing nutrition transition face an increasing double burden of malnutrition (DBM). WHO has urged the identification of risks and opportunities in nutrition interventions to mitigate the DBM, but robust evidence is missing. This review summarises the effect of nutrition-specific and nutrition-sensitive interventions on undernutrition and overnutrition in LMICs. We searched four major databases and grey literature for publications in English, French, Portuguese, and Spanish from Jan 1, 2000, to Aug 14, 2023. Eligible studies evaluated nutrition-specific or nutrition-sensitive interventions on both undernutrition and overnutrition, employing robust study designs (individually randomised, cluster randomised, and non-randomised trials; interrupted time series; controlled before-after; and prospective cohort studies). Studies were synthesised narratively, and classified as DBM-beneficial, potentially DBM-beneficial, DBM-neutral, potentially DBM-harmful, and DBM-harmful, using vote counting. This review is registered with PROSPERO (CRD42022320131). We identified 26 studies evaluating 20 nutrition-specific (maternal and child health [MCH] and school-based programmes) and six nutrition-sensitive (conditional cash transfers and other social policies) interventions. Seven of eight MCH interventions providing food-based or nutritional supplements indicated possible DBM-harmful effects, associated with increased maternal or child overweight. Most school-based programmes and MCH interventions that target behavioural change were considered potentially DBM-beneficial. Two studies of conditional cash transfers suggested DBM-beneficial effects in children, whereas one indicated potentially harmful effects on maternal overweight. A study on a family planning service and one on an education reform revealed possible long-term harmful effects on obesity. There is considerable scope to repurpose existing nutrition interventions to reduce the growing burden of the DBM in LMICs. In settings undergoing rapid nutrition transition, specific policy attention is required to ensure that food-based or supplement-based MCH programmes do not unintentionally increase maternal or child overweight. Consistent reporting of undernutrition and overnutrition outcomes in all nutrition interventions is essential to expand the evidence base to identify and promote interventions maximising benefits and minimising harms on the DBM. President's Scholarship (Imperial College London) and National Institute for Health and Care Research. For the Portuguese, Spanish and French translations of the abstract see Supplementary Materials section.

Chronic Energy Deficiency Associated with Body Mass Index of Adolescent Girls

Chronic Energy Deficiency (CED) is a nutritional issue that poses a threat to adolescents in Indonesia, particularly to adolescent girls. According to the 2018 Basic Health Survey (Riskesdas), the proportion of CED among adolescent girls in Indonesia was 36.3%. This study aimed to identify the factors associated with CED among adolescent girls in the catchment area of Poka-Rumah Tiga, Ambon City. The study was conducted in August 2022 and used a cross-sectional approach with total sampling. The respondents were students aged 15-19 years from three high schools/equivalents in the catchment area of Poka-Rumah Tiga Health Center (SMKN 5 Ambon, SMAN 3 Ambon, and MA Al-Mabrur), with a total of 441 respondents. CED was determined based on the mid-upper arm circumference size being less than 23.5 cm. Logistic regression analysis was used to identify factors associated with CED in adolescent girls. Of the 441 adolescent girls who participated in this study, 45.80% were found to have CED. The odds of CED were lower in adolescent girls with normal BMI (18.5-22.9 kg/m2) (OR=0.09; 95%CI: 0.05-0.15; p&lt;0.001) and overweight (≥23 kg/m2) (OR=0.01; 95%CI: 0.00-0.07; p&lt;0.001) compared to those who were underweight (BMI&lt;18.5 kg/m2). This study highlights the importance of conducting nutrition-specific and nutrition-sensitive interventions for adolescent girls. This includes raising the awareness and knowledge of adolescent girls, family members, and school teachers regarding the importance of balanced nutrition to reduce CED.

Fruit and Vegetable Intake of Females Before, During, and After Introduction of 3 Bundled Food System Interventions in Urban Vietnam and Nigeria

