Young Children In Rural Areas Research Articles

Association between infant and young child feeding indicators and the nutritional status of children aged 6-23 months in rural areas of Hunan Province in 2019

To estimate the status of complementary feeding among infants and young children aged 6-23 months in rural areas of Hunan Province. The association between infant and young child feeding indicators and child undernutrition were assessed. A total of 1220 infants and young children aged 6-23 months from 24 investigated places of 6 cities in Hunan Province were selected by multi-stage stratified sampling for physical measurement, hemoglobin(Hb) test and caregiver interview. Complementary diet was analyzed according to the World Health Organization's definition of infant and young child feeding indicators. Z-scores were used to elevate nutrition status. Logistic regression models were used to explore the influencing factors of the nutritional status. The prevalence rates of underweight, stunting, wasting, overweight, obesity and anemia were 3.6%, 4.8%, 2.7%, 10.5%, 2.0% and 16.3%. The percentage of infants and young children aged 6-23 months in rural areas of Hunan Province who get minimum dietary diversity, minimum meal frequency, and minimum acceptable diet was 43.3%, 68.5% and 28.1%. None of the individual infant and young child feeding indicators showed significant association with undernutrition, except minimum meal frequency for obesity and anemia. The nutritional status of infants and young children in rural areas of Hunan Province has improved, but the anemia problem is still serious. Complementary feeding frequency is closely associated with anemia for infants and young children.

The role of early childhood development and education (ECDE) in supporting learning and well-being in rural early childhood and primary schools in South Africa

ABSTRACT This paper examines how early childhood and primary schools can be constructed as enabling spaces to improve the learning and well-being of children aged six to nine who live in multidimensionally poor, low-resourced rural communities in South Africa. Quality early childhood development and education (ECDE) can be the catalyst to break the cycle of poverty for many young children in rural areas. A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart. A comprehensive search strategy using electronic databases and hand searches systematically whittled down an initial database of 30,080 articles to 16 articles for this study. A thematic analysis identified enablers and constraints for supporting children’s learning and well-being across three themes: (1) infrastructure, educational resources and child agency (2) initial teacher education (ITE) and (3) socioeconomic status. The findings and discussion highlight child agency as an enabler to learning and well-being and the structural and pedagogical challenges of implementing ITE curricula specific to rural educational contexts.

O.4.4-7 Motives and Barriers for Leisure Time Physical Activity among rural mothers with young children

Abstract Purpose The aim of this study was to analyse the motives and barriers for mothers with young children in rural areas to engage in leisure time physical activity (LTPA), based on the following research question: What LTPA needs and interests do mothers with young children living in rural areas of Gipuzkoa have? Methods Four focus groups were conducted in 4 different rural districts of Gipuzkoa, in which 19 women with at least one child under 9 years of age participated. The transcripts were analysed inductively by reading them repeatedly and then organised through triangulation by the researchers from a socio-ecological perspective. Results Regarding intrapersonal factors, because of work and informal caregiving duties, they had no time nor energy for LTPA. They felt the need to take time for themselves but put their own needs on the back burner, giving priority to the needs of their children and caregiving tasks. Moreover, they did not like being physically active, nor did they like the fact that most of users of sports facilities were men. Concerning interpersonal factors, they enjoyed doing LTPA with their friends. However, if their friends were also mothers, they found it difficult to coincide with each other. In addition, leaving their children with someone else so that they could do LTPA, made them feel guilty. Moreover, they liked the idea of doing LTPA with their family but when they put it into practice, it did not meet their personal needs. With respect to environmental factors, deficiencies in the facilities for LTPA physical activity in their rural municipalities, distances to municipalities with sports facilities and rugged terrain were barriers to LTPA. Conclusions This study has helped to understand the LTPA interests and needs of the many mothers with young children living in rural areas of Gipuzkoa. These aspects are considered important to consider when developing LTPA promotion policies and may also be of interest for similar contexts. Furthermore, these results may be important for enhancing women's well-being and quality of life through the promotion of LTPA, as well as struggling gender inequalities in leisure time for women.

