Journal articles on the topic 'Children. Nutrition, Zambia Livingstone'

Introduction In the past several decades, Zambia has suffered high levels of under nutrition particularly stunting among children below 5 years of age. Although appropriate complementary feeding practices are reported to reduce child deaths by 6%, they have not received the adequate attention from programme officers and caregivers in terms of implementation. Objectives The objective was to investigate issues surrounding the common complementary feeding practices practised by caregivers of children below five years in health facilities and areas where high rates of malnutrition admission come from. Design A cross sectional research using both qualitative and quantitative methods. The study used mostly proportions based mostly on global indicators on complementary feeding. Qualitative data was also analysed according to themes of global complementary feeding indicators Setting The study was conducted in five hospitals, namely Arthur Davison, Solwezi Central, Kabwe and Livingstone General, and University Teaching Hospital. Subjects The target populations were mothers whose children were admitted for malnutrition and those with children 0-59 months living in communities with the highest number of malnourished cases admitted to selected hospitals Results About45.2% (190) of caregivers introduced liquids before six months of age and 7.6% (32) after 6 months attributing child thirst, medication and advice from health worker as the main reasons. Slightly above half (54.2% of 224) of mothers/caregivers used cups to feed their babies. The use of feeding bottles was still common (8.2% of 34). Responsibility to feed the child is mostly left to the mother (86.4%, 362). In addition, children were being feed about 2.67 (SD 0-72) per day. Conclusions Child feeding practices were still poor. This contributes to poor child growth and health. More interventions should be planned to improve child care behaviour.

Abstract Objectives To access the association between nutrition-sensitive agriculture and the nutrition status of children aged 6–59 months in rural Zambia. Methods We examined associations between crops grown in households and height-for-age (HAZ), Weight-for-age (WAZ) and weight-for-height (WHZ) Z- scores in children age 6–59 months of Kapiri-Mposhi district in the Central Province of Zambia. T-test was performed to compare means values of various indicators of nutrition status (Z-scores) for different categories of test variables. The test variables considered here were crops grown by households. Results The prevalence of Stunting, underweight and wasting was 21%, 9% and 2% respectively. There was an association between household who grew mangoes (P = 0.001 and orange-fleshed sweet potatoes (P = 0.003) and improved HAZ. Growing groundnuts was also associated with improved WAZ. Conclusions We concluded that nutrition-sensitive agriculture is likely to improve growth in children aged 6 -59 months in low-income rural communities. Funding Sources Ministry of education Zambia.

Background: Hidden hunger affects individuals who chronically consume an inadequate intake of at least 1 micronutrient and is associated with low dietary diversity. Little data are available on dietary intake or status assessment of B vitamins among preschool children in Zambia. Objectives: The aim of this study was to assess 24-hour dietary recall records obtained from Zambian children aged 3 to 7 years for B vitamin intake in relation to adequacy and change over time in the same community. Methods: Twenty-four-hour dietary recalls were collected from 2 studies that were 2 years apart in the same district of Zambia. Data were retrospectively analyzed for B vitamin intake, that is, biotin, vitamin B12, folate, niacin, pantothenic acid, vitamin B6, riboflavin, and thiamin. The estimated average requirement (EAR) cut point method was used to assess inadequacy prevalence for EARs established by the Institute of Medicine in the United States. Results: For all B vitamins, mean values were below the EARs established for children 4 to 8 years old. Relative to the EAR, children had the highest intakes of vitamin B6 with inadequacies of 77.9% and 60.1% in 2010 and 2012, respectively. The highest prevalence of inadequate intake was associated with folate, where ≥95% of the children had intakes below the EAR in both studies. Conclusions: All median vitamin B intakes were inadequate among these young children in rural Zambia. Future researchers and policy makers may need to consider B vitamin status in resource-poor areas of the country.

<p>Zambia, and in particular Eastern Province, has one of the highest levels of malnutrition in the world with 40% of the children having stunted growth. Agricultural diversification and commercialization remain critical for improving the nutrition status of children. However, the impact may vary according to the level of the two agricultural interventions. Results from the dose response function using generalised propensity score method showed that for commercialization, there is highest risk of stunting at medium commercialization levels at 50%. A farm at this point can improve nutrition status by moving either towards high or towards zero levels. Commercialization has a negative effect on short-term nutrition outcomes leading to underweight and wasting. This could indicate that in areas with less everyday access to a range of food items, capital accumulation may not help to avoid deficiencies in child nutrition. In combination with our findings on diversification, two policy options can be recommended. Either the households specialize in cash crops to increase income, or they go into subsistence farming with high levels of diversification. Other off-farm income sources are suggested for resilience in case of yield shocks.<strong></strong></p>

