Community Social Paediatrics Approach, an Innovative Healthcare Intervention: Implementation Fidelity in Atlantic Canada.

The Community Social Paediatrics approach (CSPA) is a comprehensive and personalized approach to care that is becoming more widely used throughout Canada. However, data on its implementation fidelity remain scarce. The purpose of this research was to assess the implementation fidelity of a CSPA established in 2017 in Canada. Data were collected through focus group interviews with the CSPA team using an implementation fidelity grid based on the Dr. Julien Foundation standard accreditation criteria. Results showed that on one hand, administrative and financial management and governance were among those domains with lower ratings. On the other hand, assessment/orientation and follow-up/support had high levels of fidelity of implementation. This research helps to better understand which factors are contributing to varying levels of fidelity of implementation. To reach an increased level of fidelity of implementation, it is recommended that adequate resources be in place.

A theory-based behavioural change communication intervention to decrease the provision of water to infants under 6 months of age in the Republic of Guinea.

OBJECTIVE: In many countries, the provision of water in the early months of a baby's life jeopardises exclusive breast-feeding (EBF). Using a behavioural theory, this study assessed the impact of a behaviour change intervention on mothers' intention to act and, in turn, on the water provision in addition to breast milk to their infants under 6 months of age (IU6M) in two regions of Guinea. DESIGN: A quasi-experimental design. Data on individual and environmental factors of the theoretical framework, sociodemographic and outcomes were collected using validated questionnaires before and after the intervention. The outcomes examined were the intention to provide water to IU6M, the provision of water and EBF. Path analyses were performed to investigate pathways by which psychosocial and environmental factors influenced the water provision in addition to breast milk. SETTING: Four health centres were assigned randomly to each study's arm (one control/CG and one intervention group/IG per region). PARTICIPANTS: The sample included 300 mothers of IU6M: 150 per group. RESULTS: In IG, the proportion of mothers providing water decreased from 61 % to 29 % before and after the intervention (P < 0·001), while no difference was observed in CG (P = 0·097). The EBF rate increased in IG (from 24·0 % to 53·8 %, P < 0·001) as opposed to CG (36·7 % to 45·9 %, P = 0·107). An association (P < 0·001) between the intention and the behaviour was observed in both groups. CONCLUSIONS: An intervention developed using a sound framework reduces the provision of water among IU6M and improves EBF.

A tool to assess underlying factors to water provision among Guinean children.

In many countries, water is provided to children under 6 months of age (CU6M) in addition to breast milk (BM), hence increasing the risk of child mortality and morbidity. Factors related to this practice have not been thoroughly investigated either a tool to assess them. Based on the extended theory of planned behaviour (eTPB), we aim to develop and validate a questionnaire to assess psychosocial and environmental factors that may contribute/limit the water provision in addition to BM by mothers of CU6M in the Republic of Guinea. A three-step process was used. Ten focus group discussions (FGDs) were held to identify salient beliefs related to each of the four constructs of the eTPB. Data from FGDs were used to develop a questionnaire composed of 88 items administered to 428 mothers. Exploratory factor analyses were conducted to identify latent factors for each construct. A shorter version of the questionnaire was administered to another sample of 300 mothers. Confirmatory factor analyses (CFAs) were performed. Hancock and Mueller's H reliability indices were computed on final models to assess the tool's validity and reliability. The final questionnaire included 57 items. For all four final models, most criteria for fit indices of CFA were generally met. Reliability coefficients were all equal to or above 0.90 for each construct. This research offers a tool that could be used to investigate determinants of water provision besides BM among mothers of CU6M. Further validation in other contexts is warranted.

Dietary intake and food behaviours of Senegalese adolescent girls.

BACKGROUND: Malnutrition is a public health concern in low- and middle-income countries. In Senegal, 35% of adolescent girls are undernourished and 56% are anemic. METHODS: This study assessed the dietary intake of 14-18-year-old adolescent girls in Dakar, Senegal. Specifically, the study 1) assessed their intake in energy, fibre, macro- and micronutrients, 2) described the types and the quality of the foods they consume, and 3) assessed some of their eating behaviours. Dietary intake was measured using three non-consecutive 24-h recalls from 136 adolescent girls attending two colleges. Energy and nutrient intakes were measured and compared to recommendations. Foods were classified by food group and by whether they were healthy or unhealthy. Adolescents' daily intake (g) of fruits and vegetables, as well as the proportion of girls who ate breakfast and who consumed three meals a day were calculated. RESULTS: Sodium intake was high, while fibre intake was low. On average, 40% of the adolescents' total energy intake came from fats. Mean intakes of zinc and calcium were higher on the weekend than on weekdays, while the opposite was observed for sodium. Eighty-three percent of adolescents had an inadequate intake of iron and 99% were at risk of calcium deficiency. Approximately 60% of the foods consumed were classified as healthy, however, the majority came from grains. CONCLUSIONS: Adolescent nutrition deserves attention given the poor quality of their dietary intake which may put them at risk of malnutrition and chronic diseases. These findings may be used to help improve programs targeting Senegalese adolescent girls' nutrition.

