Young Child Nutrition Research Articles

Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi: a cluster randomized controlled trial

BackgroundExclusive breastfeeding (EBF) improves infant health and survival. We tested the effectiveness of a home-based intervention using Community Health Workers (CHWs) on EBF for six months in urban poor settings in Kenya.MethodsWe conducted a cluster-randomized controlled trial in Korogocho and Viwandani slums in Nairobi. We recruited pregnant women and followed them until the infant’s first birthday. Fourteen community clusters were randomized to intervention or control arm. The intervention arm received home-based nutritional counselling during scheduled visits by CHWs trained to provide specific maternal infant and young child nutrition (MIYCN) messages and standard care. The control arm was visited by CHWs who were not trained in MIYCN and they provided standard care (which included aspects of ante-natal and post-natal care, family planning, water, sanitation and hygiene, delivery with skilled attendance, immunization and community nutrition). CHWs in both groups distributed similar information materials on MIYCN. Differences in EBF by intervention status were tested using chi square and logistic regression, employing intention-to-treat analysis.ResultsA total of 1110 mother-child pairs were involved, about half in each arm. At baseline, demographic and socioeconomic factors were similar between the two arms. The rates of EBF for 6 months increased from 2% pre-intervention to 55.2% (95% CI 50.4–59.9) in the intervention group and 54.6% (95% CI 50.0–59.1) in the control group. The adjusted odds of EBF (after adjusting for baseline characteristics) were slightly higher in the intervention arm compared to the control arm but not significantly different: for 0–2 months (OR 1.27, 95% CI 0.55 to 2.96; p = 0.550); 0–4 months (OR 1.15; 95% CI 0.54 to 2.42; p = 0.696), and 0–6 months (OR 1.11, 95% CI 0.61 to 2.02; p = 0.718).ConclusionsEBF for six months significantly increased in both arms indicating potential effectiveness of using CHWs to provide home-based counselling to mothers. The lack of any difference in EBF rates in the two groups suggests potential contamination of the control arm by information reserved for the intervention arm. Nevertheless, this study indicates a great potential for use of CHWs when they are incentivized and monitored as an effective model of promotion of EBF, particularly in urban poor settings. Given the equivalence of the results in both arms, the study suggests that the basic nutritional training given to CHWs in the basic primary health care training, and/or provision of information materials may be adequate in improving EBF rates in communities. However, further investigations on this may be needed. One contribution of these findings to implementation science is the difficulty in finding an appropriate counterfactual for community-based educational interventions.Trial registrationISRCTN ISRCTN83692672. Registered 11 November 2012. Retrospectively registered.

Organization of hypoallergenic nutrition in young children

The article presents the main principles of rational nutrition of children of the first months and years of life with food allergy, recommendations for the selection of optimal modern nutritional hypoallergenic mixtures and food products.

Microfinance Institutions' Successful Delivery Of Micronutrient Powders: A Randomized Trial In Rural Haiti.

Globally, two-thirds of child deaths could be prevented by increased provision of health interventions such as vaccines, micronutrient supplements, and water purification tablets. We report the results from a randomized controlled trial in Haiti during 2012 that tested whether microfinance institutions-which reach 200million households worldwide-can effectively deliver health products. These institutions provide loans to underserved entrepreneurs, primarily poor women in rural areas. In the intervention group, micronutrient powders to improve the nutrition of young children were distributed at regularly occurring microfinance meetings by a trained borrower. In both the control and the intervention groups, nurses led seminars on nutrition and extended breastfeeding during microfinance meetings. At three-month follow-up, the mean difference in hemoglobin concentration between children in the intervention group and those in the control group was 0.28 grams per deciliter (g/dL)-with a subsample of younger children (under two years of age) showing greater relative improvement (0.46 g/dL)-and the odds ratio for children in the intervention group meeting the diagnostic criteria for anemia was 0.64. The results are similar to those of previous studies that evaluated micronutrient powder distribution through dedicated health institutions. Our findings suggest that microfinance institutions are a promising platform for the large-scale delivery of health products in low-income countries.

