Associations between Maternal Education and Child Nutrition and Oral Health in an Indigenous Population in Ecuador.

The global nutrition transition has increased the prevalence of childhood dental caries. Greater understanding is needed of the impact of social determinants­including maternal education­on child oral health. This is a cross-sectional analysis of a convenience sample of families of 458 indigenous Ecuadorian children aged 6 months through 6 years from 2011−2013. Data was collected by mother interviews and child dental and anthropometric examinations. Multivariate logistic and Zero-Inflated-Poisson regression analyses assessed associations between years of maternal education and maternal-child oral health practices and child oral health outcomes. Each additional year of maternal education was significantly (p < 0.05) associated with some healthier practices including greater likelihood of mothers and children drinking milk daily (OR 1.20; 95% CI 1.08, 1.34); and less healthy practices including greater likelihood of bottle-feeding children with sugary liquids (OR 1.14; 95% CI 1.06, 1.22) and to older age, giving children sweets daily, calming children with a bottle or sweets, and less likelihood of helping brush their children's teeth (OR 0.93; 95% CI 0.88, 0.98). Each year of maternal education had a small but statistically non-significant influence on increasing the odds of children being among those who are cavity-free (OR 1.03; 95% CI 0.92, 1.16). Interventions to improve health outcomes should focus not just on maternal education but also address social and commercial determinants of health through nutrition and oral health education, as well as policies to reduce sugar and ensure universal access to oral health care.

CM-SHARE: Development, Integration, and Adoption of an Electronic Health Record-Linked Digital Health Solution to Support Care for Diabetes in Primary Care.

IN BRIEF Chronic conditions such as diabetes are largely managed by primary care providers (PCPs), with significant patient self-management. This article describes the development, pilot testing, and fine-tuning of a Web-based digital health solution to help PCPs manage patients with cardiometabolic diseases during routine office encounters. It shows that such products can be successfully integrated into primary care settings when they address important unmet needs and are developed with input from end-users.

Early Childhood Dental Caries, Mouth Pain, and Malnutrition in the Ecuadorian Amazon Region.

Malnutrition and dental caries in early childhood remain persistent and intertwined global health challenges, particularly for indigenous and geographically-remote populations. To examine the prevalence and associations between early childhood dental caries, parent-reported mouth pain and malnutrition in the Amazonian region of Ecuador, we conducted a cross-sectional study of the oral health and nutrition status of 1407 children from birth through age 6 in the "Alli Kiru" program (2011-2013). We used multivariate regression analysis to examine relationships between severe caries, parent-reported mouth pain measures, and nutritional status. The prevalence of dental caries was 65.4%, with 44.7% of children having deep or severe caries, and 33.8% reporting mouth pain. The number of decayed, missing and filled teeth (dmft) increased dramatically with age. Malnutrition was prevalent, with 35.9% of children stunted, 1.1% wasted, 7.4% underweight, and 6.8% overweight. As mouth pain increased in frequency, odds for severe caries increased. For each unit increase in mouth pain frequency interfering with sleeping, children had increased odds for being underweight (Adjusted Odds Ratio (AOR): 1.27; 95% CI: 1.02-1.54) and decreased odds for being overweight (AOR: 0.76; 95% CI: 0.58-0.97). This relationship was most pronounced among 3-6 year-olds. Early childhood caries, mouth pain and malnutrition were prevalent in this sample of young children. Parent-reported mouth pain was associated with severe caries, and mouth pain interfering with sleeping was predictive of poor nutritional status. We demonstrate the utility of a parsimonious parent-reported measure of mouth pain to predict young children's risk for severe early childhood caries and malnutrition, which has implications for community health interventions.

Mapping of nutrition and sectoral policies addressing malnutrition in Latin America.

