Complex intertwined association between breastfeeding practices and household food insecurity: Systematic review and meta-analysis.

Breastfeeding offers ideal food and nutrition for infants; however, structural barriers may amplify breastfeeding inequities. We aimed to identify whether household food insecurity (HFI) is associated with exclusive and continued breastfeeding (EBF and CBF) as recommended by the World Health Organization/United Nations Children's Fund (UNICEF) Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, literature searches using 'breastfeeding', 'food insecurity' and 'infant' terms were conducted in PubMed/MEDLINE, Embase, CINAHL, Global Health and LILACS from inception through November 2023, without language restrictions, yielding 1382 publications (PROSPERO:CRD42022329836). Predetermined eligibility criteria yielded the 12 included studies (nine cross-sectional and three cohorts). The risk of bias was assessed through the Effective Public Health Practice Project. Meta-analysis was performed for studies assessing EBF (n = 10), and metaregression was used to explore heterogeneity across studies. Prevalence of EBF ranged from 1.6% to 85.3%, with a lower prevalence among HFI. The pooled effect of the association between HFI and EBF presented an odds ratio (OR) of 0.61 (95% CI = 0.49-0.76) with consistent results across marginal (OR = 0.72, 95% CI = 0.55-0.94), moderate (OR = 0.59, 95% CI = 0.41-0.84) and severe HFI (OR = 0.49, 95% CI = 0.32-0.76). High heterogeneity was found only when HFI was dichotomized. The prevalence of CBF ranged from 35.4% to 78.0%, with inconsistent prevalence among HFI; a meta-analysis was not performed due to the low number of studies (n = 3). We concluded that HFI levels are associated with lower odds of EBF. Integrating service and policy-level strategies, such as screening, referrals, skilled breastfeeding counseling and access to comprehensive nutrition and social programs, could reduce structural inequities and promote adherence to the World Health Organization/UNICEF breastfeeding recommendations among food-insecure families.

Nurturing care assets for food security: a community asset mapping approach.

BACKGROUND: Zip codes classified by the Food Insecurity Index with moderate and high food insecurity (FI) risk can be a threat to the health and well-being of children during the first 1,000 days (from pregnancy to 2 years). The presence of nurturing care assets (i.e., stable environments that promote health and nutrition, learning opportunities, security and safety, and responsive relationships) can contribute to supporting families and their communities, and ultimately reduce systemic barriers to food security. We aimed to identify and characterize nurturing care assets in under-resourced communities with moderate and high FI risk. METHODS: Four steps were used to conduct a Community Asset Mapping (CAM): (1) review of community documents across five zip codes in Clark County, Nevada (2), engagement of community members in identifying community assets (3), definition of the assets providing nurturing care services, and (4) classification of assets to nurturing care components, i.e., good health, adequate nutrition, safety and security, opportunities for early learning, and responsive caregiving. The Food Insecurity Index was used to determine FI risk in each zip code. Analyses explored whether disparities in nurturing care assets across zip codes with moderate and high FI exist. RESULTS: We identified 353 nurturing care assets across zip codes. A more significant number of nurturing care assets were present in zip codes with high FI risk. The adequate nutrition component had the most assets overall (n = 218, 61.8%), while the responsive caregiving category had the least (n = 26, 7.4%). Most of the adequate nutrition resources consisted of convenience stores (n = 96), food pantries (n = 33), and grocery stores (n = 33). Disparities in the number and type of good health, early learning, and security and safety assets were identified within zip codes with high FI risk compared to moderate FI risk. CONCLUSIONS: The quantity and type of nurturing care assets can exacerbate existing demographic disparities across zip codes, which are tied to barriers to access to food in under-resourced communities in Clark County, Nevada. Co-creating a nurturing care asset-based zip code strategy to address high FI risk will require strengthening systems across existing nurturing care assets.

Association between breastfeeding cessation among under six-month-old infants and postpartum depressive symptoms in Nevada.