Social-Emotional Interventions for Young Children in Rural Areas: A Single-Case Design Meta-Analysis

For young children with early social-emotional difficulties, early intervention is imperative. A number of interventions are available for young children to promote social-emotional competencies. Yet, little is known regarding the impact of early childhood interventions among rural children. Rural communities have several barriers which impede access to early intervention, and rural children often are at increased risk for social-emotional difficulties. Thus, the purpose of this article is to conduct a meta-analysis of single case design studies of social-emotional interventions that have been implemented within rural settings with young children, in an effort to determine the effects and types of early interventions specific to young children in rural areas. A total of 7 studies with 26 participants and 53 effects comprised the final sample. Findings indicated that all interventions, representing three different component types (i.e., teacher/parent behavior management training, social-emotional competency training, parent involvement/enhancement), produced positive social-emotional outcomes (i.e., improved prosocial behavior and decreased disruptive behavior). Moderating variables (e.g., child characteristics, intervention implementer) that may impact intervention effectiveness were also studied and one variable was significant; specifically, studies published in journals had more impact on outcomes than those which were not published. Implications for future research and policy are provided.

Dietary diversity and nutritional status of children attending early childhood development centres in Vhembe District, Limpopo province, South Africa.

The present study assessed dietary diversity and anthropometric status of children attending early development centres in South Africa. In the Vhembe District of Limpopo province, South Africa, 273 children were conveniently chosen from 8 randomly selected early childhood development centres for a cross-sectional study. Data were gathered via a questionnaire administered by the interviewer in June 2021. Height, body weight and mid-upper arm circumference were measured to assess anthropometric status. A 24-h dietary recall was obtained to provide information on dietary diversity. The prevalence of underweight, wasting and stunting was 9, 4 and 26 %, respectively. More than half of the children had a low dietary diversity score, according to the Food and Agriculture Organization scoring system for children. Grains, roots, tubers, dairy products, other fruits and vegetables, and flesh-based foods were the highest consumed food groups. The lowest consumption was for eggs, vitamin A-rich fruits and vegetables, legumes and nuts. Height for age and weight for age were significantly associated with dietary diversity score, but not weight for height. Children who did not meet the reference value of greater than 4 for dietary diversity had a significant risk of being underweight (AOR 0⋅25, 95 % CI 0⋅08, 0⋅75) and stunted (AOR 0⋅32, 95 % CI 0⋅14, 0⋅74). The nutritional status of the children was impacted by a lack of adequate dietary diversity. Young children in rural areas need to receive a wide range of food to promote greater diversification of diets in order to diminish the risk of undernutrition.

Disease Biomarkers of Giardiasis.

Giardiasis is a common, treatable intestinal disease that adversely affects underprivileged communities living in unsanitary conditions. Giardiasis causes a wide spectrum of gastrointestinal diseases in those infected, ranging from subclinical disease that can manifest as irritable bowel syndrome with persistent abdominal symptoms. Importantly, giardiasis has been identified as a predictor of malnutrition among young children in rural areas and as a cause of waterborne mass epidemics endangering not only humans but also animals in a broad clinical, social, and economic spectrum. While the diagnosis of giardiasis is heavily dependent on the presence of cysts and/or trophozoites detected using microscopy, the intermittent cyst excretion, low infection intensity, and low sensitivity method m4akes fecal examination unrewarding, thus urging the need for an improved diagnostic method for giardiasis. Proteins are key compounds in biosynthesis, cells, tissues, and organ signaling, carrying important information related to biological and pathogenic processes, as well as pharmacological responses to therapeutic intervention, and are therefore important indicators for determining disease onset, progression, and drug treatment effectiveness. In connection with this, proteins could serve as promising biomarkers for antigen-antibody detection, as well as vaccine candidates. This article is aimed at providing a comprehensive overview of proteins, serological, molecular, inflammatory, volatile, and hormonal biomarkers associated with giardiasis and their potential for diagnostics and therapeutics.