Feeding practices and factors associated with the provision of iron-rich foods to children aged 6-23 months in Matam area, Senegal.

OBJECTIVE: The objectives of this study were to document feeding practices amongst rural Senegalese children aged 6 to 23 months and to investigate psychosocial and environmental factors associated with the provision of iron-rich foods (IRF). DESIGN: This was a cross-sectional study conducted from January to July 2018. SETTING: The study took place in the region of Matam, northern Senegal. PARTICIPANTS: Ninety-eight mothers of children aged 6-23 months. RESULTS: Results show that 27·6 % of children were fed according to the minimum acceptable diet, and 55·1 % and 53·1 % had the minimum diet diversity and minimum meal frequency, respectively. About 65·3 % of mothers provided IRF to young children the day before the survey, mostly fish. Mother's intention to provide IRF to their children was not associated with the provision of these foods neither was the perceived behavioural control. Child's age (OR = 1·14, 95 % CI (1·03, 1·26), P = 0·012) and household food insecurity score (OR = 0·80, 95 % CI (0·68, 0·96), P = 0·014) were the predictors of the provision of IRF to children aged 6-23 months. CONCLUSIONS: Household food insecurity status and age of the child rather than mothers' psychosocial factors were significant predictors of IRF consumption amongst children aged 6-23 months in the study area. More attention should be given to food environment and child-related factors in order to improve children feeding practices and, in particular, their consumption of IRF in the study setting. For instance, home visits and the 5-month-old vaccine consultation in health centres might be opportunities to reinforce the importance of providing IRF as part of complementary foods from the age of 6 months. Implementation of measures for the improvement of socio-economic conditions and food security of households would also be valuable.

Assessing the Food Availability and Food Insecurity Situation among Communities of Matam Region, Senegal.

Matam is one of the poorest and most food-insecure regions of Senegal. In the past years, repeated environmental shocks such as drought have limited the access to food and it is unclear whether food insecurity is more a function of food availability (FA) and accessibility at the community level (CL) or more related to FA at the household level (HL). To better understand the FA and food security (FS) situation in this region, in 2018, a cross-sectional study was conducted in 103 households living in four villages. Through focus group discussions and direct observations, data on food available at HL and CL were collected as well as on food affordability and household FS. Overall, between 49 and 64 different foods, mostly from plant source, were identified. Around 75% of households had 0 to 3 foods and 7%, 7 to 10; 64% of all households were severely food insecure. FA at HL and its socioeconomic status were positively associated with household FS whereas FA at the CL was negatively associated. Although food assistance may be required to respond to shocks in the area, investments could be made to improve households` socioeconomic level to enhance their access to food.

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.

Public health nutrition capacity: assuring the quality of workforce preparation for scaling up nutrition programmes.

OBJECTIVE: To describe why and how capacity-building systems for scaling up nutrition programmes should be constructed in low- and middle-income countries (LMIC). DESIGN: Position paper with task force recommendations based on literature review and joint experience of global nutrition programmes, public health nutrition (PHN) workforce size, organization, and pre-service and in-service training. SETTING: The review is global but the recommendations are made for LMIC scaling up multisectoral nutrition programmes. SUBJECTS: The multitude of PHN workers, be they in the health, agriculture, education, social welfare, or water and sanitation sector, as well as the community workers who ensure outreach and coverage of nutrition-specific and -sensitive interventions. RESULTS: Overnutrition and undernutrition problems affect at least half of the global population, especially those in LMIC. Programme guidance exists for undernutrition and overnutrition, and priority for scaling up multisectoral programmes for tackling undernutrition in LMIC is growing. Guidance on how to organize and scale up such programmes is scarce however, and estimates of existing PHN workforce numbers - although poor - suggest they are also inadequate. Pre-service nutrition training for a PHN workforce is mostly clinical and/or food science oriented and in-service nutrition training is largely restricted to infant and young child nutrition. CONCLUSIONS: Unless increased priority and funding is given to building capacity for scaling up nutrition programmes in LMIC, maternal and child undernutrition rates are likely to remain high and nutrition-related non-communicable diseases to escalate. A hybrid distance learning model for PHN workforce managers' in-service training is urgently needed in LMIC.

