Paula Louise Griffiths

• PhD (Twitter account @Pgriffiths4)
• Professor at Loughborough University

Objective This study investigates and measures whether the association of childhood stunting with household socioeconomic position (SEP) differs in Sri Lanka compared to other South Asian countries. Design Secondary analysis of data of children from the latest available DHS data (survey years, 2016-2018). The exposures (SEP) were maternal educatio...

Background Clusters of health behaviours could impact changes in adiposity among adolescents over time. This study examines the clustering of screen time, physical activity, dietary behaviours and sleep, and the associations with 3-year changes in indicators of adiposity. Methods Data from the UK’s Millennium Cohort Study were utilised when partic...

Objectives Community-based arts interventions have the potential to support contextually relevant nurturing care programmes and policies that adapt to different settings. Understanding the distinctive features of using the arts in local, culturally specific ways in low/middle-income countries (LMICs); how this varies by context; and gaining a bette...

Introduction Nutrition during the complementary feeding period (6–23 months) is critical to ensure optimal growth and reduce the risk of diet-related disease across the life course. Strategies to reduce multiple forms of malnutrition (stunting, overweight/obesity and anaemia) in infants and young children (IYC) are a key priority in low-income and...

Background: In South Asia, 89 million children under 5 are at risk of not reaching their developmental potential. Household socioeconomic position (SEP) is a determinant of early child development (ECD). However, synthesised evidence for the association between ECD and SEP in young children in South Asia is not available. Therefore, this review sy...

A conceptual framework is presented for enhancing food security and nutrition in urban areas in low- and middle-income countries, highlighting key influencing factors, including food supply chains, community food environments, community infrastructure and services, and numerous underlying individual and household determinants, such as behaviours an...

Background Physical activity (PA), sedentary behaviour (SB) and diet play an important role in the physical and mental health of young people. Understanding how these behaviours cluster, and the impact of clusters on health is important for the development of public health interventions. This review examines the prevalence of clusters of PA, sedent...

Background The COVID-19 pandemic led to decline in access and utilization of the baby-friendly community initiative (BFCI) which is being implemented in Kenya. The impact of the pandemic on the BFCI and on maternal and child health and nutrition has not been documented. We undertook a qualitative study that assessed the effect of the COVID-19 pande...

Given the recent, rapid urbanisation in Asia and the Pacific region, coupled with increases in the triple burden of malnutrition, we need to better understand maternal, infant and young child nutrition (MIYCN) for populations living in urban slum environments. This research used existing large-scale datasets to explore MIYCN indicators for those li...

Rapid urbanisation in the Asia-Pacific region is associated with complex changes to urban food environments. The impact of changing food environments on food purchasing and consumption and the diets and nutritional status of vulnerable groups, especially women and young children, is not well researched in low- and middle-income country cities. This...

Background Diarrhoeal disease remains a significant cause of morbidity and mortality among the under-fives in many low- and middle-income countries. Changes to food safety practices and feeding methods around the weaning period, alongside improved nutrition, may significantly reduce the risk of disease and improve development for infants. We descri...

Introduction: Digital health support using mobile and digital technologies, such as MomConnect and WhatsApp, is providing opportunities to improve maternal and child healthcare in low- and middle-income countries. Yet, the perspective of health service providers, pregnant women, and mothers as recipients of digital health support is under-research...

Background: Global consumption of unhealthy foods, including ultra-processed foods (UPFs) and sugar-sweetened beverages (SSBs), has increased substantially among pediatric populations. Suboptimal diet during early life can track into adulthood, alongside risk factors for cardiometabolic disease. Objective: To inform the development of updated WH...

Aim This study assesses community readiness to prevent overweight/obesity among Ghanaian immigrants in Greater Manchester, England. Subject and method The Community Readiness Model (CRM) was applied using a semi-structured interview tool with 13 key informants (religious and other key community members) addressing five readiness dimensions. A maxi...

Objective: To explore communities' perspectives on the factors in the social food environment that influence dietary behaviours in African cities. Design: A qualitative study using participatory photography (Photovoice). Participants took and discussed photographs representing factors in the social food environment that influence their dietary b...

