Repeated surveys of people who inject drugs: The exception, not the rule.

HIV surveillance is the continuous, systematic collection, analysis and interpretation of HIV-related data needed for the planning, implementation, and evaluation of the HIV response. Some communities are affected by HIV more than others and require more focused responses; one of these communities are people who inject drugs (PWID.) We reviewed HIV surveillance among PWID across all countries. We identified countries with specific repeated surveys among PWID using data submitted to the UNAIDS Global AIDS Monitoring system, supplemented by national reports from countries that do not report to UNAIDS. Countries with four or more surveys since 2011, with at least one since 2017, were sent a brief survey to ask the use and relevance of the collected data for their respective HIV responses and the challenges they foresaw. Thirty-two countries were polled, of which 17 responded. Respondents highlighted the utility of the surveys to measure HIV prevalence, antiretroviral treatment and other service use. Future funding and maintaining capacity to implement surveys are current or coming challenges.

Prevalence of Vitamin A Deficiency in Children Aged 6 to 17 Years - Western and Central Rural Areas, China, 2012-2021.

What is already known about this topic?: Vitamin A deficiency (VAD) is a leading global nutritional concern, ranking among the top four major nutritional deficiencies worldwide. The prevalence of VAD is unevenly distributed across various regions, both within China and globally. What is added by this report?: The report adds valuable insights into the vitamin A nutritional status of rural students aged 6-17 years who participated in the Nutrition Improvement Programme for Rural Compulsory Education Students (NIPRCES). Over the decade from 2012 to 2021, there was a modest improvement in vitamin A status. The prevalence of VAD and sub-clinical VAD (SVAD) declined as the students aged. Throughout the majority of the survey years, the incidence of VAD was higher among males and western regions compared to females and central regions, respectively. What are the implications for public health practice?: A comprehensive approach, incorporating dietary diversification, nutrition education, and food fortification, should be implemented to prevent VAD and SVAD especially in males, younger children and children in western areas.

Japanese Nursing Staff's Knowledge and Attitude toward Bereavement Care for Couples with Miscarriage/Stillbirth and Its Associated Factors.

Bereavement care is conducted to meet the emotional needs of grieving couples who are devastated by the experience of a miscarriage or stillbirth. From January to April 2022, we distributed a questionnaire that assessed the knowledge and attitudes of Japanese nursing staff (nurses and midwives) in Japan's Chugoku-Shikoku region toward bereavement care for couples with miscarriage/stillbirth. The 370 survey respondents' answers revealed that the nursing staff's knowledge regarding recurrent pregnancy loss and subsequent bereavement care was insufficient. About 41.1% and 64.1% of the respondents had received school and on-the-job education in bereavement care, respectively, and 79.2% expressed willingness to provide such care. Our analyses revealed that the following factors were associated with the nursing staff's knowledge level: parent status, age, reproductive history, midwifery license, work experience and environment, and on-the-job education. The following were correlated with the staff's willingness to provide bereavement care: work environment, midwifery license, bereavement care knowledge, and on-the-job education. Together our findings indicate that education plays a significant role in equipping caregivers to provide effective bereavement care for couples who have experienced a miscarriage or stillbirth.

Variations in Rope Skipping Counts Among Rural Primary and Secondary School Students - China, 2013-2021.

What is already known about this topic?: Physical fitness is closely associated with children's development. Limited research has been published on the changes in physical fitness among Chinese children during the implementation of the Nutrition Improvement Program for Rural Compulsory Education Students (NIPRCES). What is added by this report?: This research utilized data from the NIPRCES between 2013 and 2021 to examine alterations in children's physical fitness levels. Over this period, there was a significant increase in the number of rope skipping counts among children. In 2021, variations in these counts were observed, which depended on factors such as age, gender, geographic location, and region. What are the implications for public health practice?: Physical fitness has been linked to a multitude of non-communicable diseases. Enhanced nutritional measures for children lead to significant improvements in their overall physical fitness, as evidenced by NIPRCES findings. It is crucial for policymakers to implement comprehensive interventions aimed at promoting and advancing children's physical fitness.

