Maternal & Child Nutrition

This secondary analysis of the Eggcel‐growth study investigated the effect of daily egg intake for 6 months in infants aged 6–9 months on environmental enteric dysfunction (EED) biomarkers and the association of EED markers with growth faltering. A randomised controlled trial was conducted in Jouberton, South Africa, among 500 infants randomly assigned equally to either an intervention group receiving a daily chicken egg or a control group. Both groups were followed up for 6 months. Data on infant and maternal sociodemographic information and anthropometric status of infants were collected. EED and inflammatory markers were analysed using Q‐Plex Human EED (11‐Plex) assay. There was a significant reduction in fibroblast growth factor 21 (FGF21) concentration in the intervention group (B = −0.132; 95% CI −0.255, −0.010; p = 0.035). Baseline, insulin‐like growth factor 1 (IGF‐1) was positively associated with endpoint length‐for‐age z‐score (LAZ), weight‐for‐age z‐score (WAZ) and weight‐for‐length z‐score (WLZ) and there was an inverse relationship between baseline FGF21 and intestinal fatty acid‐binding protein (I‐FABP) with endpoint growth indicators. Baseline IGF‐1 was positively associated with reduced odds of wasting, stunting and being underweight (p < 0.001) and baseline FGF21 was associated with increased odds of stunting (p = 0.002), wasting (p = 0.031) and being underweight (p = 0.035). There was a 20% increased odds of stunting with baseline I‐FABP (p = 0.045) and a 30% increased odds of being underweight with baseline soluble CD14 (p = 0.039). Complementary feeding with eggs decreased growth hormone resistance (reduced FGF21 levels); however, FGF21 and I‐FABP levels were linked to increased growth faltering. Trial Registration: ClinicalTrials.gov: NCT05168085

Adolescence is a period of tremendous physical and neurophysiological change, and today's rapidly changing food system has implications for adolescent nutritional and health outcomes. Ensuring nutritious diets during adolescence requires evidence on what is being consumed by adolescent boys and girls, however, little is known about the dietary patterns among this age group. This study assessed the prevalence of food group consumption and indicators of diet quality among adolescents in the Southeast Asia region and compared these results to the adult population. Secondary analysis of the Gallup World Poll, a population‐based survey, was performed using datasets from Cambodia, Indonesia, Laos PDR, the Philippines and Vietnam. Pooled analysis of nine diet quality indicators was conducted among all adolescents 15–19 years of age (n = 479), with comparison to the adult population (n = 4589). Various unhealthy food groups were consumed by one‐quarter to one‐half of adolescents, with a greater proportion of adolescents consuming instant noodles, sweets, processed meats and salty snacks, as compared to adults. Just over one‐third of adolescents (37.4%) consumed all five recommended food groups to meet dietary guidelines, almost two‐thirds (62.6%) consumed sweet beverages and over three‐quarters consumed unhealthy/ultra‐processed foods (76.8%). Overall indicators of diet quality showed that Southeast Asian adolescents' diets were less healthy than adults. This is one of the first studies to explore the healthy and unhealthy aspects of diets among both adolescent boys and girls across the Southeast Asia region, with results indicating that diets are not nutritionally adequate.

Though child anthropometric failure (CAF) is a persistent problem in India, previous studies have often neglected state‐level variance and aggregated moderate and severe CAF categories. This study addresses this gap by examining moderate and severe malnutrition across India's states and union territories (UTs) from 1993 to 2021. Data of children under 2 years old from five waves of National Family Health Surveys, a representative cross‐sectional survey of Indian households, were analysed. Outcomes included prevalence of moderate and severe stunting, underweight and wasting, as per the 2006 World Health Organization growth standards. Percentage prevalence and standardized absolute change (SAC) were calculated nationally and by region for each wave. From 1993 to 2021, there was a notable reduction in the nationwide prevalence of moderate stunting, underweight and wasting, with rates dropping from 20% to 16%, 23% to 18%, and 15% to 12%, respectively. Severe stunting and underweight declined considerably from 23% to 16% and 18% to 11%, respectively; severe wasting marginally increased from 8% to 9%. From 2016 to 2021 moderate underweight was noted to have the highest SAC across all regions, although 15 regions saw an increase in the prevalence of moderate underweight. In the 2016–2021 period, severe wasting has increased in 13 of the 36 regions. While there has been a nationwide reduction in most indicators of CAF since 1993, the rate and direction of change vary widely among states and UTs and between moderate and severe categories within each of the states and UTs. Understanding these patterns of change can direct context‐specific interventions for improving child nutrition and health. A greater focus on reducing severe wasting, which has increased since 1993, is also crucial.

