Nutrition Services Research Articles

Nutrition literacy in Vietnamese pregnant women: a cross-sectional study.

Inadequate nutrition intake during pregnancy elevates the risk of adverse health outcomes during pregnancy, with potential long-term repercussions for both mother and child, extending to subsequent generations. Current initiatives to improve individual dietary habits emphasize promoting nutrition literacy (NL), which encompasses the ability to access, comprehend, and use basic nutrition information and services necessary for making appropriate nutrition decisions. However, there were limited data on the NL of pregnant women in Vietnam. Therefore, this study aims to explore the NL levels of Vietnamese pregnant women and examine the factors related to their NL. A total of 360 Vietnamese pregnant women participated in the study from May to September 2023. A validated questionnaire (Nutrition Literacy Assessment Instrument for Pregnant Women, NLAI-P), assessing the knowledge, behavior and skill, was applied. A general linear model with univariate linear regression analysis was conducted to identify predictor factors of NL. The findings revealed that 70.3% of participants had inadequate NL. Among the three dimensions, nutrition knowledge was particularly low, with no respondents achieving an adequate level and 94.7% scoring at an inadequate level. High household monthly income, age, normal prepregnancy weight and indoor work were statistically associated with higher NL scores. This study highlights the limited NL among Vietnamese pregnant women. Increasing NL is crucial for supporting their optimal healthy diet, enhancing the health of pregnant women and their offspring and future generations.

Why do we Need to Evaluate Therapeutic Diets for Cardiac Patients Admitted in Healthcare Institutions?

Cardiovascular Disease (CVD) remains the leading cause of mortality in the Philippines. Proper nutrition is vital in managing and treating these patients, influencing their hospital stay and long-term outcomes. Cardiac patients admitted in healthcare institutions often rely on nutrition and dietetics services including therapeutic meals provided by the facilities depending on the needs of the client. A poorly planned therapeutic diet can exacerbate underlying cardiac conditions, leading to further complications which can prolong hospital stay and readmission. There is no written dietary standards or guidelines that are developed for Filipinos with cardiac health concerns. The dietary regimens intended for cardiac patients and its complications are adapted from other therapeutic diets used in other population (e.g., Mediterranean Diet, Dietary Approach to Stop Hypertension Diet (DASH Diet), American Heart Association (AHA) Diet, etc.). Although based on anecdotal evidence, therapeutic diets intended for cardiac diet patients in the Philippines are usually tagged as the Low Salt, Low Fat Diet and/or Fat-Controlled Diet. According to Hersberger et al (2021), individualized nutrition support as opposed to regular hospital diet significantly reduces the risk of complications and mortality among cardiac patients. In the Philippines, nutrition care is usually provided by the Nutrition and Dietetics Unit of the hospital manned by Registered Nutritionist-Dietitians where therapeutic diets are prepared centrally and delivered in the patient’s room. In 2016, the Department of Health implemented the Administrative Order 2016-0020 suggesting that the minimum meal allowance of at least PHP. 150.00 per patient per day for meals should be imposed. According to Casas et al (2023), the quality of inpatient meals in the Philippine public hospitals had a great difficulty setting up the necessary structures for good nutrition care abiding the nutrition care standards set in 2016. These limitations could potentially exacerbate the absence of guidelines intended for Filipino Cardiac patients needing a dietary regimen that will suit their dietary needs and requirements. These concerns were supported by the findings of Simon and Elopre (2023), indicating the need for improvements in nutritional adequacy and adherence to CVD guidelines of hospital therapeutic diets in selected hospitals in Mindanao. Having these complex issues revolving around therapeutic diets for cardiac patients, a more in-depth evaluation of therapeutic diets should be conducted in the Philippines. In addition, there is a need for consistent monitoring and evaluation as designed in the nutrition care plan as mandated by the Department of Health Administrative Order 2019-003. It is imperative that all public and private hospitals in the country shall provide the necessary logistics and management support to adhere to the Nutrition Care process for hospitalized patients. The guidelines should be also developed that will help the hospitals in the country to serve appropriate therapeutic diets for cardiac patients which are supportive to shorter stay in the hospital and avoidance of readmission for a better quality of life. Hence, there is a need for a purposeful evaluation of therapeutic diets for cardiac patients as a critical component of comprehensive cardiac care. It ensures that the dietary plan supports the patient’s medical needs, contributes to recovery and helps prevent future complications that support better quality of life even after discharge in healthcare institutions.