BACKGROUND: Postpartum depression affects 13% of women after childbirth in the United States. Mothers who experience depression are less likely to breastfeed than those who do not experience depression. On the other hand, breastfeeding may have a positive effect on maternal mental health. RESEARCH AIM: We aimed to analyze whether breastfeeding cessation is associated with postpartum depression symptoms among mothers of infants under six months old in Clark County, Nevada. METHOD: A cross-sectional study was conducted in 2021 using a purposive sample of 305 mother-infant dyads. Postpartum depression symptoms were assessed using the Patient Health Questionnaire-2 (PHQ-2), and the breastfeeding cessation was determined through a 24-hour dietary recall. Descriptive, bivariate, and multivariate logistic regression analyses were conducted. RESULTS: Most participants were between 25 and 34 years old (n = 183, 60.0%), multiparous (n = 167, 55.1%), and had a vaginal delivery (n = 204, 70.6%). High frequency of postpartum depressive symptoms was found among mothers who were young (18-24 years) (24.2%), without a partner (25.0%), had unplanned pregnancies (12.7%), and were primiparous (13.2%). Breastfeeding cessation was independently associated with postpartum depressive symptoms (AOR = 3.30, 95% CI: 1.16-9.32) after controlling for sociodemographic, environmental, and obstetric characteristics. CONCLUSION: Breastfeeding cessation is strongly associated with postpartum depressive symptoms among mother-infant dyads in Nevada. Early identification of postpartum depressive symptoms and the promotion of breastfeeding can create a positive feedback loop to foster the well-being of mothers and infants.

Scaling up a home-visiting program for child development in Brazil: a comparative case studies analysis.

Background: In 2016, Brazil scaled up the Criança Feliz Program (PCF, from the acronym in Portuguese), making it one of the largest Early Childhood Development (ECD) programs worldwide. However, the PCF has not been able to achieve its intended impact. We aimed to identify barriers and facilitators to achieving the PCF implementation outcomes across the RE-AIM dimensions (Reach, Effectiveness or Efficacy, Adoption, Implementation and Maintenance) during the COVID-19 pandemic. Methods: This comparative case study analysis selected five contrasting municipalities based on population size, region of the country, implementation model, and length of time implementing the PCF. We conducted 244 interviews with PCF municipal team (municipal managers, supervisors, home visitors), families, and cross-sectoral professionals. A rapid qualitative analysis was used to identify themes across RE-AIM dimensions. Findings: Families' limited knowledge and trust in PCF goals were a barrier to its reach. While the perceived benefit of PCF on parenting skills and ECD enabled reach, the lack of referral protocols to address social needs, such as connecting food-insecure families to food resources, undermined effectiveness. Questions about whether the social assistance sector should be in charge of PCF challenged its adoption. Implementation barriers exacerbated by the COVID-19 pandemic included low salaries, temporary contracts, high turnover, infrequent supervision, lack of an effective monitoring system, and nonexistence or non-functioning multisectoral committees. The absence of institutionalized funding was a challenge for sustainability. Interpretation: Complex intertwined system-level barriers may explain the unsuccessful implementation of PCF. These barriers must be addressed for Brazil to benefit from the enormous reach of the PCF and the evidence-based nurturing care principles it is based upon. Funding: NIH/NICHD.

Association between household food insecurity and stunting in children aged 0-59 months: Systematic review and meta-analysis of cohort studies.

Household food insecurity (HFI) during childhood is associated with poor dietary diversity and malnutrition, placing children's growth at risk. Children with growth disorders, such as stunting, are more likely to have poor cognition and educational performance, lower economic status, and an increased risk of nutrition-related chronic diseases in adulthood. Our study aimed to systematically review and conduct a meta-analysis of cohort studies investigating the association between HFI and stunting in children aged 0-59 months. Peer-reviewed and grey literature were systematically searched in electronic databases with no language or date restrictions. Two reviewers independently assessed the studies for pre-established eligibility criteria. Data were extracted using a standard protocol. Random-effects meta-analysis models were used, and I2 > 40% indicated high heterogeneity across studies. We used the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of the evidence. Nine cohort studies comprising 46,300 children were included. Approximately 80% (n = 7) of the studies found a positive association between HFI and stunting. Pooled odds ratio was 1.00 (95% confidence interval [CI]: 0.87-1.14; I2: 76.14%). The pooled hazard ratio between moderate and severe HFI and stunting was 1.02 (95% CI: 0.84-1.22; I2: 85.96%). Due to high heterogeneity, the quality of evidence was very low. Individual studies showed an association between HFI and stunting in children aged 0-59 months; however, this association was not sustained in the pooled analysis, possibly because of high heterogeneity across studies.

Infant feeding practices in three Latin American countries in three decades: what demographic, health, and economic factors are relevant?