The first 1000 days of life lay the foundations for subsequent growth. This ambidirectional study, including prenatal, perinatal and postnatal factors, aimed to identify exposure variables affecting body size and composition and corresponding Z‐score outcomes at age 18 months in infants born to women at low risk of adverse pregnancy outcomes in a peri‐urban area of South Africa. Prenatal factors (maternal age, HIV status, anthropometry, parity, food insecurity and umbilical artery resistance index Z‐score (UmA‐RIAZ) as a measure of placental function, with higher UmA‐RIAZ indicating poorer placental function); perinatal factors (infant sex, gestational age and birth anthropometry) and postnatal factors (infant feeding) were included as exposure variables, with infant anthropometry and body composition at 18 months as outcomes. Simple linear regression analysis was used to investigate associations between exposure variables and infant outcomes, and variables with p < 0.10 were included in the subsequent multiple regression analyses. Multiple regression analysis showed that higher UmA‐RIAZ predicted lower birthweight [−0.11 kg (95% CI: −0.17, −0.04 kg)], birthweight‐for‐age Z‐score [−0.24 (95% CI: −0.39, −0.09)] and 18‐month infant length [−0.9 cm (95% CI: −1.4, −0.4 cm)] and length‐for‐age Z‐score [−0.28 (95% CI: −0.45, −0.11)]. Maternal HIV infection predicted reduced 18‐month infant length‐for‐age Z‐score [−0.46 (95% CI: −0.83, −0.09)]. Household food insecurity predicted reduced fat‐free mass‐for‐age Z‐score at 18 months [−0.27 (95% CI: −0.51, −0.03)]. Infant anthropometry and body composition outcomes, therefore, are greatly affected by pre‐ and postnatal nutrition‐related factors, such as placental insufficiency in utero and household food insecurity, with long‐term consequences including stunting, which impact the individual, future generations and society.

A simplified, combined protocol treats children with moderate acute malnutrition (MAM), defined by mid‐upper arm circumference (MUAC) of < 125 and ≥ 115 mm and no oedema, with 1 daily sachet of ready‐to‐use therapeutic food (RUTF) and those with severe acute malnutrition (SAM), defined by MUAC < 115 mm and/or oedema, with two daily sachets of RUTF. This protocol was previously shown to result in non‐inferior recovery compared to standard treatment that used higher, weight‐based RUTF dosing among children with SAM and ready‐to‐use supplementary food (RUSF) for MAM in a cluster‐based randomised controlled trial in Kenya and South Sudan. We conducted a secondary analysis of this trial to compare linear growth among children admitted with MUAC < 115 mm. Linear and ponderal growth were calculated from admission to discharge and visualised using aggregate growth curves. HAZ change adjusted for admission characteristics was negative across the course of treatment but similar across arms [−0.21 ± 0.18 SE in the standard arm, −0.24 ± 0.18 SE in simplified; difference (95% confidence interval) 0.03 (−0.12, 0.18)]. The unadjusted mean ± SE linear growth velocity from admission to discharge was 1.8 ± 0.7 mm/week in the standard arm compared to 1.7 ± 0.7 mm/week in the simplified arm [difference = 0.09 (−0.36, 0.53)] and similar in adjusted analysis. MUAC and weight gain velocities were not significantly different by treatment arm. Reducing the RUTF dose prescribed to children during SAM treatment does not appear to affect linear growth or other growth velocities during treatment.

Long‐chain n–3 polyunsaturated fatty acid (PUFA) consumption in maternal and infants has been positively associated with cognitive and visual development. Tails even meta‐analysis showed mixed results. To evaluate the effects of maternal and infant n–3 PUFA supplementation on childhood psychomotor and cognitive development, PubMed, Embase, the Cochrane Library, PsycINFO and clinicaltrials.gov were searched. Randomized controlled trials were included to evaluate the effect on child cognitive and psychomotor outcomes of n–3 PUFA supplementation in mothers or infants (age ≤ 2 years). Findings were pooled with mean differences (MD) with 95% confidence intervals (95% CIs). Heterogeneity was explored using I² and subgroup analyses, stratified for maternal (pregnancy and/or lactation) and infant (preterm infant and term infant). We identified 47 articles, with 14 trials on mothers and 33 on infants. Pooled results showed that infants' mental development index (MDI) increased with n–3 PUFA supplementation (MD = 2.91, 95% CI: 1.32–4.51, I² = 65.1%). Subgroup analysis of MDI also demonstrated a benefit in preterm infants (MD = 4.16, 95% CI: 1.40–6.93, I² = 49.5%) and term infants (MD = 2.28, 95% CI: 0.27–4.29, I² = 70.1%). No significant association was found in subgroup analyses of supplementation to mothers during pregnancy or lactation period. Supplementation did not increase the psychomotor development index (PDI) in the mother or infant group. Language composite score increased for infants whose mothers accepted supplementation in pregnancy or breastfeeding (MD = 8.57, 95% CI: 5.09–12.04, I² = 70.2%). The cognitive composite score did not improve in any subgroup. Intelligence Quotient (IQ) increased in the infants' group with n–3 PUFA supplementation (MD = 2.54, 95% CI: 0.45–4.63, I² = 66.0%). Furthermore, IQ in term infants also improved (MD = 2.91, 95% CI: 0.24–5.57, I² = 69.2%). The funnel plot and Egger's test confirmed no publication bias in any endpoints. Supplementation with n–3 PUFA during pregnancy or breastfeeding in mothers has increased language abilities. Furthermore, direct supplementation in term infants can improve intelligence in later childhood. However, insufficient evidence supports the claim that supplementation improves cognitive abilities.