Introduction The Nurturing Care Framework (NCF) describes “nurturing care” as the ability of nations and communities to support caregivers and provide an environment that ensures children's good health and nutrition, protects them from threats, and provides opportunities for early learning through responsive and emotionally supportive interaction....

Evidence on the individual-level drivers of dietary behaviours in deprived urban contexts in Africa is limited. Understanding how to best inform the development and delivery of interventions to promote healthy dietary behaviours is needed. As noncommunicable diseases account for over 40% of deaths in Ghana, the country has reached an advanced stage...

Objective To examine the evidence on the associations between socioeconomic position and young people’s physical activity and sedentary behaviours in the UK. Design Scoping review. Data sources PubMed, SCOPUS and Web of Science databases were searched for articles published up to and including January 2021. Eligibility criteria for selecting stu...

Behavior change and improving health literacy based on normative ideals of motherhood is a dominant paradigm to address maternal health challenges. However, these ideals often remove women’s control over their bodies overlooking how the bodily experiences of pregnancy are socially and culturally constructed. We report on 27 interviews with pregnant...

Background Diarrheal disease remains a significant cause of morbidity and mortality among the under-fives in many low- and middle-income countries. Changes to food safety practices and feeding methods around the weaning period, alongside improved nutrition, may significantly reduce the risk of disease and improve development for infants. This artic...

This WHO-commissioned review contributed to the update of complementary feeding recommendations, synthesizing evidence on effects of unhealthy food and beverage consumption in children on overweight and obesity. We searched PubMed (Medline), Cochrane CENTRAL and Embase for articles, irrespective of language or geography. Inclusion criteria were: 1)...

The COVID-19 pandemic may impact diet and nutrition through increased household food insecurity, lack of access to health services, and poorer quality diets. The primary aim of this study is to assess the impact of the pandemic on dietary outcomes of mothers and their infants and young children (IYC) in low-income urban areas of Peru. We conducted...

Background Diarrheal disease remains a significant cause of morbidity and mortality among the under-fives in many low- and middle-income countries. Changes to food safety practices and feeding methods around the weaning period, alongside improved nutrition, may significantly reduce the risk of disease and improve development for infants. This artic...

The Baby Friendly Community Initiative (BFCI) offers a unique platform for integration of counselling on early childhood development (ECD) with existing maternal and child health and nutrition messages. To understand how to efficiently deliver such a program, this study determined the feasibility of integrating counselling on child stimulation into...

We identified factors in the physical food environment that influence dietary behaviours among low-income dwellers in three African cities (Nairobi, Accra, Ho). We used Photovoice with 142 males/females (≥13 years). In the neighbourhood environment, poor hygiene, environmental sanitation, food contamination and adulteration were key concerns. Econo...

Background Exclusive breastfeeding (EBF) during the first six months of life is crucial for optimising child’s growth, development and survival. Mother’s employment may hinder optimal breastfeeding. We assessed the effectiveness of a workplace support intervention on EBF in Kenya. Methods This quasi-experimental study employing a pre-post interven...

Background Although recent policies have sought to increase the rates of exclusive breastfeeding (EBF) and continued breastfeeding for HIV exposed infants, few programs have considered the multiple social and cultural barriers to the practice. Therefore, to generate evidence for exclusive and continued breastfeeding policies in Kenya, we examined c...

This study developed, validated, and evaluated a framework of factors influencing dietary behaviours in urban African food environments, to inform research prioritisation and intervention development in Africa. A multi-component methodology, drawing on concept mapping, was employed to construct a framework of factors influencing dietary behaviours...

Community Readiness Model (CRM) through pragmatic mixed methods design, combining quantitative CRM survey with qualitative data, was used to assess the level of preparedness and readiness among local leaders, employers and community members in supporting working mothers to combine breastfeeding with work. The study was conducted in one of the tea s...

Exclusive breastfeeding (EBF) during the first 6 months of life is crucial for optimizing child growth, development and survival, as well as the mother's wellbeing. Mother's employment may hinder optimal breastfeeding, especially in the first 6 months. We assessed the effectiveness of a baby‐friendly workplace support intervention on EBF in Kenya....