OBJECTIVE: To map existing policies addressing malnutrition in all its forms in Latin America and identify gaps in enabling environments supporting the five priority lines of action outlined in the World Health Organization Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition (CIP) approved in 2014. METHODS: This descriptive study consisted of a systematic Internet search for and mapping of publicly available nutrition-related and sectoral policies already in place to address malnutrition in all its forms in 18 Latin American countries (Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, and Uruguay). The policies were described in documents retrieved from the websites of ministries of health, education, agriculture, labor, and development; the national congress; and other government agencies. RESULTS: All 18 countries had relevant policies to address malnutrition, especially undernutrition and micronutrient deficiencies, but only a few had policies to address overweight and obesity. Nutrition actions were incorporated in food and nutrition security and social protection policies in all 18 countries, and were part of education, environment, agricultural, development, and/or employment policies in some countries. Information on human and financial resources assigned to nutrition was not available through the search strategies used in the study. CONCLUSIONS: All 18 countries included in this review had established enabling environments to support CIP implementation. However, each of the 18 countries needs to develop integrated policies for the promotion of nutrition and prevention of noncommunicable diseases through cross-sector involvement and multi-stakeholder collaboration.

Mapping of nutrition and sectoral policies addressing malnutrition in Latin America / Mapeo de las políticas alimentarias y sectoriales orientadas a combatir la malnutrición en América Latina

ABSTRACT Objective To map existing policies addressing malnutrition in all its forms in Latin America and identify gaps in enabling environments supporting the five priority lines of action outlined in the World Health Organization Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition (CIP) approved in 2014. Methods This descriptive study consisted of a systematic Internet search for and mapping of publicly available nutrition-related and sectoral policies already in place to address malnutrition in all its forms in 18 Latin American countries (Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, and Uruguay). The policies were described in documents retrieved from the websites of ministries of health, education, agriculture, labor, and development; the national congress; and other government agencies. Results All 18 countries had relevant policies to address malnutrition, especially undernutrition and micronutrient deficiencies, but only a few had policies to address overweight and obesity. Nutrition actions were incorporated in food and nutrition security and social protection policies in all 18 countries, and were part of education, environment, agricultural, development, and/or employment policies in some countries. Information on human and financial resources assigned to nutrition was not available through the search strategies used in the study. Conclusions All 18 countries included in this review had established enabling environments to support CIP implementation. However, each of the 18 countries needs to develop integrated policies for the promotion of nutrition and prevention of noncommunicable diseases through cross-sector involvement and multi-stakeholder collaboration.

Resumen Objetivo Hacer un mapeo de las políticas que existen para combatir la malnutrición en todas sus formas en América Latina y encontrar las brechas que pueda haber en los ambientes propicios para la aplicación de las cinco líneas de acción prioritarias descritas en el Plan de aplicación integral sobre nutrición materna, del lactante y del niño pequeño de la Organización Mundial de la Salud, aprobado en el 2014. Métodos El presente estudio descriptivo consistió en una búsqueda sistemática de la Internet y en un mapeo de las políticas nutricionales y sectoriales a disposición del público que ya se han adoptado para combatir el problema de la malnutrición en todas sus formas en 18 países latinoamericanos (Argentina, Belice, Bolivia, Brasil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, México, Nicaragua, Panamá, Paraguay, Perú, República Dominicana y Uruguay). Las políticas estaban descritas en diversos documentos que se obtuvieron de los sitios web de los ministerios de salud, educación, agricultura y ganadería, trabajo y desarrollo; del congreso nacional; y de otras dependencias gubernamentales. Resultados Los 18 países tenían políticas para combatir la malnutrición, especialmente la desnutrición y las carencias de micronutrientes, pero solo unos cuantos tenían políticas relativas al sobrepeso y la obesidad. Diversas medidas de tipo alimentario estaban incorporadas en las políticas de seguridad alimentaria y nutricional y en las de protección social en los 18 países, y en algunos países formaban parte de las políticas educativas, medioambientales, agropecuarias, de desarrollo y laborales. No se encontró ninguna información acerca de los recursos humanos y económicos asignados al área de la nutrición mediante las estrategias de búsqueda que se usaron en el estudio. Conclusiones Los 18 países incluidos en esta revisión habían creado ambientes propicios para la puesta en práctica del Plan de aplicación integral sobre nutrición materna, del lactante y del niño pequeño. Sin embargo, cada uno de ellos tiene que formular políticas integradas para la promoción de la buena nutrición y la prevención de las enfermedades no transmisibles mediante la participación intersectorial y la colaboración entre los diversos interesados directos.

