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OBJECTIVES: Despite been in a positive pathway to achieve maternal and child healthcare targets in sustainable development goals, maternal nutrition is a leading public health problem in Sri Lanka. We studied the economic status, pregnancy expenditure and nutritional status of the pregnant mother to explore these associations. METHODS: The study was carried out in Anuradhapura District, Sri Lanka. Consecutive pregnant women registered in the public health clinics and who was in the 1(st) trimester of pregnancy were recruited as a part of a large cohort study. Detail evaluation of household income, expenditure and pregnancy costs were assessed together with anthropometric measurements. RESULTS: The mean age of the pregnant women (n = 750) was 28.3 years (SD 5.7) and 84.6% of them have not engaged in any income-generating activities. Among the employed group, the majority (58.6%) were in the government sector. Of the 750 pregnant women, 17.3% were underweight (BMI < 18.5). The average household income of the underweight group (USD 237.56) was significantly lower (t = −2.718, P = 0.007) than the others (USD 311.59). There was a significant difference in monthly food cost between underweight and normal mothers (t = −1.774, P = 0.076). The average cost for food of underweight and normal mothers was USD 53.33 (SD 40.07) and USD 60.05 (SD 39.13). In addition, the pregnancy cost of underweight mothers as a fraction of the money available for food was 23.05%. CONCLUSIONS: Despite having significantly low income and low resources for food, the additional burden of pregnancy cost may be leading to a vicious cycle of undernutrition. More details and context-specific approaches are required to combat nutrition in pregnancy. FUNDING SOURCES: Accelerating Higher Education Expansion and Development (AHEAD), World Bank.

OBJECTIVES: Routine antenatal care (ANC) offers opportunities to receive a broad range of services including support for adequate nutritional care for pregnant women and their newborns. Alive & Thrive (A&T) aimed to strengthen provision of iron-folic acid (IFA) supplementation and interpersonal counseling on maternal nutrition and breastfeeding through government ANC services and community-based contacts in two regions in Burkina Faso. We assessed the impacts of intensified nutrition interventions during ANC (A&T) and standard ANC services (control) on intervention coverage and maternal nutrition practices. METHODS: A cluster-randomized design compared 40 health center catchment areas in A&T areas to 40 in control areas. Repeated cross-sectional surveys in 2019 and 2021 (960 pregnant women and 1920 women with children 0–5 months of age per survey round) provided data on impact indicators and intervention exposure. We derived difference-in-difference effect estimates (DID), adjusted for geographical clustering, for maternal dietary diversity, IFA consumption, and early breastfeeding practices. RESULTS: More women in A&T areas had 4 + ANC visits (DID: 8.5 percentage points [pp]) and 4 + community-based contacts during their last pregnancy (DID: 14.7 pp) and started ANC during the first trimester (DID: 11.3 pp), compared to control areas. A larger improvement in exposure to nutrition counseling during ANC was achieved in A&T areas than in control areas (DID: 39.5 pp). Women in A&T areas consumed more IFA supplements during pregnancy than in control areas (DID: 21 tablets). Both early initiation of breastfeeding and exclusive breastfeeding also improved (DID: 17.1 pp and 8.3 pp, respectively). However, dietary diversity (4 out of 10 food groups) and mean probability of adequacy of micronutrients intake (14%) among pregnant women remained low in both areas. CONCLUSIONS: Strengthening maternal nutrition interventions delivered through government ANC services was feasible and effective in ...

OBJECTIVES: Interventions to improve maternal nutrition are poorly integrated into antenatal care (ANC) services in India. Alive & Thrive aimed to strengthen delivery of micronutrient supplements and intensify interpersonal counseling and community mobilization implemented through government ANC services. We evaluated the impact of nutrition-intensified ANC (I-ANC) compared to standard ANC (S-ANC) on diet diversity, consumption of iron-folic acid (IFA) and calcium supplements, and early breastfeeding practices. METHODS: We used a cluster-randomized design with cross-sectional surveys at baseline (2017) and endline (2019) (n ∼660 pregnant women and 1800 recently delivered women per survey) and a process evaluation. We derived difference-in-difference effect estimates, adjusted for geographic clustering, gestational age, infant age, and sex. RESULTS: Coverage of interventions was high at endline; 70–90% women were contacted by frontline workers at home or nutrition centers. Women in the I-ANC arm were significantly more likely to have received counseling on core nutrition messages (10–18 percentage points [pp]) than those in the S-ANC arm. Dietary diversity improved modestly among pregnant women in the I-ANC arm compared to the S-ANC arm (effect: 8.3 pp). The number of food groups consumed increased slightly over time but remained low in both arms. The percentage of women who consumed 100 + IFA improved equally in both arms (from 8 to 25%). Small significant impacts were observed for any consumption of IFA and calcium supplements (effects 10.3 and 12.4 pp, respectively). Significant impacts were also observed for non-prelacteal feeding (effect: −6.3 pp) and exclusive breastfeeding (effect: 7.4 pp) but not for early initiation of breastfeeding. The process evaluation found that system-level and supply-chain challenges, household context, and local diet preferences affected implementation and uptake. CONCLUSIONS: Intensifying nutrition in existing government ANC services resulted in modest improvements in ...