BackgroundLow fruit and vegetable (FV) intake in low- and middle-income countries, which is associated with noncommunicable diseases and micronutrient deficiencies, requires food system interventions addressing FV accessibility, affordability, and acceptability. Periodic FV intake monitoring during interventions informs progress toward achieving increased intakes and contributes to understanding the effectiveness of these interventions. ObjectivesThis study evaluates the trend in FV intake before, during, and after implementation of a set of nutrition-sensitive food system interventions addressing accessibility, affordability, and acceptability to increase FV consumption over a 1-y period in Vietnamese and Nigerian low-income urban and periurban females. MethodsWe used the Diet Quality Questionnaire to assess FV food group consumption among 600 Vietnamese (Hanoi) and 610 Nigerian (Ibadan) females before, during, and after the interventions (Vietnam: July 2020–September 2021; Nigeria: November 2020–December 2021). A FV score was compared between exposure groups with (mixed) count modeling. The trend in consumption of individual FV groups was analyzed with mixed logistic regression. ResultsThe FV score was stable over time, and a small increase was observed after the intervention period especially in Nigeria and in urban Vietnam. A decrease in the total score was observed in periurban Vietnam. Fluctuations were detected in the probability of consumption of individual FV groups over time especially within the fruit groups, probably due to seasonal availability. The degree of exposure could not explain differences in FV intake. ConclusionsWe found a marginal increase in the proportion of females consuming FV during the interventions in both countries. The FV score appeared to be a simple, quick, and easy-to-use indicator for monitoring diversity, variety, and consumption.

Sustainable home gardens in Western Kenya: A qualitative study for co-designing nutrition-sensitive interventions

Populations living in rural sub-Saharan Africa (SSA) increasingly face negative climate change impacts on their nutrition and health status. For smallholder farming families, home gardens can serve as an adaptation strategy, by offsetting climate change-related harvest losses and diversifying households' diets. The present study aimed to identify perceptions and experiences among rural caregivers of children under five years and local stakeholders working in the fields of agriculture or nutrition with regard to home gardening in Siaya County, Kenya. Thirty in-depth interviews with caregivers of young children and 26 interviews with local stakeholders were conducted, using a semi-structured interview guide. The data were analysed employing inductive content analysis. Caregivers and local stakeholders perceived home gardens as beneficial for the households’ nutrition, finances, and women empowerment. However, they also pointed to five major challenges in the process of establishing and maintaining home gardens: 1) water scarcity, 2) limited financial capital, 3) demanding physical labour, 4) limited land availability/control, and 5) lack of knowledge and technical support. For the design of sustainable home gardens, we identified four components as essential at the implementation stage: 1) locally available material and resources, 2) strong community collaboration and co-design, 3) comprehensive capacity building, 4) and lasting local partnerships. In conclusion, the establishment and sustained management of home gardens in Siaya County require a holistic, participatory and multi-actor approach. This will facilitate the provision of essential inputs and activities to ensure a sense of ownership and responsibility.

Protocol for integrated solutions for healthy birth, growth and development: a cluster-randomised controlled trial to evaluate the effectiveness of a mixed nutrition intervention package in reducing child undernutrition in Lao People’s Democratic Republic

IntroductionWhile Lao People’s Democratic Republic has seen economic gains in recent years, one-third of children aged 5 years and under are stunted. There is a need for evidence around clinically...

Increasing Household Diet Diversity and Food Security in Rural Rwanda Using Small-Scale Nutrition-Sensitive Agriculture: A Community-Engaged Proof-of-Concept Study.

Malnutrition and food insecurity remain high in rural Rwanda, where residents consume a low-diversity diet provided through subsistence farming. Agricultural interventions using kitchen gardens may improve diet diversity in some populations. However, little is known about their efficacy when developed using community-based participatory research in combination with nutrition education focused on the empowerment of women. The objective of this study was to develop and implement a kitchen garden and nutrition education intervention using a community-engaged model and examine its impact on household diet diversity and food security. Using a mixed methods community-level design, we assessed a 16-week intervention implemented in Cyanika, Rwanda. Stratified purposeful sampling was used to select women participants representing 42 households. Household diet diversity scores (HHDS) and hunger scores were calculated at the baseline, post-intervention and one-year follow-up. HDDS increased after intervention from a pre-intervention intake of 2.59 [1.3] food groups/day, to 4.85 [1.6] at four months post-intervention and at one year post-intervention, reaching 5.55 [1.3]. There were no significant changes in household hunger scores. Our results indicate that collaborative community-engaged nutrition-sensitive agricultural interventions can increase household diet diversity; however, future work should explore whether this type of intervention strategy can lead to sustained changes and impact nutritional adequacy in this population.

