Determinants and drivers of young children's diets in Latin America and the Caribbean: Findings from a regional analysis.

The Latin America and Caribbean region exhibit some of the lowest undernutrition rates globally. Yet, disparities exist between and within countries and countries in the region increasingly face other pressing nutritional concerns, including overweight, micronutrient deficiencies and inadequate child feeding practices. This paper reports findings from a regional analysis to identify the determinants and drivers of children's diets, with a focus on the complementary feeding window between the age of 6-23 months. The analysis consists of a narrative review and descriptive data analysis, complemented with qualitative interviews with key informants in four countries: Guatemala, Paraguay, Peru and Uruguay. Findings indicate that poverty and inequality (disparities within countries by wealth and residence), unequal access to services, inadequate coverage of social programmes and lack of awareness on appropriate feeding practices are important drivers for inadequate diets. We conclude that countries in the region need to invest in policies to tackle overweight and micronutrient deficiencies in young children, considering inequalities between and within countries, enhance coverage of social protection programmes, improve coordination between sectors to improve children's diets and expand the coverage and intensity of awareness campaigns on feeding practices, using iterative programme designs.

Consumo de agua, bebidas azucaradas y uso de bebederos en secundarias del Programa Nacional de Bebederos Escolares de la Ciudad de México / Plain water and sugar sweetened beverages intake and use of school drinking fountains in secondary schools of the National School Drinking Fountains Program in Mexico City

Resumen: Objetivo: Describir prácticas de consumo de bebidas y uso de bebederos escolares en estudiantes de secundarias del Programa Nacional de Bebederos Escolares (PNBE). Material y métodos: Estudio transversal descriptivo, con enfoque mixto en secundarias públicas (turnos matutino y vespertino). Se indagó el consumo de agua y bebidas azucaradas, utilización de bebederos escolares y barreras-facilitadores para el consumo de agua. Resultados. Se entrevistaron 617 estudiantes (11 a 16 años); 51.5% fueron hombres. El consumo promedio de agua (568.9 ml; IC95%: 470.7-667.1) y bebidas azucaradas (143.4 ml; IC95%:124.0-162.7) fue similar entre hombres y mujeres. En el turno matutino las mujeres presentaron una menor probabilidad de hacer uso de los bebederos en comparación con los hombres (p=0.032). Hombres y mujeres desconfían del agua de los bebederos. Conclusiones: Se requieren acciones integrales para favorecer el consumo de agua y el uso de los bebederos en las secundarias del PNBE.

Abstract: Objective: To describe beverages consumption practices, and school drinking fountains utilization among secondary school's students from National School Drinking Fountains Program (PNBE, Spanish acronym). Materials and methods: Descriptive cross-sectional study with mixed methods in public secondary schools (morning and afternoon shifts). We estimated plain water and sugar sweetened beverages consumption, school drinking fountains utilization, and barriers-facilitators for plain water consumption. Results: We interviewed 617 students (11 to 16 y); 51.5% were men. The mean of plain water intake (568.9 ml; CI95%: 470.7-667.1), and sugar sweetened beverages (143.4 ml; CI95%:124.0-162.7) was similar among women and men. In the morning shift women had a lower probability of utilizing the school drinking fountains in comparison with men (p=0.032). Men and women have mistrust water that comes from school drinking fountains. Conclusions: Integral actions are necessary to favor plain water consumption, and utilization of school drinking fountains at PNBE secondary schools.

Barriers and enablers of breast-feeding protection and support after the 2017 earthquakes in Mexico.

OBJECTIVE: To study the barriers and enablers of breast-feeding protection and support after the 2017 earthquakes in Mexico. DESIGN: A qualitative study using a phenomenological approach to analyse data collected from in-depth interviews, virtual ethnography and documentary analysis of newspapers. SETTING: Data were collected after the September 2017 earthquakes in Mexico (from 8 September 2017 to 15 May 2018). PARTICIPANTS: The participants included key informants (n 13) from different sectors. Postings retrieved from forty-two Facebook and forty-seven Twitter accounts and a WhatsApp group informed the virtual ethnography analysis. Newspaper material covering the 2017 earthquakes in Mexico (seven newspapers) was retrieved for the documentary analysis. RESULTS: Interviews with key informants revealed a lack of knowledge, unclear institutional protocols during emergencies and lack of enforcement of existing international frameworks. The virtual ethnography uncovered a strong call for donations in the immediate aftermath of the earthquakes, and generalized donations of formula revealed a tense relationship between actions taken by breast-feeding experts and the negative reactions from the government and citizens. This analysis highlights the relevance of pre-existing networks of experts in protecting and supporting breast-feeding. From the newspaper documentary analysis, similar themes emerged. CONCLUSIONS: This study identified key barriers and enablers in the protection and support of breast-feeding during the 2017 earthquakes in Mexico. Relevant actors should embrace the lessons highlighted in this study because countries such as Mexico are likely to experience other emergencies in the near future.

