Urban poverty and nutrition challenges associated with accessibility to a healthy diet: a global systematic literature review.

BACKGROUND: There is an increasing global trend towards urbanization. In general, there are less food access issues in urban than rural areas, but this "urban advantage" does not benefit the poorest who face disproportionate barriers to accessing healthy food and have an increased risk of malnutrition. OBJECTIVES: This systematic literature review aimed to assess urban poverty as a determinant of access to a healthy diet, and to examine the contribution of urban poverty to the nutritional status of individuals. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology, our review included quantitative and qualitative studies published in English or in Spanish between 2000 and 2019. The articles were eligible if they focused on nutrition access (i.e. access to a healthy diet) or nutrition outcomes (i.e., anemia, overweight and obesity, micronutrient deficiency, micronutrient malnutrition) among urban poor populations. Articles were excluded if they did not meet pre-established criteria. The quality of the quantitative studies was assessed by applying Khan et al.'s methodology. Similarly, we assessed the quality of qualitative articles through an adapted version of the National Institute for Health and Care Excellence (NICE) methodology checklist. Finally, we systematically analyzed all papers that met the inclusion criteria based on a qualitative content and thematic analysis. RESULTS: Of the 68 papers included in the systematic review, 55 used quantitative and 13 used qualitative methods. Through the analysis of the literature we found four key themes: (i) elements that affect access to healthy eating in individuals in urban poverty, (ii) food insecurity and urban poverty, (iii) risk factors for the nutritional status of urban poor and (iv) coping strategies to limited access to food. Based on the systematization of the literature on these themes, we then proposed a conceptual framework of urban poverty and nutrition. CONCLUSIONS: This systematic review identified distinct barriers posed by urban poverty in accessing healthy diets and its association with poorer nutrition outcomes, hence, questioning the "urban advantage". A conceptual framework emerging from the existing literature is proposed to guide future studies and policies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO Registration number: CRD42018089788 .

Breastfeeding at the workplace: a systematic review of interventions to improve workplace environments to facilitate breastfeeding among working women.

BACKGROUND: Breastfeeding can be affected by maternal employment. This is important considering that in 2019, 47.1% of women globally participated in the labor force. The aim of this study was to review workplace interventions to promote, protect and support breastfeeding practices among working mothers globally. METHODS: A systematic review was conducted following the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Observational, experimental and qualitative peer-reviewed studies in English and Spanish, published between 2008 and 2019 were included. The review focused on working women who were pregnant, breastfeeding or who recently had a child, and women's working environments. The outcomes of interest included breastfeeding intentions, initiation, exclusivity and duration, confidence in breastfeeding or breastmilk extraction, and perceived support at workplace. Quality was assessed according to National Institute for Health and Care Excellence (NICE) checklist for systematic reviews. It was registered on PROSPERO (#140624). RESULTS: Data was extracted from 28 quantitative and 9 qualitative studies. The most common interventions were designated spaces for breastfeeding or breastmilk extraction (n = 24), and the support from co-workers (n = 20). The least common interventions were providing breast pumps (n = 4) and giving mothers the flexibility to work from home (n = 3). Studies explored how interventions affected different breastfeeding outcomes including breastfeeding duration, breastfeeding exclusivity, confidence in breastmilk expression, and breastfeeding support. The evidence suggests that workplace interventions help increase the duration of breastfeeding and prevent early introduction of breastmilk substitutes. Having a lactation space, breastmilk extraction breaks, and organizational policies are key strategies. However, to achieve equitable working conditions for breastfeeding mothers, organizational and interpersonal changes need to occur as well. CONCLUSIONS: The systematic review revealed that interventions at the workplace are important in protecting, promoting and supporting breastfeeding among working mothers. To achieve equitable work environments and fair nutritional opportunities for infants of working mothers, interventions should focus at the three ecological layers - individual, interpersonal, and organizational. The quality of studies can be improved. There is a need for studies assessing impacts of workplace interventions on infant feeding practices, mothers' self-esteem and outcomes such productivity and abstentionism.

Evaluating the effect of the initiative 'Caring for the Newborn and the Mother at Home' in Mexico.