Application of the workload indicators of staffing need (WISN) to assess dietetic workforce needs in South African central and tertiary public hospitals

South Africa faces both under- and over-nutrition, highlighting the need for prioritizing nutrition services. Registered dietitians are crucial for delivering appropriate and quality nutrition services. Consequently, this case study employs the World Health Organization evidence-based Workload Indicators of Staffing Need to ascertain the requisite dietetic workforce needed at central and tertiary public hospitals in South Africa. Head dietitians from 21 of 22 central and tertiary public hospitals participated in an online survey to provide data and consensus on workload components and activity standards via Delphi technique. Data were analyzed using the World Health Organisation Workload Indicators of Staffing Need software. Dietetic staffing needs were determined based on the difference between existing and required numbers of dietitians. WISN ratio was used as a metric to gauge dietitians’ workload pressure. Majority (95%) of hospitals experienced dietetic staff shortages and few (14%) had requisite staff to cover basic health services. Majority (76%) exhibited a WISN ratio below 0.5, indicating fullfilment of less than 50% of staff requirements. Based on the Workload Indicators of Staffing Need, dietitians in South African central and tertiary public hospitals experience high workload pressures due to extreme understaffing. The results can guide future profession workforce planning to facilitate enhanced nutrition outcomes in South Africa.

‘Health Camp’ model: a unique approach for child vaccination in non-state armed actor controlled, inaccessible geographies in Somalia

ABSTRACT Decades of conflict, political instability, and limited infrastructure left Somalia facing significant challenges to offer consistent and equitable health services, especially for child vaccination. Recent data reveals alarming vaccination gaps, with 60% of children receiving no vaccinations, and only 11% completing required vaccines. Despite global support, an estimated 1.15 million children remain unvaccinated, half of them reside in inaccessible areas controlled by non-state armed actors. In this context, the Far-Reaching Integrated Delivery (FARID) project was initiated since October 2022 across 10 districts of Galmudug and Hirshabelle state in Somalia. Employing the ‘Health Camp’ model, FARID addresses social, structural, and gender barriers, adapting to ever-changing context of inaccessible regions by providing mobile health facilities and outreach health and nutrition services, including child vaccination. This approach effectively reached previously unreached population in Somalia’s most difficult-to-reach areas. Implemented in phases, the project immunized 51,168 children (0–23 months) who had not received any prior vaccinations (23,753 boys and 27,415 girls), screened and treated 14,158 malnourished children (0–59 months) and vaccinated 11,672 pregnant women during March–December 2023. The project’s success hinges on intensive community engagement, local partnerships, innovation in mapping and data management, and delivery of integrated services tailored to population needs. The project underscores the critical role of local community-based organizations and clan elders in reaching inaccessible populations through humanitarian negotiation amidst security challenges. The project has achieved significant milestones aligned with national health strategic plans, including progress towards universal health coverage and improved immunization access in Somalia’s most challenging regions.

A food product development project with humanitarian character: an exploratory study