Assessing the prevalence of young children living in households prepared for COVID-19 in 56 low- and middle-income countries

BackgroundThe COVID-19 pandemic and governments’ attempts to contain it are negatively affecting young children’s health and development in ways we are only beginning to understand and measure. Responses to the pandemic are driven largely by confining children and families to their homes. This study aims to assess the levels of and associated socioeconomic disparities in household preparedness for protecting young children under the age of five from being exposed to communicable diseases, such as COVID-19, in low- and middle-income countries (LMICs).MethodsUsing data from nationally representative household surveys in 56 LMICs since 2016, we estimated the percentages of young children under the age of five living in households prepared for communicable diseases (e.g., COVID-19) and associated residential and wealth disparities at the country- and aggregate-level. Preparedness was defined on the basis of space for quarantine, adequacy of toilet facilities and hand hygiene, mass media exposure at least once a week, and phone ownership. Disparities within countries were measured as the absolute gap in two domains—household wealth and residential area - and compared across regions and country income groups.ResultsThe final data set included 766,313 children under age five. On average, 19.4% of young children in the 56 countries lived in households prepared for COVID-19, ranging from 0.6% in Ethiopia in 2016 to 70.9% in Tunisia in 2018. In close to 90% of countries (50), fewer than 50% of young children lived in prepared households. Young children in rural areas or in the poorest households were less likely to live in prepared households than their counterparts.ConclusionsA large portion of young children under the age of five in LMICs were living in households that did not meet all preparedness guidelines for preventing COVID-19 and caring for patients at home. This study highlights the need to ensure all families in LMICs have the means to prevent the spread of the pandemic or other communicable illnesses to young children during pandemics.

Theory of change: Driving a digital school in rural Pakistan

This paper reports the findings of the initial phase of a longitudinal study that aims to investigate barriers to digital literacy in rural Pakistan. The research employs the Theory of Change to plan various stages of a digital literacy program for young children living in a remote area of Pakpattan, Pakistan. A Digital Access Vehicle (DAVe) was deployed as an innovative tool to introduce digital literacy for those who were unable to travel to the project’s NGO partner headquarters to access DAVe’s array of digital technologies. An interpretive case study approach is used to perform in-depth analysis of the subject under investigation by conducting one-on-one interviews and focus groups with key informants. The contributions of this research are twofold: (a) it operationalizes the Theory of Change to systematically plan a social impact project in a resource-constrained developing country; and (b) it creates a better understanding of barriers hindering digital literacy of young children in rural areas of a developing country such as Pakistan.

Study on the Relationship between First-Time Complementary Feeding Practice and the Nutritional Status of Infants and Young Children in the Multi-Ethnic Rural Areas of Sichuan Province