Mothers Adherence to Global Infant and Young Child Feeding Strategies in Ketu North District, Volta Region - Ghana

Background: Infant and young child nutrition has been engaging the attention of scientists and governments over the years. Their feeding practices comprise both breastfeeding as well as complementary feeding which have major role in determining the nutritional status of the child, therefore, there has been a well-established link between malnutrition and infant feeding. Children are the future of the world and yet the most vulnerable population, with some 6.6 million children dying before their fifth birthday globally. Studies have shown that poor breastfeeding and complementary feeding practices, coupled with high rates of morbidity from infectious diseases are the primary causes of malnutrition and death in the first two years of life. Ketu-North district noted that even though nutrition and health programmes were in place, breastfeeding coverage has been between 53% in 2013 and 69% in 2015. This study sought to assess mothers or caregivers adherence to Infant and Young Child Feeding (IYCF) practices in Ketu North District of the Volta Region in Ghana. Method: A crosssectional study among mothers/caregivers with children 0-24 months in the district. Multistage sampling techniques was used to select 518 respondents. A semi-structured questionnaire was used to conduct face-to-face interviews. Statistical software Epi Data version 3.1 and Stata version 12.1 were used for data entry and analysis respectively. Descriptive statistics was presented in tables and graphs. Beyond descriptive statistics, associations between the outcome and predictor variables were analysed using Pearson chi-square and logistics regression. P-value < .05 was considered as statistically significant. Findings: Respondents had a mean age of 25.6 years (±3.6 SD). Only 8.7% of the mothers adhered to IYCF strategies with practices of exclusive breastfeeding, complementary feeding, hygiene and sanitation practices, meal variety, and meal frequency being 57.9%, 38.0%, 16.2%, 37.1%, and 33.2% respectively. Ethnicity (p < .000), age of child (p = .032), employment (p =.041) and level of education (p = .042) were found to be associated with adherence to IYCF strategies. Conclusions: Adherence to infant and young child feeding practices were not encouraging in the district therefore the district health management team need to strengthen health education and implement other behaviour change interventions to improve on the adherence to feeding strategies. Further studies should be conducted to assess factors influencing the low adherence to the feeding strategies in the district.

Results of Applying Cultural Domain Analysis Techniques and Implications for the Design of Complementary Feeding Interventions in Northern Senegal.

Designing effective nutrition interventions for infants and young children requires knowledge about the population to which the intervention is directed, including insights into the cognitive systems and values that inform caregiver feeding practices. To apply cultural domain analysis techniques in the context of implementation research for the purpose of understanding caregivers' knowledge frameworks in Northern Senegal with respect to infant and young child (IYC) feeding. This study was intended to inform decisions for interventions to improve infant and young child nutrition. Modules from the Focused Ethnographic Study for Infant and Young Child Feeding Manual were employed in interviews with a sample of 126 key informants and caregivers from rural and peri-urban sites in the Saint-Louis region of northern Senegal. Descriptive statistics, cluster analysis, and qualitative thematic analysis were used to analyze the data. Cluster analysis showed that caregivers identified 6 food clusters: heavy foods, light foods, snack foods, foraged foods, packaged foods, and foods that are good for the body. The study also revealed similarities and differences between the 2 study sites in caregivers' knowledge frameworks. The demonstration of differences between biomedical concepts of nutrition and the knowledge frameworks of northern Senegalese women with regard to IYC feeding highlights the value of knowledge about emic perspectives of local communities to help guide decisions about interventions to improve nutrition.

Nutrition Status of Young Children in Periphery of Lalitpur Sub-Metropolitan City in Nepal

Background & Objectives:Under nutrition in young children is a major public health concern in countries like Nepal. Despite high rate of chronic malnutrition in young children, very less focus has been given to reduce it, thus affecting the lives of these children during adolescence. Objectives: To assess the nutritional status of young children aged between 6 to 12 years in Dukuchhap village in Lalitpur district of Nepal.Materials & Methods: A cross sectional study was conducted in all the households of Dukuchhap village in Lalitpur district during Community Diagnosis Program. Out of 338 young children, 319 were assessed by anthropometric measurements and the data was compared to the standards developed by World Health Organization.Results:A total of 319 children were assessed. Mean height, weight and BMI were high in children from Chhetri ethnicity and low in Dalit children. BMI for age was less than 5th percentile in 23.2% of children. The proportions of underweight and stunted children were 10% and 8.3% respectively. The percentage of underweight (16.9%) and stunted (12.2%) girls was more than that of boys.Conclusion:Nutritional status of young children in Dukuchhap village was found to be low especially considering the high proportion of underweight girls.