Vulnerable livelihood groups, such as the Fulanis in Guinea-Bissau, are affected by the consequences of inequality, as they lack access to healthy food, a healthy environment and adequate primary health care. Coordination between sectors can be key to building resilient food and health systems by integrating and scaling up preventive and emergency nutrition services, especially in the context of malnutrition. In 2021, a cashew-based food product was launched in Portugal in partnership with an NGO and a Portuguese food retailer. This study aims to explore the development and marketing of the product with humanitarian objectives, assessing its impact on the different stakeholders of the project. A mixed methodology was applied, combining the evaluation of consumer behavior, assessed through self-reported electronic questionnaires and in-depth interviews with the actors involved in the project. According to the retailer group stakeholders, a great opportunity for the future lies in developing new products with a humanitarian character. The results show that consumers are indeed interested in buying a product associated with a humanitarian cause, and that the product “100% Cashew Nut Butter” has a favorable consumer acceptance in terms of sensory attributes. The long-term nature of the project and the financial return were cited as strengths by all NGO stakeholders involved, but all stakeholders agreed that innovation was needed to sustain donations. Thus, this may be a cyclical process: businesses can create demand through product development, while management and consumers, in turn, drive demand. These findings can be used to improve the design of future projects that might use this as an example.

A pilot study to assess the knowledge, attitude and utilization of Kishori Balika Yojana among adolescent girls (14-18yrs) at rural mahasamund, Chhattisgarh

Adolescent girls face risks including injuries, reproductive and sexual health issues, mental and emotional problems, and abuse. In response, the Government of India launched the Adolescent Girls’ Scheme in 2000 under the Integrated Child Development Scheme, aiming to enhance nutrition, health, and empowerment among adolescent girls.A community-based cross-sectional descriptive study was carried out in rural Mahasamund to evaluate the knowledge, attitudes, utilization of the Kishori Balika Yojana (KBY), and nutritional status of adolescent girls. A convenient sampling technique selected a sample of 35 adolescent girls. Data collection involved a structured knowledge questionnaire (20 items), a Likert scale (18 items), a checklist (7 items), and a nutritional assessment checklist.Among the 35 adolescent girls, 5 (14.2%) were school dropouts, and 16 (45.7%) were undernourished. Most participants (27 or 77.2%) had moderately adequate knowledge, while 7 (20%) had inadequate knowledge. Perception towards KBY services was neutral for 33 (94.2%) and unfavorable for 2 (5.8%). All 35 girls visited the Anganwadi center; 32 (91.4%) utilized supplementary nutrition services, 33 (94.2%) received iron and folic acid tablets, 22 (62.8%) participated in health checkups, and 17 (48.6%) attended health education sessions. Only 2 (5.7%) were aware of life skills education, and none participated in vocational training services. The study found moderately adequate knowledge, neutral perceptions, and good utilization of supplementary nutrition and iron-folic acid supplementation among the girls. However, participation in health checkups, nutrition and health education, life skills education, and vocational training was limited. Educational interventions and modules on KBY services could enhance knowledge, foster favorable perceptions, and improve utilization of KBY services.

Cultural Competence in Dietetic Practice

In the European context shaped by migration, it is necessary to adapt dietitians to cultural diversity for effective professional practice. The objectives of the research are to analyze the cultural and ethnic diversity in Romania, highlighting the possible influence of acculturation on the dietary behaviors of different ethnic groups, and to formulate ways to apply the stages of cultural competence. The research methodology included the collection and use of data from the population census and other statistical sources to analyze the ethnic, linguistic, and religious composition in different regions of Romania, and the use of a cultural competence model that could be applied in the Romanian medical context for the formulation of health recommendations tailored to eating habits and influenced by acculturation and sociocultural factors. The study reveals the cultural diversity of the Romanian population, with more than 1.7 million inhabitants having a native language other than Romanian and with a wide ethnic and religious variety. We adapted a cultural competence model including methods to assess dietary acculturation, understand food preferences, and respect ethnic, religious, and generational diversity, ensuring its applicability in various multicultural contexts. This study emphasizes the importance of cultural competence in dietetic practice in a diverse health care setting and tailoring nutrition services according to cultural diversity to improve health and patient satisfaction.