Inadequate physical growth and poor development are significant global challenges affecting millions of children. Globally, 149.2 million children under five experience stunted growth and 45.4 million suffer from wasting. Growth monitoring and promotion (GMP) programmes aim to identify growth faltering in children before they develop malnutrition. However, understanding the factors influencing GMP service utilization is crucial for improving its effectiveness in the study area. This community‐based cross‐sectional study in the Sude district of southeastern Ethiopia investigated GMP service utilization among mothers of children aged 0–23 months. The study included 874 participants selected through systematic random sampling. Data collected through a structured questionnaire revealed a GMP service utilization rate of 40.2%. The study identified several factors significantly associated with GMP service utilization. This includes maternal education, husband involvement, institutional delivery, maternal autonomy and birth interval, which are the most significant factors identified to influence GMP service utilization. Mothers with higher levels of education were more likely to utilize GMP services [AOR = 3.70 (95% CI: 2.09, 6.54)]. Discussions about child growth with husbands were linked to increased GMP utilization [AOR = 2.22 (95% CI: 1.24, 3.968)]. Moreover, mothers who delivered at health facilities and with greater autonomy in decision‐making showed higher GMP utilization with [AOR = 1.83 (95% CI: 1.23, 2.72)] and [AOR = 3.79 (95% CI: 2.41, 5.96), respectively. Mothers with longer birth intervals were also more likely to utilize GMP services [AOR = 1.947 (95% CI: 1.39, 2.73)]. The study highlights the importance of addressing these factors to increase GMP service utilization and improve child health outcomes in the study area. Behavioural change communication programmes targeting fathers can promote their engagement in child growth discussions. Moreover, empowering women to make decisions about their children's health and access to healthcare services and promoting open communication within families about child growth and development can raise awareness and support for GMP services. Addressing these factors through targeted interventions will promote GMP utilization and improve child growth and development.

Responsive feeding practices are crucial for developing healthy eating behaviours in children. However, chaotic households and financial stress may disrupt these practices. This cross‐sectional study aimed to characterise feeding practices among Australian parents experiencing financial hardship. Parents of children aged 5–35 months, who identified as experiencing financial hardship, completed an online questionnaire from October 2021 to June 2022. Validated tools gathered data on feeding practices, mealtime structure and environment, household chaos (HC), household food insecurity (HFI) and sociodemographic characteristics. Bivariate correlations and hierarchical regression assessed relationships between these variables, adjusted for parent age, education and number of children. Data from 213 parent–child dyads were analysed (97% mothers, median age = 31 years, IQR 28–36; 50% boys, median age = 12 months, IQR 8–17). Median HC score was 4 (IQR 2–7). Seventy‐six percent of families reported experiencing HFI (median = 6, IQR 3–9). Over 80% of parents often or always ate meals as a family and never or rarely engaged in ‘parent‐led’ feeding (median = 1.75, IQR 1.00–2.50), or used ‘(non)‐food as reward’ (median = 1.33, IQR 1.00–2.00). ‘(Non)‐food as reward’ was positively correlated with HC (p = 0.016), and ‘food to calm’ was positively associated with HC (p = 0.004). ‘Feeding on demand’ was negatively associated with HC and HFI (p = 0.002). ‘Persuasive feeding’ was not associated with either. Findings suggest that HC had more influence than HFI on some nonresponsive feeding practices. Increasing levels of HC and HFI may result in less structured mealtimes. Interventions must consider how financial hardship, HFI and HC can impact parents' ability to engage in responsive feeding practices. This cross‐sectional study examined feeding practices among Australian parents facing financial hardship. Over 75% were food insecure. While the meal environment supported responsive feeding, increasing household chaos and food insecurity led to fewer structured mealtimes and household chaos increased coercive practices such as using (non)‐food rewards and food to calm.