Frontline health workers are the first and often the only access point to basic health care services in low-and-middle income countries. However, the work and the issues frontline health workers face are often invisible to the healthcare system, with limited resources to assist them. This study explores the work practices, challenges and roles of f...

The baby-friendly hospital initiative (BFHI) promotes exclusive breastfeeding (EBF) in hospitals, but this is not accessible in rural settings where mothers give birth at home, hence the need for a community intervention. We tested the effectiveness of the baby-friendly community initiative (BFCI) on EBF in rural Kenya. This cluster randomized stud...

Climate change presents significant threats to human health, especially for low-income urban communities in the Global South. Despite numerous studies of heat stress, surprisingly little is known about the temperatures actually encountered by people in their homes, or the benefits of affordable adaptations. This paper examines indoor air temperatur...

p class="abstract"> Background: Employment poses a barrier in achieving the World Health Organization’s recommendation of exclusive breastfeeding for the first six months of life. Effective strategies and evidence to improve breastfeeding for women working in the agricultural sector – the main employer for women in Kenya – is lacking. This study ai...

A cluster randomized trial design was used to test the efficacy of a behaviour change communication intervention on the quality of the home environment and infant development at 15 months of age. Children (n = 600) in rural South India were followed from 3 through 15 months of age. The control group (C group) received the standard of care, the comp...

In sub-Saharan Africa (SSA), rapid urbanisation coupled with the high prevalence of infant and young child (IYC) undernutrition in low-income settings means that interventions to support IYC nutrition are a priority. Little is known about how urbanisation influences IYC feeding (IYCF) practices, and evidence-based interventions to improve IYC healt...

Growing urbanisation in Africa is accompanied by rapid changes in food environments, with potential shifts towards unhealthy food/beverage consumption, including in socio-economically disadvantaged populations. This study investigated how unhealthy food and beverages are embedded in everyday life in deprived areas of two African countries, to ident...

Few studies in HCI4D have examined the lived experiences of women with pregnancy complications. We conducted a qualitative study with 15 pregnant women to gain an in-depth understanding of the context in which pregnancy takes place and everyday experiences living with complications in rural North-West India. To complement our interviews, we conduct...

Extreme weather events disproportionately affect residents of low-income urban settlements in the global South. This paper explores the impacts of extreme heat and flooding on water and electricity services in Accra and Tamale, Ghana. Interviews with water/electricity providers and water quality analysis are combined with household interviews, focu...

Background: Although the baby-friendly community initiative (BFCI) has been proposed as a community-level approach to improve infant feeding practices, there is little data on its variation in effectiveness by HIV status. We conducted a study to determine the effectiveness of BFCI in changing knowledge and attitudes towards exclusive breastfeeding...

Background Adrenarche involves maturation of the hypothalamic‐pituitary‐adrenal axis and increased production of dehydroepiandrosterone and its sulfate ester, dehydroepiandrosterone‐sulfate (DHEA‐S). It occurs at ages 6 to 8 in industrialized populations, marking the transition from childhood to juvenility and cognitive development at middle childh...

Many cities in the Global South are facing challenges as they increasingly experience extreme weather events, which disproportionately affect the urban poor. Focussing on severe heat and surface water flooding, this paper explores how these extreme weather events impact on infrastructure provision and livelihoods in low-income urban communities in...

Objectives The aim of this study was to characterise the local foods and beverages sold and advertised in three deprived urban African neighbourhoods. Design Cross-sectional observational study. We undertook an audit of all food outlets (outlet type and food sold) and food advertisements. Descriptive statistics were used to summarise exposures. La...

Malnutrition can adversely influence women's overall health and development and that of their children. In the Yangon region of Myanmar, young women aged 15–19 years can be excessively thin, overweight, or anemic. A significant proportion of these young women working within the formal sector are employed in the garment industry. This study used a m...

Sedentary screen-time is an increasingly prevalent behaviour, associated with a range of adverse health outcomes. Sedentary time and screen-use increase during adolescence, making this age group a prime target for behaviour change interventions. Better understanding the context in which sedentary screen-behaviours occur is important for ensuring fu...