Diets of Men and Women in Rural Bangladesh Are Equitable but Suboptimal

BackgroundRecent evidence suggests that diet inequities between men and women may have diminished within rural Bangladeshi households. However, this has not been directly tested with appropriate physiologic adjustments and it is unclear whether changes have occurred across socioeconomic strata. Understanding intrahousehold dietary patterns at different points on the income and food-security distribution in rural Bangladesh—particularly, within ultrapoor and farm households—is important for appropriate design of gender-sensitive and nutrition-sensitive interventions, which often target these groups. ObjectiveUsing 2012 and 2016 data, we aimed to examine gender differences in diet quantity and quality among ultrapoor and farm households in rural Bangladesh. MethodsThe study used baseline 24-h dietary data from 2 randomized control trials conducted in rural Bangladesh: the Transfer Modality Research Initiative (ultrapoor households) and the Agriculture, Nutrition, and Gender Linkages project (farm households). Ordinary least squares regressions with household-level fixed effects tested for gender differences among constructed diet measures, such as caloric intake, caloric adequacy ratio, dietary diversity score, global diet quality score, and probability of consuming moderate or high levels of healthy food groups. ResultsIn both samples, on average, women consumed fewer calories than men in the same households but consumed near equal or more in reference to their caloric needs. Women scored <1% lower than men on diet quality indicators and showed similar probabilities to men of consuming healthy foods. Most men and women in both samples were calorically inadequate (>60%) and recorded poor diet quality scores that indicated high risk of nutrient inadequacy and chronic disease (>95%). ConclusionsIn both ultrapoor and farm households, although men record higher intake quantities and diet quality scores, the apparent male advantage disappear when energy requirements and the magnitudes of difference are considered. Diets of men and women in these rural Bangladeshi households are equitable but suboptimal.

Contribution of home garden vegetables on reducing stunting among 6- to 23-month-old children in South Tigray, northern Ethiopia.

The study was conducted to analyze the contribution of home garden vegetables in reducing stunting among 6- to 23-month-old children from South Tigray, Northern Ethiopia. The quasi-experimental study design was used. Multistage sampling technique was used to select the districts and study communities. A total of 94 purposively selected vegetable producer (intervention) households and 260 randomly selected non-producer (control) households were included in the study (1:3 ratio). The recumbent length of children was measured using horizontal wooden board to the nearest 0.1 cm. The length-for-age Z-scores were computed using WHO-Anthro 2006 software. Propensity score-matching and difference-in-difference (DID) estimates were used to analyze data using STATA software version 12. Prevalence of child stunting was 19.8 (12.7-29.4) and 21.1 (16.4-26.7)% (baseline) and 43.5 (33.5-54.1) and 46.5 (45.7-47.2)% (end line) among intervention and control groups, respectively. Child stunting was higher for boys and older children from both intervention and control households. DID estimation revealed that there was no significant difference in child stunting between intervention and control households (DID = 1.7, p = .604). However, there was an intervention effect of -0.5, 2.5, and 1.7% in the prevalence of child stunting among females, males, and both sexes, respectively. Vegetable production as an intervention strategy reduced the prevalence of stunting in children aged 6-23 months. However, vegetable production needs to be well integrated with other nutrition-sensitive interventions to realize the objective of reducing child stunting.

Association of Women Leading Land Use with Energy and Nutrient Intakes Among Children Aged 6 to 59 Months in Oromia, Ethiopia

Nutrition-specific interventions alone will not help countries to end child malnutrition; nutrition-sensitive interventions such as women empowerment are also needed. Therefore, this cross sectional study was conducted to assess the association of women leading land use with nutrient intakes among children aged 6 to 59 months in Oromia, Ethiopia. Three hundred thirty-two caregivers participated in the study. A pretested questionnaire was used to collect data on background characteristics of child caregivers, women leading land use status, and caregivers’ exposure to mass media. Dietary assessment for nutrients intake was collected using a 24-hour recall. The survey data was analyzed using SPSS software version 25. Descriptive statistics were presented in frequency and percentages and in the form of mean ± SD. The nutrient intakes were compared with recommended dietary allowances to analyze the gap between the intakes and the recommendations were presented as percentages. Any difference in the variables was compared, based on women leading land use, using Chi square test and Mann Whitney u test, depending on the type of data. Results were considered statistically significant at P<0.05. Starchy staples were consumed by more than 90% of the children; close to ¾ of the children consumed legumes and nuts; animal source foods consumption was below 20% except dairy products (84%). Vitamin A rich fruits and vegetables were consumed by 33% of the children on average; and the minimum dietary diversity score was achieved by 48% of the children. The median energy intakes for children aged above a year and calcium intakes during the second half of the first year were more than 90%. On the other hand, the intakes of energy, at the stage of the second 6 months, fat, the calcium (>1 year) and the ascorbic acid intake were below 90%. Intake of Fat and Ascorbic acid was very low. Interestingly, iron intake for the children of 6-12 months age was more than 100%. However, there was statistical difference (p<0.05) in the proportion children of women with land leading power and without land leading power who consumed starchy staples, legumes and nuts, dairy products as well as ascorbic acid. Women empowerment in deciding land use issues affect about their child feeding practices and ultimately nutritional outcome and therefore, Women empowerment should be ensured for better child feeding practices and nutrients intake.