Frequency of Food Consumption Among Students Aged 8-15 Years - China, 2019 and 2021.

What is already known about this topic?: Malnutrition continues to be the primary cause of delayed growth and development among students in economically disadvantaged rural areas of China. Ensuring adequate and appropriate dietary intake is crucial for promoting the healthy growth of these students. What is added by this report?: In rural areas of central and western regions in China, the weekly consumption frequencies of meat, eggs, milk, legumes, fruits, and vegetables in 2021 were higher than those in 2019. However, the consumption levels remained relatively low in economically underdeveloped rural areas in 2021. What are the implications for public health practice?: Understanding the frequency of food consumption among students can provide a solid evidence base for the development of policies and strategies aimed at controlling and preventing malnutrition.

Perceptions of Primary Caregivers on Children's Weight Status Versus Actual Weight Status in Children Aged 6-15 Years - China, 2021.

What is already known about this topic?: Childhood obesity has been linked to adverse health outcomes during both childhood and adulthood. An accurate understanding of children's weight status by primary caregivers is essential for effective weight management strategies. What is added by this report?: The data utilized in this study were obtained from the 2021 Nutrition Improvement Program for Rural Compulsory Education Students in China. It was found that over one-third of primary caregivers underestimated their children's weight status, and more than half of the primary caregivers of overweight or obese children underreported the weight status of those children. A low level of agreement was observed between primary caregivers' perceptions of their children's weight status and the actual weight status. What are the implications for public health practice?: There is a relatively higher underestimation of children's weight in China, which necessitates more effective strategies to enhance the primary caregivers' perception of their children's weight status, especially in primary caregivers of males, younger children and children in urban areas.

Dietary Patterns and Associations with Myopia in Chinese Children.

Dietary shifts in populations undergoing rapid economic transitions have been proposed as partly contributing toward the rapid intergenerational rise in myopia prevalence; however, empirical evidence of the effect of dietary factors on myopia is limited. This study investigated the association between dietary factors and incident myopia in Chinese children aged 10-11 years. We evaluated dietary habits using a 72-item food frequency questionnaire (FFQ) among 7423 children. Myopic status was assessed using the "General Personal Information Questionnaire". Principal component analysis was used to extract dietary patterns and investigate their association with myopia. After adjusting for potential confounders, participants with the highest adherence to dietary pattern A (95% confidence interval (CI): 0.66-0.92, p for trend = 0.007) and dietary pattern C (95% CI: 0.58-0.80, p for trend < 0.001) had a lower risk of myopia than participants with the least adherence. Both of these dietary patterns are characterized by high consumption of meats, aquatic product, dairy and its products, eggs, legumes, vegetables, fruits, grains, and potatoes. Our findings suggest that other environmental factors, such as those related to the dietary environment, may contribute to the development of myopia. These findings can serve as a reference for diet-related primary prevention of myopia.

[Intake of main food among the children aged 6-17 years in different regions of China in 2019-2021].