Introduction: Studies in Latin America have focused either on analyzing factors associated with exclusive breastfeeding (EBF) or infant formula (IF). Purpose: Analyze the association between economic, sociodemographic, and health factors with EBF, mixed milk feeding (MixMF), and exclusive use of IF in three Latin American and Caribbean countries in the 1990s, 2000s, and 2010s. Methods: Cross-sectional time-series study using data from Demographic and Health Surveys between the 1990s and 2010s in Colombia (1995-2010), Haiti (1994-2017), and Peru (1996-2012) accounting for a sample of 12,775 infants under 6 months. Hierarchical logistic multilevel regression models were used to estimate the adjusted association between infant feeding outcomes (EBF, MixMF, exclusive use of IF) and contextual level DHS survey decade (1990s, 2000s and 2010s) and economic factors (Gross Domestic Product by purchasing power parity, female wage and salaried workers, labor force participation rate female) as well as individual level sociodemographic (maternal age, maternal education, number of children in the household, wealth index, mother living with a partner, area of residence, mother working outside of home), and health factors (breastfed in the first hour, C-section). Results: Factors associated with EBF cessation were c-section (OR: 0.76; 95%CI: 0.64, 0.92), mothers working outside of the home (OR: 0.79; 95%CI: 0.69, 0.90), families in the highest income quintile (OR: 0.64; 95%CI: 0.49, 0.84), and female wage and salaried workers (OR: 0.92; 95%CI: 0.91, 0.94). MixMF was associated with women with higher education (OR: 1.54; 95%CI: 1.21, 1.97), mother working outside of the home (OR: 1.26; 95%CI: 1.10, 1.43), c-section (OR: 1.37; 95%CI: 1.15, 1.62), families in the highest income quintiles (OR: 2.77; 2.10, 3.65). and female wage and salaried workers (OR: 1.08;95% CI: 1.05, 1.09). Exclusive use of IF was associated with a mother working outside of the home (OR: 2.09; 95%CI: 1.41, 3.08), c-section (OR: 1.65; 95%CI: 1.09, 2.51), families in the highest income quintiles (OR: 12.08; 95% CI: 4.26, 34.28), the 2010s (OR: 3.81; 95%CI: 1.86, 7.79), and female wage and salaried workers (OR: 1.12; 95%CI: 1.07, 1.16). Discussion/Conclusion: Factors related to women empowerment and gender equality jeopardized EBF and favored the exclusive use of IF in Latin America. Therefore, workplace interventions to promote, protect, and support breastfeeding practices are key to reducing exclusive use of IF.

Implementation of strategies and programs for breastfeeding, complementary feeding, and malnutrition of young children in Brazil: advances and challenges.

Malnutrition in all its forms has risen on global agendas due to the recognition of its magnitude and consequences for a wide range of human, social, and economic outcomes. Implementing strategies and programs with the needed scale and quality is a major challenge. The Brazilian National Survey on Child Nutrition (ENANI-2019) pointed out several advances but numerous challenges. In this paper, we reflect on the implementation progress of breastfeeding, complementary feeding and young children malnutrition strategies and programs in Brazil and how existing challenges can be overcome through the lens of implementation science. First, we present a brief history of such programs. Second, we selected two breastfeeding initiatives to illustrate and reflect on common implementation challenges. In these case studies, we used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to analyze the implementation and scaling up barriers and facilitators. We found common barriers related to unclear goals about the reach of programs, challenges in assessing effectiveness and fidelity/quality during the real-world implementation, discontinuation or lack of funding, and lack of monitoring and evaluation impacting the sustainability of programs. We also discuss the use of implementation science to achieve adequate nutrition by 2030 and present critical elements for successful scale implementation of nutrition programs based on global evidence. Despite the investment to implement different actions aimed at facing infant feeding and malnutrition, high-quality implementation research must become a priority to catalyze progress in Brazil.

Correction: Moura et al. Implementation of the Strategy for Breastfeeding and Complementary Feeding in the Federal District in Brazil. Int. J. Environ. Res. Public Health 2022, 19, 5003.

The authors would like to make the following corrections to this paper [...].

Pathways to scale up early childhood programs: A scoping review of Reach Up and Care for Child Development.