Empowering rural service providers to improve nutrition in mountain regions

Improved agroecological practices tend to lead to production diversity but often fall short of achieving optimal dietary diversity in rural contexts. Thus, multi-prong interventions involving knowledge and skill development for production and consumption are needed. This study assesses nutrition and production-related interventions implemented in the East African Highlands, Pamir-Tian Shan, Hindukush and the Andes. Overall, 601 rural service providers were trained and supported to implement various nutrition-sensitive agroecological interventions. Study results show that these interventions significantly increased the intake of flesh food, eggs, vitamin A-rich leafy greens, and vitamin-A-rich vegetables and fruits. The increase in production diversity was correlated with the increase in dietary diversity. Thus this study highlights the crucial role of rural service providers in catalyzing nutrition-related changes in mountain contexts.

Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: A systematic review.

Evidence that nutrition-specific and nutrition-sensitive interventions can improve maternal and child nutrition status in sub-Saharan Africa is inconclusive. Using behaviour change theory and techniques in intervention design may increase effectiveness and make outcomes more predictable. This systematic review aimed to determine whether interventions that included behaviour change functions were effective. Six databases were searched systematically, using MeSH and free-text terms, for articles describing nutrition-specific and nutrition-sensitive behaviour change interventions published in English until January 2022. Titles, abstracts and full-text papers were double-screened. Data extraction and quality assessments followed Centre for Reviews and Dissemination guidelines. Behaviour change functions of interventions were mapped onto the COM-B model and Behaviour Change Wheel. PROSPERO registered (135054). The search yielded 1193 articles: 79 articles met inclusion criteria, ranging from low (n = 30) to high (n = 11) risk of bias. Many that applied behaviour change theory, communication or counselling resulted in significant improvements in infant stunting and wasting, household dietary intake and maternal psychosocial measures. Interventions with >2 behaviour change functions (including persuasion, incentivisation, environmental restructuring) were the most effective. We recommend incorporating behaviour change functions in nutrition interventions to improve maternal and child outcomes, specifically drawing on the Behaviour Change Wheel, COM-B model (SORT B recommendation). To enhance the designs of these interventions, and ultimately improve the nutritional and psychosocial outcomes for mothers and infants in sub-Saharan Africa, collaborations are recommended between behaviour change and nutrition experts, intervention designers, policy makers and commissioners to fund and roll-out multicomponent behaviour change interventions.

Sustainable intensification and household dietary diversity in maize-based farming systems of Zambia and Zimbabwe

With only four years before the end date for the United Nations Decade of Action on Nutrition, the need to identify nutrition-sensitive and sustainable agricultural interventions that can address hunger and malnutrition cannot be more urgent. This paper assesses associations between sustainable intensification practices and dietary diversity in maize-based farming systems of Zambia and Zimbabwe. Using survey data from 1124 households, we apply an instrumental variable approach that allows to control for the fact that farmers self-select themselves into adopting sustainable intensification practices, making adoption endogenous. We also explore pathways from intensification to dietary diversity. We find significant positive associations between the adoption intensity of sustainable intensification practices (SIPs) such as minimum tillage, minimum tillage and crop rotation, and minimum tillage and intercrops and improved production and crop diversity and in turn, dietary diversity on average. These findings hinge on there being widespread adoption of SIPs. There is need for concerted efforts to address current bottlenecks that hinder widespread adoption and promote broader food group diversification to realize the nutrition related co-benefits associated with sustainable intensification.

Dietary patterns in Uganda and their influencing factors: A critical review

Improving the understanding of dietary patterns and underlying factors remains crucial in designing nutritional interventions and policy making. This review sought to provide a holistic picture of the studies covering dietary patterns in Uganda and the associated factors so as to identify gaps in existing literature and provide a basis for nutrition-sensitive interventions. A literature search for publications dating from March 2010 to 2021 was done using the terms dietary diversity, nutrient intake, food consumption and food choices in Uganda. Studies covering populations above 6 months of age, male and female, with exception of diseased populations, were screened. Because of the variability in the methodologies for assessment of dietary intake and dietary diversity, meta-analysis was not conducted. A total of 17,728 articles were found and 25 studies met the inclusion criteria. Nine of the 25 studies reported on dietary diversity indicators and their associated factors. The literature shows that diets in Uganda are mainly composed of starchy staples, especially cereals, roots, tubers and bananas, with legumes constituting the main protein source. The diets are characterized by low consumption of fruits and vegetables as well as animal protein sources. The share of food expenditure allocated to the different food groups corresponded to information on consumption for the different groups. Studies revealed that household food expenditure was higher among urban households, an observation attributable to their high reliance on food purchases to meet food requirements. The share of household expenditure on cereals and staples was reported to decrease with increasing wealth quantile and was lower among urban households. An opposite trend was reported for animal protein sources. Across the different studies, the mean dietary diversity score was above three (3). Nonetheless, intake of micronutrients and the mean dietary energy consumption (DEC) were reported to be lower than the daily recommended values. Given the lack of uniformity in the indicators across the different studies and differences in methodologies especially for dietary diversity scores, the existing research is inadequate for establishing quantitative evidence on the trends in dietary patterns and diversity, gender and age group differences in relation to dietary patterns. There is a need for high-quality, nation-wide research using validated tools and methodologies to measure dietary patterns and trends and explore the relation to gender and age groups. Key words: Food consumption, Food choices, Dietary Patterns, Uganda, Dietary diversity