Each year, malnutrition accounts for about 50% of the deaths of under-fives in developing countries. In Zambia, about 45% of children under the age of five exhibit stunted growth, mainly due to malnutrition. Early detection of cases by health workers and prompt health-seeking practices at household and community levels can improve the identification and management of malnutrition, and prevent unnecessary deaths. The study provides insights into the perceptions of mothers, caregivers, community members and community health workers regarding the detection, referral and health-seeking practices of malnourished children in Kalomo district of Zambia. This was a qualitative study which explored perceptions and challenges of detection and prompt treatment of malnutrition (kwashiorkor and marasmus) in children under five years of age in the community. Focus group discussions using pictographs were conducted with purposely selected mothers and caregivers of children attending immunization clinics in rural health centres in Zambia. In-depth interviews were also conducted with purposely selected grandparents, community health workers and nutrition advisors to validate the findings obtained from focus group discussions. Data were analysed using thematic analysis. Malnutrition, particularly marasmus, was linked to HIV infection. Barriers to seeking health care for severely malnourished children included beliefs about causes of malnutrition, failure to link malnutrition to poor feeding practices, distance to health care facilities and lack of free feeding schemes for malnourished children. Mothers’ decisions to seek care for malnourished children were influenced largely by grandparents. Increasing awareness about causes, signs and symptoms of malnutrition in this community is needed to improve detection and treatment of malnourished children.

Background The burden of child under-nutrition still remains a global challenge, with greater severity being faced by low- and middle-income countries, despite the strategies in the Sustainable Development Goals (SDGs). Globally, malnutrition is the one of the most important risk factors associated with illness and death, affecting hundreds of millions of pregnant women and young children. Sub-Saharan Africa is one of the regions in the world struggling with the burden of chronic malnutrition. The 2018 Zambia Demographic and Health Survey (ZDHS) report estimated that 35% of the children under five years of age are stunted. The objective of this study was to analyse the distribution, and associated factors of stunting in Zambia. Methods We analysed the relationships between socio-economic, and remote sensed characteristics and anthropometric outcomes in under five children, using Bayesian distributional regression. Georeferenced data was available for 25,852 children from two waves of the ZDHS, 31% observation were from the 2007 and 69% were from the 2013/14. We assessed the linear, non-linear and spatial effects of covariates on the height-for-age z-score. Results Stunting decreased between 2007 and 2013/14 from a mean z-score of 1.59 (credible interval (CI): -1.63; -1.55) to -1.47 (CI: -1.49; -1.44). We found a strong non-linear relationship for the education of the mother and the wealth of the household on the height-for-age z-score. Moreover, increasing levels of maternal education above the eighth grade were associated with a reduced variation of stunting. Our study finds that remote sensed covariates alone explain little of the variation of the height-for-age z-score, which highlights the importance to collect socio-economic characteristics, and to control for socio-economic characteristics of the individual and the household. Conclusions While stunting still remains unacceptably high in Zambia with remarkable regional inequalities, the decline is lagging behind goal two of the SDGs. This emphasises the need for policies that help to reduce the share of chronic malnourished children within Zambia.

Background: Malnutrition is a severe and persisting cause of morbidity and mortality among under-five children in Zambia. We assessed malnutrition and its determinants among under-five children in Lusaka urban, Zambia. Methods: This cross-sectional study was conducted at Chawama, Kabwata, Chilenje and Mtendere urban clinics in Lusaka. A simple random sample of 384 under-five children were selected between February and March 2015. A structured interview schedule was used to collect data on demographic characteristics, determinants of malnutrition and anthropometric measurements. Multivariate binary logistic regression analysis was carried out using IBM® SPSS® Statistics for Windows Version 20.0 to identify determinants of malnutrition while adjusting for confounders. Results: Of the 384 under-five children, most (51.8%) of them were male and the mean (SD) age was 13.83±10.17 months. The zH/A; zW/H; and zW/A was 68.5% and 31.5%; 95.6% and 4.4%; and 86.2% and 13.8% for normal and stunted; normal and wasted; and normal and underweight respectively. Majority (77.1%) of the children had MUAC > 12.5 cm, 16.9% had 11.5 – 12.5 cm and 6.0% had < 11.5 cm. Mother’s good nutritional practices (OR 0.50, 95% CI: 0.27 – 0.95) and MUAC > 12.5 cm (OR 0.10, 95% CI: 0.01 – 0.94; OR 0.01, 0.00 – 0.10; and OR 0.4, 0.01 – 0.19) were statistically significantly associated with stunting, wasting and underweight respectively. Conclusion: We established varied levels of stunting, wasting and underweight and mother’s nutritional practices and MUAC predicted these levels. More information, education and communication messages to the mothers and caretakers with regard to nutritional practices are needed so that under-nutrition can be improved, to ensure healthy living for mothers, care takers and under-five children.