Linking agriculture and nutrition education to improve infant and young child feeding: Lessons for future programmes.

Agriculture and food systems play a central role in nutrition by supplying nutritious, healthy and affordable foods. When integrated with nutrition education for behaviour change, agricultural interventions that supply diverse affordable foods from all food groups have great scope for improving young child and family diets. In 2014, process reviews were conducted in Cambodia and Malawi of food security projects that provided agricultural support and community-based nutrition education on improved infant and young child feeding (IYCF). In both countries, household visits were carried out with mothers/caregivers, and interviews and Focus Group Discussions (FGDs) were conducted with purposively selected project stakeholders (53 in Cambodia, 170 in Malawi), including government staff from the agriculture and health sectors. Results highlight that adoption of improved IYCF practices was facilitated by participation in nutrition education and practical cooking sessions, and supportive family and community structures. Barriers faced by families and caregivers were identified, such as women's workload and lack of access to high quality foods, namely fruits, vegetables, legumes, nuts and animal source foods. Implementation challenges regarding coordination of cross-sectoral targeting strategies and capacities of extension services to sustain community-based IYCF nutrition education need to be addressed to improve programme effectiveness and impact. The project lessons from Cambodia and Malawi are useful for integrated agriculture-IYCF nutrition education programmes to help ensure better young child nutrition outcomes.

“An Be Jigi”: Collective cooking, whole grains, and technology transfer in Mali

This paper addresses how available resources, food security, technology, and culture are shaping the choices rural Malian women are making to ensure the health, energy, and well-being of their families. This research contributed to evaluating an eight-year research project (An Be Jigi) targeting improved nutrition. The study, performed over four months, used semi-structured interviews of 120 women in six villages in Mali to assess the identified issues with qualitative and quantitative approaches. This paper describes the history of the An Be Jigi project, whole-grain processing techniques, and group cooking for knowledge sharing with rural women for improved nutrition. Interviews revealed substantial adoption of whole-grain processing techniques and women’s appreciation of the nutritional benefits of those techniques. The women engaged in group cooking ( cuisines collectives) appreciated the activities and mentioned multiple benefits from using them. Women identified access to mills, and to some extent the social stigma of laziness and poverty associated with whole-grain food, as limiting factors of adoption. This study of women’s practices and perceptions regarding use of whole grain tells a story of changing consumption habits being shaped by culture, technology, knowledge, and available resources. Malian women are agents of change and care in their adoption of new techniques and recipes for the improved nutrition of young children and households.

Assessment of nutrition and physical activity environments in family child care homes: modification and psychometric testing of the Environment and Policy Assessment and Observation