Evidence-based early childhood development (ECD) programs that strengthen nurturing parenting skills and promote early stimulation, such as Reach Up (RU) and Care for Child Development (CCD), are critical investments for interrupting cycles of intergenerational poverty; however, the implementation impact of these programs varies greatly globally. Analyzing systematically the evidence on the implementation pathways based on contexts (i.e., external and internal influences on intervention implementation), implementation strategies (i.e., mechanisms used to promote program initiation, design, and delivery with existing systems), and implementation outcomes (i.e., related to the implementation goals) can increase the likelihood of implementation success. Our scoping review aimed to identify implementation pathways of RU and CCD programs in low- and middle-income countries. A search in English, Spanish, and Portuguese of grey literature and five databases of peer reviewed literature; from inception through July 16, 2022, yielded 2,267 publications. Using predetermined eligibility criteria, 75 records yielded implementation details for 33 programs across 23 low- and middle-income countries. Two reviewers independently extracted program data on context, implementation strategies, and implementation outcomes following a program theory. A thematic analysis identified 37 implementation strategies across six "building blocks of implementation": program emergence, intersectoriality, intervention characteristics, workforce, training, and monitoring systems. Implementation pathways across building blocks are highly influenced by contextual factors, such as infrastructure, social norms, and the target population's demand and interest, which may shape different implementation outcomes. Six 'building blocks' shaping implementation pathways of CCD and RU in LMICs were identified. The careful consideration of context and use of intentional evidence-based planning can enable the successful implementation of ECD nurturing care interventions. We recommend the use of the ECD Implementation Checklist for Enabling Program Scale Up to guide decision-making regarding context and implementation strategies to support implementation outcomes and subsequent ECD program success.

An Analysis of Key Actor Networks for Scale-Up Strategies for Childhood Obesity Prevention and the Care of Children with Obesity in Brazil.

Background: Effective scale-up of multisectoral strategies aimed to prevent and treat childhood obesity has been a challenge in Brazil, the largest country in Latin America. Implementation Science methods, such as Net-Map, can identify key actors and opinion leaders (OLs) to advance the implementation and promote sustainability. Objectives: This study aimed to analyze power relations between key actors and OLs who influence the scale-up of Brazilian strategies for childhood obesity at the federal and state/municipal (local) levels. Methods: A mixed method study, applying the Net-Map method, collected data through virtual workshops with federal and local level stakeholders. The Net-Map included key actors mapping, power mapping, and identification of OLs. Four domains of power were analyzed: command, funding, technical assistance, and dissemination. Network cohesion and centrality measures were calculated. A qualitative analysis was conducted to qualify power relations according to ∗ gears for a successful scale-up (i.e., coordination, goals, and monitoring; advocacy; political will; legislation and policy; funding and resources; training; program delivery; communication; and research and technical cooperation). Results: A total of 121 federal key actors and 63 local key actors were identified across networks, of which 62 and 28 were identified as OLs, respectively. Whereas the command domain of power had the highest number of key actors, the funding domain had the least. The health sector executive branch emerged as an OL across all domains of power. Conclusions: Barriers that threatened successful scale-up include the lack of coordination between domains of power, missing leadership within key actors, and lack of mechanisms to manage conflict of interest. Governance strategies to enhance multisectoral coordination and communication are needed to effectively scale-up and sustain childhood obesity strategies in Brazil.

A qualitative analysis of the nurturing care environment of families participating in Brazil's Criança Feliz early childhood program.

Investing in early childhood programs such as Brazil's Criança Feliz Program (PCF) to support low-income families in providing a nurturing care environment is critical to ensure that children reach their full developmental potential. We aimed to analyze the influence of the PCF on the nurturing care environment provided by families enrolled in the program in the Federal District, Brazil. A qualitative case study was conducted based on in-depth interviews with a purposive sampling of 22 caregivers enrolled in the PCF for at least six months. Eighteen subthemes emerged from the thematic analysis following the five components of the Nurturing Care Framework (i.e., good health, adequate nutrition, responsive care, early learning, and security and safety). Caregivers recognized the benefits of the PCF on children's mental health (good health) and reported challenges in providing adequate nutrition due to food insecurity (adequate nutrition). A bond between the home visitor and families was identified as critical to promote responsive parenting practices (responsive care). Caregivers appreciated the early stimulation activities provided during PCF home visits (opportunities for early learning). Access to social welfare programs, such as conditional cash transfer and food assistance, were facilitated through PCF multisectoral actions (safety and security). On the other hand, families reported not receiving support from PCF for issues such as breastfeeding, maternal mental health, and disciplinary practices. In summary, PCF enhanced the components of the nurturing care environment provided by families. However, their vulnerabilities and contextual implementation barriers may prevent families from fully benefiting from PCF activities.

Socio-demographic, maternal, and infant characteristics associated with pacifier use among six-months old infants in Clark County, Nevada.