OBJECTIVE: To analyze the intakes of main food among the children of 6-17 years in different regions of China from 2019 to 2021, and to provide a scientific basis for evaluation and guiding Chinese children to make reasonable diet. METHODS: Multistage stratified random sampling method was used to collect data in east China, north China, central China, south China, southwest, northwest and northeast seven areas of each random two provinces, randomly selected from each province one urban survey site and one rural survey site, 28 sites of the 13th Five Year National Science and Technology Basic Resources Survey Project-Chinese children aged 0-18 investigation and application of nutrition and health system in 14 provinces of China. The study included 6413 children aged 6 to 17. Three consecutive 24-hour recalls method combined with weighing were used to collect the information of food intake. According to the food classification in the standard version of the food composition list, the food was divided into cereals, tubers, fresh vegetables, fresh fruits, meat and poultry, fish and shrimp, eggs, milk, etc. , and the intake of various foods was calculated for boys and girls aged 6-8, 9-11, 12-14 and 15-17 in different regions. RESULTS: Compared with the average daily food intake of children of the same sex and age in the urban and rural, The average daily intake of cereals and tubers for boys aged 9-17, cereals for girls aged 9-17, tubers for girls aged 12-17, and fish and shrimp for boys of edible population aged 15-17 were higher in rural areas than in urban areas. There were differences in the average daily food intake and consumption rate of fresh vegetables, fresh fruits, meat and poultry, eggs and milk of the same sex and age, which were higher in urban than in rural areas(P<0.05). Compared with the average daily food intake of children of the same sex and age in the south and the north, the average daily intake of cereals and eggs for boys aged 9-14, cereals for girls aged 6-8, and fresh fruits for boys and girls of edible population aged 6-17 were higher in the north than in the south. There were differences in average daily intake and consumption rates of tubers, fresh vegetables, meat and poultry, milk and fish and shrimp of the same sex and age, which were higher in the south than in the north(P<0.05). Compared with the average daily food intake of children of the same sex and age in the eastern, central and western regions, the average daily intake of cereals for boys aged 6-14, cereals for girls aged 6-17, fresh fruits for boys and girls of edible population aged 6-17, and fish and shrimp for boys and girls of edible population aged 15-17 were lower in the eastern region than in the central and western regions. The average daily intake of tubers for boys aged 9-11 and 15-17, for girls aged 9-17 were higher in the western regions than the eastern and central regions. The average daily intake of eggs for boys and girls aged 12-17 was lower in western regions than the eastern and central regions. There were differences in average daily intake and consumption rates of fresh vegetables, meat and poultry and milk of the same sex and age, which were higher in the eastern region than in the central and western regions. (P<0.05). The proportion of coarse grains to cereals was low, between 3.7% and 10.1%. The proportion of pork to meat and poultry was high, between 56.1% and 71.4%. CONCLUSION: In China, there are differences in daily intake of main food for children aged 6 to 17 years old in urban and rural areas, north and south areas, east, central and west areas.

Research progress on the relationship between home food environment and overweight and obesity in children and adolescents / 中国学校卫生

Abstract@#The rate of overweight and obesity in Chinese children and adolescents is gradually increasing, and it has multiple hazards for their health. Overweight and obesity are affected by many factors such as genetics and environment. The home food environment is very important among the many factors affecting children s overweight and obesity. This paper analyzes the relationship between parents feeding behaviors, including pressure eating, restricted eating and food as reward, accessibility and usability of family food, with overweight and obesity of children and adolescents, aiming to provide a scientific reference for controlling children overweight and obesity by focusing on home food environment.

Research progress on the effects of meal timing and frequency for overweight and obesity among children and adolescents / 中国学校卫生

Abstract@#The prevalence of overweight and obesity among children and adolescents in China is increasing during recent years, which could be influenced by multiple factors such as genetics, diet and lifestyle. To understand the relationship between meal timing, frequency with childhood overweight and obesity, the paper reviews recent studies on the relationship between meal or snack timing, frequency with overweight and obesity among children and adolescents, so as to provide scientific evidence for obesity prevention and control.

Effect of School-Based Nutrition and Health Education for Rural Chinese Children.

The nutritional status of rural Chinese children has improved in recent years, but their nutritional knowledge is still relatively lacking. School-based nutrition and health education was conducted for children in three counties of China from 2018 to 2020. The students in the intervention schools were given two-year nutrition and health education courses, while the control schools did not receive any intervention. Students' nutrition knowledge, dietary intake, and dietary behaviors were collected using a questionnaire, and height and weight were measured uniformly. The nutrition knowledge score in the intervention group was increased by 1.01 and 0.64 points in the first and second years. A multilevel model was used to evaluate the intervention effects. Statistically significant interactions between groups and time were observed in nutrition knowledge, the frequency of eating breakfast, and dietary intake, including meat, eggs, milk, and vegetables (p < 0.05), but not in nutritional status. Therefore, the supplementation of school-based nutrition and health education had a positive impact on the nutrition knowledge and dietary intake of rural Chinese children.