OBJECTIVES: High coverage of any antenatal care (ANC) and near-universal coverage of iron-folic acid (IFA) supplementation is reported by nationally representative surveys in Burkina Faso. We examined the coverage of maternal nutrition interventions during ANC to assess gaps and missed opportunities in achieving global and national recommendations. METHODS: We used household survey data among 1920 mothers with children <6 months of age in 2 regions in Burkina Faso, collected in November-December 2019. Descriptive statistics were used to examine exposure to nutrition interventions during antenatal care throughout pregnancy and equity analyses were conducted to assess differences in exposure by maternal age (adolescents 15–19 y of age and older mothers) and education (none vs. any schooling). RESULTS: All mothers reported having attended at least one ANC visit at a health facility (mostly government health centers) during last pregnancy, but only 66.6% reported attending at least 4 visits. All consumed IFA tablets, but reported consuming 109 tablets on average during pregnancy, which was short of the recommended 180 tablets over 6 months. Only 42.7% reported receiving any nutrition counseling during ANC, with the most common messages reported on consuming one IFA tablet daily (93.4%) and eating a variety of foods (68.8%). While nearly all mothers were weighed during ANC, very few reported receiving information about weight gain. Among mothers, 14% were adolescents below 20 y, and 66.1% never attended school. For all indicators related to exposure to ANC or maternal nutrition intervention, we observed no differences by maternal age, education or other subgroups such as religion, parity or household composition. CONCLUSIONS: The government health system in Burkina Faso with its widespread and uniform reach provides an opportunity for improving the low coverage of maternal nutrition interventions during ANC. Doing so will require efforts both to improve the coverage of 4 or more ANC visits and the effective ...

OBJECTIVES: Nutrition during fetal and early postnatal life impacts brain development, however evidence from randomized trials from low-and-middle-income countries (LMIC) is limited. We evaluated effects of maternal nutrition supplementation before and during pregnancy on neurodevelopment and vision in children from 4 LMIC with high rates of stunting, using a simplified assessment tool. METHODS: Women First was an individually randomized trial comparing the impact of maternal nutrition supplementation initiated preconception vs at ∼12 wk gestation vs no supplement; interventions were discontinued at delivery in trial sites in Democratic Republic of the Congo, Guatemala, India, and Pakistan. Neurodevelopment and visual acuity and visual contrast sensitivity were assessed at 24 mo using the INTER-NDA and the Cardiff tests, respectively, in a random sub-set, representing ∼1/3 of infants with valid birth measurements from the WF trial. Anthropometry and Family Care Indicators (FCI) were also obtained at 24 mo. RESULTS: 667 and 634 children (91% and 86% of sub-set) were included in INTER-NDA and vision analyses. Arm-proportionate contribution was 32.2–32.8%. Overall, we observed the following percentage of children with delays: 66.6% cognitive; 87.4% fine motor; 91.3% gross motor; and 11.7% language; 25.9% had positive behavior problems; and 26.0% and 21.0% had low acuity and contrast sensitivity scores, respectively. WF intervention arm was not significant for INTER-NDA scores, rates of mild-to-moderate or severe delay (F = 0.004–1.518, p = 0.28–0.99; X(2 )= 3.81–5.92, p = 0.18–0.42; X(2 )= 3.81–6.33, p = 0.18–0.43); or for low acuity and contrast sensitivity (X(2 )= 0.91, p = 0.63 and X(2 )= 1.64, p = 0.44). LAZ(24mo) was significantly associated with cognitive, motor, language, and behavior scores; maternal education predicted cognitive, language, and vision; and FCI was significantly associated with fine motor, language, and behavior after adjusting for other covariates (R(2) 0.33 cognitive; 0.40 language; 0.12 ...