Extreme weather events pose significant threats to urban health in low- and middleincome countries, particularly in sub-Saharan Africa where there are systemic health challenges. This paper investigates health system vulnerabilities associated with flooding and extreme heat, along with strategies for resilience building by service providers and com...

Background: Many young people form unhealthy behavioural habits, such as low intake of fruit and vegetables, high intake of energy-dense snack foods, and excessive sedentary screen-based behaviours. However, there is a shortage of parent-and home-focused interventions to change multiple health behaviours in children. Methods: Kids FIRST was a 12...

Over 66 per cent of children in sub-Saharan Africa remain affected by poor developmental outcomes, exacerbating early inequalities. UNICEF and WHO evolved the Care for Child Development package (CCD) as a community-based initiative to support caregivers to develop stronger relationships with young children and support nurturing care. The Baby Frien...

Background: Nutritional interventions to prevent stunting of infants and young children are most often applied in rural areas in low- and middle-income countries (LMIC). Few interventions are focused on urban slums. The literature needs a systematic assessment, as infants and children living in slums are at high risk of stunting. Urban slums are c...

Background Ghana has reached an advanced stage of nutrition transition, contributing to an increase in nutrition-related non-communicable diseases, particularly amongst urban women. Community involvement is an important factor in the success of efforts to promote healthy eating. The readiness of populations to accept a range of interventions needs...

We need a deeper understanding of the everyday challenges of pregnancy care in lower socio-economic settings in India. This paper reports reflections from three workshops involving multiple stakeholders, conducted as part of a larger project exploring the role of digital technology in enhancing everyday practices of pregnancy care. In particular, t...

Children in slums are at high risk of acute malnutrition and death. Cost-effectiveness of community-based management of severe acute malnutrition programmes has been demonstrated previously, but there is limited evidence in the context of urban slums where programme cost structure is likely to vary tremendously. This study assessed the cost-utility...

Disability-Adjusted Life Years (DALYs), DALYs averted, and cost per DALY averted under different social weighting scenarios comparing the treatment and prevention programme versus ICDS standard care. DALY[K;r] denotes the applied age weighting constant (K) and discount rate (r). (DOCX)

Database including all cases during the time period with data for anthropometric measurements. (XLSX)

Cost centres and their descriptions for Aahar acute malnutrition programme. (DOCX)

Detailed costs per cost centres and average costs per children in USD for the community based treatment and prevention programme. (DOCX)

Mean Disability-Adjusted Life Years (DALYs), Years of Life Lost (YLL), Years of Life lived with Disability (YLD) for the community based treatment and prevention programme (Aahar acute malnutrition programme) versus ICDS standard care only (base scenario) disaggregated for SAM, MAM and normal. (DOCX)

Background: Screen-time and unhealthy dietary behaviours are highly pervasive in young children and evidence suggests that these behaviours often co-occur and are associated. Identifying clusters of unhealthy behaviours, and their influences early in childhood, can assist in the development of targeted preventive interventions. The purpose of this...

Background: In Kenya, poor maternal nutrition, suboptimal infant and young child feeding practices and high levels of malnutrition have been shown among the urban poor. An intervention aimed at promoting optimal maternal infant and young child nutrition (MIYCN) practices in urban poor settings in Nairobi, Kenya was implemented. The intervention in...

Background Exclusive breastfeeding (EBF) improves infant health and survival. We tested the effectiveness of a home-based intervention using Community Health Workers (CHWs) on EBF for six months in urban poor settings in Kenya. Methods We conducted a cluster-randomized controlled trial in Korogocho and Viwandani slums in Nairobi. We recruited pregn...

Background Screen-time and eating behaviours are associated in adolescents, but few studies have examined the clustering of these health behaviours in this age group. The identification of clustered health behaviours, and influences on adolescents’ clustered health behaviours, at the time when they are most likely to become habitual, is important f...

Background Despite numerous interventions promoting optimal breastfeeding practices in Kenya, pockets of suboptimal breastfeeding practices are documented in Kenya’s urban slums. This paper describes cultural and social beliefs and practices that influence breastfeeding in two urban slums in Nairobi, Kenya. Methods Qualitative data were collected...