OBJECTIVE: The WHO and UNICEF recommend home visits to improve health outcomes for mothers and newborns. We evaluated the effect of home visits by community volunteers during pregnancy and postpartum on breast-feeding practices, women's knowledge about benefits, beliefs and myths of breast-feeding, obstetric and neonatal warning signs, preparation for childbirth and initial care for newborns, and diarrhoea and respiratory diseases in children. DESIGN: Community quasi-experimental design. We estimated difference-in-difference models with fixed effects at the community level weighted by propensity score and investigated implementation barriers through focus groups and semi-structured interviews. SETTING: Poor rural communities in Mexico; 48 intervention and 29 control. PARTICIPANTS: Baseline and follow-up information were reported from two independent cross-sectional samples of women with babies aged between 6 and 18 months (baseline: 292 control, 320 intervention; follow-up: 292 control, 294 intervention). RESULTS: The intervention increased reports of exclusive breast-feeding in the first 6 months by 24·4 percentage points (pp) (95 % CI: 13·4, 35·4), mothers' knowledge of obstetric warning signs by 23·4 pp (95 % CI: 9·2, 37·5) and neonatal warning signs by 26·2 pp (95 % CI: 15·2, 37·2) compared to the control group. A non-linear dose-response relation with the number of home visits was found. Diarrhoea and respiratory diseases among children decreased in the intervention v. control group but were not statistically significant. CONCLUSIONS: Home visits should be implemented as a complementary strategy to the provision of prenatal and postnatal care in rural communities due to their potential positive effects on the health of mothers and their children.

Content analysis of media coverage of breastfeeding in Mexico.

Media can be a powerful communication tool to promote breastfeeding programs, influence mother's breastfeeding behaviour, and generate support among stakeholders for breastfeeding. Yet, there is little information on how media coverage influences a country's breastfeeding enabling environment. This study addressed this gap by conducting a retrospective content analysis of documents published between January 1, 2017 and January 1, 2018 to analyse the media coverage related to breastfeeding in Mexico. Content analysis was based on the breastfeeding gear model and a strategic planning technique to identify strengths, weaknesses, opportunities, and threats for enabling the national breastfeeding environment. Media coverage of breastfeeding was more frequent in August (36% of all documents). The top three topics commonly covered by the media were advocacy events promoting breastfeeding, promotion campaigns, and changes in breastfeeding legislation and policy. In general, the media coverage focused on strengths of specific breastfeeding policies. There was limited news coverage of key factors that negatively influenced or threatened the breastfeeding environment. Findings support the need to design strategies to engage the media covering in more depth and breadth diverse aspects of breastfeeding protection, promotion, and support efforts in Mexico.

Association between Feelings of Trust and Security with Subjective Health among Mexican Migrants in the New York City Area.

The size of the foreign-born population living in the United States makes migrants' health a substantive policy issue. The health status of Mexican immigrants might be affected by the level of social capital and the social context, including the rhetoric around immigration. We hypothesize that a diminished perception of trust and safety in the community has a negative impact on self-reported health. In a cross-sectional study, we conducted a survey among 266 Mexican Immigrants in the New York City Area who used the Mexican Consulate between May and June 2019 for regular services provided to documented and undocumented immigrants. A univariate and bivariate descriptive analysis by trust and security items first shows the diversity of the Mexican population living in the US and the conditions of vulnerability. Then, logistic regression models estimate the association between trust and security items with self-reported health status. Results show that safety is consistently associated with good self-rated health, especially when rating the neighborhood, and trust showed mixed results, more reliant to the way it is operationalized. The study illustrates a pathway by which perceptions of the social context are associated with migrants' health.

An analysis of stakeholder networks to support the breastfeeding scale-up environment in Mexico.

Little information exists on how to garner political commitment to strengthen large-scale breastfeeding policies and programmes by targeting key decision makers. The present study aims to map and describe the influence of stakeholders involved in breastfeeding policy and programming and identify opportunities to strengthen the breastfeeding-friendly environment in Mexico. A total of nine key informants from seventeen stakeholder organisations were selected based on their in-depth knowledge of the breastfeeding environment in Mexico and were individually interviewed using Net-Map methodology. This participatory interview technique combines stakeholder mapping, social network analysis and influence mapping to identify relevant stakeholders. Participants identified a total of fifty-five stakeholders shaping breastfeeding programmes and policies through four domains of influence: commands (n 32 stakeholders), dissemination (n 40), funding (n 35) and technical assistance (n 37). The Federal Ministry of Health emerged as the most influential stakeholder of breastfeeding policy and programming decisions in Mexico among all domains of influence. The Ministry of Finance and Public Credit as well as the National Institute of Public Health were identified as additional key stakeholders providing funding and technical assistance to the Federal Ministry of Health, respectively. Engaging identified key stakeholders can generate a multisectoral commitment to breastfeeding and strengthen the breastfeeding-friendly environment in Mexico.