In many developing countries, food environments are changing rapidly, with modern retailers—such as supermarkets—gaining in importance. Previous studies have suggested that the rise of modern retailers contributes to overweight and obesity. Effects of modern retailers on dietary quality have not been analyzed previously due to the unavailability of individual-level dietary data. Here, we address this research gap with data from randomly selected households in Lusaka, Zambia. Anthropometric and food-intake data from 930 adults and 499 children were analyzed to estimate effects of purchasing food in modern retailers on body weight, height, and dietary quality while controlling for income and other confounding factors. The food expenditure share spent in modern retailers was found to be positively associated with overweight in adults, but not in children. For children, a positive association between expenditures in modern retailers and height was identified. Modern retailers contribute to higher consumption of ultra-processed foods and calories. But they also increase protein and micronutrient intakes among adults and children, mainly through higher consumption of meat and dairy. The findings underline that modern retailers can influence diets and nutrition in positive and negative ways. Differentiated regulatory policies are needed to shape food environments for healthy food choices and nutrition.

The study sought to establish the benefits of school feeding programme (SFP) in Western Zambia. It also brought out the challenges encountered in the execution of the programme. This article is an extract from one of the objectives of ongoing study. School feeding entails the distribution of food commodities to children who attend school. The commodities may be locally grown and purchased or contributed by international donor community. The food may be consumed by the learners in school. In other settings, it may be given as take-home ration for consumption by the families that regularly send their children to school. The study employed a descriptive survey research design to collect, analyse and interpret both quantitative and qualitative data from 415 respondents. The results of the study showed that the school feeding programme is an intervention which has enormous education benefits; equitable access to education, increased school enrolment, improved attendance, punctuality and academic performance. Other benefits include: health and nutrition, social protection, parent involvement, and opportunities for local farmers. However, challenges were also reported; there were some possible negative attributes to the increase in the enrolment rates, that is, the educational quality may be compromised if the number of learners exceeds available resources such as desks, text books, teachers, and irregular supply of food to schools. The study recommended that plans and measures should be put in place by the government, relevant ministries and development partners on how to increase existing human, physical, and financial resources for the school feeding programme to be effective and sustainable. SFP should also be decentralized to the schools and community levels with more support from provincial offices to ensure a more effective school feeding programme.

Abstract Background We carried out analyses of early infant testing results at Livingstone Central Hospital in Zambia to assess time of testing, linkages to care and availability of test results for clinical decision making. Methods We abstracted data from registers of HIV-exposed infants who had dried blood spots cards (DBS) collected for DNA-PCR from January 2009 to December 2017. Only those tested from 2014 to 2017 had additional data which were used to estimate risk factors for mother-to-child HIV transmission using logistic regression models. Results DBS were collected from 2630 children. The proportion of HIV-positive tests decreased from 21% in 2009 to 2% in 2016 and 2017. Median turnaround time for results was 9 weeks (IQR: 5, 15) for HIV-negative, 7 weeks (IQR: 5, 13) for HIV-positive children. Only 2% of infants whose mothers took antiretroviral therapy (ART) were HIV positive, while 18% of infants whose mothers took short course antiretroviral drugs (ARVs) were infected. Infants of mothers who did not take ARVs had 9 times the odds of an HIV positive test (OR = 8.9, 95% CI: 3.6, 22.6). Infants of mothers who received short course ARVs were 40% less likely to get an HIV test within the first 2 months of life (OR = 0.6, 95% CI: 0.4, 0.9) compared to infants of mothers who received ART. Only 52% had a third test at median age 52 weeks (IQR: 50, 54). Conclusions Long turnaround time for test results and low retention in care after the initial HIV test were critical challenges to clinical decision making.

AbstractInadequate nutrient intakes put children at risk for impaired growth and development. We described diet, usual intakes of energy and macro- and micronutrients and prevalence of nutrient intake adequacies among 4–8-year-old Zambian children. Children not yet in school and living in Mkushi District, Central Province, Zambia were enrolled into an efficacy trial of pro-vitamin A biofortified maize. Children in the non-intervened arm were included in this analysis (n 202). Dietary intake data were collected by tablet-based 24-h recall on a monthly basis over the 6-month trial. Observed nutrient intakes were derived from reported food quantities, standard recipes and food composition tables. Usual nutrient intake distributions were modelled based on observed intakes. Prevalence of inadequacy was estimated by comparing the usual nutrient intake distribution to the nutrient requirement distribution. Frequency and quantity of consumption of commonly reported foods were described and key sources of energy and nutrients were identified. Median usual energy intake was 6422 kJ/d (1535 kcal/d). Most childrens’ macronutrient intakes fell within recommended ranges (74–98 %). Estimated prevalences of inadequate intakes of Fe, folate, vitamin B12 and Ca were 25, 57, 76 and >99 %, respectively. Estimated prevalences of inadequacy for other micronutrients were low (0·1–2·2 %). Commonly consumed foods included maize, vegetable oil, tomatoes, rape leaves and small fish (>0·6 servings/d), whereas meat, eggs or dairy were rarely eaten (<0·2 servings/d). These findings suggest that the heavily plant-based diet of rural Zambian children provides inadequate Ca, folate, vitamin B12 and Fe to meet recommended nutrient intakes.