BackgroundEarly care and education (ECE) settings play an important role in shaping the nutrition and physical activity habits of young children. Increasing research attention is being directed toward family child care homes (FCCHs) specifically. However, existing measures of child care nutrition and physical activity environments are limited in that they have been created for use with center-based programs and require modification for studies involving FCCHs. This paper describes the modification of the Environment and Policy Assessment and Observation (EPAO) for use in FCCHs.MethodsThe EPAO underwent a through modification process that incorporated an updated format for the data collection instrument, assessment of emerging best practices, tailoring to the FCCH environment, and creation of a new scoring rubric. The new instrument was implemented as part of a larger randomized control trial. To assess inter-rater reliability, observations on 61 different days were performed independently by two data collectors. To assess construct validity, associations between EPAO scores and measures of children’s dietary intake (Healthy Eating Index (HEI) score) and physical activity (accelerometer-measured minutes per hour of moderate to vigorous physical activity, MVPA) were examined.ResultsThe modified EPAO assesses 38 nutrition and 27 physical activity best practices, which can be summarized into 7 nutrition-related and 10 physical activity-related environmental sub- scores as well as overall nutrition and overall physical activity scores. There was generally good agreement between data collectors (ICC > 0.60). Reliability was slightly lower for feeding practices and physical activity education and professional development (ICC = 0.56 and 0.22, respectively). Child HEI was significantly correlated with the overall nutrition score (r = 0.23), foods provided (r = 0.28), beverages provided (r = 0.15), nutrition education and professional development (r = 0.21), and nutrition policy (r = 0.18). Child MVPA was significantly associated with overall time provided for activity (r = 0.18) and outdoor playtime (r = 0.20). There was also an unexpected negative association between child MVPA and screen time (−0.16) and screen time practices (r = −0.21).ConclusionsThe EPAO for the FCCH instrument is a useful tool for researchers working with this unique type of ECE setting. It has undergone rigorous development and testing and appears to have good psychometric properties.Trial registrationNCT01814215, March 15, 2013.

Nutrition behaviour change communication causes sustained effects on IYCN knowledge in two cluster‐randomised trials in Bangladesh

Behaviour change communication (BCC) can improve infant and young child nutrition (IYCN) knowledge, practices, and health outcomes. However, few studies have examined whether the improved knowledge persists after BCC activities end. This paper assesses the effect of nutrition sensitive social protection interventions on IYCN knowledge in rural Bangladesh, both during and after intervention activities. We use data from two, 2‐year, cluster randomised control trials that included nutrition BCC in some treatment arms. These data were collected at intervention baseline, midline, and endline, and 6–10 months after the intervention ended. We analyse data on IYCN knowledge from the same 2,341 women over these 4 survey rounds. We construct a number correct score on 18 IYCN knowledge questions and assess whether the impact of the BCC changes over time for the different treatment groups. Effects are estimated using ordinary least squares accounting for the clustered design of the study. There are 3 main findings: First, the BCC improves IYCN knowledge substantially in the 1st year of the intervention; participants correctly answer 3.0–3.2 more questions (36% more) compared to the non‐BCC groups. Second, the increase in knowledge between the 1st and 2nd year was smaller, an additional 0.7–0.9 correct answers. Third, knowledge persists; there are no significant decreases in IYCN knowledge 6–10 months after nutrition BCC activities ended.

Behavior change communication activities improve infant and young child nutrition knowledge and practice of neighboring non-participants in a cluster-randomized trial in rural Bangladesh.

ObjectiveTo examine the impact on infant and young child nutrition knowledge and practice of mothers who were neighbors of mothers participating in a nutrition Behavior Change Communication (BCC) intervention in rural Bangladesh.MethodsWe analyzed data from 300 mothers whose neighbor participated in a nutrition BCC intervention and 600 mothers whose neighbor participated in an intervention that did not include BCC. We constructed measures capturing mothers’ knowledge of infant and young child nutrition (IYCN) and measures of food consumption by children 6-24m. The effect on these outcomes of exposure to a neighbor receiving a nutrition BCC intervention was estimated using ordinary least squares and probit regressions. The study was registered with ClinicalTrials.gov (Study ID: NCT02237144).ResultsHaving a neighboring mother participate in a nutrition BCC intervention increased non-participant mothers’ IYCN knowledge by 0.17 SD (translating to 0.3 more correct answers). They were 14.1 percentage points more likely to feed their 6-24m children legumes and nuts; 11.6 percentage points more likely to feed these children vitamin A rich fruits and vegetables; and 10.0 percentage points more likely to feed these children eggs. Children of non-participant mothers who had a neighboring mother participate in a nutrition BCC intervention were 13.8 percentage points more likely to meet World Health Organization (WHO) guidelines for minimum diet diversity, 11.9 percentage points more likely to meet WHO guidelines for minimum acceptable diet, and 10.3 percentage points more likely to meet WHO guidelines for minimum meal frequency for children who continue to be breastfed after age 6m. Children aged 0-6m of non-participant mothers who are neighbors of mothers receiving BCC were 7.1 percentage points less likely to have ever consumed water-based liquids.ConclusionsStudies of nutrition BCC that do not account for information spillovers to non-participants may underestimate its benefits in terms of IYCN knowledge and practice.

