'Counselling is not just providing information': perceptions of caregivers and stakeholders on the design of nutrition and health counselling interventions for families with young children in rural Kenya.

BACKGROUND: Globally, a fifth of the children continue to face chronic undernutrition with a majority of them situated in the Low- and Middle-Income Countries (LMIC). The rising numbers are attributed to aggravating factors like limited nutrition knowledge, poor feeding practices, seasonal food insecurity, and diseases. Interventions targeting behaviour change may reduce the devastating nutrition situation of children in the LMICs. OBJECTIVE: For the co-design of a Behaviour Change Communication (BCC) intervention for young children in rural Kenya, we aimed to identify the experiences, barriers, facilitators, and preferences of caregivers and stakeholders regarding nutrition and health counselling. DESIGN: We employed a qualitative study design and used a semi-structured interview guide. The in-depth interviews were recorded, transcribed, and analysed using content analysis, facilitated by the software NVivo. SETTING: Health and Demographic Surveillance System (HDSS) area in Siaya County, rural Kenya. PARTICIPANTS: We interviewed 30 caregivers of children between 6 and 23 months of age and 29 local stakeholders with experience in implementing nutrition projects in Kenya. RESULTS: Nutrition and health counselling (NHC) was usually conducted in hospital settings with groups of mothers. Barriers to counselling were long queues and delays, long distances and high travel costs, the inapplicability of the counselling content, lack of spousal support, and a high domestic workload. Facilitators included the trust of caregivers in Community Health Volunteers (CHVs) and counselling services offered free of charge. Preferences comprised (1) delivering of counselling by CHVs, (2) offering individual and group counselling, (3) targeting male and female caregivers. CONCLUSION: There is a disconnect between the caregivers' preferences and the services currently offered. Among these families, a successful BCC strategy that employs nutrition and health counselling should apply a community-based communication channel through trusted CHVs, addressing male and female caregivers, and comprising group and individual sessions.

Using mid-upper arm circumference z -score measurement to support youth malnutrition screening as part of a global sports and wellness program and improve access to nutrition care.

Objective: Historically, mid-upper arm circumference (MUAC) has been instrumental to identifying malnutrition in children under 5 years living in resource restricted settings. Less attention is directed to at-risk, school-aged youth. Updated and validated pediatric age- and gender-specific MUAC growth curves expand malnutrition screening opportunities (2 months-18 years) including overweight/obesity. An innovative partnership was created to integrate MUAC z-score measurement trainings and screenings in the Real Madrid Foundation's (RMF) Social Sports Schools (S3) program, which provide sports and wellness programming to under-resourced communities. This work aimed to investigate the feasibility of leveraging non-healthcare professionals (non-HCPs) to identify malnutrition risk as part of RMF S3. Methods: This global, two-part program on malnutrition risk identification included training adult facilitators and screening children attending RMF S3. RMF facilitators were trained with didactic lectures on malnutrition, and practical hands-on learning of proper MUAC z-score tape measurement. Aggregate data on facilitators and the number of times to correctly administer the MUAC z-tape were recorded. Aggregate data on child malnutrition risk screenings were collected. Results: Nine countries participated representing Europe, Pacific Asia, Africa, Latin America, and North America. In total, 143 RMF facilitators were trained, and 318 children were screened across 11 sites. More than half of facilitators were male (56%, n = 80), and majority were coaches (41.3%, n = 59), followed by staff (25.2%, n = 36), and volunteers (16.1%, n = 23). Facilitator attempts ranged from 1 to 4 times for proper MUAC z-score administration with mean 2.12 (± 0.86). There were no significant differences for attempts among RMF facilitator types (p = 0.10). Sixteen percent (n = 51) of children screened were recommended for HCP referral, with concentrations in Pacific Asia (68%, n = 35), Latin America (24%, n = 12), and Africa (8%, n = 4). Conclusions: Findings from our sample demonstrate that integration of MUAC z-score based malnutrition risk screening within community sports and wellness programming among non-HCPs is feasible, and that some regions with less frequent access to routine health care may experience greater benefit from these programs. Equipping non-HCP facilitators in community sports and wellness programs with training on malnutrition screening provides a means to meet under-resourced families where they live to begin conversations around malnutrition risk with the hope of establishing additional pathways to care.

Aetiological research on the health of migrants living in Germany: a systematic literature review.