The impact of livestock interventions on nutritional outcomes of children younger than 5 years old and women in Africa: a systematic review and meta-analysis.

Nutrition-sensitive livestock interventions have the potential to improve the nutrition of communities that are dependent on livestock for their livelihoods by increasing the availability and access to animal-source foods. These interventions can also boost household income, improving purchasing power for other foods, as well as enhance determinants of health. However, there is a lack of synthesized empirical evidence of the impact and effect of livestock interventions on diets and human nutritional status in Africa. To review evidence of the effectiveness of nutrition-sensitive livestock interventions in improving diets and nutritional status in children younger than 5 years old and in pregnant and lactating women. Following PRISMA guidelines, we conducted a systematic review and meta-analysis of published studies reporting on the effect of livestock interventions on maternal and child nutrition in Africa. Data were extracted, synthesized, and summarized qualitatively. Key outcomes were presented in summary tables alongside a narrative summary. Estimation of pooled effects was undertaken for experimental studies with nutritional outcomes of consumption of animal-source foods (ASFs) and minimum dietary diversity (MDD). Fixed effects regression models and pooled effect sizes were computed and reported as odds ratios (ORs) together with their 95% confidence intervals (CI). After the screening, 29 research papers were included in the review, and of these, only 4 were included in the meta-analysis. We found that nutrition-sensitive livestock interventions have a significant positive impact on the consumption of ASFs for children < 5 years (OR = 5.39; 95% CI: 4.43-6.56) and on the likelihood of meeting minimum dietary diversity (OR = 1.89; 95% CI: 1.51-2.37). Additionally, the impact of livestock interventions on stunting, wasting, and being underweight varied depending on the type of intervention and duration of the program/intervention implementation. Therefore, because of this heterogeneity in reporting metrics, the pooled estimates could not be computed. Nutrition-sensitive livestock interventions showed a positive effect in increasing the consumption of ASFs, leading to improved dietary diversity. However, the quality of the evidence is low, and therefore, more randomized controlled studies with consistent and similar reporting metrics are needed to increase the evidence base on how nutrition-sensitive livestock interventions affect child growth outcomes.

Implications of Young Child Malnutrition on Health and Development: Prioritize Nutrition Interventions in the First 1000 Days of Life

Implications of child undernutrition is not limited to adverse impact on physical growth but on optimum brain growth, mental health and cognitive development. The adverse effects of micronutrient deficiencies in mothers and children are serious with impact on morbidity, mortality, anemia, school performance, overall productivity and national development. Only in the last two decades, studies on the month-wise trend in the prevalence rate of child undernutrition in under five years has drawn attention to the fact that the stunting and underweight rate increases steadily up to 24 months, peaks at about two years of age and then stabilises. Efforts are therefore being directed to the significance of concentrating on implementation of child undernutrition preventive measure in the first 1000 days of life. As per the globally accepted conceptual framework of child malnutrition and the evidence available of effective interventions, emphasis is to ensure universal coverage of selected package of essential nutrition interventions (ENIs) and coupling these with nutrition sensitive interventions. Priority interventions in the first 1000 days comprise nutrition care package linked to antenatal care services, intensive efforts for universal adoption of appropriate infant and young child feeding practices and context specific nutrition sensitive measures .For effective implementation, special attention to mapping of the ’at risk’ households having a member falling in the 1000 days window needs special attention. The contacts of health workers with antenatal care and routine child immunization services need to be effectively used for promoting appropriate maternal nutrition care and breastfeeding and complementary feeding practices in the first 1000 days of life. Along with universal coverage of ‘at risk’ households with ENIs, it is imperative to ensure that the context specific nutrition sensitive interventions are simultaneously addressed, as reflected in the design of India’s National Nutrition Mission/Poshan2.0.