A measurement scale to assess responsive feeding among Cambodian young children.

The caregiver-child interaction during mealtime, which refers to responsive feeding (RF), influences child's dietary intake. In Cambodia, given the level of malnutrition, getting better knowledge of RF among young children is essential, but to do so, using an appropriate assessment tool is necessary. We aim to develop and to validate a measurement tool to assess RF in two different situations (before and after an intervention) among children 6-23 months old. This research is part of a larger trial assessing the impact of nutrition education combined or not with the provision of complementary foods on child nutritional status. The "Opportunistic Observation Form" from the Process for the Promotion of Child Feeding package was used to collect data on RF through direct observations of child's meal episodes. Data were used to define an initial scale composed of four constructs and 15 indicators. Confirmatory factor analyses (CFA) and Hancock and Mueller's H reliability indices were computed to assess the validity and reliability of the scale. The final tool was applied to baseline and endline data. At baseline, the sample included 243 pairs and, at endline, 248 pairs. The final scale included two latent constructs (RF and active feeding) that comprise three indicators for active feeding and five for RF. Criteria for fit indices of CFA were met for both constructs though better at baseline. Reliability coefficients were above 0.80 for each construct at baseline and endline. This research proposes a scale that could be used to assess active feeding and RF. Further validation is warranted in different contexts.

Determinants of Undernutrition among Young Children Living in Soth Nikum District, Siem Reap, Cambodia.

BACKGROUND: Child undernutrition is of public concern in Cambodia. An understanding of factors influencing child nutritional status is essential to design programs that will reduce undernutrition. Using the UNICEF conceptual framework of causes of malnutrition, our research investigates the relationship between nutritional status of children aged 6⁻23 months and its immediate and underlying determinants. METHODS: Baseline data from a cluster-randomized controlled trial aiming to assess the impact of the promotion of optimal feeding practices combined or not with the provision of local foods among 360 children 6⁻23 months of age were used. Anthropometry and biochemical measurements were performed at baseline. Data on each determinant of undernutrition were collected through interviews and direct observations. RESULTS: Our results show that the degree of satisfaction of proteins and zinc requirements as well as the access to improved water sources and sanitation were positively associated with length-for-age, while having a better health status and a higher degree of satisfaction of energy, protein, zinc, and iron requirements were associated to an improved weight-for-length. Only child health status was associated to ferritin. CONCLUSION: Our results reiterate the importance of improving child diet and health status, but also the access to a healthy environment to ensure an optimal nutritional status.

Mitigated Impact of Provision of Local Foods Combined with Nutrition Education and Counseling on Young Child Nutritional Status in Cambodia.

BACKGROUND: In Cambodia, stunting and wasting affect, respectively, 32% and 10% of children 0⁻59 months while 55% are anemic. Our research aims to assess the efficiency of two local foods combined with nutritional education and counseling (CEN) activities as compared to CEN alone on improving child nutritional status and dietary intake. METHODS: A cluster-randomized controlled trial was conducted in Soth Nikum area over a six-month period among children 6⁻23 months (n = 360) assigned to receive either moringa +CEN, cricket +CEN or CEN alone. Anthropometric measurements were performed and hemoglobin and ferritin levels assessed. RESULTS: Overall, no significant increase in the mean length/height-for-age z-score was observed, although a small increase of the weight-for-length/height was noted in intervention groups. Hemoglobin and ferritin mean values increased in all groups. The degree of satisfaction of energy, proteins, iron, and zinc requirements improved in all groups, but to a greater extent in the intervention groups and more children were healthy. CONCLUSION: Our research shows no significant impact of the provision of two local foods combined with CEN on the improvement of child nutritional status as compared to CEN alone. However, children consuming them better fulfilled their energy, iron, and zinc requirements and were healthier.

Promoting health in Georgia.

This paper discusses the public health situation in Georgia. In 1991 Georgia became an independent republic following the collapse of the Soviet Union. The armed conflict with Russia in 2008 and political unrest in recent years has presented the Georgian population and politicians with a demanding situation. As part of the WHO European Region, the Commonwealth of Independent States (CIS) including Georgia is on the unfortunate side of a European health divide, with low male life expectancy and high under-five mortality. There is also a high degree of economic inequality in the population. We first look at the main players and the current strategies in public health work. Next we discuss this on the background of health promotion principles and recent international developments in knowledge and policy recommendations in the field of health promotion. Finally we point to some of the major public health challenges that Georgia faces. We conclude that the Georgian focus on reducing risk behaviours and improving access to quality health care is worthy of praise, but that this is not sufficient to solve the current public health challenges. Strategies for working across sectors with social determinants of health should be built into Georgian health thinking and policies. A health promotion work force should be developed. International developments such as the Commission on Social Determinants of Health (CSDH) report, the 'Health 2020' framework and the HP Core Competencies project all provide useful input to future development of healthy public policies in Georgia.