BACKGROUND: Pacifier use can interfere with nurturing care practices such as breastfeeding, soothing, and sleeping. Due to contradicting beliefs, recommendations, and the high frequency of pacifier use, understanding its associations may support shaping equitable public health recommendations. This study explored the socio-demographic, maternal, and infant characteristics associated with pacifier use among six-months old infants in Clark County, Nevada. METHOD: Cross-sectional survey was conducted in 2021 with a sample of mothers (n = 276) of infants under six months old in Clark County, Nevada. Participants were recruited through advertisements in birth, lactation, pediatric care centers, and social media. We used binomial and multinomial logistic models to assess the association between pacifier use and the age of pacifier introduction, respectively, with household, maternal, infant, healthcare characteristics, and feeding and sleeping practices. RESULTS: More than half of the participants offered pacifiers (60.5%). Pacifier use was higher among low-income households (OR (95% CI) 2.06 (0.99-4.27)), mothers who identified as non-Hispanic (OR (95% CI) 2.09 (1.22-3.59)), non-first-time mothers (OR (95% CI) 2.09 (1.11-3.05)), and bottle-feeding infants (OR (95% CI) 2.76 (1.35-5.65)). Compared to those who did not introduce a pacifier, non-Hispanic mothers (RRR (95% CI) 2.34 (1.30-4.21)) and bottle-fed infants (RRR (95% CI) 2.71 (1.29-5.69)) had a higher risk of introducing pacifier within two weeks. Likewise, infants living in food insecure households (RRR (95% CI) 2.53 (0.97-6.58)) and mothers who have more than one child (RRR (95% CI) 2.44 (1.11-5.34)) had a higher risk of introducing a pacifier after two weeks. CONCLUSION: Pacifier use is independently associated with maternal income, ethnicity, parity, and bottle feeding among six-month-old infants living in Clark County, Nevada. Household food insecurity increased the relative risk of introducing a pacifier after two weeks. Qualitative research on pacifier use among families with diverse ethnic/racial backgrounds is needed to improve equitable interventions.

Implementation of strategies and programs for breastfeeding, complementary feeding, and malnutrition of young children in Brazil: advances and challenges / Implementação de estratégias e programas de amamentação, alimentação complementar e desnutrição de crianças pequenas no Brasil: avanços e desafios / Implementación de estrategias y programas de lactancia materna, alimentación complementaria y desnutrición en niños pequeños en Brasil: avances y desafíos

Abstract: Malnutrition in all its forms has risen on global agendas due to the recognition of its magnitude and consequences for a wide range of human, social, and economic outcomes. Implementing strategies and programs with the needed scale and quality is a major challenge. The Brazilian National Survey on Child Nutrition (ENANI-2019) pointed out several advances but numerous challenges. In this paper, we reflect on the implementation progress of breastfeeding, complementary feeding and young children malnutrition strategies and programs in Brazil and how existing challenges can be overcome through the lens of implementation science. First, we present a brief history of such programs. Second, we selected two breastfeeding initiatives to illustrate and reflect on common implementation challenges. In these case studies, we used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to analyze the implementation and scaling up barriers and facilitators. We found common barriers related to unclear goals about the reach of programs, challenges in assessing effectiveness and fidelity/quality during the real-world implementation, discontinuation or lack of funding, and lack of monitoring and evaluation impacting the sustainability of programs. We also discuss the use of implementation science to achieve adequate nutrition by 2030 and present critical elements for successful scale implementation of nutrition programs based on global evidence. Despite the investment to implement different actions aimed at facing infant feeding and malnutrition, high-quality implementation research must become a priority to catalyze progress in Brazil.

Resumo: A desnutrição, em todas as suas formas, cresceu nas agendas globais devido ao reconhecimento de sua magnitude e consequências para uma ampla gama de resultados humanos, sociais e econômicos. Implementar estratégias e programas com a escala e a qualidade necessárias é um grande desafio. O Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) apontou vários avanços, mas inúmeros desafios. Este artigo reflete sobre o progresso da implementação de estratégias e programas de amamentação, alimentação complementar e desnutrição de crianças pequenas no Brasil e como os desafios existentes podem ser superados através das lentes da ciência da implementação. Primeiramente, um breve histórico de tais programas é apresentado. Em seguida, duas iniciativas de amamentação selecionadas para ilustrar e refletir sobre os desafios comuns de implementação. Nesses estudos de caso, o modelo RE-AIM (alcance, eficácia, adoção, implementação e manutenção) foi utilizado para analisar a implementação e ampliar barreiras e facilitadores. Foram encontradas barreiras comuns relacionadas a metas pouco claras sobre o alcance dos programas, desafios na avaliação da eficácia e fidelidade/qualidade durante a implementação no mundo real, a interrupção ou falta de financiamento e a falta de monitoramento e avaliação que afetam a sustentabilidade dos programas. O uso da ciência da implementação para alcançar uma nutrição adequada até 2030 também foi discutido, apresentando elementos críticos para a implementação em escala bem-sucedida de programas de nutrição com base em evidências globais. Apesar do investimento para implementar diferentes ações voltadas para o enfrentamento da alimentação infantil e da desnutrição, a pesquisa de implementação de alta qualidade deve se tornar uma prioridade para catalisar o progresso no Brasil.