A large body of research investigates the determinants of stunting in young children, but few studies have considered which factors are the most important predictors of stunting. We examined the relative importance of predictors of height‐for‐age z‐scores (HAZ) and stunting among children under 5 years of age in seven of the most food‐insecure districts in South Africa using data from the Grow Great Community Stunting Survey of 2022. We used dominance analysis and variable importance measures from conditional random forest models to assess the relative importance of predictors. We found that intergenerational and socioeconomic factors—specifically maternal height (HAZ: Coef. 0.02, 95% CI 0.01–0.03; stunting: OR 0.96, 95% CI 0.94–0.98), birth weight (HAZ: Coef. 0.3, 95% CI 0.16–0.43; stunting: OR 0.5, 95% CI 0.35–0.72) and asset‐based measures of socioeconomic status (HAZ: Coef. 0.17, 95% CI 0.10–0.24; stunting: OR 0.77, 95% CI 0.67–0.89)—were the most important predictors of HAZ and stunting in these districts. We explored whether any other factors moderated (weakened) the relationship between these intergenerational factors and child height using conditional inference trees and moderation analysis. We found that being on track for vitamin A and deworming, adequate sanitation, a diverse diet and good maternal mental health moderated the effect of birth weight or mother's height. Though impacts are likely to be small relative to the impact of intergenerational risk factors, these moderating factors may provide promising avenues for helping to mitigate the intergenerational transmission of stunting risk in South Africa.

A male partner or husband is the most influential person in the family, especially in Ethiopia. The role of a male partner or husband in promoting and supporting breastfeeding has hardly been investigated in low‐ and middle‐income countries, including Ethiopia. Therefore, the objective of this study was to evaluate the effect of breastfeeding education and support interventions that focus on male partners, with the goal of promoting optimal breastfeeding practices in central Ethiopia. A two‐arm parallel design cluster randomized controlled trial was carried out among couples in a community setting in the Hadiya Zone, Central Ethiopia. Fathers and mothers in the intervention group received breastfeeding education and support via social events, home visits and using printed materials, while those in the control group received existing routine care. A total of 408 couples from 16 clusters were randomly assigned to either the intervention group (n = 204) or the control group (n = 204). A Generalized Estimating Equation (GEE) model was used to evaluate the effectiveness of the interventions. At the end of the interventions, the proportion of optimal breastfeeding practice increased by 19.5% in the intervention group and by 2% in the control group. The differences‐in‐difference in optimal breastfeeding practice between the intervention and control groups was 17.5% [95% CI: 13.8%–21.2%; p = 0.001]. In the GEE model, babies born to mothers in the mother‐father pair group had a 38% higher likelihood [RR = 1.38, 95% CI (1.106, 1.723)] of being optimally breastfed at the sixth month compared with babies born to mothers who received standard care. Breastfeeding education and support interventions targeting male partners in low‐resource settings improve optimal breastfeeding practices, highlighting the need to give due emphasis to integrating breastfeeding promotion and counselling for male partners into existing maternal and child health services. Trial Registration: ClinicalTrials.gov identifier (NCT number): NCT05173454, First registered on 30/12/2021.

This study aimed to examine the directionality of the relationship between children's satiety responsiveness and parental pressure to eat and to explore how children's temperament moderates this relationship. Parents of preschoolers (n = 482, Mage = 3.66, SD = 0.29, 51.2% boys) were surveyed at two‐time points spaced 2 years in China, and 76.6% of those were mothers. Cross‐lagged analyses indicated that children's satiety responsiveness positively predicted parental pressure to eat over time. Moderation analyses revealed that children's high anger/frustration intensified the predictive relationship above. These findings suggest that parents should accurately understand their children's satiety responsiveness and tailor their responses based on children's temperament, thereby fostering a virtuous cycle of parent–child interaction.

The Ethiopia Food and Nutrition Strategy (FNS 2021–2030) aims to provide evidence‐based, nutrition‐specific, and sensitive interventions to address malnutrition. A costing exercise was done to estimate the minimum financing needed to implement nutrition interventions for the ten‐year FNS, and further analysis was made to estimate the investment required to implement the prioritised recommended Lancet series interventions for 10 years. Activity‐based costing methodology was used to carry out the FNS costing for nutrition interventions prioritised by the different line ministries, and then estimated costs to implement the 2021 recommended Lancets interventions were examined from the FNS. The minimum cost of implementing the National FNS was estimated to be US$2.55bn with an average annual cost of US$ 250 million over 10 years (2021–2030). The cost of nutrition‐sensitive approaches represents US$1.8 billion (72$ 704 million (28%) of the total cost of the FNS. The Lancet series intervention costs accounted for US$ 1.7 billion (66%) of the total cost of the strategy. In this costing, half of the strong/moderate evidence (7 out of 13) Lancet interventions are costed. Therefore, the strategy's costing should be revised every 3 years to integrate new evidence and consider lessons from real expenditure. Furthermore, the need to establish a nutrition expenditure tracking system is urgent.