Mapping of nutrition and sectoral policies addressing malnutrition in Latin America / Mapeo de las políticas alimentarias y sectoriales orientadas a combatir la malnutrición en América Latina

Objective. To map existing policies addressing malnutrition in all its forms in Latin America and identify gaps in enabling environments supporting the five priority lines of action outlined in the World Health Organization Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition (CIP) approved in 2014. Methods. This descriptive study consisted of a systematic Internet search for and mapping of publicly available nutrition-related and sectoral policies already in place to address malnutrition in all its forms in 18 Latin American countries (Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, and Uruguay). The policies were described in documents retrieved from the websites of ministries of health, education, agriculture, labor, and development; the national congress; and other government agencies. Results. All 18 countries had relevant policies to address malnutrition, especially undernutrition and micronutrient deficiencies, but only a few had policies to address overweight and obesity. Nutrition actions were incorporated in food and nutrition security and social protection policies in all 18 countries, and were part of education, environment, agricultural, development, and/or employment policies in some countries. Information on human and financial resources assigned to nutrition was not available through the search strategies used in the study. Conclusions. All 18 countries included in this review had established enabling environments to support CIP implementation. However, each of the 18 countries needs to develop integrated policies for the promotion of nutrition and prevention of noncommunicable diseases through cross-sector involvement and multi-stakeholder collaboration.

Objetivo. Hacer un mapeo de las políticas que existen para combatir la malnutrición en todas sus formas en América Latina y encontrar las brechas que pueda haber en los ambientes propicios para la aplicación de las cinco líneas de acción prioritarias descritas en el Plan de aplicación integral sobre nutrición materna, del lactante y del niño pequeño de la Organización Mundial de la Salud, aprobado en el 2014. Métodos. El presente estudio descriptivo consistió en una búsqueda sistemática de la Internet y en un mapeo de las políticas nutricionales y sectoriales a disposición del público que ya se han adoptado para combatir el problema de la malnutrición en todas sus formas en 18 países latinoamericanos (Argentina, Belice, Bolivia, Brasil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, México, Nicaragua, Panamá, Paraguay, Perú, República Dominicana y Uruguay). Las políticas estaban descritas en diversos documentos que se obtuvieron de los sitios web de los ministerios de salud, educación, agricultura y ganadería, trabajo y desarrollo; del congreso nacional; y de otras dependencias gubernamentales. Resultados. Los 18 países tenían políticas para combatir la malnutrición, especialmente la desnutrición y las carencias de micronutrientes, pero solo unos cuantos tenían políticas relativas al sobrepeso y la obesidad. Diversas medidas de tipo alimentario estaban incorporadas en las políticas de seguridad alimentaria y nutricional y en las de protección social en los 18 países, y en algunos países formaban parte de las políticas educativas, medioambientales, agropecuarias, de desarrollo y laborales. No se encontró ninguna información acerca de los recursos humanos y económicos asignados al área de la nutrición mediante las estrategias de búsqueda que se usaron en el estudio. Conclusiones. Los 18 países incluidos en esta revisión habían creado ambientes propicios para la puesta en práctica del Plan de aplicación integral sobre nutrición materna, del lactante y del niño pequeño. Sin embargo, cada uno de ellos tiene que formular políticas integradas para la promoción de la buena nutrición y la prevención de las enfermedades no transmisibles mediante la participación intersectorial y la colaboración entre los diversos interesados directos.