Improving child nutrition and development through community-based childcare centres in Malawi \u2013 The NEEP-IE study: study protocol for a randomised controlled trial

BackgroundThe Nutrition Embedded Evaluation Programme Impact Evaluation (NEEP-IE) study is a cluster randomised controlled trial designed to evaluate the impact of a childcare centre-based integrated nutritional and agricultural intervention on the diets, nutrition and development of young children in Malawi. The intervention includes activities to improve nutritious food production and training/behaviour-change communication to improve food intake, care and hygiene practices. This paper presents the rationale and study design for this randomised control trial.MethodsSixty community-based childcare centres (CBCCs) in rural communities around Zomba district, Malawi, were randomised to either (1) a control group where children were attending CBCCs supported by Save the Children’s Early Childhood Health and Development (ECD) programme, or (2) an intervention group where nutritional and agricultural support activities were provided alongside the routine provision of the Save the Children’s ECD programme. Primary outcomes at child level include dietary intake (measured through 24-h recall), whilst secondary outcomes include child development (Malawi Development Assessment Tool (MDAT)) and nutritional status (anthropometric measurements). At household level, primary outcomes include smallholder farmer production output and crop-mix (recall of last production season). Intermediate outcomes along theorised agricultural and nutritional pathways were measured. During this trial, we will follow a mixed-methods approach and undertake child-, household-, CBCC- and market-level surveys and assessments as well as in-depth interviews and focus group discussions with project stakeholders.DiscussionAssessing the simultaneous impact of preschool meals on diets, nutrition, child development and agriculture is a complex undertaking. This study is the first to explicitly examine, from a food systems perspective, the impact of a preschool meals programme on dietary choices, alongside outcomes in the nutritional, child development and agricultural domains. The findings of this evaluation will provide evidence to support policymakers in the scale-up of national programmes.Trial registrationISRCTN registry, ID: ISRCTN96497560. Registered on 21 September 2016.

Fish and Meat Are Often Withheld From the Diets of Infants 6 to 12 Months in Fish-Farming Households in Rural Bangladesh.

Fish is a widely available animal-source food in Bangladesh and a rich source of nutrients, yet little is known about practices related to incorporating fish into the diets of infants and young children. Use dietary diversity data to explore consumption patterns of fish and high-quality food items within the household and examine factors associated with delayed introduction of fish to infants and young children. Cross-sectional survey of 496 households with children <36 months participating in the Aquaculture for Income and Nutrition project in Bangladesh. Data collected included household characteristics, women's dietary diversity score, and minimum dietary diversity score along with data on Infant and Young Child Feeding practices. Most children (63.4%) met the threshold for minimum dietary diversity. Despite having received extensive nutrition education related to including fish in complementary foods, only half of the caretakers introduced fish at 6 months and the mean age of introduction of small fish was 8.7 months. Meat and fish were not common in infant diets but increased with child age. Concerns about bones were a major barrier to incorporating fish into infant diets. Given its nutrient profile and widespread availability in certain contexts, fish could be an underutilized opportunity to improve nutrition and health outcomes of infants and young children. Further research, including utilizing food processing technologies, is needed to develop appropriate responses to overcome these barriers.

Policy content and stakeholder network analysis for infant and young child feeding in Bangladesh