Feeding practices among Indonesian children above six months of age: a literature review on their potential determinants (part 2).

BACKGROUND: Feeding practices among young children are not optimal in Indonesia. Improving these practices is crucial to prevent and reduce malnutrition among young children. A better understanding of the underlying factors to appropriate practices is essential to address barriers and identify opportunities to optimal practices. This paper aims to shed light on potential determinants of feeding practices among children above 6 months of age. METHODS: A systematic research of several databases using combinations of different search terms: feeding, child, Indonesia, MPASI/complementary food, gizi/nutrition, factor, determinant, praktek/practices was conducted. All documents were reviewed using a three-step procedure to assess content appropriateness and research quality. Data were analyzed using the Hector's framework on behaviour change. RESULTS: Available data on individual factors influencing feeding practices related mainly to mother's attributes, namely knowledge, perceptions, attitudes, beliefs and skills. Some of them are positively linked to good practices. Some environmental-related factors such as health services, home and peer environment were conducive to improved practices. Studies on societal factors were mostly restricted to food systems which do not favour optimal feeding practices. CONCLUSIONS: The review provides insights on underlying factors conducive to optimal feeding practices. Yet, relevant and quality research is required to get a better understanding on factors related to the environment and society as well as on how they are related with each other and operate in different contexts. Indonesia has already experimented successful programs which can be used as a reference to strengthen young child feeding practices.

Feeding practices among Indonesian children above six months of age: a literature review on their magnitude and quality (part 1).

BACKGROUND: In Indonesia, 37% of children under-five are stunted, 12% wasted and 12% overweight. Adequate feeding practices among children above 6 months of age are critical to tackle malnutrition. National surveys have been conducted to assess feeding practices but these aggregates hide geographic disparities. While several studies have been conducted in specific country locations to address this gap, no attempt has been made to reconcile available information. This paper aims to provide a comprehensive review of the literature on feeding practices among Indonesian children above six months of age. METHODS: A literature search was conducted in several databases using combinations of different search terms: feeding, child, Indonesia, MPASI/complementary feeding, gizi/nutrition, factor, determinant, praktek/practices. All documents were reviewed using a three-step procedure to assess content appropriateness and research quality. Available information was analyzed using current recommendations on feeding practices. RESULTS: Dietary diversity, consumption of iron-rich foods, active feeding and hygiene practices were among the non-optimal feeding practices. Consequently dietary intakes are not fulfilled for several micronutrients. Some feeding practices are worst in younger children. Differences between data from national and site-specific surveys are noted. Overall quality of the surveys needs to be strengthened. CONCLUSIONS: Generally, child feeding practices are not optimal. Indicators used to assess components of child feeding vary and make inter-survey comparisons challenging. The results also stress the need to investigate the underlying factors to optimal child feeding practices. The results may be used for advocacy of additional resource allocation for effective child feeding promotion programs.

Contribution of natural resources to nutritional status in a protected area of Gabon.

BACKGROUND: In protected areas, legislation restricts the population's access to natural food resources, which might have an impact on their welfare. OBJECTIVE: To assess the contribution of the individual use of natural resources to nutritional status in the rural population of the Gamba Complex of Gabon. METHODS: Four villages were selected to represent the rural population. All households were invited to participate, and 95% agreed. In each of the two major seasons, data were collected from all individuals (n = 637) in these 95 households during a 7-day period using a weighed food-consumption survey, observations, interviews, and anthropometric measures. RESULTS: Among children 5 to 9 years of age (n = 82) and adolescents (n = 169), their use of natural resources was the best predictor of nutritional status (explaining 8% of the variance), mainly via its contribution to the achievement of nutrient requirements. The use of natural resources was not a predictor for children 6 to 23 months (n = 28) or 24 to 59 months of age (n = 63), where the best predictors were access to care (26%) and health status (15%), respectively. Household food security predicted nutritional status in women caregivers (n = 96), although negatively. CONCLUSIONS: Natural resources contribute to the nutritional status of children 5 to 9 years of age and adolescents but not of other groups. The intrahousehold allocation of food, particularly of natural food resources, needs to be investigated to better appreciate the contribution of natural resources to the population's well-being. Women seem particularly vulnerable. Other than activities related to conservation, work is needed to understand the role of natural resources for populations living within and around protected areas.