To evaluate the current status of first food supplement and the nutrition of infants and young children in rural areas inhabited by people of Han, Tibetan, and Yi ethnicities in Sichuan Province, and to explore the relationship between the first ever feeding of food supplement and the nutritional status. Using a multi-stage randomized cluster sampling method, we selected 2 Han counties, 2 Tibetan counties and 2 Yi counties in rural areas of Sichuan Province. These counties were previously defined as economically poor counties, but had since been lifted out of poverty. They were selected for this study before they came out of poverty. Infants and young children of 12-24 months old and their main caregivers from these counties were the subjects of the study. Structured questionnaires were used to collect information concerning the sociodemographic characteristics of infants and young children and their caregivers, and the first complementary feeding for infants and young children. Infant and young children weight scales and length/height tapes were used to collect the weight and length/height data of infants and young children. Unconditional logistic regression was used to analyze the correlation between the behavior of giving supplementary food for the first time to infants and young children and their nutritional status. A total of 1117 pairs of infants and children and their caregivers were investigated. Regarding the time of first supplementary food addition, nearly half of the caregivers in Han areas started adding supplementary food when the infants were 6 months old, accounting for 43.07% (171/397). Most of the caregivers in Yi and Tibetan areas started giving infants and young children supplementary food when they were less than 6 months old, accounting for 77.18% (301/390) and 47.58% (157/330), respectively. In terms of the types of supplementary food added for the first time, caregivers in Han areas mainly used homemade rice cereal, accounting for 41.56% (165/397), caregivers in Tibetan areas mainly used meat, vegetables or fruits and other complementary foods, accounting for 42.12% (139/330), and caregivers in Yi areas mainly used homemade rice cereal, accounting for 46.41% (181/390). The overall malnutrition rate of infants and young children was 28.83% (322/1117) and the malnutrition rate of infants and young children in Han, Tibetan, and Yi areas were 10.58% (42/397), 24.85 (82/330), and 50.77 (198/390), respectively. The regression analysis results show that after controlling for confounding factors, compared with Han areas, it is more likely for infants and young children in Yi areas to be malnourished ( OR=9.49, 95% CI 6.00-15.00). Compared with adding other types of complementary foods for the first time, infants and young children given iron-fortified rice cereal had a lower risk of malnutrition ( OR=0.54, 95% CI0.29-0.99). The multi-ethnic rural areas of Sichuan Province had problems that supplementary foods are added too early, and that the types of supplementary foods added for the first time were not appropriate. In addition, the nutritional status of local infants and young children in these areas was causing concerns. The malnutrition problem of infants and young children was especially prominent in the Yi ethnic areas. Adding iron-fortified rice cereal for the first time could reduce the possibility of malnutrition in infants and young children to a certain extent. It is recommended that attention should be given to the health education intervention of the first supplementary food for infants and young children to effectively improve the nutritional status of infants and young children in these areas.

How Prepared Were Households for COVID-19? Implications for Young Children in 45 Low- and Middle-Income Countries

Background: COVID-19 and governments’ attempts to contain the pandemic are having many negative impacts on young children’s health and development, including confining them and their families to their homes. However, little is known about levels of household preparedness for protecting young children from the direct and indirect effects of the pandemic in low- and middle-income countries’ (LMICs). Methods: Using data from nationally-representative household surveys (Demographic and Health Surveys, Multiple Indicator Cluster Surveys) in 45 LMICs since 2016, we estimated the percentages of young children living in households prepared for the pandemic and associated socioeconomic disparities. Preparedness was defined on the basis of space for quarantine, adequacy of toilet facilities and hand hygiene, mass media exposure, and phone ownership. The assessment was made at the country and aggregate levels. The final data set included 681,682 children under age five. Findings: Of all young children in the sample, only 19·6% (95% CI, 16·8%-22·4%) lived in households prepared for COVID-19, ranging from 0·6% in Ethiopia (95% CI, 0·3-0·9%) in 2016 to 70·9% (95% CI, 68·4-73·4%) in Tunisia in 2018. In close to 90% of countries (40), fewer than 50% of young children lived in prepared households and fewer than 10% in 23 countries. Young children in rural areas or in the poorest households were less likely to live in prepared households than their counterparts, with an average gap of 11·2 (95% CI, 9·2-13·3) and 34·3 (95% CI, 26·9-41·7) percentage points, respectively. In 28 countries, fewer than 1% of young children in the poorest wealth quintiles lived in households prepared for the COVID-19, mostly concentrated in sub-Saharan Africa. Interpretation: A large portion of young children in 45 LMICs were not protected from COVID-19 in their homes and were at risk of worsening health and development. Global and national investments are urgently needed to improve housing conditions needed to prevent spread of COVID and other communicable diseases. Funding Statement: UKRI Collective Fund Award (Grant Ref: ES/T003936/1) to the University of Oxford, “UKRI GCRF Harnessing the power of global data to support young children's learning and development: Analyses, dissemination and implementation” Declaration of Interests: The authors declare no competing interests.