Systematic crises may disrupt well‐designed nutrition interventions. Continuing services requires understanding the intervention paths that have been disrupted and adapting as crises permit. Alive & Thrive developed an intervention to integrate nutrition services into urban antenatal care services in Dhaka, which started at the onset of COVID‐19 and encountered extraordinary disruption of services. We investigated the disruptions and adaptations that occurred to continue the delivery of services for women and children and elucidated how the intervention team made those adaptations. We examined the intervention components planned and those implemented annotating the disruptions and adaptations. Subsequently, we detailed the intervention paths (capacity building, supportive supervision, demand generation, counselling services, and reporting, data management and performance review). We sorted out processes at the system, organizational, service delivery and individual levels on how the intervention team made the adaptations. Disruptions included decreased client load and demand for services, attrition of providers and intervention staff, key intervention activities becoming unfeasible and clients and providers facing challenges affecting utilization and provision of services. Adaptations included incorporating new guidance for the continuity of services, managing workforce turnover and incorporating remote modalities for all intervention components. The intervention adapted to continue by incorporating hybrid modalities including both original activities that were feasible and adapted activities. Amidst health system crises, the adapted intervention was successfully delivered. This knowledge of how to identify disruptions and adapt interventions during major crises is critical as Bangladesh and other countries face new threats (conflict, climate, economic downturns, inequities and epidemics).

Emerging research suggests that a more infant‐led approach to complementary feeding may confer benefits for child language, but these findings are based on parent report studies. Using an observational approach this study examines whether different complementary feeding experiences relate to infant language exposure and language use. Fifty‐eight parents recorded a typical infant mealtime in the home (mean infant age = 14 months, SD = 4.15). Observations were coded to measure the prevalence of infant‐led and parent‐led feeding using the Family Mealtime Coding Scheme. Caregiver language use (word types and token directed at the child, mean length of utterances in child‐directed speech, responsiveness and initiations) and the number of infant vocalisations were coded in ELAN using CHAT conventions and parents completed the MacArthur Communicative Development Inventory short form as a measure of child language. Greater observed infant self‐feeding was significantly associated with greater observed exposure to language from caregivers (r = 0.312 percentage of infant self‐feeding correlated with caregiver word types directed at the child) and a greater number of infant vocalisations (r = 0.320 percentage of infant self‐feeding correlated with number of child vocalisations produced). Structural Equation Modelling showed the relationship between infant self‐feeding and infant vocalisations to be significantly mediated by enhanced quality and quantity of caregiver child‐directed speech (model fit: χ² [5] = 5.01, p = 0.415, CFI = 1.00 [NF = 0.98], RMSEA = 0.006). Differences in the approach to complementary feeding may shape infant's experiences in ways that support language exposure and use. Autonomy associated with infant self‐feeding may enhance opportunities for social interaction.

Infant and young child feeding practices (IYCF) are crucial for children's growth and development but often deteriorate during periods of instability. A cross‐sectional survey conducted in three oblasts of Ukraine—Kyiv City and Kyiv, Lviv, and Odesa—enroled 724 children 0–23 months of age from 699 households. Using global WHO IYCF Guidelines, 12 indicators of optimal IYCF practices were evaluated. The study found IYCF practices to be relatively stable since 2015, despite the continued escalation of conflict, with an improvement in exclusive breastfeeding (EBF). EBF was reported by 51% of mothers, while breastfeeding was initiated early in 65% of children. Complementary feeding practices were optimal for most children, with 79% having a minimum acceptable diet. Infant formula assistance was independently associated with suboptimal breastfeeding practices in multi‐variable models. Children from households that received formula assistance had 67% (adjusted odds ratio [aOR] 0.33, 95% confidence interval [CI] 0.14–0.73) lower odds of being exclusively breastfed, 65% (aOR 0.35, 95% CI 0.20–0.61) lower odds of continued breastfeeding at 12 months, and 3.3 times (95% CI 2.31–4.78) higher odds of being bottlefed. Baby food assistance did not independently predict a minimum acceptable diet. High levels of optimal complementary feeding sustained since 2015 suggest protective factors for child nutrition in Ukraine, such as domestic agriculture and social safety nets. Additionally, maternal education was consistently linked to better IYCF outcomes, highlighting the need for targeted support for less‐educated mothers. The negative association of formula assistance with EBF warrants further research alongside reinforcement of guidelines to prevent inappropriate formula targeting.

This study aimed to define complementary feeding trends in Guinea from 2005 to 2018 and complementary feeding risk factors at the individual, household, and community levels. Data from 2005 to 2018 demographic health surveys (DHS) and Multiple Indicator Cluster Surveys were used to describe complementary feeding trends in Guinea. The most recent DHS was used to examine complementary feeding risk factors at the individual, household, and community levels. Complementary feeding indicators including introduction to complementary foods (INTRO), minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) were calculated based on the 2010 World Health Organisation guidance. Multivariate logistic regressions were used to identify significant risk factors (p < 0.05). Since 2005, there has been a marginal increase in MDD and MAD, but a decrease in INTRO and MMF. The 2018 DHS survey revealed various complementary feeding risk factors. At the individual level, travelling 1–60 min to get water was associated with decreased odds of meeting INTRO, while iron supplementation and maternal education were associated with increased odds of meeting MMF and MDD, respectively. Routine vitamin A supplementation, fever in the past 2 weeks, and low birth weight were associated with increased odds of meeting MAD. At the household level, being in a lower wealth quintile was associated with decreased odds of meeting MDD and MAD. National and subnational programmes and policies designed to improve infant and young child diets may consider tailored approaches that address the specific indicators and risk factors associated with poorer diets in this Guinean context.