BackgroundAppropriate infant and young child feeding (IYCF) practices are essential for nutrition of infants and young children. Bangladesh has one of the highest levels of malnutrition globally along with sub-optimal IYCF practices. A supportive policy environment is essential to ensure that effective IYCF interventions are scaled up.The objectives of our study were to assess the support for IYCF in the national policy environment through policy analysis and stakeholder analysis and in so doing identify opportunities to strengthen the policy environment.MethodsWe used a matrix developed by SAIFRN (the South Asian Infant Feeding Research Network) to systematically identify supportive national policies, plans and guidelines for IYCF. We adapted narrative synthesis and descriptive approaches to analyze policy content, based on four themes with a focus on support for mothers. We conducted three Net-Map interviews to identify stakeholders who influenced the policies and programs related to IYCF.ResultsWe identified 19 national policy documents relevant to IYCF. Overall, there was good level of support for IYCF practices at policy level – particularly regarding general support for IYCF and provision of information to mothers – but these were not consistently supported at implementation level, particularly regarding specificity and population coverage. We identified gaps regarding the training of health workers, capacity building, the monitoring and targeting of vulnerable mothers and providing an enabling environment to mothers, specifically with respect to maternity leave for working women. Urban populations and providers outside the public sector remained uncovered by policy. Our stakeholder analysis identified government entities such as the National Nutrition Service, as the most influential in terms of both technical and funding support as they had the mandate for formulation and implementation of policies and national programs. Stakeholders from different sectors played important roles, demonstrating the salience of IYCF.ConclusionsAlthough there is strong supportive policy environment for IYCF, it is important that policies cover all populations. Our analysis indicated that opportunities to strengthen the policy environment include: expanding population coverage, increasing inter-sector coordination, improving translation of policy objectives to implementation-level documents, and the engagement of non-public sectors. In addition, we recommend explicit strategies to engage diverse stakeholders in the formulation and implementation of IYCF policies.

Analysis of stakeholders networks of infant and young child nutrition programmes in Sri Lanka, India, Nepal, Bangladesh and Pakistan

BackgroundEffective public policies are needed to support appropriate infant and young child feeding (IYCF) to ensure adequate child growth and development, especially in low and middle income countries. The aim of this study was to: (i) capture stakeholder networks in relation to funding and technical support for IYCF policy across five countries in South Asia (i.e. Sri Lanka, India, Nepal, Bangladesh and Pakistan); and (ii) understand how stakeholder networks differed between countries, and identify common actors and their patterns in network engagement across the region.MethodsThe Net-Map method, which is an interview-based mapping technique to visualise and capture connections among different stakeholders that collaborate towards achieving a focused goal, has been used to map funding and technical support networks in all study sites. Our study was conducted at the national level in Bangladesh, India, Nepal, and Sri Lanka, as well as in selected states or provinces in India and Pakistan during 2013–2014. We analysed the network data using a social network analysis software (NodeXL).ResultsThe number of stakeholders identified as providing technical support was higher than the number of stakeholders providing funding support, across all study sites. India (New Delhi site – national level) site had the highest number of influential stakeholders for both funding (43) and technical support (86) activities. Among all nine study sites, India (New Delhi – national level) and Sri Lanka had the highest number of participating government stakeholders (22) in their respective funding networks. Sri Lanka also had the highest number of participating government stakeholders for technical support (34) among all the study sites. Government stakeholders are more engaged in technical support activities compared with their involvement in funding activities. The United Nations Children’s Emergency Fund (UNICEF) and the World Health Organization (WHO) were highly engaged stakeholders for both funding and technical support activities across all study sites.ConclusionInternational stakeholders were highly involved in both the funding and technical support activities related to IYCF practices across these nine study sites. Government stakeholders received more support for funding and technical support activities from other stakeholders compared with the support that they offered. Stakeholders were, in general, more engaged for technical support activities compared with the funding activities.

Nutrition of Infants and Young Children in Poland – Pitnuts 2016

The study evaluating the feeding practices and the nutritional status of children aged 5 to 36 months in a general, Polish, representative population (n=1059) was carried out from May to July 2016. The aim of this study was to evaluate the feeding practices in children aged 5 to 36 months with regard to models of safe nutrition on the basis of the outcome of the population study performed in 2016. The data obtained show that the feeding practices in children in their first year of life do not meet the guidelines presented in the model of safe nutrition, particularly in matters of timing of complementary feeding introduction and food choice. The analysis of nutrient profile in toddlers’ diets indicated the differentiated energy and protein intake is significantly higher than population norms (EAR/AI). It is necessary to modify the nutrition of infants and young children through a better selection of products. Nutritional practice should always be monitored and modified according to the model of safe nutrition as part of medical nutritional counselling. More educational efforts are required to increase the awareness of the relation between the diet and nutritional status of young children among healthcare professionals.