OBJECTIVES: Maternal undernutrition remains high in India and is associated with maternal mortality and adverse birth outcomes. To address this challenge, Alive & Thrive (A&T) aimed to strengthen interpersonal counseling, micronutrient supplement provision, and community mobilization through the government antenatal care (ANC) platform in UP. The nutrition-intensified ANC (I-ANC) intervention facilitated regular use of data to enable corrective actions. We aimed to understand how maternal health data was used for improving the delivery of maternal nutrition services and to identify factors associated with data use. METHODS: In-depth interviews (N = 35) were conducted among sub-district government staff, frontline worker (FLW) supervisors and A&T staff in two districts in UP. Systematic coding of verbatim transcripts and detailed summaries was undertaken to elucidate themes and patterns related to data use and facilitators and barriers. RESULTS: Sub-district government staff reported using government data (i.e., HMIS) to estimate demand for prenatal supplements. Sub-district government staff, FLW supervisors and A&T staff used government and intervention monitoring data to understand the impact and reach of services delivered to women. Key indicators on the attendance of pregnant women at community health events and number of women receiving adequate supplements was discussed with FLWs in monthly review meetings. Data review guided identification of areas of low FLW performance (i.e., monitoring weight gain) and prompted refresher trainings. Facilitators of data use included collaboration between sub-district health department officials on data analysis and monthly review meetings to provide feedback on improving performance (including counseling topics and stock of supplements). Barriers to data use included staff vacancies, education level of FLWs and conflicts between FLWs and supervisors. CONCLUSIONS: Use of data for decision making is critical for supporting intervention planning and ...

OBJECTIVES: Minimum Dietary Diversity (MDD) is an indicator to assess feeding practices of children aged 6–23 months. The WHO and UNICEF have recently revised the definition of MDD, replacing '≥4 out of 7 food groups (MDD-7FG)' with '≥5 out of 8 food groups (MDD-8FG)'. In the new definition, breast milk was considered as a separate food group. We aimed to estimate the implications of this change on the prevalence of MDD at the national and regional levels of Bangladesh. METHODS: We analyzed data from the national food security and nutrition surveillance round 2018–2019. MDD was defined and calculated according to the WHO-UNICEF guidelines. The prevalence of MDD-7FG and MDD-8FG was estimated and stratified by gender, age groups, place of residence, division, and wealth index. The difference between the prevalence between MDD-7FG and MDD-8FG was presented as percentages. RESULTS: Compared to the older definition, the overall prevalence of MDD was lower among 6 to 23 months old children in Bangladesh (46.2% vs. 54.7%). The absolute percentage point difference between the estimates (MDD-8FG vs. MDD-7FG) was higher among the boys (44.0% vs. 53.2%), 12–23 months aged old children (53.4% vs. 63.4%), children living in the non-slum urban areas (30.2% vs. 42.4%) and Dhaka division (42.0% vs. 56.3%), and among the children of middle-class families (40.3% vs. 57.6%). CONCLUSIONS: The new definition and the inclusion of breast milk intake as a new food group led to a decrease in the prevalence of minimum dietary diversity in Bangladesh. The country program needs to emphasize the continuation of breastfeeding until two years of age of the children. Moreover, the changes in the definition of MDD and the resultant consequence should be kept in mind while performing trend analysis of dietary diversity in Bangladesh and elsewhere. FUNDING SOURCES: Ministry of Health and Family Welfare, Government of Bangladesh.

OBJECTIVES: To describe long-term breastfeeding initiation trends by prenatal WIC participation and race/ethnicity among low-income women in the U.S. METHODS: We used birth certificate data (2009–2017) for 24 states that adopted the 2003 birth certificate revision by 2009. The analytic sample included term births with hospital costs covered by Medicaid. Descriptive characteristics of WIC participants and WIC-eligible nonparticipants were assessed by year and race/ethnicity. Adjusted breastfeeding initiation prevalence was estimated using linear regression with county fixed effects, controlling for sociodemographic, obstetric, and health factors. Trends were compared by WIC status overall and within racial/ethnic groups. RESULTS: Breastfeeding initiation increased for WIC participants and WIC-eligible nonparticipants (2009 to 2017). WIC participants had consistently lower breastfeeding initiation (2009: 68.6%; 2017: 78.0%) compared to nonparticipants (2009: 72.1%; 2017: 81.3%). The gap between WIC participants and nonparticipants narrowed more for Non-Hispanic Asian/Pacific Islander and non-Hispanic American Indian/Alaska Native women due to a larger increase among WIC participants (% Change: 32.4% and 12.9%, respectively) compared with nonparticipants (% Change: 11.4%, 6.4%). CONCLUSIONS: Breastfeeding statistics are often underrepresented among certain racial/ethnic groups, particularly for low-income populations. These findings can inform WIC and other maternal child health program efforts to improve breastfeeding initiation and reduce disparities. FUNDING SOURCES: This study was funded by cooperative agreement between the United States Department of Agriculture Economic Research Service and the University of Maryland, College Park. The findings and conclusions in this publication are those of the authors and should not be construed to represent any official USDA or US Government determination or policy.