Barriers and facilitators to breastfeeding during the immediate and one month postpartum periods, among Mexican women: a mixed methods approach.

BACKGROUND: Evidence suggests that inadequate hospital practices, as well as sociocultural and community factors have detrimental effects on timely initiation as the first breastfeed within first hour after birth, and exclusive breastfeeding. The purpose of the study was to examine the factors that influence timely initiation of breastfeeding and exclusive breastfeeding at birth and 1 month postpartum in Mexican women delivering in public and private hospitals. METHODS: Mixed methods were conducted between May and July 2017, including surveys (n = 543) and semi-structured interviews (n = 60) in the immediate (7 h) and intermediate (30 days) postpartum periods. Participants were women aged 15-49 years, in public and private hospitals, of urban and rural municipalities of Chihuahua and Puebla, Mexico. RESULTS: Timely initiation was reported by 49.4% of mothers, and 34.7% reported that their children received infant formula at the hospital. Only 44.8% of women reported exclusive breastfeeding at 1 month postpartum. Timely initiation of breastfeeding was higher in women with vaginal delivery (62.1 vs 35.5%; p < 0.05) and those who received information during pregnancy (OR 1.07; p = 0.018). Exclusive breastfeeding at 1 month postpartum was related to older maternal age (OR 1.05; p < 0.001) and the fact that the mothers had received more information about breastfeeding during pregnancy (OR 1.13; p = 0.0001). Infant formula use was less associated with timely initiation (OR 0.46; p = 0.001). Participants in qualitative data identified the emotional, physical and economic benefits of breastfeeding, however, the perception about insufficient production of human milk, and the belief that infant formula is recommended, persists. CONCLUSIONS: Modification of hospital practices, such as decreasing the number of cesarean and the use of infant formula, as well as the support of the initiation and continuation of exclusive breastfeeding by health personnel and family members, could help increase breastfeeding practices in Mexican women.

Consumo de agua, bebidas azucaradas y uso de bebederos en secundarias del Programa Nacional de Bebederos Escolares de la Ciudad de México.

Objetivo. Describir prácticas de consumo de bebidas y uso de bebederos escolares en estudiantes de secundarias del Programa Nacional de Bebederos Escolares (PNBE). Material y métodos. Estudio transversal descriptivo, con enfoque mixto en secundarias públicas (turnos matutino y vespertino). Se indagó el consumo de agua y bebidas azucaradas, utilización de bebederos escolares y barreras-facilitadores para el consumo de agua. Resultados. Se entrevistaron 617 estudiantes (11 a 16 años); 51.5% fueron hombres. El consumo promedio de agua (568.9 ml; IC95%: 470.7-667.1) y bebidas azucaradas (143.4 ml; IC95%:124.0-162.7) fue similar entre hombres y mujeres. En el turno matutino las mujeres presentaron una menor probabilidad de hacer uso de los bebederos en comparación con los hombres (p=0.032). Hombres y mujeres desconfían del agua de los bebederos. Conclusiones. Se requieren acciones integrales para favorecer el consumo de agua y el uso de los bebederos en las secundarias del PNBE.

[Food labeling in Ecuador: implementation, results, and pending actions]. / Etiquetado de alimentos en Ecuador: implementación, resultados y acciones pendientes.

Noncommunicable diseases are the world's leading cause of death, responsible for 38 million deaths in 2012. This epidemic is primarily associated with smoking, excessive alcohol consumption, sedentary lifestyle, and changes in dietary patterns, characterized by diets high in sugar and saturated fat, typical of processed foods and sugar-sweetened beverages, plus low intake of fruits and vegetables. Ecuador is no exception to this epidemiological profile or to changes in eating patterns. Thus, Ecuador's government designed and implemented an action plan aimed at changing the obesogenic environment, which includes six strategic lines. One of these is implementation of a traffic-light nutritional labeling system for processed foods, in late 2014, aimed at guaranteeing people's right to timely, clear, accurate, and non-deceptive information on the content and characteristics of these foods. This article analyzes implementation of processed food labeling and results to date, and proposes complementary measures needed to reach the goal in the National Plan for Good Living, in light of new scientific evidence and different agreements and regulatory frameworks in our Region. Methods included a literature and documentary review, key informant interviews, and analysis and processing of secondary sources.