Factors influencing provider deviation from national HIV and nutritional guidelines for HIV-exposed children in western Kenya: a qualitative study

BackgroundMalnutrition and HIV interact in a vicious cycle for HIV-exposed infants (HEIs), increasing vulnerability and the severity of each condition and contributing to poor health outcomes. We identified multi-level factors influencing provider adherence to Kenyan HIV and nutrition guidelines for HEIs.MethodsWe conducted six focus group discussions and seven in-depth interviews using a semi-structured question guide. Participants were selected through purposive maximum variation sampling of health workers involved in maternal and child health services and outpatient nutrition programs at two facilities in western Kenya. Data collection and analysis were guided by the Theoretical Domains Framework (TDF). Transcripts were coded by two primary coders using both deductive and inductive thematic analysis.ResultsTDF domains that drove guideline adherence included: environmental context and resources, beliefs about capabilities, and social influences. While participants praised attempts to integrate HIV and nutritional services through teamwork and service colocation, challenges in the successful referral of patients between services persisted. Participants described siloed HIV and nutrition-related knowledge across staff, leading to missed or delayed care if certain providers were unavailable. Participants emphasized understaffing as a major contributor to gaps in care. Inconsistent material resource availability also disrupted linkages between HIV and nutrition services for patients. While participants frequently expressed high intention and internal motivation to link children between services, they described minimal structured supervision or positive reinforcement from supervisors and feeling demoralized when resource constraints interfered with care provision. Lastly, participants described patient-level factors that made it challenging for families to seek or remain in care, including poverty and HIV and malnutrition-related stigma. Participants made several recommendations, including training multiple cadres in the fundamentals of both HIV and nutritional care to address siloed services and understaffing.ConclusionsThis study details the factors that facilitate or hinder health workers as they implement national guidelines and link HEIs between HIV and nutritional services, including the impact of physical integration of service sites, human and material resource constraints, and health worker motivation. Future interventions can address these challenges by expanding access to needed resources, task sharing, and testing implementation strategies that increase the efficiency of service delivery to improve linkages in care for vulnerable infants.

Integration of family planning into the primary health care in Ethiopia: results from national assessment

BackgroundFamily planning (FP) is part of Ethiopia’s essential health service package. However, integrating FP into other health care services is a relatively new concept. Integrated service can minimize missed opportunities and allow health workers to provide FP services and Reproductive, Maternal, Newborn, Child, Adolescent, and Nutrition (RMNCAH-N) services simultaneously. Thus, the objective of this study was to assess the levels of FP integration into maternal and child health (MCH) services at primary health care service delivery units in Ethiopia.MethodsThis was a facility-based cross-sectional study conducted from July to October 2022. We conducted a nationally representative survey of primary health care (PHC) facilities selected from seven regions and two-city administrations in Ethiopia to assess the current level of FP integration across four service delivery units (antenatal care unit, postnatal care unit, post-abortion care unit, and immunization unit) of the facilities. We collected data from selected health facilities through interview with health facility managers, healthcare providers in the selected service units, clients seeking health services, and extraction of data from facility records. We employed descriptive analysis, and categorized the degree of FP integration according to the FP information and services provided in the selected service delivery units.ResultsThis national FP integration survey included 122 health facilities (39 primary hospitals, 42 health centers, and 41 health posts) from seven regions and two city administrations. The study found a huge discrepancy regarding FP counselling given at ANC, PNC, PAC, and immunization service delivery units as reported by health care providers and clients. The proportion of PNC and immunization clients who received FP counselling was higher at health post compared to hospitals and health centers. Moreover, the proportion of PAC clients who received FP information was higher in primary hospitals compared to health centers.ConclusionData from facility records and provider interviews showed significant FP integration within ANC, PNC, and immunization units of PHC facilities. However, client exit interviews indicated low FP counselling integration. Facility records revealed few PNC and PAC clients received contraceptives in the past year. The study found high FP counselling and provision of at least one short- or long-acting contraceptive at PNC and PAC units. No facility offered contraceptives at immunization units, indicating missed FP integration opportunities.

Trends in the Prevalence and Factors Associated with Undernutrition in Tunisian Children Aged 0-23 Months.