Changes in Fitness of Rural Primary School Students from Southwest China after Two-Year's Nutrition Intervention.

Children in China's poor rural areas often have insufficient protein and micronutrient intake. There is little research about the effect of milk and egg supplementation published on these children. A prospective randomized controlled trial was applied to evaluate the effect of milk and egg supplementation on the growth and fitness of poor rural primary school students in southwest China whose physical development was below national averages. A total of 955 healthy students aged 6-13 years old were recruited. The intervention group (538) received 200 g milk and 50 g braised egg at each school day, while the control group (417) kept their normal diet and received no extra supplementation. Serum vitamin D levels were measured by an enzyme-linked immunosorbent assay. A mixed linear model with repeated measures was performed to analyze the efficacy of the supplementation. Statistically significant interactions between groups and time were seen in weight in boys, but not in girls. Significant improvement in vitamin D levels, the broad jump, and the 8 × 50 m shuttle run were observed in both genders. Therefore, the supplementation of egg and milk for two years might have a positive effect on growth and physical fitness and decreasing vitamin D deficiency in poor rural Chinese children.

Sugar-Sweetened Beverage Consumption Status and Its Association with Childhood Obesity among Chinese Children Aged 6-17 Years.

OBJECTIVE: There is a remarkable growth in sugar-sweetened (SSB) production and obesity prevalence among school-aged children in China. This paper describes SSB consumption and its association with obesity among Chinese children aged 6-17 years in 2012. METHODS: in total, 25,553 children aged 6~17 years enrolled in the China Nutrition and Health Surveillance 2010-2013 were included in this study. Data of SSB consumption frequency and quantity were obtained from a food frequency questionnaire, and the children's nutritional status was assessed. Multivariate logistic regression was used to evaluate the association between SSB consumption and obesity status. RESULTS: SSB intake was estimated as 181.0 g/day, occurring 2.2 times/week. Older children, males, children from urban areas, and children with higher socioeconomic status were more likely to consume SSBs. Children who consumed SSBs 1~<5 times/week (11.7%) and >5 times/week (12.9%) were more likely to be overweight/obesity than those who consumed SSBs less than once/week. CONCLUSION: SSB consumption was common among Chinese school-aged children, especially among males, older children, and children from urban areas. High consumption of SSBs was associated with a higher prevalence of overweight/obesity. Actions and plans are required to reduce SSB consumption and control childhood obesity in China.

Analysis school absenteeism in Nutrition Improvement Program for Rural Compulsory Education Students area from 2012-2017 / 中国学校卫生

Objective@#To investigate the changes of school absenteeism among students received Nutrition Improvement Program for Rural Compulsory Education Student (NIPCES), and to provide basic data for further nutritional health improvement for rural students.@*Methods@#Among 699 NIPCES monitored counties among 22 provinces across western and central China, 10%-30% of elementary and junior high schools were randomly selected as monitoring schools within each stratification according to the food supply pattern (school canteen, company and mix) in each county, school absenteeism information were collected and analyzed from 2012 to 2017.@*Results@#The total rate of student absenteeism was 26.0 per 10 000. From 2012 to 2016, it dropped from 30.8 per 10 000 to 23.4 per 10 000 year by year, but it increased again in 2017(28.2 per 10 000). The rate of school absenteeism in the western region (29.4 per 10 000) was higher than that in the central region (21.5 per 10 000); The sick leave rate (15.0 per 10 000) of primary school students was higher than that of junior high school students (13.4 per 10 000), and the rate of personal leave absences (16.9 per 10 000) of junior high school students was higher than that of elementary school students(9.9 per 10 000); the absentees rate in mixed-food supply schools (28.5 per 10 000) was higher than that in canteen food supply schools(26.4 per 10 000), the latter was higher than that of company food supply schools(25.0 per 10 000). The rate of sick leave absenteeism was highest in December(18.4 per 10 000), and the rate of personal leave absenteeism in June was highest(14.6 per 10 000).@*Conclusion@#The rate of school absenteeism among students in the NIPCES area showed an overall downward trend year by year. The absentee rate of students varies by regions, grade, food supply patterns and school locations.