Child malnutrition is a major health problem in Sub‐Saharan Africa. Complementary foods made from African indigenous and locally available raw materials are often low in protein and nutrients. It is, therefore, important to supply complementary foods that are nutritious and affordable, and with an acceptable consistency and taste. The objective of this study was to develop, on a pilot scale, food‐to‐food fortified, convenient, canned complementary porridges based on blends of African indigenous crops, i.e., orange fleshed sweet potato (OFSP) flour, and leguminous (i.e., cowpea, and Bambara groundnut) and cereal flours (i.e., teff, finger millet, maize, and amaranth), and milk powder. Plant‐based, African complementary foods are often lacking in vitamin A, zinc, iron, and energy. Porridge with OFSP on a 32% dry weight (dw) basis achieved recommended levels of vitamin A (530 µg per 100 g dw). Satisfactory energy (431 Kcal per 100 g dw) was obtained by supplementation of vegetable oil. A nutritious, low‐cost porridge (costing 0.15 € per 100 g can) that fulfills consistency constraints was obtained by including supplements of zinc and iron salts as ingredients. The solids content and thus protein/energy could be significantly increased using protein fractionated or germinated cowpea flours without compromising on viscosity. The sensory profile was characterised by more intense vegetable, leguminous, and malty flavours as compared to traditional reference porridges.

The prevalence of common mental disorder (CMD) and anemia is observed to be on the rise over time, adversely affecting the health and overall quality of life among adolescents. Extensive literature corroborates the significant impact of anemia on cognitive development, intelligence and developmental milestones. Nevertheless, the linkage between hemoglobin level and CMD emerging during adolescence remains relatively unexplored. Thus, the objective of this study was to investigate the association between hemoglobin level and CMD as well as the mediating factor among school adolescent girls residing in Central Ethiopia. A cross‐sectional study design was conducted among adolescent girls attending schools in Silti Woreda, Central Ethiopia, comprising a total sample size of 516 individuals during the period from October 2–20, 2023. Hemoglobin level was adjusted for altitude, while CMD was evaluated utilising the summation score of a 20‐item Self‐Reporting Questionnaire. Data were analysed through fitting Structural Equation Model and the maximum likelihood estimation method. Goodness of fit was assessed using the χ2The ‐test statistic, Comparative Fit Index, Root Mean Square Error of Approximation, Standardised Root Mean Square Residual, Non‐Normed Fit Index, Pclose and coefficient of determination (R²). The prevalence of CMD was 22.3% (95% CI: 18.6%–25.8%). Hemoglobin level (UTE = −0.73, CI: −0.93, −0.53) and experience of morbidity symptoms (UTE = 1.05; CI: 0.74, 1.38) were significantly associated with CMD. Furthermore, hemoglobin level is significantly influenced by morbidity frequency symptoms (UDE = −0.63, CI = −0.77, −0.49) and animal source food (ASF) (UDE = 0.09, CI = 0.01, 0.17). Hemoglobin level has been identified as a significant mediator of the experience of morbidity symptoms and ASF on CMD. However, household food insecurity and wealth index had no significant association with CMD. A significant proportion of adolescent girls face CMD, often linked to a lower hemoglobin level. Having a significant association with CMD, the hemoglobin level is found to mediate a significant effect of morbidity symptom experience and ASF on CMD. Hence, addressing early infection prevention, promoting ASF and treating anemia are promptly needed.

Persistent organic pollutants (POPs) are environmental contaminants that can accumulate in human tissues and pose potential health risks. Despite global efforts to reduce their prevalence, follow‐up studies are needed to see if the measures are successful. Since most infants in Norway are breastfed for the first 6 months of life, monitoring POP contamination in breastmilk is important for children's health and development. This study aims to evaluate the current levels of various POPs in women's breastmilk in Innlandet County, Norway. A cross‐sectional study was conducted measuring concentrations of 35 different POPs, including polychlorinated biphenyls (PCBs), chlordanes (ChlDs), hexachlorocyclohexanes (HCHs), dichlorodiphenyltrichloroethanes (DDTs), Mirex, and brominated flame retardants in 120 breastmilk samples. The study analysed the impact of maternal age, parity, pre‐pregnancy BMI, and infant age on POPs levels and compared the estimated daily intake per body weight of infants to existing health guidelines. The detected percentages for PCBs were 100%, for DDTs 98.3%, and for ChlDs 98.3%. The highest median concentration was found for ΣPCBs (26.9 ng/g lw). Maternal age, parity, and infant age were significant determinants of POP concentrations. Most infants exceeded the health‐based guidance values for ΣPCB, and 6.4% percent did so for ΣHCHs. Despite lower POPs concentrations in breastmilk than in earlier studies, many breastfed infants are still exposed to levels exceeding health‐based guidance values. Although the study's design had limitations, the study provides updated population‐based data on POPs in breastmilk. Continued monitoring and research are necessary to understand and mitigate potential health risks associated with POPs.