In recent years, undernutrition has remained a significant public health issue in Tunisia, increasing the risk of illness and mortality in young children. Therefore, this study aims to analyse the prevalence and factors contributing to undernutrition among Tunisian children aged 0-23 months. The study included 3265 children aged 0-23 months from the 2011-2023 Tunisia Multiple Indicator Cluster Surveys (MICS). Trends and logistic regression analyses were used to determine the prevalence and predictors of undernutrition. The prevalence of stunting, wasting, and underweight in infants and children aged 0-23 months has increased by 3.3%, 0.5%, and 2.1%, respectively. Stunting and underweight were more common among infants aged 0-5 months (11.8% for stunting, 8.9% for underweight, p < 0.01), and first-time mothers (8.3% for stunting, 4.1% for underweight, p < 0.01). In 2023, compared to 2011, the odds of stunting, wasting, and being underweight had increased by 22%, 16%, and 70%, respectively. Infants aged 0-5 months had higher odds of undernutrition in all three indices. Children of obese or overweight mothers, and those who started breastfeeding late, were more likely to be stunted. Boys had significantly higher odds of wasting and underweight. Children with low birth weight, and duration of breastfeeding > 12 months, had significantly higher odds of being underweight. This study shows that infants aged 0-5 months, first-time mothers, boys, and children from poor households in Tunisia are at a higher risk of undernutrition. To address the growing issue of undernutrition in Tunisian children, enhancing maternal and child health and nutrition services, improving parental education, and implementing community-based programs that provide breastfeeding and nutritional education to infants born to new mothers and mothers with high/low BMI is recommended.

Disruptions and adaptations of an urban nutrition intervention delivering essential services for women and children during a major health system crisis in Dhaka, Bangladesh.

Systematic crises may disrupt well-designed nutrition interventions. Continuing services requires understanding the intervention paths that have been disrupted and adapting as crises permit. Alive & Thrive developed an intervention to integrate nutrition services into urban antenatal care services in Dhaka, which started at the onset of COVID-19 and encountered extraordinary disruption of services. We investigated the disruptions and adaptations that occurred to continue the delivery of services for women and children and elucidated how the intervention team made those adaptations. We examined the intervention components planned and those implemented annotating the disruptions and adaptations. Subsequently, we detailed the intervention paths (capacity building, supportive supervision, demand generation, counselling services, and reporting, data management and performance review). We sorted out processes at the system, organizational, service delivery and individual levels on how the intervention team made the adaptations. Disruptions included decreased client load and demand for services, attrition of providers and intervention staff, key intervention activities becoming unfeasible and clients and providers facing challenges affecting utilization and provision of services. Adaptations included incorporating new guidance for the continuity of services, managing workforce turnover and incorporating remote modalities for all intervention components. The intervention adapted to continue by incorporating hybrid modalities including both original activities that were feasible and adapted activities. Amidst health system crises, the adapted intervention was successfully delivered. This knowledge of how to identify disruptions and adapt interventions during major crises is critical as Bangladesh and other countries face new threats (conflict, climate, economic downturns, inequities and epidemics).

Clinical impact of multidisciplinary team management on postoperative short-term outcomes in colorectral cancer surgery.

The multidisciplinary team (MDT) approach has become the standard for perioperative patient care. At our institution, a multidisciplinary perioperative care team called "Surgical, Nutrition and Rehabilitation Integrated Services for Excellence Team (SUNRISE)" was established for all patients with gastrointestinal cancer undergoing surgery. This study aimed to elucidate the significance of SUNRISE as a perioperative MDT by comparing short-term postoperative outcomes before and after the introduction of SUNRISE in patients with colorectal cancer. We included 181 patients diagnosed with colorectal who underwent radical surgical resection with regional lymphadenectomy. The patients were divided into two groups: the pre-SUNRISE group, consisting of 105 patients who underwent radical colorectal surgery before the introduction of the SUNRISE, and the SUNRISE group, consisting of 76 patients who underwent radical colorectal surgery after the introduction of the SUNRISE. We compared the short-term postoperative outcomes between these two groups and analyzed the risk factors affecting postoperative complications using logistic regression models. The incidence of postoperative complications in the SUNRISE group was significantly lower than that in the pre-SUNRISE group (22.4% vs. 41.0%, p = 0.011). Multivariate analysis identified the presence of SUNRISE (odds ratio, 0.33, 95% confidence interval, 0.15-0.73, p < 0.006) as an independent risk factor for postoperative complications. The median postoperative hospital stay in the SUNRISE group was significantly shorter than that in the pre-SUNRISE group (9 vs. 11days, p < 0.01). The MDT approach is useful for optimizing preoperative patient care and improving short-term postoperative outcomes in patients with colorectal cancer.

