Rural-urban disparities in child nutrition in Bangladesh and Nepal

Background The persistence of rural-urban disparities in child nutrition outcomes in developing countries alongside rapid urbanisation and increasing incidence of child malnutrition in urban areas raises an important health policy question - whether fundamentally different nutrition policies and interventions are required in rural and urban areas. Addressing this question requires an enhanced understanding of the main drivers of rural-urban disparities in child nutrition outcomes especially for the vulnerable segments of the population. This study applies recently developed statistical methods to quantify the contribution of different socio-economic determinants to rural-urban differences in child nutrition outcomes in two South Asian countries – Bangladesh and Nepal. Methods Using DHS data sets for Bangladesh and Nepal, we apply quantile regression-based counterfactual decomposition methods to quantify the contribution of (1) the differences in levels of socio-economic determinants (covariate effects) and (2) the differences in the strength of association between socio-economic determinants and child nutrition outcomes (co-efficient effects) to the observed rural-urban disparities in child HAZ scores. The methodology employed in the study allows the covariate and coefficient effects to vary across entire distribution of child nutrition outcomes. This is particularly useful in providing specific insights into factors influencing rural-urban disparities at the lower tails of child HAZ score distributions. It also helps assess the importance of individual determinants and how they vary across the distribution of HAZ scores. Results There are no fundamental differences in the characteristics that determine child nutrition outcomes in urban and rural areas. Differences in the levels of a limited number of socio-economic characteristics – maternal education, spouse’s education and the wealth index (incorporating household asset ownership and access to drinking water and sanitation) contribute a major share of rural-urban disparities in the lowest quantiles of child nutrition outcomes. Differences in the strength of association between socio-economic characteristics and child nutrition outcomes account for less than a quarter of rural-urban disparities at the lower end of the HAZ score distribution. Conclusions Public health interventions aimed at overcoming rural-urban disparities in child nutrition outcomes need to focus principally on bridging gaps in socio-economic endowments of rural and urban households and improving the quality of rural infrastructure. Improving child nutrition outcomes in developing countries does not call for fundamentally different approaches to public health interventions in rural and urban areas.

Report on child nutrition ...

Mode of access: Internet.

The Child nutrition labeling program : an overview /

"April 1984"--T.p. verso.

State child welfare program self-assessment manual /

"Contract no. HEW-105-75-1113."

Child nutrition in camp and institution. A study of food with respect to costs, nutritional value, educational value and administration in Cleveland camps and institutions,

Mimeographed.

Guide for the audit of school food authorities participating in federally supported child nutrition programs.

WI docs. no.: Ed.3/2:0051

Food buying guide for child nutrition programs /

Includes index.

Food buying guide for child nutrition programs /

Includes index.

Child nutrition labeling for meat and poultry products /

Mode of access: Internet.

The influence of the initial state of nutrition on the lifespan of patients with amyotrophic lateral sclerosis (ALS) during home enteral nutrition

Aim: Amyotrophic lateral sclerosis (ALS) is a chronic, neurodegenerative disease, which leads to development of malnutrition. The main purpose of this research was to analyze the impact of malnutrition on the course of the disease and long-term survival. Material and methods: A retrospective analysis has been performed on 48 patients (22 F [45,83%] and 26 M [54,17%], the average age of patients: 66,2 [43-83]) in 2008-2014.The analysis of the initial state of nutrition was measured by body mass index (BMI), nutritional status according to NRS 2002, SGA and concentration of albumin in blood serum. Patients were divided into two groups, depending on the state of nutrition: well-nourished and malnourished. The groups were created separately for each of these, which allowed an additional comparative analysis of techniques used for the assessment of nutritional status. Results: Proper state of nutrition was interrelated with longer survival (SGA: 456 vs. 679 days, NRS: 312 vs. 659 vs. 835 days, BMI: respectively, 411, 541, 631 days, results were statistically significant for NRS and BMI). Concentration of albumin was not a prognostic factor, but longer survival was observed when level of albumin was increased during nutritional therapy. Conclusions: The initial nutrition state and positive response to enteral feeding is associated with better survival among patients with ALS. For this reason, nutritional therapy should be introduced as soon as possible.