Resumen: La desnutrición, en todos sus grados, es un tema que está presente en las agendas mundiales debido a su magnitud y consecuencias para una amplia gama de resultados humanos, sociales y económicos. La implementación de estrategias y programas con la escala y calidad requeridas es un gran desafío. El Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019) apunta varios avances y numerosos desafíos. Este artículo reflexiona sobre el progreso en la implementación de estrategias y programas para la lactancia materna, la alimentación complementaria y la desnutrición infantil en Brasil y sobre cómo se pueden superar los desafíos existentes desde la implementación. En primer lugar, se presenta una breve historia de tales programas. A continuación, se seleccionan dos iniciativas de lactancia materna para ilustrar y reflexionar sobre los desafíos comunes de implementación. En este estudio de caso se utilizó el modelo RE-AIM (alcance, eficacia, adopción, implementación y mantenimiento) para analizar la implementación y ampliar las barreras y facilitadores. Se encontraron barreras comunes relacionadas con los objetivos poco definidos sobre el alcance de los programas, con los desafíos para evaluar la efectividad y la fidelidad/calidad durante la implementación, con la interrupción o falta de financiamiento y con la falta de monitoreo y evaluación que afectan la sostenibilidad de los programas. También se discutió el uso de la implementación para lograr una nutrición adecuada para 2030, mediante la presentación de elementos críticos para implementar con éxito los programas de nutrición basados en evidencia global. Si bien se promueve la implementación de diferentes acciones destinadas al combate de la alimentación infantil y la desnutrición, la implementación de gran calidad debe ser una prioridad en Brasil.

Pesquisas de implementação na área da primeira infância: revisão de escopo / Estudio de implementación en el área de la primera infancia: revisión de alcance / Implementation research in the area of early childhood: scoping review

Resumo Objetivo Mapear sistematicamente as pesquisas de implementação com foco em intervenções voltadas ao desenvolvimento na primeira infância, suas principais características e estratégias de implementação. Métodos Uma revisão de escopo da literatura global foi planejada e executada conforme as recomendações do Instituto Joanna Briggs. A busca foi realizada em nove bases eletrônicas (PubMed, Scopus, Embase, Health System Evidence, Social Systems Evidence, Cochrane, ERIC e CINHAL e BVS), do início da indexação até agosto de 2021. Resultados As buscas mapearam 4.105 referências, sendo 2.805 únicas. Após triagem, 211 estudos foram lidos na íntegra e 82 incluídos. O setor saúde foi o mais frequente nas intervenções, seguido da educação e serviço social. Programas voltados ao desenvolvimento infantil e estratégias focadas na parentalidade, família, nutrição, foram principais intervenções. No total, 89,0% apresentaram as crianças como beneficiárias diretas das estratégias. A duração média das intervenções foi de 14,5 meses e 25,6% dos estudos fundamentaram sua metodologia em frameworks para analisar a implementação das intervenções. A metade analisou adaptações das intervenções ou programas, enquanto 29,3% citaram aspectos de equidade da implementação. Conclusão Esta revisão de escopo permitiu a análise de um conjunto de intervenções voltadas à primeira infância, demonstrando o potencial das pesquisas de implementação de programas de desenvolvimento da primeira infância, identificando estratégias mais adequadas aos contextos e o alcance dos objetivos pretendidos, a partir da incorporação dos desfechos de implementação.

Resumen Objetivo Mapear sistemáticamente los estudios de implementación con foco en intervenciones dirigidas al desarrollo en la primera infancia, sus principales características y estrategias de implementación. Métodos Se planificó y ejecutó una revisión de alcance de la literatura global de acuerdo con las recomendaciones del Instituto Joanna Briggs. La búsqueda se realizó en nueve bases electrónicas (PubMed, Scopus, Embase, Health System Evidence, Social Systems Evidence, Cochrane, ERIC y CINHAL y BVS), desde el comienzo de la indexación hasta agosto de 2021. Resultados Las búsquedas mapearon 4105 referencias, de las cuales 2805 eran únicas. Luego de la clasificación, se leyeron 211 estudios completos y se incluyeron 82. El sector de la salud fue el más frecuente en las intervenciones, seguido de educación y servicio social. Las principales intervenciones fueron programas dirigidos al desarrollo infantil y estrategias centradas en la parentalidad, familia y nutrición. En total, el 89,0 % presentó a los infantes como beneficiarios directos de las estrategias. La duración promedio de las intervenciones fue de 14,5 meses y el 25,6 % de los estudios fundamentaron su metodología en frameworks para analizar la implementación de las intervenciones. La mitad analizó adaptaciones de las intervenciones o programas, mientras que el 29,3 % citó aspectos de equidad de la implementación. Conclusión Esta revisión de alcance permitió el análisis de un conjunto de intervenciones dirigidas a la primera infancia, lo que demuestra el potencial de los estudios de implementación de programas de desarrollo de la primera infancia e identifica estrategias más adecuadas a los contextos y al cumplimiento de los objetivos pretendidos, a partir de la incorporación de los resultados de implementación.