Child malnutrition in sub-Saharan Africa: A meta-analysis of demographic and health surveys (2006-2016).

BackgroundSub-Saharan Africa has one of the highest levels of child malnutrition globally. Therefore, a critical look at the distribution of malnutrition within its sub-regions is required to identify the worst affected areas. This study provides a meta-analysis of the prevalence of malnutrition indicators (stunting, wasting and underweight) within four sub-regions of sub-Saharan Africa.MethodsCross-sectional data from the most recent Demographic and Health Surveys (2006–2016) of 32 countries in sub-Saharan Africa were used. The countries were grouped into four sub-regions (East Africa, West Africa, Southern Africa and Central Africa), and a meta-analysis was conducted to estimate the prevalence of each malnutrition indicator within each of the sub-regions. Significant heterogeneity was detected among the various surveys (I2 >50%), hence a random effect model was used, and sensitivity analysis was performed, to examine the effects of outliers. Stunting was defined as HAZ<-2; wasting as WHZ<-2 and underweight as WAZ<-2.ResultsStunting was highest in Burundi (57.7%) and Malawi (47.1%) in East Africa; Niger (43.9%), Mali (38.3%), Sierra Leone (37.9%) and Nigeria (36.8%) in West Africa; Democratic Republic of Congo (42.7%) and Chad (39.9%) in Central Africa. Wasting was highest in Niger (18.0%), Burkina Faso (15.50%) and Mali (12.7%) in West Africa; Comoros (11.1%) and Ethiopia (8.70%) in East Africa; Namibia (6.2%) in Southern Africa; Chad (13.0%) and Sao Tome & Principle (10.5%) in Central Africa. Underweight was highest in Burundi (28.8%) and Ethiopia (25.2%) in East Africa; Niger (36.4%), Nigeria (28.7%), Burkina Faso (25.7%), Mali (25.0%) in West Africa; and Chad (28.8%) in Central Africa.ConclusionThe prevalence of malnutrition was highest within countries in East Africa and West Africa compared to the WHO Millennium development goals target for 2015. Appropriate nutrition interventions need to be prioritised in East Africa and West Africa if sub-Saharan Africa is to meet the WHO global nutrition target of improving maternal, infant and young child nutrition by 2025.

The Life Course Implications of Ready to Use Therapeutic Food for Children in Low-Income Countries.

The development of ready-to-use therapeutic food (RUTF) for the treatment of uncomplicated cases of severe acute malnutrition in young children from 6 months to 5 years old has greatly improved survival through the ability to treat large numbers of malnourished children in the community setting rather than at health facilities during emergencies. This success has led to a surge in demand for RUTF in low income countries that are frequently food insecure due to environmental factors such as cyclical drought. Worldwide production capacity for the supply of RUTF has increased dramatically through the expansion and development of new manufacturing facilities in both low and high income countries, and new business ventures dedicated to ready-to-use foods have emerged not only for emergencies, but increasingly, for supplementing caloric intake of pregnant women and young children not experiencing acute undernutrition. Due to the lack of evidence on the long term health impact these products may have, in the midst of global nutrition transitions toward obesity and metabolic dysfunction, the increased use of manufactured, commercial products for treatment and prevention of undernutrition is of great concern. Using a framework built on the life course health development perspective, the current research presents several drawbacks and limitations of RUTF for nutrition of mothers and young children, especially in non-emergency situations. Recommendations follow for potential strategies to limit the use of these products to the treatment of acute undernutrition only, study the longer term health impacts of RUTF, prevent conflict of interests arising for social enterprises, and where possible, ensure that whole foods are supported for life-long health and nutrition, as well as environmental sustainability.