Depressão pós-parto e estado nutricional infantil no segundo mês de vida

INTRODUÇÃO: As chances de adoecer e de mortalidade são maiores, em crianças com estado nutricional (EN) inadequado nos primeiros meses de vida. Fatores de risco para o EN inadequado, incluem os aspectos psicossociais maternos, como a ansiedade, a depressão pós-parto (DPP), a ausência de suporte social. No entanto, são poucos os estudos sobre o papel destes fatores na determinação do EN infantil e seus resultados controversos. OBJETIVO: Investigar a relação entre depressão no pós-parto e o estado nutricional infantil inadequado no segundo mês de vida. MÉTODOS: Trata-se de um estudo seccional com 466 crianças aos dois meses de vida (média= 65 dias; DP=0,5) oriundas de unidades básicas de saúde do município do Rio de Janeiro, realizado entre junho de 2005 e dezembro de 2009. Para compor o desfecho, médias de peso-para-idade foram expressas em escores z e comparadas às informações da nova curva de referência WHO (2006) para menores de cinco anos. Foram classificadas como estado nutricional inadequado, crianças com escore z abaixo de -2, baixo peso-para-idade, e crianças com escore z acima de +2, excesso de peso-para- idade. Informações referentes à DPP foram obtidas por meio da aplicação da versão em português do instrumento EPDS (Edinburgh Postnatal Depression Scale). As análises das associações entre a DPP e os desfechos foram verificadas via modelos de regressão logística multinomial, mediante estimativas de razões de chances (OR) brutas e ajustadas e seus respectivos intervalos de confiança de 95% (IC 95). RESULTADOS: A amostra revelou escores z médios de -0,22 para peso-para-idade, 4,51%(n=21) apresentaram baixo peso-para- idade e 1,72% (n=8) de excesso de peso-para-idade. A prevalência de depressão foi de 27,6%. Nas análises brutas, filhos de mães deprimidas apresentavam 2,45 mais chance (OR=2,45; I.C. 95%=1,01-5,93;p-valor=0,050) de baixo peso-para-idade e 0,38 chance de excesso de peso-para-idade (OR=0,38;I.C. 95%=0,04-3,17;p-valor=0,38), do que os filhos de mães não deprimidas, porém esta associação apresentou nível de significância maior que 5%. Após ajuste pelo peso ao nascer, condições ambientais, posse de utensílios, prematuridade, idade materna e escolaridade materna a associação entre depressão e estado nutricional infantil não apresentou significância estatística (OR=2,39;I.C. 95%=0,74-7,71;p- valor>0,05).CONCLUSÃO: A DPP não foi associada ao estado nutricional infantil.