Abstract Objective To systematically map implementation research focusing on interventions aimed at early childhood development, its main characteristics and implementation strategies. Methods A scoping review of the global literature was planned and performed in accordance with recommendations of the Joanna Briggs Institute. The search was carried out in nine electronic databases (PubMed, Scopus, Embase, Health System Evidence, Social Systems Evidence, Cochrane, ERIC and CINHAL and VHL) from the beginning of indexing until August 2021. Results The searches mapped 4,105 references, 2,805 of which were unrepeated. After screening, 211 studies were read in full and 82 included. The health sector was the most frequent in interventions, followed by education and social services. Programs aimed at childhood development and strategies focused on parenting, family and nutrition were the main interventions. In total, 89.0% presented children as direct beneficiaries of the strategies. The average duration of interventions was 14.5 months and 25.6% of studies based their methodology on frameworks to analyze the implementation of interventions. Half analyzed adaptations of interventions or programs, while 29.3% cited equity aspects of implementation. Conclusion This scoping review allowed the analysis of a set of interventions aimed at early childhood, demonstrating the potential of implementation research on early childhood development programs, identifying more appropriate strategies to the contexts and the reach of intended objectives, based on incorporation of implementation outcomes.

Brazilian Strategy for Breastfeeding and Complementary Feeding Promotion: A Program Impact Pathway Analysis.

BACKGROUND: The Brazilian Breastfeeding and Complementary Feeding Strategy (Estratégia Amamenta e Alimenta Brasil-EAAB) aims to improve Primary Health Care (PHC) workers' counseling skills to promote and support infant and young children feeding (IYCF). However, the maintenance and scaling up of the EAAB has been challenging. The theory-driven Program Impact Pathway (PIP) is recommended to assess and enhance the large-scale implementation of IYCF programs. The purpose of this study was to document barriers and facilitators to scale up the EAAB using a PIP analysis. METHODS: First, we reviewed EAAB documents to develop an initial PIP diagram. Then, we interviewed EAAB key informants to identify Critical Quality Control Points (CCP) in the PIP. We revised and analyzed the PIP to inform the EAAB core functions and pathways. RESULTS: Six CCPs for EAAB maintenance were identified: CCP1-Definition and strengthening of the coordination in states and municipalities; CCP2-Maintenance of tutors' work; CCP3-Feasibility of the certification process; CCP 4-Quality improvement of IYCF activities in PHC units; CCP 5-Adequate use of monitoring systems; and CCP 6-Consistent implementation monitoring. Four implementation pathways and seven core functions identified may assist with scaling up the EAAB in Brazil. CONCLUSION: The PIP analysis proved to be useful for documenting the factors that influence the maintenance and scaling up of the EAAB.

Implementation of the Strategy for Breastfeeding and Complementary Feeding in the Federal District in Brazil.

BACKGROUND: The Brazilian Breastfeeding and Complementary Feeding Strategy-Estratégia Amamenta e Alimenta Brasil (EAAB) aims to promote optimal breastfeeding (BF) and complementary feeding (CF) practices through the training of primary health professionals. Competition among health priorities and programs is one of the organizational contextual barriers to consolidating the implementation of the EAAB. METHODS: This case study included six Primary Health Units (PHU) certified in the EAAB. Documentary analysis, interviews, and surveys were conducted, which informed a conceptual logical model. Organizational context indicators (positive and negative) were identified across the logical model based on the Matus Triangle, and they were used to analyze the degree of implementation of the EAAB in the PHUs. RESULTS: The logic model elucidated six stages of EAAB implementation, but none on post-certification monitoring. Ten indicators positively influenced the implementation, including having legislation that prioritizes BF and CF. Seven indicators exerted negative influence, especially the lack of specific funding resources for the EAAB. Only one PHU had a consolidated degree of implementation. CONCLUSIONS: Lack of specific funding, monitoring of BF and CF practices, and compliance with certification criteria are the main challenges for the EAAB's sustainability.