BACKGROUND: Germany has become an important immigration country and health services need to adopt to meet the needs of an increasingly multicultural population. For public health planning, it is essential to understand the aetiology of health problems among migrant populations. The main objective was to systematically identify, evaluate and synthesise population-based studies that investigated exposure-outcome relationships among migrant groups in Germany. METHODS: In November 2019, we searched PubMed and LIVIVO, and updated this search in November 2020, to identify peer-reviewed publications that fulfilled our eligibility criteria: English or German language; study on disease aetiology among major migrant groups in Germany, according to the latest microcensus; publication date from inception to 01 November 2020 and observational or experimental study designs. For quality appraisal, we used the Critical Appraisal Skills Programme checklists. Outcomes under investigation were categorised according to the WHO major disease groups, and their associations with risk factors were synthesised as a heat map. RESULTS: Out of 2407 articles retrieved, we included 68 publications with a total number of 864 518 participants. These publications reported on cross-sectional data (n=56), cohort studies (n=11) and one intervention study. The population groups most frequently studied were from the Middle East (n=28), Turkey (n=24), sub-Saharan Africa (n=24), Eastern Europe (n=15) and the former Soviet Union (n=11). The outcomes under study were population group specific. There were consistent associations of demographic and socioeconomic factors with ill health among migrants in Germany. DISCUSSION: In this systematic review, we observed low risk of bias in two-thirds of the studies. There is an increasing body of evidence for aetiological research on migrants' health in Germany. Still, the directions of associations between a wide range of risk factors and major disease groups seem only partially understood. PROSPERO REGISTRATION NUMBER: CRD42018085074.

ALIMUS-We are feeding! Study protocol of a multi-center, cluster-randomized controlled trial on the effects of a home garden and nutrition counseling intervention to reduce child undernutrition in rural Burkina Faso and Kenya.

BACKGROUND: Climate change heavily affects child nutritional status in sub-Saharan Africa. Agricultural and dietary diversification are promising tools to balance agricultural yield losses and nutrient deficits in crops. However, rigorous impact evaluation of such adaptation strategies is lacking. This project will determine the potential of an integrated home gardening and nutrition counseling program as one possible climate change adaptation strategy to improve child health in rural Burkina Faso and Kenya. METHODS: Based on careful co-design with stakeholders and beneficiaries, we conduct a multi-center, cluster-randomized controlled trial with 2 × 600 households in North-Western Burkina Faso and in South-Eastern Kenya. We recruit households with children at the age of complementary feed introduction (6-24 months) and with access to water sources. The intervention comprises the bio-diversification of horticultural home gardens and nutritional health counseling, using the 7 Essential Nutrition Action messages by the World Health Organization. After 12-months of follow-up, we will determine the intervention effect on the primary health outcome height-for-age z-score, using multi-level mixed models in an intention-to-treat approach. Secondary outcomes comprise other anthropometric indices, iron and zinc status, dietary behavior, malaria indicators, and household socioeconomic status. DISCUSSION: This project will establish the potential of a home gardening and nutrition counseling program to counteract climate change-related quantitative and qualitative agricultural losses, thereby improving the nutritional status among young children in rural sub-Saharan Africa. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00019076 . Registered on 27 July 2021.

Climate Change, Health Risks, and Vulnerabilities in Burkina Faso: A Qualitative Study on the Perceptions of National Policymakers.

Climate change (CC) constitutes one of the greatest threats to human health, and requires political awareness for effective and efficient adaptation planning. This study identified the perceptions of climate change and health adaptation (CC&H) among relevant stakeholders, decision-makers, and policymakers (SDPs) in Burkina Faso (BF) by determining their perceptions of CC, of related health risks and vulnerabilities, and of CC impacts on agriculture and food security. We carried out 35 semi-structured, qualitative in-depth interviews with SDPs, representing national governmental institutions, international organizations, and civil society organizations. The interviews were analyzed using content analysis. SDPs shared similar perceptions of CC and concurred with three ideas (1) CC is a real and lived experience in BF; (2) the population is aware of climatic changes in their environment; (3) CC is intertwined with the agricultural and economic development of the country. SDPs identified biodiversity loss, floods, droughts, and extreme heat as posing the highest risk to health. They elaborated five exposure pathways that are and will be affected by CC: water quality and quantity, heat stress, food supply and safety, vector borne diseases, and air quality. In conclusion, SDPs in Burkina Faso are highly aware of CC hazards, relevant health exposure pathways, and their corresponding health outcomes. Mental health and the interplay between social factors and complex health risks constitute perception gaps. SDPs perceived CC&H risks and vulnerabilities align with current evidence.