Health in Brazil 2 Maternal and child health in Brazil: progress and challenges

In the past three decades, Brazil has undergone rapid changes in major social determinants of health and in the organisation of health services. In this report, we examine how these changes have affected indicators of maternal health, child health, and child nutrition. We use data from vital statistics, population censuses, demographic and health surveys, and published reports. In the past three decades, infant mortality rates have reduced substantially, decreasing by 5.5% a year in the 1980s and 1990s, and by 4.4% a year since 2000 to reach 20 deaths per 1000 livebirths in 2008. Neonatal deaths account for 68% of infant deaths. Stunting prevalence among children younger than 5 years decreased from 37% in 1974-75 to 7% in 2006-07. Regional differences in stunting and child mortality also decreased. Access to most maternal-health and child-health interventions increased sharply to almost universal coverage, and regional and socioeconomic inequalities in access to such interventions were notably reduced. The median duration of breastfeeding increased from 2.5 months in the 1970s to 14 months by 2006-07. Official statistics show stable maternal mortality ratios during the past 10 years, but modelled data indicate a yearly decrease of 4%, a trend which might not have been noticeable in official reports because of improvements in death registration and the increased number of investigations into deaths of women of reproductive age. The reasons behind Brazil`s progress include: socioeconomic and demographic changes (economic growth, reduction in income disparities between the poorest and wealthiest populations, urbanisation, improved education of women, and decreased fertility rates), interventions outside the health sector (a conditional cash transfer programme and improvements in water and sanitation), vertical health programmes in the 1980s (promotion of breastfeeding, oral rehydration, and immunisations), creation of a tax-funded national health service in 1988 (coverage of which expanded to reach the poorest areas of the country through the Family Health Program in the mid-1990s); and implementation of many national and state-wide programmes to improve child health and child nutrition and, to a lesser extent, to promote women`s health. Nevertheless, substantial challenges remain, including overmedicalisation of childbirth (nearly 50% of babies are delivered by caesarean section), maternal deaths caused by illegal abortions, and a high frequency of preterm deliveries.

Maternal correlates of maternal child feeding practices : a systematic review

Establishing healthy eating habits early in life is one important strategy to combat childhood obesity. Given that early maternal child feeding practices have been linked to child food intake and weight, identifying the maternal correlates of maternal child feeding practices is important in order to understand the determinants of childhood obesity; this was the overall aim of the current review. Academic databases were searched for studies examining the relationship between maternal child feeding practices and parenting, personal characteristics and psychopathology of mothers with preschoolers. Papers were limited to those published in English, between January 2000 - June 2012. Only studies with mothers of normally developing children between the ages of 2 - 6 years were included. There were no restrictions regarding the inclusion of maternal nationality or SES. Seventeen eligible studies were sourced. Information on the aim, sample, measures and findings of these was summarised into tables. The findings of this review support a relationship between maternal controlling parenting, general and eating psychopathology, and socioeconomic status and maternal child feeding practices. The main methodological issues of the studies reviewed included inconsistency in measures of maternal variables across studies and cross-sectional designs. We conclude that the maternal correlates associated with maternal child feeding practices are complex, and the pathways by which maternal correlates impact these feeding practices require further investigation.

Association between maternal depressive symptoms in the early postnatal period and responsiveness in feeding at child age 2 years

Maternal depression is a known risk factor for poor outcomes for children. Pathways to these poor outcomes relate to reduced maternal responsiveness or sensitivity to the child. Impaired responsiveness potentially impacts the feeding relationship and thus may be a risk factor for inappropriate feeding practices. The aim of this study was to examine the longitudinal relationships between self-reported maternal post-natal depressive symptoms at child age 4 months and feeding practices at child age 2 years in a community sample. Participants were Australian first-time mothers allocated to the control group of the NOURISH randomized controlled trial when infants were 4 months old. Complete data from 211 mothers (of 346 allocated) followed up when their children were 2 years of age (51% girls) were available for analysis. The relationship between Edinburgh Postnatal Depression Scale (EPDS) score (child age 4 months) and child feeding practices (child age 2 years) was tested using hierarchical linear regression analysis adjusted for maternal and child characteristics. Higher EPDS score was associated with less responsive feeding practices at child age 2 years: greater pressure [β = 0.18, 95% confidence interval (CI): 0.04–0.32, P = 0.01], restriction (β = 0.14, 95% CI: 0.001–0.28, P = 0.05), instrumental (β = 0.14, 95% CI: 0.005–0.27, P = 0.04) and emotional (β = 0.15, 95% CI: 0.01–0.29, P = 0.03) feeding practices (ΔR2 values: 0.02–0.03, P < 0.05). This study provides evidence for the proposed link between maternal post-natal depressive symptoms and lower responsiveness in child feeding. These findings suggest that the provision of support to mothers experiencing some levels of depressive symptomatology in the early post-natal period may improve responsiveness in the child feeding relationship.