Becoming Baby Friendly: A Complex Adaptive Systems Toolbox for Scaling up Breastfeeding Programs Globally

Metrics exist to assist committed countries with measuring their existing environments for scaling up breastfeeding programs. Yet, no evidence‐based toolboxes exist to help countries to both assess as well as guide the development of national breastfeeding programs and their scaling‐up. The Becoming Breastfeeding Friendly (BBF)Toolbox provides an evidence‐based index (BBFI) as well as case studies designed to guide the development and tracking of large scale well‐coordinated multi‐sector national breastfeeding promotion programs that can be uniformly translated for use in low, middle, and high income countries worldwide Grounded in the evidence‐based Breastfeeding Gear Model (BFGM) complex adaptive systems framework, the BBFI was developed between August 2015 and January 2016 by Yale University researchers in collaboration with a 13‐member Technical Advisory Committee (TAG) comprised of academic (Bangladesh, Brazil, Canada, Ghana, Mexico, UK, USA), international agencies (WHO, UNICEF, PAHO), philanthropic organizations (Bill and Melinda Gates Foundation, Alive &amp; Thrive), and policy experts in breastfeeding as well as members with expertise in metric development relevant to scaling up of health and nutrition programs. First, a review of the academic and grey literature was conducted by the BBF steering committee to identify metrics to assess country‐level readiness to scale up health initiatives within the areas of infant and young child feeding, food and nutrition, and newborn survival. The steering committee met regularly to develop and reach agreement on the key benchmarks and definitions for the BBFI, which were then proposed to the TAG. TAG members participated in the progressive assessment and revision of the BBFI following a Delphi consensus methodology. As part of this process, the TAG was convened for a three day highly intensive participatory meeting to discuss and reach initial consensus on the definitions and benchmarks for the metric. Following this meeting, TAG members continued to provide their expertise with the refinement of the BBFI, including weighting the benchmarks to help develop the BBF scoring algorithm. The resulting BBFI consists of eight gears that correspond to the BFGM: Advocacy (4 benchmarks); Political Will (3 benchmarks); Legislation &amp; Policy (10 benchmarks); Funding &amp; Resources (4 benchmarks); Training &amp; Program Delivery (17 benchmarks); Promotion (3 benchmarks); Research &amp; Evaluation (10 benchmarks); and Coordination, Goals, &amp; Monitoring (3 benchmarks). Each gear contains gear‐related themes and associated benchmarks. A global BBFI total score as well as sub‐scores for each of the eight gears can be calculated from the benchmarks. The country environment as BBF is ranked as weak, moderate, strong and outstanding according global BBFI result. To aid countries in how to use their baseline enabling environment assessment to advocate for policy and program changes, the toolbox includes eighty‐seven case studies illustrating data‐driven decision making along with their references. The BBF toolbox is currently in the final stages of validation in Mexico and Ghana. Findings thus far indicate that BBF has a strong potential to influence effective scaling up of breastfeeding protection, promotion and support worldwide.Support or Funding InformationFunded by the Family Larsson‐Rosenquist Foundation.

Infant and Young Child Feeding Pattern in Children Attending in the Outpatient Department of an Urban Hospital

Background: Proper feeding practices during the first two years of life is essential for growth nutrition and development of young children. Optimum infant and young child feeding can reduce childhood mortality and morbidity significantly. Present study was done to know the infant and young child feeding pattern in the children of 0-23 months of age attending out patient department of an urban hospital.Methods: This cross sectional study was conducted among 314 mother/child pair attending the outpatient department of an urban hospital during the period of September 2014 to December 2014.Result: 68.5% children had early initiation of breast feeding and exclusive breast feeding among children below 6 months was 66.8%.Continued breast feeding among the children of 12 to 15 months was 80.4% and 84.2 % children were given solid food at 6 months of age. Adequate minimum dietary diversity, minimum meal frequency and minimal acceptable diet among children 6-23 months were 61.4%,57.3% and 39.4% respectively.64.5%% children were taking iron rich food or supplementation.Conclusion: Early initiation of breast feeding(0-23mo) and Exclusive breastfeeding(0- 6mo) were satisfactory in the study children but IYCF practice in children of 6-23 months was not optimum and far away from the HPNSDP 2011-2016 target of 52% of children to be fed with minimum acceptable diet.Bangladesh J Child Health 2016; VOL 40 (2) :92-97