Prevalence of stunting among students under the Nutrition Improvement Program for Rural Compulsory Education Students during 2012-2017 / 中国学校卫生

Objective@#To analyze the prevalence of stunting among students received subsidies of the National Nutrition Improvement Program for rural Compulsory Education Students (NNIPRCES) during 2012-2017.@*Methods@#By using the data from 2012-2017 NNIPRCES survey, students aged 6-15 with valid height records were included. Stunting was defined according to the Screening Criteria of Malnutrition for School Age Children and Adolescents (WS/T 456—2014). To explore the association of the risk of stunting between different regions, gender or age groups in rural students.@*Results@#The prevalence of stunting among students aged 6-15 who received subsidies of NNIPRCES during 2012-2017 were 8.0%, 7.9%, 6.9%, 6.5%, 6.0% and 5.3%, declined by 2.7, 1.8, 4.0 percentage points in average, as well as in central and western region, respectively. The prevalence of stunting declined with 2.7 percentage points for boys and ,2.9 percentage points for girls. The prevalence of stunting declined most at the age of 13, with 4.0 percentage points.@*Conclusion@#The prevalence of stunting of students has declined after the implementation of NNIPRCES from 2012 to 2017. However, the total prevalence of stunting was still high and the development was unbalanced between central and western region, which requires more target intervening strategies to improve the nutritional status of students.

Temporal trend in energy and macronutrients for pilot schools involved in the Nutrition Improvement Program for Rural Compulsory Education Students in 2012-2017 / 中国学校卫生

Objective@#To evaluate temporal trend in food supply among pilot schools involved in the National Nutrition Improvement Program for Rural Compulsory Education Students (NNIPRCES).@*Methods@#Ten percent of pilot schools were randomly selected and asked to report the information on food supplies. Daily intake of energy, carbohydrates and protein for each student were calculated and compared with the reference value in Nutrition Guidelines of School Meals (WS/T 554-2017).@*Results@#Energy and protein supply increased among those pilot schools. The supply of energy increased from 1 566.5 kcal in 2012 to 1 927.4 kcal in 2017, protein increased from 49.0 g to 61.0 g. The energy ratio of fat increased from 31.9% to 34.9%, while energy ratio of carbohydrate decreased significantly (F=83.38, 128.36, 20.27 and 17.28, all P<0.05). The proportion of reasonable energy supply from carbohydrate and fat in 2017 were 17.5% and 26.8%, respectively.@*Conclusion@#The supply of energy and macronutrients in the pilot areas were unreasonable, more measures including dietary guide and monitoring need to be adopted to improve students nutrition status among rural areas.

Changing trends in school-meal catering services as part of the Nutrition Improvement Program for Rural Compulsory Education Students / 中国学校卫生

Objective@#To analyze the usage of catering software and the creation of recipes by schools, as part of the Nutrition Improvement Program for Rural Compulsory Education Students (NIPRCES) 2013-2017.@*Methods@#In each county of the 699 trial counties across 22 provinces in central and western area of China under the NNIPRCES, no less than 10% of primary and junior middle schools were randomly selected according to their catering mode (i.e., school feeding, food packages, and family feeding). School questionnaires were used to collect information concerning the schools and the creation of recipes.@*Results@#From 2013 to 2017, the utilization rate of catering software was 11.7%, 8.0%, 17.8%, 16.9%, and 14.0%, respectively with significant differences(χ 2=345.09，P<0.01). The creators of school-meal recipes included schools, the Education Bureau, hospitals and colleges, the centers of disease prevention and control. Differences were observed in the proportion of recipe creators across school type, area, and catering mode, while annual trends also varied (P<0.01), as indicated by the following proportions: 74.9%, 20.0%, 3.7%, 1.3%, respectively. Food safety was identified as the main factor that needs to be considered when creating school recipes, the proportions of which were 58.0%, 78.4%, 70.6%, and 87.4% from 2014 to 2017.@*Conclusion@#From 2013 to 2017, the utilization rate and the frequency of catering software were both relatively low, and recipe creation was in need of professional guidance. It is necessary to strengthen the popularization of catering software and improve the nutritional knowledge and skills of canteen workers to ensure the quality of school meals.