Management of Nutritional Services in Regional General Hospitals Drs. Haji Amri Tambunan

Management of Nutritional Services in Regional General Hospitals Drs. Haji Amri Tambunan

An assessment of the content of antenatal care provided by obstetricians in Lebanon: A cross-sectional study.

Quality and timely antenatal care is a vital component of pregnancy care for the well-being of mothers and babies. The aim of this study of to assess self-reported obstetricians' adherence to national and international antenatal care guidelines in Lebanon. This cross-sectional study approached all obstetricians registered with the Lebanese Society of Obstetrics and Gynecology and the Lebanese Order of Physicians to participate in an online and telephone-based survey. The study tool included all of the items from the World Health Organization and national guidelines for antenatal care. Obstetricians' self-reported adherence was assessed across five modules including dietary interventions, dietary supplements, antenatal care assessment, fetal growth assessment, and antenatal care preventive measures. A total of 134 obstetricians completed the survey. Overall, adherence was high for most antenatal care guidelines except for providing nutrition services to undernourished pregnant women, screening for intimate partner violence, and providing tetanus vaccines. The number of recommended antenatal care visits (≥8 vs. <8 visits) was higher among obstetricians in Mount Lebanon or Beirut compared to other areas in Lebanon (72.7%vs.48.6%; p-value <0.01). Provision of tetanus or diphtheria, tetanus, and pertussis (DTP) vaccination was lower for obstetricians who provide care for women who pay out-of-pocket compared to obstetricians who provide care to women who use other payment methods (25.3%vs.45.7%; p-value = 0.024). Group B streptococcus screening test and the provision of at least five ultrasounds were higher among obstetricians who provide care in private clinics or clinics in private hospitals compared to clinics in public hospitals or primary healthcare centers (88.8%vs.66.7%; p-value = 0.023) and (83.6%vs.55.6%; p-value = 0.011), respectively. Reinforcing the adherence to all antenatal care guidelines by continuous monitoring of health facilities is crucial for best practice. Subsidies for essential services may be required for those who are unable to afford components of antenatal care.

Tele-Medical Nutrition Therapy to Promote Healthy Eating and Nutrition Adherence of Chronic Patients in the COVID-19 Pandemic: A Pragmatically Before-After Trial.

Patients find it difficult, during the pandemic, to receive appropriate nutrition services because of the limited access to health services. This study assessed the effectiveness of a tele-consulting nutrition intervention on the nutrition adherence of patients with diabetes and hypertension. A tele-medical nutrition therapy (MNT) intervention was conducted as a one-group before-after trial. The estimated sample size was 314. Of these, 183 patients were selected from Hefdah-e-Shahrivar and 131 from Farabi Hospital. Patients were asked to complete an adapted version of the nutrition adherence self-reported instrument to compare nutrition adherence when they received face-to-face therapy versus tele MNT. In total, 166 completed all phases of the study. The results showed that the nutrition adherence score significantly increased compared to before the intervention. Hedges's g effect size also confirmed the high efficacy of telenutrition therapy. The magnitude of differences was within a high range (effect size 3.76 [CI: 3.40-4.12]). The present findings showed that providing teleconsulting nutrition services to diabetic and hypertensive patients can positively affect their nutrition adherence. Telenutrition to promote a healthy diet can contribute to effectively controlling diseases in chronic patients during/after the pandemic with no gaps or failures. This study was a tele-nutrition intervention. In this study, we provided consultation on regular food consumption and did not order any chemical substances or nutritional supplements. Furthermore, we did not perform any treatment or invasive intervention, we assumed that a registration number was unnecessary, so we did not apply for clinical trial registration.