Evolution of breastfeeding indicators and early introduction of foods in Latin American and Caribbean countries in the decades of 1990, 2000 and 2010.

BACKGROUND: Early introduction of liquid/solid food before 6 months of age is one of the major barriers to exclusive breastfeeding. Our objective was to analyze the evolution of infant feeding practices for infants under 6 months of age in Latin American and Caribbean countries in the decades of 1990, 2000 and 2010. METHOD: Cross-sectional time series study with data from Demographic and Health Surveys carried out between 1990 and 2017 in six Latin America and Caribbean countries: Bolivia (1994 to 2008), Colombia (1995 to 2010), Dominican Republic (1996 to 2013), Guatemala (1995 to 2015), Haiti (1994/1995 to 2016/2017), Peru (1996 to 2018). Pooled sample comprised of 22,545 infants under the age of 6 months. Surveys were grouped in three decades: 1990s for surveys from 1990 to 1999, 2000s for surveys from 2000 to 2009, and 2010s for surveys from 2010 to 2017. Exclusive breastfeeding (EBF), predominant breastfeeding (PBF), mixed breastfeeding (mixed BF), supplemented breastfeeding (supplemented BF) and non-breastfeeding (non-BF), and individual foods (water, liquids, milk, infant formula, semi-solid/solid) were analyzed. Prevalence of breastfeeding and food indicators were calculated in pooled sample, according to the infant monthly age groups, decade of survey and residence area(rural/urban). RESULTS: Between 1990s and 2010s, there was an increase in the exclusive breastfeeding prevalence (1990s = 38.1%, 2010s = 46.6%) and a reduction in the PBF prevalence (1990s = 51.7%, 2010 s = 43.1%). There was a decrease in the liquids (1990s = 40.7%, 2010s = 15.8%) and milk prevalence (1990s = 20.4%, 2010s = 8.3%) and an increase in water (1990s = 32.3%, 2010s = 37.6%), and infant formula (1990s = 16.6%, 2010s = 25.5%) prevalence. All breastfeeding indicators, except exclusive breastfeeding, progressively increased according to the monthly age group in three decades, and EBF prevalence sharply decreased from 2 to 3 months of age in all decades. Exclusive breastfeeding prevalence was higher in rural area in the three decades (1990s rural = 43.8%, 1990s urban = 32.4%, 2010s rural = 51.1%, 2010s urban = 42.4%) and infant formula prevalence was higher in urban area (1990s rural = 8.6%, 1990s urban = 24.6%, 2010s rural = 15.9%, 2010s urban = 34.1%). CONCLUSIONS: In the last three decades, in all age groups, there was an increase in exclusive breastfeeding prevalence, as well as a significant reduction in liquids and milk. In the rural area, EBF prevalence remains higher than in urban. Increased water and infant formula feeding are the main barriers to achieving the Global Nutrition Target 2025 for exclusive breastfeeding.

Prioritizing nurturing care at the municipal and district level with the Brazilian Early Childhood Friendly Municipal Index (IMAPI).

The Brazilian Early Childhood Friendly Municipal Index (IMAPI) is a population-based approach to monitor the nurturing care environment for early childhood development (ECD) using routine information system data. It is unknown whether IMAPI can be applied to document metropolitan urban territorial differences in nurturing care environments. We used Brasilia, Brazil's capital with a large metropolitan population of 2,881,854 inhabitants divided into 31 districts, as a case study to examine whether disaggregation of nurturing care data can inform a more equitable prioritization for ECD in metropolitan areas. IMAPI scores were estimated at the municipal level (IMAPI-M, 31 indicators) and at the district level (IMAPI-D, 29 indicators). We developed a quantitative prioritization process for indicators in each IMAPI analysis, and those selected were jointly mapped in the socioecological model for the role of indicators in relation to the enabling environment for nurturing care. Out of 28 common nurturing care indicators across IMAPI analysis, only four were prioritized in both analyses: one from the Adequate nutrition, two from the Opportunities for early learning, and one from the Responsive caregiving domains. These four indicators were mapped as enabling policies, supportive services, and caregivers' capabilities (socioecological model) and Effort, Coverage, and Quality (indicator's role). In conclusion, the different levels of nurturing care data disaggregation in the IMAPI can better inform decision-making than each one individually, especially in metropolitan areas where municipalities and districts within metropolitan areas have relative decision-making autonomy.