Abstract. In some societies, studies involving blood draws, oral vaccinations, or supplementation are surrounded by myths and disbeliefs. If not clarified, they may affect study implementation and negatively impact the outcome of well-intended studies from inadequate participation. Through participatory action research, this paper suggests how future trials could be enhanced with reference to community mobilization, drawing from the experience of two interventions in Zambian children with nutritionally enhanced, biofortified orange maize conducted by the National Food and Nutrition Commission and Tropical Diseases Research Center (Zambia), and University of Wisconsin-Madison (USA). The preparatory phase included site visits, signing of a Memorandum of Understanding, equipment inventory, hiring staff, and community meetings. Prior results were shared before the second intervention. After Institutional Review Boards’ approval of procedures, written informed consent was obtained from caregivers. There was overwhelming community participation attributed to the demystification that the project was run by satanists prior to and during the study. Participation led to excellent compliance with 92.8 and 96.4% of subjects completing the final blood draw in 2010 and 2012, respectively. The results of the trials were successfully shared with the district officials and communities from where the study participants were drawn. The positive response by partners and communities, including information sharing, suggests that community mobilization, with the use of varied methods, is effective for full participation of the target groups in feeding trials and would be the case in similar trials if effectively carried out. Community participation in research studies may result in long-term adoption of biofortified foods.

AbstractObjectiveTo determine the prevalence of vitamin A deficiency, infection and adequacy of vitamin A intakes among Zambian children, and the contribution of dietary vitamin A and infection to vitamin A status.DesignA cross-sectional survey of vitamin A intakes by the 24 h recall method, vitamin A status by plasma retinol and the modified relative dose-response test, and infection by acute-phase proteins.SettingRural communities in Central and Eastern Provinces of Zambia.SubjectsChildren 2–5 years of age.ResultsThe prevalence of vitamin A deficiency was 56 % by plasma retinol, 48 % with infection-adjusted plasma retinol and 22 % by the modified relative dose-response test. The majority of children (61 %) had a current infection. Vitamin A intakes were relatively high (331 to 585 μg retinol activity equivalents/d in the harvest/early post-harvest and late post-harvest seasons, respectively) and the prevalence of inadequate intakes was <1 % when compared with the Estimated Average Requirement (210 and 275 μg retinol activity equivalents/d for children aged 1–3 and 4–8 years, respectively). Elevated α-1-acid glycoprotein was negatively associated with plasma retinol (P< 0·0 0 1) and vitamin A intake was positively associated with plasma retinol (P< 0·05), but only when estimated assuming a 26:1 retinol equivalence for provitamin A from green and yellow vegetables.ConclusionsInfection and vitamin A intakes were significant determinants of plasma retinol. We cannot conclude which indicator more accurately represents the true vitamin A status of the population. Reasons for the persistent high prevalence of vitamin A deficiency in the presence of adequate vitamin A intakes are unclear, but the high rates of infection may play a role.

Nutrition transition is characterised by shift to highly refined diets high in fat, salt and caloric sweeteners and low in fibre in rapidly growing economies. Dietary shifts occur almost concurrently with demographic and epidemiologic shifts, urbanisation and industrialisation and together contribute to increased prevalence of nutrition related (NR)-non-communicable disease (NCR). The emergence of nutrition transition in Southern Africa countries (SAC) was examined using anthropometric, NCD prevalence, and food consumption data. The findings reveal growing prevalence of overweight and obesity (OWOB) across SAC, with national prevalence estimated between 30 and 60 % in all but two SAC. Overweight prevalence in excess of 60 % has been reported in some sub-population groups. Hypertension prevalence of at least 30 % has also been reported. Further, the prevalence of OWOB and hypertension in many SAC exceeds that of HIV and is often at par with stunting in children. NCD are equally serious public health problems as stunting and HIV. Collectively, NR-NCD explain 20–31 % of mortality for Botswana, South Africa, Swaziland, Mozambique and Zambia. At least 72 % of adults in SAC have fewer servings of fruit and vegetable servings daily than recommended. Additionally, adults in SAC do poorly in physical activity; 31–75 % do not exercise regularly. Not surprisingly, 15–40 % of adults in SAC have at least three risk factors of CVD. SAC are grappling with NR-NCD which threaten to surpass infectious diseases burden. SAC are at various levels in interventions for moving their populations to stage 5, but there is room for much improvement.