Nutrition Intervention among Children under 24 months suffering from Iron Deficiency Anemia in rural Cameroon

Almost 63% of young children living in Cameroon are anemic. However, young children in rural area are most affected. Current policy recommends the need to combine several strategies to reduce the burden of anemia in rural areas. A 20-week nutrition intervention program consisting of 4 weeks of nutrition education and 16 weeks of iron supplementation was carried out in 50 Cameroonian children aged 6-23 months in rural area, with mild iron deficiency anemia (IDA). Participants were distributed randomly by drawing lots into intervention and control groups with 25 participants in each group. A nutrition knowledge questionnaire, anthropometric measurements, hemoglobin (Hb) level, serum ferritin (SF), serum iron and iron status biomarkers were obtained in both groups before and after nutrition intervention. At the end of the study, the mothers of intervention group had greater knowledge on iron, IDA and dietary strategies to reduce IDA in children. Concerning anthropometric parameters, there were no significant differences in the weight/age, height/age and weight/height (p>0.05) before and after the intervention in both groups. At the end of nutrition intervention, a significant gain in Hb level was found in the both groups but significant difference was observed in the intervention group (10.63±0.18 and 11.46±0.19g/L; p=0.0001). However, the SF and serum iron were significantly lower in the control group compared to the intervention group (18.89±7.54 µg/L vs 28.93±5.81 µg/L; p=0.03) and (11.46±1.02 µg/L vs 19.65±0.78 µg/L; p=0.01) respectively. Iron status has improved in the both group. The incidence of anemia (28% and 76%; p=0.0007), iron deficiency (56% and 68%; p>0.05) and iron deficiency anemia (32% and 64%; p=0.02) was significantly lower in the intervention group compared to the control group. The study findings showed that, nutrition education combined with iron supplementation impact positively on the iron status of young children. It is therefore important to educate mothers or caregivers about good nutrition in addition to with others strategies.

Young Children's Family Sex Education in Rural Areas of Sichuan Province and Its Influencing Factors

Objective To understand the family sex education for young children in rural areas of Sichuan province and analyze the influencing factors. Methods A multi-stage random sampling method was used to select 2246 parents of kindergarten children from rural areas in Sichuan province for a questionnaire-based survey.The Chi-square test and Logistic regression model were used for data analysis. Results It was found 1132(52.33%)parents had implemented family sex education for young children and 1031(47.67%)had not.Young children having asked sex-related questions(OR=1.536,95%CI=1.257-1.878),parents thinking that early childhood sex education is necessary(OR=3.691,95%CI=2.029-6.717),and parents having the intention to know early childhood sex education(OR=1.700,95%CI=1.274-2.269),and kindergarten having implemented early childhood sex education(OR=3.316,95%CI=2.515-4.372)were promoting factors for parents to conduct early childhood sex education,whereas a total annual household income at the middle level(OR=0.664,95%CI=0.456-0.968)was a hindering factor for parents to conduct early childhood sex education. Conclusions Parents of young children in rural areas of Sichuan province have poor awareness of sex education,and the proportion of parents who have never conducted sex education for children is high.The total annual income of the family,whether the children have asked about sex-related questions,parents' attitude towards early childhood sex education,and whether the kindergarten has conducted the early childhood sex education are important factors that influence the level of children's family sex education.

Education and poverty trap: Evidence from mountian areas in Sichuan province

Education involves current cost and future returns, thus can be viewed as an investment in human capital, which is essential for breaking the poverty traps in developing areas. Since investment decisions on education are usually made by parents, especially for young children in rural area, parents’ expectations of return on education, cost of education and their time preferences has a huge impact on the years of schooling for their children. We sketch a portrait of education investment for villagers in Daliang Mountain in Sichuan province with a detailed survey for parents. Those families have below-average income and receive government support on the 9-year compulsory education. The survey data shows parents with higher expectation of return on education are more likely to spend more time with their children on homework and tutoring, but the effect on monetary expenditure on education is insignificant. Also, children whose parents expect higher return on education are less likely to drop out from school. Both the direct costs (e.g., tuition) and indirect costs (forgone income because of schooling) don’t have significant impact on education investment. In terms of time preferences, more patient parents desire a higher level of education for their children. In summary, with government funding, the financial concern is not the major constraint for education investment for most families, but parents’ attitudes and beliefs play a more important role.