This mixed‐method study explored the experiences of mothers and fathers combining breastfeeding with returning to paid employment after childbirth. Tasmanian State Service employees participated in an online survey and phone interviews. A total of 130 parents completed the survey, and 42 participated in 60‐min phone interviews. The survey had more female respondents (109) than male (21), and only 4 of the 42 interviews were with fathers. The sample consisted mainly of professional women (84%) and men (16%), predominantly Australian‐born (88%). Two‐thirds of participants worked part‐time (62%), taking either unpaid (52%) or paid leave (61%) within the first 12 months after birth. The majority (88%) preferred to breastfeed, with the mean age of the first formula feed being 4.1 months. A narrative analysis of the qualitative data, informed by work–family conflict theory, reveals that transitioning back to paid work while breastfeeding is challenging for both mothers and fathers. Parents face multiple conflicts between paid work, family responsibilities and maintaining breastfeeding. The emotional and physical demands of feeding, expressing, storing and transporting breast milk, combined with often inadequate workplace facilities, policies and gender discrimination, add to parental pressure. Mothers bear the greatest burden, while fathers’ roles and needs are often overlooked in the workplace. The major finding of this study is that breastfeeding is insufficiently recognised as an integral part of the return‐to‐work process for both parents, generating a form of work–family breastfeeding conflict, where work (part‐time or full‐time) interferes with family responsibilities and breastfeeding. Family‐friendly breastfeeding policies based on equity principles are needed to address workplace gender inequality and discrimination and better support parents in combining work and breastfeeding.

Dietary diversity has been widely used as a proxy indicator for micronutrient adequacy. In low‐ and middle‐income countries (LMICs), including Rwanda, women are at high risk of inadequate micronutrient intake resulting from poorly diversified diets. This study was conducted to examine the factors associated with women's dietary diversity, with emphasis on homestead production diversity and market access in the Northern Province of Rwanda. A cross‐sectional design was used, involving 606 women aged 18–49 years. Linear regression analyses were performed to examine the association between various factors and women's dietary diversity. Results show that 84% of the sample households raised at least one livestock species. Seventy‐one percent of the households had no agricultural land. Eighty percent of those without land had a homestead garden on which they grew food crops, mainly vegetables and fruit trees. The average crop species was 2.3. On average, women consumed 3 out of 9 food groups. The homestead production diversity score was positively associated with women's dietary diversity score (β = 0.16, p < 0.001). Women's dietary diversity score was negatively associated with distance from the household to the nearest market (β = −0.08, p = 0.027) and household food insecurity (β = −0.06, p < 0.001). Maternal education (p < 0.001), household wealth index (p < 0.05), and ownership of more than 2.5 acres compared to being without land (p < 0.05) were associated with women's dietary diversity score. The dietary diversity of women could be enhanced through interventions that promote the diversity of livestock and crop species produced through homestead production. Potential interventions to explore may include integrated farming systems that combine small livestock and crop production utilising improved livestock breeds and high‐quality seeds and planting materials of high‐yielding varieties of fruits and vegetables, along with rainwater harvesting to facilitate small‐scale irrigation. The impact of such interventions on women's dietary diversity can be further reinforced by parallel programmes aimed at improving women's education and the socioeconomic status of households.

Breastfeeding is a critical public health strategy for optimal child development and maternal health across the life course. The 2021 Global Burden of Diseases, Injuries and Risk Factors Study reveals that, despite reductions in mortality and disability‐adjusted life years (DALYs) attributed to suboptimal breastfeeding practices—namely, non‐exclusive breastfeeding during the first 6 months or early discontinuation within the first 2 years—low‐ and middle‐income countries (LMICs) continue to bear a staggering 50‐fold higher burden compared to high‐income nations. This inequity signals a pressing global health priority. Hence, we propose to address these challenges by first, expanding the Baby‐Friendly Hospital Initiative (BFHI) reach through community‐driven efforts such as the Baby‐Friendly Community Initiative (BFCI) to enhance breastfeeding support in both clinical and community settings; second, embedding breastfeeding counselling within national health and social protection programmes to fill in gaps in culturally competent care, drawing on large scale breastfeeding peer counselling programme experiences like the one being implemented by the US Supplemental Nutrition Program for Women, Infants and Children (WIC); third, improving maternity leave policies and workplace accommodations for breastfeeding women and fourth, stringent regulation of exploitative commercial milk formula (CMF) marketing to combat misinformation and reduce health inequities. Governments must implement strong, evidence‐driven policies—such as strict monitoring and regulation of product labelling and digital media marketing—to establish safeguards against the powerful influence of the CMF industry. Collectively, these strategies will enhance breastfeeding outcomes, reduce health disparities and drive progress across countries towards meeting the UN Sustainable Development Goals.