This study aimed to examine individual, behavioural and home environmental factors associated with frequency of consumption of fruit, vegetables and energy-dense snacks among adolescents. Adolescents aged 11-12 years (n = 521, 48% boys) completed a paper-based questionnaire during class-time which included a Food Frequency Questionnaire assessing t...

Portugal has one of the highest rates of childhood overweight and obesity in Europe. However, little is known about the health of ethnic minorities living in its capital city, Lisbon. The Cape Verdean community in Lisbon tend to have low educational levels, material deprivation and struggle with discrimination and racism, factors that would probabl...

Objective Children in slums are at high risk of undernutrition, which has long-term negative consequences on their physical growth and cognitive development. Severe undernutrition can lead to the child’s death. The present paper aimed to understand the causes of undernutrition in children as perceived by various groups of community members in Nairo...

Background: Obesity is a risk factor for many chronic diseases and the prevalence is increasing worldwide. Research suggests that sedentary behaviour (sitting) may be related to obesity. Aim: To examine the association between sitting time and obesity, while controlling for physical activity, in a large international sample. Subjects and methods: 5...

Background South Africa is undergoing epidemiological and nutrition transitions with associated increases in the incidence of overweight, obesity and diet-related chronic diseases. With the emergence of the nutrition transition in South Africa, there is an urgent need for interventions to prevent overweight and obesity in children and adolescents a...

Context: Children living in slums are at high risk of being malnourished. There are no published reviews on existing interventions promoting better nutrition for children living in slums and the risks factors for children's malnutrition. Improved understanding of the risks factors for malnutrition in slums communities and the impact of interventio...

Objective Social epidemiology models suggest that socioeconomic status (SES) mobility across the life course affects blood pressure. The aim of this study was to investigate the association between SES change between infancy and adolescence, and blood pressure, in young adults, and the impact of early growth on this relationship. Setting Data for t...

Background: In total, 3.1 million young children die every year from under-nutrition. Greater understanding of associations between socio-economic status (SES) and the biological factors that shape under-nutrition are required to target interventions. Aim: To establish whether SES inequalities in under-nutrition, proxied by infant size at 12 mon...

Background The tendency for screen viewing and unhealthy eating behaviours to aggregate in young people has important implications for health promotion. There is much evidence highlighting the importance of parents and the family environment on young people’s screen time and dietary behaviours. However, few interventions target the family and home...

Early nutrition is critical for later health and sustainable development. We determined potential effectiveness of the Kenyan Community Health Strategy in promoting exclusive breastfeeding (EBF) in urban poor settings in Nairobi, Kenya. We used a quasi-experimental study design, based on three studies [Pre-intervention (2007-2011; n=5824), Interven...

Determinants of television viewing and eating behaviours in 11-12 year old children ,International Congress on Obesity and Binge Eating (ICOBE),2015 (Poster).

Background Interventions promoting optimal infant and young child nutrition could prevent a fifth of under-5 deaths in countries with high mortality. Poor infant and young child feeding practices are widely documented in Kenya, with potential detrimental effects on child growth, health and survival. Effective strategies to improve these practices a...

The aim of this study was to use a theoretical model (bench) for human factors and ergonomics (HFE) and a comparison with occupational slips, trips, and falls (STFs) risk management to discuss patient STF interventions (bedside). Risk factors for patient STFs have been identified and reported since the 1950s and are mostly unchanged in the 2010s. T...

Poor breastfeeding practices are widely documented in Kenya, where only a third of children are exclusively breastfed for 6 months and only 2% in urban poor settings. This study aimed to better understand the factors that contribute to poor breastfeeding practices in two urban slums in Nairobi, Kenya. In-depth interviews (IDIs), focus group discuss...

Introduction: Measuring physical activity and sedentary time in young children (<5 years) is complex. Objective measures (although more reliable than proxy-reports) require specialised expertise, are expensive, and can be burdensome for participants; such issues are amplified when measuring large samples. Therefore, a physical activity and sedentar...

This is the protocol for a review and there is no abstract. The objectives are as follows: Primary objective To assess the impact of nutritional interventions to reduce stunting in children under five years old in urban slums. Secondary objective To assess the effect of nutritional interventions on other nutritional (wasting and underweight) and...