Sanitation and hygienic practices of young children in rural area of Assam

Background: Assam, one of the North Eastern States of India contributes significantly to the high national child mortality rates. Hygienic practices are very important for a child’s well-being and influence mortality. Objectives: Our study was conducted with the objectives to assess the sanitary and hygienic practices of under-five children in a rural community of Assam and to analyze the factors influencing the sanitation and hygienic practices of young children. Materials and Methods: It was a community-based cross-sectional study conducted among 360 under-5 children from rural areas of Kamrup district, Assam. The parents of the children were interviewed and sanitation, hygienic practices of the children and caregivers were observed. The data thus collected were analyzed using Microsoft Excel and SPSS version 18. Results: Most children (54.7%) were in the age group of 3–5 years while rest 45.3% were

Migration and young child nutrition: evidence from rural China

The unprecedented large-scale rural-to-urban migration in China has left many rural children living apart from their parents. In this study, we examine the impact of parental migration on the nutritional status of young children in rural areas. We use the interaction terms between wage growth, by gender, in provincial capital cities and initial village migrant networks as instrumental variables to account for migration selection. Our results show that parental migration has no significant effect on the height of children, but it improves their weight. We provide suggestive evidence that the improvement in weight may be achieved through increased access to tap water in migrant households.

Migration and Young Child Nutrition: Evidence from Rural China

The unprecedented large scale rural-to-urban migration in China has left many rural children living apart from their parents. In this study, we examine the impact of parental migration on the nutritional status of young children in rural areas. We use the interaction terms between wage growth in provincial capital cities and initial village migrant networks as instrumental variables to account for migration selection. Our results show that parental migration has no significant impact on the height of children, but it improves their weight. We provide suggestive evidence that the improvement in weight may be achieved through increased access to tap water in migrant households. Concerns about the sustainability of the impact on weight are raised in the conclusions.

Effect of Ecuador’s cash transfer program ( Bono de Desarrollo Humano) on child development in infants and toddlers: A randomized effectiveness trial

We examined the effects of Ecuador’s Bono de Desarrollo Humano (BDH) – an unconditional cash transfer program that was rolled-out using a randomized design – on health and development outcomes in very young children. Communities that were randomly assigned to the treatment group began receiving the BDH in 2004 and those randomly assigned to the comparison group began receiving benefits two years later. Families enrolled in the BDH received a monthly cash stipend ($15USD) representing an approximate 6–10% increase in household income. Participants analyzed in this study are children aged 12–35 months from treatment ( n = 797) and comparison ( n = 399) communities in rural and urban Ecuador. Main outcomes measured were language skills (the Fundación MacArthur Inventorio del Desarollo de Habilidades Comunicativas – Breve), height-for-age z-score, and hemoglobin concentration. Results indicate that in rural areas, being randomized to receive the BDH in very early childhood led to significantly better performance on the number of words a child was saying, and on the probability that the child was combining two or more words. There were no significant effects on language development for children in urban areas and there were no effects on height-for-age z-score or hemoglobin concentration in rural or urban areas. A limited number of potential pathways with respect to cognitive/language stimulation, health behaviors, and parenting quality were also explored. Findings indicate that compared to children in comparison areas, rural children in treatment areas were more likely to have received vitamin A or iron supplementation and have been bought a toy in the past six months. This study provides evidence for significant benefits of an unconditional cash transfer program for language development in very young children in rural areas.