Acute malnutrition in children under 5 years is persistent in Eastern Africa's arid and semiarid lands. This study aimed to identify the drivers of acute malnutrition in Turkana and Samburu counties, Kenya. This was a population‐based longitudinal mixed‐methods observational study. Qualitative and quantitative data were collected at Wave 1, but only quantitative data were collected during follow‐up. Participants were a representative sample of children and their primary caregivers from households with children under 3 years at Wave 1. Anthropometric measurements of all children under 5 years in the sampled households were taken at Wave 1 (May to July 2021), and one child under 3 years was randomly selected for follow‐up about every 4 months over 2 years for six data collection waves. The study also collected data on sociodemographics; child feeding practices and morbidity; household water and food insecurity; shocks; coping strategies, social safety nets and economic safeguards; water, sanitation and hygiene; women's decision‐making and food consumption. Qualitative data were collected through community dialogues, focus group discussions, in‐depth interviews, photovoice and key informant interviews with mothers and fathers with children under 5 years, community leaders, county officials and staff of nongovernmental organisations. Data collection is complete and analysis is ongoing. The analysis includes thematic analysis of qualitative data and descriptive and multi‐variable regression analyses of quantitative data.

Management of undernourished children depends only on wasting yet it can coexist with underweight and/or stunting. Among children admitted to hospital with acute illness, we determined the proportion with wasting coexisting with underweight and/or stunting and their risk factors. A retrospective review of hospital records of children 6‒59 months old admitted at Garissa County referral hospital, Kenya, from January 2017 to December 2019 was conducted. Using World Health Organization 2006 growth standards, undernutrition were defined: wasting as Weight‐for‐height Z‐score < −2, stunting Height‐for‐age Z‐score < −2 and underweight Weight‐for‐age Z‐score < −2. We studied wasting coexisting with underweight and/or stunting. Among 624 children recruited, 347 (56%) were males and 511 (82%) <24 months old. Diarrhoea 210 (34%) and pallor/anaemia 310 (50%) were the most frequent admission diagnosis. HIV infection was present among 8 (1.3%) children. Wasting, underweight and stunting were present among 595 (95%), 518 (83%) and 176 (28%) children respectively. 161 (26%), 506 (81%) and 161 (26%) children had wasting coexisting with stunting, underweight and both stunting and underweight respectively. In the multivariable regression, diarrhoea was positively associated with wasting coexisting with stunting (adjusted risk ratio [aRR = 2.96] [95% CI = 2.06‒4.23]) and anaemia with wasting coexisting with underweight (aRR = 1.23) (95% CI = 1.03‒1.47). Overall, 343 (55%) children were discharged alive, 67 (11%) absconded from the wards, 164 (26%) were transferred to another hospital and 50 (8.0%) died before discharge. The risk of inpatient death was 10.3%, 7.9%, 8.4% and 6.8% among children not wasted, wasted only, wasted & underweight, and wasted and underweight and stunted respectively (Chi‐square p = 0.60). The study reports an unacceptably high levels of undernourishment, including coexisting forms of undernutrition among hospitalised children. This highlights a public health priority for current nutrition therapeutic care and need of continuity of care among those children discharged alive in the community‐based management of acute malnutrition programmes.

Rural households in East Africa rely on local markets, but the influence of market food diversity and household food purchase diversity on diets has not been well‐characterized. We quantify the associations among market food diversity, household food purchase diversity and dietary diversity of mothers, fathers and children in rural Tanzania. This study uses baseline data from a randomized controlled trial, Engaging Fathers for Effective Child Nutrition and Development in Tanzania. We used the 10 food groups for women's dietary diversity to assess the seasonal availability of nutritious foods in 79 markets. Using data from 957 rural households in two districts in Mara, Tanzania, we measured household food purchase diversity over the previous month and dietary diversity among children (6–23 months), mothers and fathers. Overall, 63% of markets sold all 10 food groups throughout the year, indicating high‐market food diversity and minimal seasonality. However, only 33% of women and 35% of children met dietary diversity recommendations. Households that reported higher purchasing power (0.14, p < 0.001), lived within 30 min of a market (0.36, p = 0.001) and had access to a highly diverse market (0.37, p = 0.01) purchased a higher diversity of foods. In turn, food purchase diversity was positively associated with the dietary diversity of mothers (p < 0.001) and children 9–23 months (p < 0.001) but not fathers (p = 0.56). Interventions must account for food availability and access in local markets, and promoting diverse food purchases may be an effective strategy to improve women's and children's diets in rural areas.