In-depth information on dietary diversity and food consumption patterns in Zambian households is still scarce. This study, therefore, probed dietary intakes of mothers and their children living in households of two Zambian districts, Chipata and Monze, located in the eastern and southern provinces of Zambia, respectively. After assessing their diet, Dietary Diversity Scores (DDSs) were calculated and classified into low and high categories, while correlations were used to test determinants of DDS. The assessment revealed that the consumption of cereal-based products ranked highest in frequency. Specifically, the consumption of maize-based foods was highest in Chipata (55.43%) and then in Monze (43.56%) households. There was an observed low preference for mixed dishes that were not either maize or groundnut porridges. We also found positive and negative correlations of DDS with the educational level of household heads and age of mothers, respectively. We, therefore, suggest that increased nutrition education may improve dietary preferences, so also further investigation into other factors hindering low choices for mixed recipes will be useful in increasing overall diet quality.

Background: The Integrating Orange Project promotes production and consumption of orange-fleshed sweet potato (OFSP) to address vitamin A deficiency among rural populations of Zambia since 2011. Objective: This study assessed household production and consumption of OFSP and identified factors associated with consumption thereof in Integrating Orange Project areas in Chipata district, Zambia. Methods: Respondents of 295 randomly selected households were interviewed using a structured questionnaire during the sweet potato harvest season. Associations between OFSP consumption and household factors were assessed using χ2 tests. Results: Frequency of OFSP consumption was categorized as ≥4 days during the last 7 days (30.2%), 1 to 3 days during the last 7 days (49.5%), eats OFSP but not during the last 7 days (7.1%), and never (13.2%). In total, 60.3% of households planted OFSP, and 40.0% bought OFSP, mostly from farmers within the community. Orange-fleshed sweet potato consumption was associated with the presence of children aged less than 5 years in the household ( P = .018), production of OFSP ( P < .001), purchasing of OFSP ( P < .001), and respondent having knowledge on health benefits of OFSP ( P = .014). Age and sex of the household head and household size had no association with OFSP consumption ( P > .05). Conclusion: A high percentage of households consumed OFSP during the harvesting season in Integrating Orange Project areas. Programs promoting OFSP consumption should thus focus on OFSP production and sensitizing households on nutritional benefits of OFSP and target households with children aged less than 5 years as entry point.

AbstractEstimates of the components of nutrient intake variation are needed for modelling distributions of usual intake or predicting the usual intake of individuals. Season is a potential source of variation in nutrient intakes in addition to within- and between-person variation, particularly in low- or middle-income countries. We aimed to describe seasonal variation in nutrient intakes and estimate within-person, between-person and other major components of intake variance among Zambian children. Children from rural villages and peri-urban towns in Mkushi District, Zambia aged 4–8 years were enrolled in the non-intervened arm of a randomised controlled trial of pro-vitamin A carotenoid biofortified maize (n 200). Up to seven 24-h dietary recalls per child were obtained at monthly intervals over a 6-month period covering the late post-harvest (August–October), early lean (November–January) and late lean (February–April) seasons (2012–2013). Nutrient intakes varied significantly by season. For energy and most nutrients, intakes were highest in the early lean season and lower in the late post-harvest and late lean seasons. Season and recall on a market day had the strongest effects on nutrient intakes among covariates examined. Unadjusted within- to between-person variance ratios ranged from 4·5 to 31·3. In components of variance models, season accounted for 3–20 % of nutrient intake variance. Particularly in rural settings in low- and middle-income countries, where availability of locally grown, nutrient-rich foods may vary seasonally, studies should include replicates across seasons to more precisely estimate long-term usual intakes.

Background Impaired growth among infants remains one of the leading nutrition problems globally. In this study, we aimed to compare the growth trajectory rate and evaluate growth trajectory characteristics among children, who are HIV exposed uninfected (HEU) and HIV unexposed uninfected (HUU), under two years in Zambia. Method Our study used data from the ROVAS II study (PACTR201804003096919), an open-label randomized control trial of two verses three doses of live, attenuated, oral RotarixTM administered 6 &10 weeks or at 6 &10 weeks plus an additional dose at 9 months of age, conducted at George clinic in Lusaka, Zambia. Anthropometric measurements (height and weight) were collected on all scheduled and unscheduled visits. We defined linear growth velocity as the rate of change in height and estimated linear growth velocity as the first derivative of the mixed effect model with fractional polynomial transformations and, thereafter, used the second derivative test to determine the peak height and age at peak heigh. Results We included 212 infants in this study with median age 6 (IQR: 6–6) weeks of age. Of these 97 (45.3%) were female, 35 (16.4%) were stunted, and 59 (27.6%) were exposed to HIV at baseline. Growth velocity was consistently below the 3rd percentile of the WHO linear growth standard for HEU and HUU children. The peak height and age at peak height among HEU children were 74.7 cm (95% CI = 73.9–75.5) and 15.5 months (95% CI = 14.7–16.3) respectively and those for HUU were 73 cm (95% CI = 72.1–74.0) and 15.6 months (95% CI = 14.5–16.6) respectively. Conclusion We found no difference in growth trajectories between infants who are HEU and HUU. However, the data suggests that poor linear growth is universal and profound in this cohort and may have already occurred in utero.