Etiquetado de alimentos en Ecuador: implementación, resultados y acciones pendientes / Food labeling in Ecuador: implementation, results, and pending actions

Las enfermedades no transmisibles representan la principal causa de muerte en el mundo entero, siendo responsables de 38 millones de las defunciones registradas en 2012. Esta epidemia se asocia, principalmente, al tabaquismo, al consumo excesivo de alcohol, el sedentarismo y cambios en el patrón alimentario, caracterizado por el consumo de dietas con un elevado contenido de azúcar y grasas saturadas, propio de los alimentos procesados y bebidas azucaradas, sumado a una escasa ingesta de frutas y hortalizas. El Ecuador no escapa a ese perfil epidemiológico ni a los cambios en el patrón de consumo de alimentos, por lo cual, el Estado Ecuatoriano diseñó e implementó un plan de acción orientado a modificar el entorno obesogénico, que contempla seis líneas estratégicas, una de las cuales es la implementación de un sistema de etiquetado nutricional tipo semáforo a los alimentos procesados, a finales de 2014, orientado a garantizar el derecho de las personas a la información oportuna, clara, precisa y no engañosa sobre el contenido y características de estos alimentos. El presente artículo analiza el proceso de implementación del etiquetado de alimentos procesados, los resultados alcanzados hasta la fecha y propone medidas complementarias que se requieren para el logro de la meta prevista en el Plan Nacional del Buen Vivir, a la luz de la nueva evidencia científica y los distintos acuerdos y marcos regulatorios disponibles en nuestra Región. La metodología de estudio incluyó revisión bibliográfica y de actas, entrevistas a informantes clave, y análisis y procesamiento de fuentes secundarias.

Noncommunicable diseases are the world’s leading cause of death, responsible for 38 million deaths in 2012. This epidemic is primarily associated with smoking, excessive alcohol consumption, sedentary lifestyle, and changes in dietary patterns, characterized by diets high in sugar and saturated fat, typical of processed foods and sugar-sweetened beverages, plus low intake of fruits and vegetables. Ecuador is no exception to this epidemiological profile or to changes in eating patterns. Thus, Ecuador’s government designed and implemented an action plan aimed at changing the obesogenic environment, which includes six strategic lines. One of these is implementation of a traffic-light nutritional labeling system for processed foods, in late 2014, aimed at guaranteeing people’s right to timely, clear, accurate, and non- deceptive information on the content and characteristics of these foods. This article analyzes implementation of processed food labeling and results to date, and proposes complementary measures needed to reach the goal in the National Plan for Good Living, in light of new scientific evidence and different agreements and regulatory frameworks in our Region. Methods included a literature and documentary review, key informant interviews, and analysis and processing of secondary sources.

Etiquetado de alimentos en Ecuador: implementación, resultados y acciones pendientes / Food labeling in Ecuador: implementation, results, and pending actions

RESUMEN Las enfermedades no transmisibles representan la principal causa de muerte en el mundo entero, siendo responsables de 38 millones de las defunciones registradas en 2012. Esta epidemia se asocia, principalmente, al tabaquismo, al consumo excesivo de alcohol, el sedentarismo y cambios en el patrón alimentario, caracterizado por el consumo de dietas con un elevado contenido de azúcar y grasas saturadas, propio de los alimentos procesados y bebidas azucaradas, sumado a una escasa ingesta de frutas y hortalizas. El Ecuador no escapa a ese perfil epidemiológico ni a los cambios en el patrón de consumo de alimentos, por lo cual, el Estado Ecuatoriano diseñó e implementó un plan de acción orientado a modificar el entorno obesogénico, que contempla seis líneas estratégicas, una de las cuales es la implementación de un sistema de etiquetado nutricional tipo semáforo a los alimentos procesados, a finales de 2014, orientado a garantizar el derecho de las personas a la información oportuna, clara, precisa y no engañosa sobre el contenido y características de estos alimentos. El presente artículo analiza el proceso de implementación del etiquetado de alimentos procesados, los resultados alcanzados hasta la fecha y propone medidas complementarias que se requieren para el logro de la meta prevista en el Plan Nacional del Buen Vivir, a la luz de la nueva evidencia científica y los distintos acuerdos y marcos regulatorios disponibles en nuestra Región. La metodología de estudio incluyó revisión bibliográfica y de actas, entrevistas a informantes clave, y análisis y procesamiento de fuentes secundarias.

ABSTRACT Noncommunicable diseases are the world’s leading cause of death, responsible for 38 million deaths in 2012. This epidemic is primarily associated with smoking, excessive alcohol consumption, sedentary lifestyle, and changes in dietary patterns, characterized by diets high in sugar and saturated fat, typical of processed foods and sugar-sweetened beverages, plus low intake of fruits and vegetables. Ecuador is no exception to this epidemiological profile or to changes in eating patterns. Thus, Ecuador’s government designed and implemented an action plan aimed at changing the obesogenic environment, which includes six strategic lines. One of these is implementation of a traffic-light nutritional labeling system for processed foods, in late 2014, aimed at guaranteeing people’s right to timely, clear, accurate, and non-deceptive information on the content and characteristics of these foods. This article analyzes implementation of processed food labeling and results to date, and proposes complementary measures needed to reach the goal in the National Plan for Good Living, in light of new scientific evidence and different agreements and regulatory frameworks in our Region. Methods included a literature and documentary review, key informant interviews, and analysis and processing of secondary sources.