"We Will Always Ask Ourselves the Question of How to Feed the Family": Subsistence Farmers' Perceptions on Adaptation to Climate Change in Burkina Faso.

In West Africa, climate change aggravates subsistence farmers' vulnerability to weather variability to sustain their agricultural and nutritional requirements. For successful adaptation policies, in-depth understanding of farmers' perceptions about climate change, agriculture, and adaptation strategies is essential. This qualitative study in rural Burkina Faso characterized farmers' perceptions and knowledge through in-depth interviews. The study enumerated the barriers, possibilities, strategies/practices, and support sources of farmers. There was awareness but limited understanding of climate change amongst farmers. Those unable to adapt, faced increased health difficulties, specifically regarding nutrition and mental health. Farmers could implement some dietary and agricultural adaptation strategies (reduce meal size, frequency and variety, preemptive purchase of cereals, multi-cropping, crop rotation, modified seeds) but were unable to implement others (soil rehabilitation, water management). Barriers to implementation comprised financial and time constraints, material and labor shortages, and inaccessible information. Farmers did not understand, trust or utilize meteorological services, but appreciated and relied on agricultural extension services. They reported that social and governmental support was sporadic and inconsistent. This study uncovers the following targets for climate change adaptation policies in rural Burkina Faso: promoting meteorological services, expanding agricultural extension services, increasing access to financial resources, and framing sustainable adaptation within national development goals.

Climate Change Policies in 16 West African Countries: A Systematic Review of Adaptation with a Focus on Agriculture, Food Security, and Nutrition.

Climate change strongly impacts the agricultural sector in West Africa, threatening food security and nutrition, particularly for populations with the least adaptive capacity. Little is known about national climate change policies in the region. This systematic review identifies and analyses climate change policy documents in all 16 West African countries: (1) What are the existing climate change adaptation policies publicly available? (2) Which topics are addressed? (3) How are agriculture and food security framed and addressed? Following PRISMA guidelines, PubMed and Google scholar as key databases were searched with an extensive grey literature search. Keywords for searches were combinations of "Africa", "Climate Change", and "National Policy/Plan/Strategy/Guideline". Fifteen countries have at least one national policy document on climate change in the frame of our study. Nineteen policy documents covered seven key sectors (energy, agriculture, water resources, health, forestry, infrastructure, and education), and eight thematic areas (community resilience, disaster risk management, institutional development, industry development, research and development, policy making, economic investment, and partnerships/collaboration). At the intersection of these sectors/areas, effects of changing climate on countries/populations were evaluated and described. Climate change adaptation strategies emerged including development of local risk/disaster plans, micro-financing and insurance schemes (public or private), green energy, and development of community groups/farmers organizations. No clear trend emerged when analysing the adaptation options, however, climate change adaptation in the agriculture sector was almost always included. Analysing agriculture, nutrition, and food security, seven agricultural challenges were identified: The small scale of West African farming, information gaps, missing infrastructure, poor financing, weak farmer/community organizations, a shifting agricultural calendar, and deteriorating environmental ecology. They reflect barriers to adaptation especially for small-scale subsistence farmers with increased climate change vulnerabilities. The study has shown that most West African countries have climate change policies. Nevertheless, key questions remain unanswered, and demand for further research, e.g., on evaluating the implementation in the respective countries, persists.

NUTRItion and CLIMate (NUTRICLIM): investigating the relationship between climate variables and childhood malnutrition through agriculture, an exploratory study in Burkina Faso.

Malnutrition remains a leading cause of death in children in low- and middle-income countries; this will be aggravated by climate change. Annually, 6.9 million deaths of children under 5 were attributable directly or indirectly to malnutrition. Although these figures have recently decreased, evidence shows that a world with a medium climate (local warming up to 3-4 °C) will create an additional 25.2 million malnourished children. This proof of concept study explores the relationships between childhood malnutrition (more specifically stunting), regional agricultural yields, and climate variables through the use of remote sensing (RS) satellite imaging along with algorithms to predict the effect of climate variability on agricultural yields and on malnutrition of children under 5. The success of this proof of purpose study, NUTRItion and CLIMate (NUTRICLIM), should encourage researchers to apply both concept and tools to study of the link between weather variability, crop yield, and malnutrition on a larger scale. It would also allow for linking such micro-level data to climate models and address the challenge of projecting the additional impact of childhood malnutrition from climate change to various policy relevant time horizons.