AbstractObjectiveTo investigate trends in child malnutrition in six countries in southern Africa, in relation to the HIV epidemic and drought in crop years 2001/2 and 2002/3.DesignEpidemiological analysis of sub-national and national surveys with related data.SettingData from Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe, compiled and analysed under UNICEF auspices.SubjectsSecondary data: children 0–5 years for weight-for-age; HIV prevalence data from various sources especially antenatal clinic surveillance.ResultsChild nutritional status as measured by prevalence of underweight deteriorated from 2001 onwards in all countries except Lesotho, with very substantial increases in some provinces/districts (e.g. from 5 to 20% in Maputo (Mozambique, 1997–2002), 17 to 32% in Copperbelt (Zambia, 1999–2001/2) and 11 to 26% in Midlands province (Zimbabwe, 1999–2002)). Greater deterioration in underweight occurred in better-off areas. Areas with higher HIV/AIDS prevalences had (so far) lower malnutrition rates (and infant mortality rates), presumably because more modern areas – with greater reliance on trade and wage employment – have more HIV/AIDS. Areas with higher HIV/AIDS showed more deterioration in child nutrition. A significant area-level interaction was found of HIV/AIDS with the drought period, associated with particularly rapid deterioration in nutritional status.ConclusionsFirst, the most vulnerable may be households in more modern areas, nearer towns, to whom resources need to be directed. Second, the causes of this vulnerability need to be investigated. Third, HIV/AIDS amplifies the effect of drought on nutrition, so rapid and effective response will be crucial if drought strikes again. Fourth, expanded nutritional surveillance is now needed to monitor and respond to deteriorating trends. Finally, with or without drought, new means are needed of bringing help, comfort and assistance to the child population.

<p class="abstract"><strong>Background:</strong> Investing in parents and children during the critical period between birth and five years of a child’s life can have long-lasting benefits in the life of the child. Recently, the 2016 Lancet Series estimated that 250 million children aged less than five years in low- and middle-income countries (LMICs) are at risk of not reaching their developmental potential. Over 66 % of these, who live in sub-Saharan Africa and are at risk due to poor nutrition, exposure to poverty, high HIV prevalence as well as under stimulation in the home environment.</p><p class="abstract"><strong>Methods:</strong> The study will employ a cluster-randomized control trial design and will use a mixed-methods approach combining quantitative and qualitative methodologies <strong>(</strong>Concurrent Triangulation Design).<strong> </strong>This will be a two-arm study, where the first arm will participate in the parenting empowerment program implemented by the faith-based organizations, while the second (control) will not receive the parenting interventions. A total of 510 mother/primary caregiver-child dyads will be recruited into this study. We will estimate the causal effect of the intervention using mixed linear models and the Difference-in-Differences (DID) estimator.</p><p class="abstract"><strong>Conclusions: </strong> This implementation research will provide greater scientific rigor and a deeper process and outcome evaluation including measurement of child development outcomes. The findings will be useful for early childhood practitioners, multilateral stakeholders and funders as they provide information on the factors to consider in the implementation of high quality ECD interventions.</p><p class="abstract"><strong>Trial Registration: </strong>Ethical approval: ESRC P467/2018 and IRB No.00005948).</p>