Impact of 2022 flood on socio-economic and health status of people residing in flood-stricken areas of Pakistan: a cross-sectional survey.

The events of extreme weather and climate-related disasters such as drought, flood, and heat waves are increasing worldwide. This paper highlights the impact of the 2022 flood in Pakistan on the socio-economic and health status of people residing in flood-stricken areas of Pakistan. A post-flood survey was conducted from three districts of Pakistan with a myriad of questions inquiring about the biopsychosocial aspects of the affected community. Data were collected through a validated questionnaire and was analyzed through SPSS software version 25. Forty percent of people became homeless; the number of individuals with a low income decreased by 9%; and the number of individuals with a moderate income decreased by 22%. Additionally, 48.7% of subjects lost their income due to flooding, 83.4% of subjects reported having some type of illness or disability since the flooding (previously 16.4%), and 92.8% believed that the floods had affected the health and sanitation of their area. Importantly, 22.6% of subjects expressed difficulty in accessing food after flooding compared to before and 59.9% of respondents noted they were unaware of proper pre-flood evacuation protocols in their area. The authors' study indicates that the floods had a significant impact on the socio-economic and health status of residents, particularly those with lower incomes depriving a large proportion of nutrition, health facilities, and property. Without access to necessities and healthcare, individuals are more vulnerable to illnesses, such as chronic respiratory disease, diabetes, and heart disease. The authors stress the importance of providing infrastructural, nutritional, and medical services support to ensure that a community such as Pakistan can recover and thrive post-environmental disaster.

Cognitive testing of dietary assessment and receipt of nutrition services for use in population-based surveys: results from a Demographic and Health Surveys pilot in Uganda

BackgroundAssessing dietary intake and receipt of nutrition services is essential for monitoring health and development, yet accurately measuring these indicators via population-based surveys remains challenging. ObjectiveWe investigated how respondents understood survey instructions and questions used to measure dietary intake and receipt of nutrition services. We also explored the possible influence of social desirability on responses. MethodsIn a Demographic and Health Surveys pilot conducted in Uganda, women were randomly assigned to hear either a short or long introduction to dietary intake questions regarding themselves (n=1,116) and/or their children (n=289). Dietary indicators were compared between groups using a Pearson chi-square test. Cognitive interviews about questions on both dietary intake and receipt of nutrition services were conducted with a subset of respondents with children under age 2 (n=19). Transcripts were analyzed using deductive and inductive approaches. ResultsMinimum dietary diversity did not differ significantly between respondents who received the short versus long introduction to dietary questions (42.5% versus 37.0%, respectively, for women; 39.7% versus 46.6%, respectively, for children). The most common issues with dietary questions were inclusion or omission of items consumed in small quantities and from mixed dishes, terminology for milk feeding and yogurt consumption, and misclassification of foods by food group. Questions on receipt of nutrition services were generally well understood, although there was some confusion with terminology related to rooming-in after birth and breastfeeding observation by a health worker. Social desirability bias likely influenced responses to questions on exclusive breastfeeding in the first two days after birth and soda consumption, and may have influenced responses to questions on meat consumption. ConclusionsSmall modifications to survey questions may improve questions on dietary intake and receipt of nutrition services. Other identified issues may be best addressed through interviewer training or data interpretation. Further survey implementation research may be needed.

Acceptability and factors associated with the community nutrition service for children under two years of age by mothers in the Degadamot district, west Gojjam, Ethiopia, 2023

