Implementing a Care Pathway for small and nutritionally at-risk infants under six months of age: A multi-country stakeholder consultation.

Nutritional vulnerability under the age of 6 months is prevalent in low- and middle-income countries with 20.1% infants underweight, 21.3% wasted and 17.6% stunted in a recent review. A novel Care Pathway for improved management of small and nutritionally at-risk infants under 6 months and their mothers (MAMI) has recently been developed to provide outpatient care at large coverage. We aimed to investigate stakeholders' views on the feasibility of its implementation and to identify barriers and enablers. This was an early stage formative mixed-methods study: an online survey plus in-depth interviews with country-level stakeholders in nutrition and child health from different geographical regions and stakeholder groups. 189 stakeholders from 42 countries responded to the online survey and 14 remote interviews were conducted. Participants expressed an urgent need for improved detection and care for small and nutritionally at-risk infants under 6 months. Whilst they considered the MAMI Care Pathway feasible and relevant, they noted it was largely unknown in their country. The most mentioned implementation barriers were: community-specific needs and health care seeking barriers, health workers' lack of competence in breastfeeding counselling and the absence of a validated anthropometric screening method. Possible enablers for its implementation were: patients' preference for outpatient care, integrating the MAMI care pathway into existing maternal and child health programmes and the possibility of a local pilot project. Adaptation to the local context was considered crucial in further scale-up.

[Factors associated with exclusive breastfeeding among mothers of children 24 months in Bamako]. / Facteurs associés à l'allaitement maternel exclusif chez les mères d'enfants de 24 mois à Bamako.

OBJECTIVE: The aim of our study was to examine the factors associated with exclusive breastfeeding in the city of Bamako. METHODS: It was a cross sectional and quantitative study. It was held from March 03 to April 14, 2013 in Bamako. Mothers of children 24 months not having reached their third birthday constituted the study population. Two-stage random sampling was used to interview them using a questionnaire. The data analysis using logistic regression was performed with Epi 2000 version 3.5.1. RESULTS: The study interviewed 362 mothers. The average age of mothers and of the duration of breastfeeding were 26.86 +/- 6.44 years and 19.22 +/- 3.28 months, respectively. Approximately 92% of mothers were married, 30.7% had practiced exclusive breastfeeding, 22.9% breastfed in the 30 minutes following birth and 29% of mothers breastfed to at least 24 months. However, we observed an association between exclusive breastfeeding and the practice of breastfeeding in the 30 minutes following birth, and education. CONCLUSION: We have identified modifiable factors for improving the practice of exclusive breastfeeding in Bamako.

High unhealthy food and beverage consumption is associated with poor diet quality among 12-35-month-olds in Guédiawaye Department, Senegal.

Background: High consumption of unhealthy foods and beverages (UFB) during early childhood is cause for concern, with growing evidence from low- and middle-income countries finding associations with poor diet quality and malnutrition. Research from sub-Saharan Africa remains limited, with no studies quantifying the contribution of UFB to total energy intakes among young children or exploring the relationship between such intakes and diet quality or anthropometric outcomes. Objectives: Assess UFB consumption patterns and their contribution to total energy intake from non-breastmilk foods/beverages (TEI-NBF), assess the association between high UFB consumption and dietary/nutrition outcomes, and explore drivers of unhealthy food choice among young children in Guédiawaye Department, Senegal. Methods: We conducted a cross-sectional study of a representative sample of 724 primary caregivers and their 12-35.9-month-old children. The study included a questionnaire, a quantitative four-pass 24-h dietary recall, and anthropometric measurements. The contribution of UFB to TEI-NBF was calculated and terciles generated. Logistic and linear models were used to compare outcomes of high versus low UFB consumption terciles. Results: UFB contributed on average 22.2% of TEI-NBF, averaging 5.9% for the lowest tercile and 39.9% for the highest. Diets of high UFB consumers, as compared to low, were significantly less dense in protein, fiber, and seven of the 11 micronutrients assessed and significantly denser in total fat, saturated fat, and total sugar. No associations were found with anthropometric outcomes. High UFB consumers were older and more likely to be living in food insecurity. The most common drivers of commercial UFB consumption were related to child preference, the use of these products as behavior management tools, treats, or gifts, and the sharing of these products by someone else eating them. Conclusion: High UFB consumption is associated with poor diet quality among 12-35-month-olds in Guédiawaye Department, Senegal. Addressing high UFB consumption during this critical developmental period should be prioritized in young child nutrition research, programming, and policy development.