Abstract Objectives Water insecurity may coincide with and exacerbate food insecurity and poor nutrition and health. The Household Water Insecurity Experiences (HWISE) Scale permits quantification and comparison of water access and use across low- and middle-income countries (LMICs). With Gallup and UNESCO, we collected the first nationally representative data on water insecurity in half the world's population. We investigated the national prevalence of water insecurity and predictors of altered food choice resulting from problems (in quantity, quality, or stability) with water. Methods The 2020–2021 Gallup World Poll administered the 12-item HWISE module to individuals ≥ 15 y in 31 countries in Africa, Asia, and South America. Responses to each item were “never,” “1–2 months,” “some, not all months,” and “almost every month” (scored 0–3, total range 0–36) in the prior 12 months. One HWISE item asked the frequency with which respondents changed what was eaten due to water problems. Ordered logistic regression models controlling for country fixed effects examined the odds of reporting a higher frequency of water-induced changes in food choices in relation to 10-y-increment age groups, sex, rural/urban residence, marital status, education, number of children and adult household members, 27 income brackets, difficulty affording shelter, and social support. Results In the seven countries for which data were available at the time of submission (China, Congo Brazzaville, Ghana, Ivory Coast, Mauritius, Uganda, and Zambia, n = 8,916), the national prevalence of water insecurity (HWISE score &gt; 12) ranged from 2.4 ± 0.4% in China to 42.7 ± 2.1% in Zambia. Higher odds of water-induced changes in food choices were found for each additional child (OR: 1.05; 95% CI: 1.02, 1.08) and with difficulty affording shelter (OR: 1.90; 95% CI: 1.69, 2.14). Lower odds of water-induced changes in food choices were found for each higher income bracket (OR: 0.97; 95% CI: 0.96, 0.98) and amongst those with social support (OR: 0.76; 95% CI: 0.67, 0.87) and those &gt; 65 years of age relative to other age groups (ORs ranging from 0.50–0.60; all P &lt; 0.02). Conclusions Water insecurity is a concern in many LMICs and may constrain food choices for people experiencing other social and economic hardships. Funding Sources Carnegie Corporation and United State Agency for International Development Cooperative Agreement.

Background Educational film is a communication tool that helps to present complex information simply and clearly, keeping audiences interested for longer and helping to reinforce important learning. Medical Aid Films produces educational films targeted at communities and health workers, with a focus on maternal and child health (MCH) content. Pilot work suggests that film screenings have attracted male as well as female viewers and have started to increase male involvement in MCH care. We explored stakeholder perspectives and gender-specific responses to educational films screened in a rural district of Serenje, Zambia. Methods A qualitative study using focus group discussions and in-depth interviews with men and women who had viewed the films at least once, and key informant interviews with health workers who helped deliver the film screenings. Thematic framework analysis was used to derive themes and subthemes, and illustrative quotes are used to substantiate interpretation of the findings. Results Men’s and women’s perspectives are clustered around the influence of the films on knowledge and behavior in relation to MCH topics and male involvement and overall community responses to the films. The three themes summarizing key informant perspectives relate to their impressions of the influence of the films on male involvement in MCH and their views on using film to deliver heath information. Conclusion Educational films have the potential to improve women’s and men’s knowledge and awareness of MCH topics, including healthy nutrition and welfare of women during pregnancy, the need to seek skilled care during pregnancy and for childbirth, and the importance of male involvement in supporting the care of women and children. Before widespread implementation, decisions must be made about whether and how to integrate the films with community health education programs, the needs, values, and preferences of men and women and how to present and deliver the film content in a way that maximizes participation of men and women in MCH but does not undermine women’s rights, autonomy, or safety.

The introduction of basic computer media for early childhood is very important because it is one of the skills that children need in this century. Need to support parents and teachers in developing the implementation of the use of computer technology at home or at school. This study aims to determine and understand the state of learning conducted based on technology. This research uses a qualitative approach with a case study model. This study involved 15 children and 5 parents. Data obtained through interviews (children and parents) and questionnaires for parents. The results showed that children who were introduced to and taught basic computers earlier became more skilled in learning activities. Suggestions for further research to be more in-depth both qualitatively and quantitatively explore the use of the latest technology to prepare future generations who have 21st century skills. 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AbstractStunting has remained a challenge in Zambia. Poor nutrition in early life of children below the age five has a great effect on stunting. This paper looked at other factors that can influence stunting among children aged 6–59 months. A cross-sectional survey was conducted in Kapiri-Mposhi district among 100 children aged 6–59 months. This study was part of the macro study Implementation of Nutrition-sensitive Agriculture in the Central Province of Zambia.” We looked at four factors, which included, the Mothers age, level of mother's education, Family size and marital status. These factors where compared to the nutrition status of children (Stunting). We used descriptive and binary logistic regression analysis to assess the factors that influence stunting. The prevalence of stunting was found to be 21%, wasting was 9% and underweight was 2%.This study found that Children who were born from teenage mothers were likely to be stunted (P < 0.02) than those from older mothers. In addition, we also found that there was a significant relationship between family size and stunting (P < 0.01). Most families that had over eight member were likely to have stunted children than those we had less. This study did not find any association between the mother's level of education or marital status and stunting in Kapiri-Mposhi district. Family size and mother's age are associated to stunting in Kapiri-Mposhi district.