Snack consumption and the influencing factors of students participation in the Nutrition Improvement Program for Rural Compulsory Education in 2019 / 中国学校卫生

Objective@#To evaluate snack consumption and the influencing factors associated with student participation in the Nutrition Improvement Program, and to provide a scientific basis for improving the program.@*Methods@#Among the 50 monitoring counties that implemented the Compulsory Education Student Nutrition Improvement Program, two primary schools and two junior schools were randomly selected according to different food supply patterns (i.e., school, company, and mix). This study randomly selected one or two classes from each grade, which ranged from grade 3 to grade 9. A questionnaire, which addressed snack consumption and choice, was distributed to 27 374 students.@*Results@#The findings revealed that 14.0% of students from poor rural areas in central and western regions consumed snacks two or more times per day, and 21.6% of students spent 3 yuan or more on snacks each day. The top three choices of snacks included fruit and vegetables (50.6%), biscuits and bread (50.1%), and puffed food (40.0%). Students who had mothers who worked outside the home, parents who worked outside the home, who consumed corporate meals, and who had access to a small shop on campus were more likely to consume snacks one or more times per day(OR=1.35，1.19，1.11，1.51，P<0.05).@*Conclusion@#The phenomenon of snack consumption among primary and middle school students from poor rural areas in central and western regions is common, and the selection of unhealthy snacks was identified as a problem. A health education system with comprehensive support and guidance from individuals, families, schools, and society should be established to guide students to opt for healthier snacks.

School canteen construction and canteen meal provision from 2012 to 2017 in schools under the National Nutrition Improvement Program for Rural Compulsory Eudcation Students / 中国学校卫生

Objective@#To analyze changes of school canteen construction and canteen meal provision in surveilled schools after the initiation of the National Nutrition Improvement Program for Rural Compulsory Education Student (NNIPRCES), therefore to provide data basis for improving efficacy of school canteen meals.@*Methods@#From 2012 to 2017, among the 699 trial counties in 22 provinces under NNIPRCES, at least 10% of elementary schools and middle schools with each food supply model (canteen meals, enterprise meals, and family meals) were randomly selected in each county in each year. Questionnaire survey was conducted to collect school canteen construction and meal provision information. The sample size were around 8 000 to 11 000 schools every year.@*Results@#From 2012 to 2017, the proportion of schools that have canteens only, have both canteen and dining room, as well as those have canteen and dining room with tables and chairs significantly increased with years(χ 2=3 043.95, 6 383.85, 6 731.17, P<0.01). The proportion of schools having canteen increased from 59.5% in 2012 to 87.0% in 2017. The proportion of schools with canteen providing breakfast, lunch or dinner varied across years(χ 2=51.85, 144.96, 189.19, P<0.01). The varieties of food groups of three meals all significantly increased during 2012, 2014 and 2017(χ 2=702.30, 892.38, 550.55, P<0.01). The canteen construction indicators, proportion of canteens providing three meals, and food groups included in three meals all significantly differed between elementary schools and middle schools, also between schools of central area and western area(P<0.05). The changing patterns with year were significantly different in elementary schools and middle schools, and in schools of central area and western area(P<0.05).@*Conclusion@#After the implementation of NNIPRCES, canteen construction and food variety in canteen meals significantly improved during 2012 to 2017. However, there are still gaps between changes of canteen construction and canteen meal provision. It is necessary to overcome obstacles to further increase the proportion of schools with canteen offering meals and the variety of food of meals.