Production and Nutrient Composition of Fufu Made From a Mixture of Cassava and Cowpea Flours

High consumption of cassava products such as cassava fufu characterize the food habits of rural dwellers. Although cassava roots are rich in calories, they are grossly deficient in proteins, fats, and some minerals and vitamins. The nutritional hazard of cassava dependency includes chronic protein deficiency. Research toward the enrichment of cassava fufu is needed, especially for children under 5 years. This study aims to develop fufu from flours of fermented cassava and cowpea, evaluate the new cassava–cowpea fufu produced using sensory evaluation procedures, and determine their micronutrient content. Three cassava–cowpea flours BZC, FZC, and FIC were obtained. Cassava–cowpea fufu BZC was produced from cowpea seeds that were first boiled and then fermented for 2 days (48 hours). Cassava–cowpea fufu FZC was made from cowpea seeds that went through 2 days (48 hours) of fermentation, and cassava–cowpea fufu FIC was produced from cowpea seeds that were soaked for one day (24 hours). These cassava–cowpea fufus were evaluated using sensory methods and then sent to the laboratory for the determination of calcium, iron, and zinc using standard procedures. Data were analyzed using evaluation scores that were rated according to the level of acceptance or rejection of the cassava–cowpea fufu. BZC cassava–cowpea fufu was the cassava–cowpea fufu of choice and it had a higher protein content of 4.92 g than control cassava fufu FFF (0.47 g). It also had higher calcium, iron, and zinc content (79.47, 1.09, and 0.82 mg, respectively) compared to cassava fufu FFF, which had calcium, iron, and zinc values of 75.64, 0.39, and 0.19 mg, respectively. The cassava–cowpea fufu contained significantly higher amounts of protein and micronutrients than the commonly consumed cassava fufu. The addition of cowpea to cassava fufu will improve nutrition derived from cassava consumption among young children in rural areas who depend on monotonous cassava meals. This study has shown that cassava fufu can be enriched with cowpea to increase its protein and micronutrients content.

Molecular and spatial epidemiology of human campylobacteriosis: source association and genotype-related risk factors

The epidemiology of human campylobacteriosis is complex but in recent years understanding of this disease has advanced considerably. Despite being a major public health concern in many countries, the presence of multiple hosts, genotypes and transmission pathways has made it difficult to identify and quantify the determinants of human infection and disease. This has delayed the development of successful intervention programmes for this disease in many countries including New Zealand, a country with a comparatively high, yet until recently poorly understood, rate of notified disease. This study investigated the epidemiology of Campylobacter jejuni at the genotype-level over a 3-year period between 2005 and 2008 using multilocus sequence typing. By combining epidemiological surveillance and population genetics, a dominant, internationally rare strain of C. jejuni (ST474) was identified, and most human cases (65.7%) were found to be caused by only seven different genotypes. Source association of genotypes was used to identify risk factors at the genotype-level through multivariable logistic regression and a spatial model. Poultry-associated cases were more likely to be found in urban areas compared to rural areas. In particular young children in rural areas had a higher risk of infection with ruminant strains than their urban counterparts. These findings provide important information for the implementation of pathway-specific control strategies.

Are children from Crete abandoning a Mediterranean diet?

Mediterranean countries such as Greece have experienced rapid social change in the last decade. These community changes affect nutritional habits and there is a tendency for the traditional healthy Mediterranean diet to be abandoned. The parents of children from one rural Greek village on Crete (Neapolis), and one rural village in Sweden (Kisa) were invited to their primary health care centers for an interview and to fill in a validated nutrition questionnaire, KidMed. There were no differences (p = 0.48) in total KidMed score between the Cretan and Swedish children, adjusted for gender and age. However, there were some significant differences in scores on certain KidMed questions. Parents of the Cretan children reported significantly higher daily use of olive oil at home and more regular nut consumption, but also more commercially baked goods or pastries for breakfast. The parents of Swedish children reported significantly higher use of cereals, grains or bread for breakfast. The mean BMIs were similar for the Cretan (Neapolis mean 16.8, 95% CI 13.5-23.0) and for the Swedish children (Kisa mean 17.4, 95% CI 13.7-25.5) The results suggest the possibility of changing nutritional habits, measurable among young children in rural areas. The study raises the question of whether Cretan children may have abandoned some aspects of the traditional Mediterranean diet. It may also be that Swedish children have changed their diet in favor of a more Mediterranean food choice. The major limitation of the study is the small sample size, and further, larger studies are warranted.