Abstract Objectives The reduction of child stunting in the East African region remains slow, emphasizing the need to examine the contributions of less commonly studied determinants of linear growth faltering. The purpose of this study was to determine the association between the newly issued WHO and UNICEF Joint Monitoring Programme WASH indicators and child length in East Africa. Methods The most recent Demographic and Health Survey (DHS) nationally representative data from Burundi, Ethiopia, Kenya, Malawi, Rwanda, Tanzania, Uganda, and Zambia were used. Data from young children aged 6–23 months were included in the analyses. The association between individual water, sanitation and hygiene indicators and length-for-age (LAZ) was analyzed using linear regression models while controlling for the known child, maternal, and household characteristics for each country. Results Stunting rates were very high in all countries (more than 25%) reaching 44.6% in Burundi. In most of the countries, more than half of the population did not have improved WASH indicators. Better drinking water was significantly associated with higher LAZ in Burundi (b = 0.05, P < 0.05, R2 = 0.24), Kenya (b = 0.04, P < 0.01, R2 = 0.14), Tanzania (b = 0.06, P < 0.01, R2 = 0.21), and Zambia (b = 0.05, P < 0.05, R2 = 0.19) in the adjusted models. Improved sanitation facilities were associated with LAZ in Ethiopia (b = 0.20, P < 0.001, R2 = 0.24) and Uganda (b = 0.12, P < 0.05, R2 = 0.20). Lastly, the positive association between LAZ and hygiene practices remained significant after adjustments only in Ethiopia (b = 0.04, P < 0.01, R2 = 0.23). Conclusions Improved water quality was associated with better LAZ in most countries. Integrating nutrition interventions with WASH components for young children might be effective in reducing high child stunting rates in East Africa. Funding Sources None.

Abstract Objective: Adolescent girls are at risk for both macro- and micronutrient deficiencies affecting growth, maternal and child health. This study assessed the impact of an adolescent-girl-tailored nutritional education curriculum on nutritional outcomes, including knowledge, dietary behaviour, anthropometry and anaemia. Design: A cluster-randomised evaluation was conducted with two study arms: girls in mentor-led weekly girls’ groups receiving sexual and reproductive health and life-skills training assigned to an age-appropriate nutritional curriculum and control girls in the weekly girls’ groups without the nutritional education. The primary analysis was intent-to-treat (ITT) generalised least squares regression. Secondary analysis using two-stage, instrumental-variables estimation was also conducted. Setting: The intervention and evaluation were conducted in urban and rural areas across four of ten provinces in Zambia. Participants: In total, 2660 girl adolescents aged 10–19 years were interviewed in 2013 (baseline) and annually through 2017. Results: ITT results indicate that exposure to the nutritional educational programme did not meaningfully change outcomes for adolescents or their children. Intervention adolescents were no more likely to correctly identify healthy foods (P = 0·51) or proper infant-feeding practices (P = 0·92); were no less likely to be stunted (P = 0·30) or underweight (P = 0·87) and no less likely to be anaemic (P = 0·38). Outcomes for children of intervention participants were not improved, including being breastfed (P = 0·42), stunted (P = 0·21), wasted (P = 0·77) or anaemic (P = 0·51). Conclusions: Even a high-quality nutritional educational intervention tailored to adolescents within an empowerment programme does not assure improved nutritional outcomes; adolescent preferences, resource control and household dynamics require consideration in the context of nutritional educational programmes.

Abstract Background Malnutrition is the primary cause of death in infants and children. Malnutrition is very common in individuals aged from 6 to 60 months due to the lack of high-quality protein and to deficiencies in the intake of vitamin A, D, thiamine, riboflavin, niacin, calcium and iron. In low-income countries, the nutritional approach to treat child malnutrition is mainly based on RUTFs (Ready-to-Use Therapeutic Foods). Being produced by donor countries, RUTFs do not solve the problem of malnutrition at source: RUTFs are expensive for low-income communities and are distant from their local tradition. The use of ingredients not locally available and the passive participation of the community are the main cause of RUTFs failure among mothers of malnourished children. Community engagement and educating the local populations represent a key element in addressing the causes and treatment of malnutrition. Results Based on these concepts, the Pappa di Parma project, developed at Department of Food and Drug of University of Parma, aims to create a hyper-energetic and nutritional balanced meal, tailored on children from 6 to 60 months suffering from severe/moderate malnutrition, including only affordable local ingredients and technologies, providing in this way a potential long-term solution to decrease malnutrition. Conclusions The Pappa di Parma approach has been applied in Sierra Leone, Zambia, Tanzania, Burundi, Senegal, Togo from 2009 adapting to the different context. The Pappa di Parma approach consists in: (a) identifying the local food and creating a nutritional database; (b) developing recipes with accessible-to-family ingredients and with local technologies; (c) testing in loco the recipes in the real setting; (d) creating educational materials aiming to enhance awareness about the importance of a balanced nutrition.