BackgroundMalnutrition accounts for 45 percent of children under five years of age in Ethiopia and is a more common problem in rural communities. In this regard, Ethiopia has implemented the Community Based Neutrition (CBN) program at the community level to improve the nutritional status of children. Despite this, malnutrition still causes a significant rate of child morbidity and mortality. The status of the implementation of the CBN program is unknown. MethodsA single case study design was employed from March 28 to April 28, 2023. A total of 407 systematically selected mothers for exit interviews participated in the study. The data was entered into Epi-Inf version 7 and exported to STATA version 17 for analysis. Multivariate logistic regression was performed to determine the factors associated with the acceptability of mothers. Findings were presented using descriptions, tables, and graphs. ResultsAccording to the predetermined judgment parameter, the acceptability of CBN services by mothers (66.6 %). Rural residence 0.28 (AOR = 0.28, 95 % CI 0.106, 0.754), merchant 0.11 (AOR = 0.11, 95 % CI 0.036, 0.47), primary 2.5 (AOR = 2.53, 95 % CI 1.09, 5.85), secondary 3.29 (AOR = 3.29, 95 % CI 1.03, 8.43), and higher education 1.46 (AOR = 1.46, 95 % CI 1.09, 4.05) were significantly associated with acceptability. ConclusionsThe general acceptability of the mother to community nutrition services was measured fairly according to the predetermined judgment parameter. Educating mothers is an important factor in increasing service acceptability.

An economic evaluation of breast cancer interventions in Kenya

Cancer is the third leading cause of death in Kenya. Breast cancer is responsible for 3100 deaths annually. Quantifying the economic and social impacts of breast cancer supports inclusion of cancer care within Kenya's universal healthcare plan. Kenya's Ministry of Health led an economic cost-benefit analysis of expanding breast cancer prevention and treatment services. Three scenarios (early diagnosis only, screening with clinical breast exam (CBE-led), and screening with mammography (MG-led)) were modelled using an adapted version of a deterministic state-transition cohort simulation model jointly developed by the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC) and maintained by Forecast Health. Real world evidence on the favorable stage-shift induced by each early detection scenario was used as model inputs. The model estimated the mortality benefits of favorable stage-shifting, and net financial costs and health and economic benefits in 2020 USD. Respectively, over 40 years, the cost to sustain early diagnosis programs only, CBE-led screening, or mammogram-led screening would require 1.4, 2.8, or 5.2 percent increases above current government health spending. All three strategies are economically efficient in the long run. Net economic benefits of expanded breast cancer care using clinical breast exam screening are $2.3 billion dollars (USD) over the next 40 years with 236,000 women's lives saved in Kenya. Mammographic screening provides net benefits of $1.9 billion (USD) with an additional 34,000 lives saved over 40 years compared to the CBE-led screening approach. Over 40 years, an early diagnosis-only strategy saves the fewest lives and has the lowest net benefit among the three strategies. We offer a novel economic evaluation for breast cancer prevention and care expansion within Universal Health Coverage in Kenya. It demonstrates the economic viability of providing those services in a low-middle income (LMI) context. The work was funded by the World Bank Group's Tackling Non-Communicable Diseases Challenges in Low- and Middle-Income Countries Trust Fund, supported by the Access Accelerated Partnership. This report was also partially financed by the Global Financing Facility for Women, Children and Adolescents (GFF). The GFF is a global multi-stakeholder partnership hosted at the World Bank that provides catalytic financing and technical support for safe and equitable delivery of essential health and nutrition services for women, children and adolescents, while helping countries to build more resilient health systems.

Sistem pendukung keputusan dalam menentukan balita stunting menggunakan metode Simple Additive Weighting (SAW) berbasis website

The health center that has the highest prevalence of stunting in Sleman Regency is the Minggir health center at 13.15%. The results of interviews with nutrition officers for toddlers at the Minggir Health Center showed that there were still toddlers with poor nutritional status. In addition, the nutrition service system for toddlers has not functioned properly. Because such suboptimal performance will, it is easier to create a system that can handle or minimize such problems. Thus, building a decision support system can be a solution to the problem that occurs. The SAW method is one of the methods used and the system is designed using the PHP programming language, MySQL database and laravel framework. The research resulted in the creation of a website that can determine the nutritional status of stunted toddlers at the Minggir Health Center Posyandu. This system is designed according to the needs based on the criteria that have been set by the nutrition officer. In the application test, the preference values and nutritional status results obtained from calculations using the system were in accordance with the results of manual calculations with Excel and the nutritional status determination system was as expected.