OBJECTIVES: To determine whether children in a population with a high prevalence of kwashiorkor (HPP) have lower dietary intakes of Sulfur Amino Acids (SAAs) than children in a low-prevalence population (LPP). METHODS: A cross-sectional census survey design of 358 children was used to compare two adjacent populations of children 36 to 59 months old in North Kivu Province of the Democratic Republic of the Congo. One population had a high prevalence of kwashiorkor (4.5%) and the other had a low prevalence (1.7%). Data collected included urinary sulfate and thiocyanate, linamarin in cassava-based food products, recent history of illness, and a 24-hour quantitative diet recall for the child. RESULTS: Median intake of SAAs was 32.4 mg/kg for the LPP and 29.6 mg/kg for the HPP (P < 0.05). A higher percentage of children in the HPP were at risk for inadequate intake of SAAs than in the LPP (23.2% versus 13.3%, P < 0.05). Methionine was the first limiting amino acid in both populations, with the highest risk for inadequate intake among children in the HPP (35.1% versus 23.6%, P < 0.05). CONCLUSIONS: Children in a population with a higher prevalence of kwashiorkor have lower dietary intake of SAAs than children in a population with a lower prevalence. Interventions to reduce incidence of kwashiorkor should consider increasing SAA intake with particular attention to methionine. FUNDING SOURCES: Private donors, USAID/Office of Foreign Disaster Assistance through Action Against Hunger, Dignitas Foundation through the Feinstein International Center. CD was supported in part by funds from the NIH. SG was supported in part by funds from USAID.

When developing a new product, many obstacles have to be overcome from the idea to the shelf: know-how from different subject areas is called for to create a product that is not only technically feasible, but also complies with regulations and meets consumer needs and preferences. This book addresses and tries to identify forces that potentially drive innovation in pediatric nutrition, an endeavor which surpasses research, clinical and academic thinking. The likelihood of translating innovative research concepts into practical applications depends on a large number of factors; Clinical studies, adherence to regulatory standards and environments of various countries, policy and politics on child health and nutrition, marketing issues, economic considerations as well as the state of food technology all determine whether and how a product can be brought to the market. Expectations and response of both consumers and health care professionals are likewise of very high importance.Due to its broad scope, this publication is of interest to everyone involved in one way or another in the development and launch of new products for pediatric nutrition.

When developing a new product, many obstacles have to be overcome from the idea to the shelf: know-how from different subject areas is called for to create a product that is not only technically feasible, but also complies with regulations and meets consumer needs and preferences. This book addresses and tries to identify forces that potentially drive innovation in pediatric nutrition, an endeavor which surpasses research, clinical and academic thinking. The likelihood of translating innovative research concepts into practical applications depends on a large number of factors; Clinical studies, adherence to regulatory standards and environments of various countries, policy and politics on child health and nutrition, marketing issues, economic considerations as well as the state of food technology all determine whether and how a product can be brought to the market. Expectations and response of both consumers and health care professionals are likewise of very high importance. Due to its broad scope, this publication is of interest to everyone involved in one way or another in the development and launch of new products for pediatric nutrition.

This report summarizes selected data on child health and nutritional indicators received from state, territorial, and tribal governments that contributed to the Centers for Disease Control and Prevention (CDC) Pediatric nutrition surveillance 2004 report. ; Title from PDF t.p. (viewed April 12, 2007). ; PedNSS is produced by the National Center for Chronic Disease Prevention and Health Promotion, Maternal and Child Nutrition Branch, Division of Nutrition and Physical Activity. ; Mode of access: Internet. ; Includes bibliographical references. ; Polhamus B, Thompson D, Dalenius K, Borland E, Smith B, Grummer-Strawn L. Pediatric Nutrition Surveillance 2004 Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2006.

This report summarizes selected data on child health and nutritional indicators received from state, territorial, and tribal governments that contributed to the Centers for Disease Control and Prevention (CDC) Pediatric nutrition surveillance 2002 report. ; Title from PDF t.p. (viewed April 12, 2007). ; PedNSS is produced by the National Center for Chronic Disease Prevention and Health Promotion, Maternal and Child Nutrition Branch, Division of Nutrition and Physical Activity. ; Mode of access: Internet. ; Includes bibliographical references. ; Polhamus B, Dalenius K, Thompson D, Scanlon K, Borland E, Smith B, Grummer-Strawn L. Pediatric Nutrition Surveillance 2002 Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2004.