bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perspectives of Wife‐Husband Pairs on Their Roles in Infant and Young Child Feeding Decision‐Making in the Context of Malawi's Prevention of Mother‐to‐Child HIV Transmission Program
Authors: Chintalapudi Nainisha , Hamela Gloria , Mofolo Innocent , Hosseinipour Mina , Hoffman Irving , Bentley Margaret , Maman Suzanne , Flax Valerie 
Published: November 2023

Studies have examined the role of male involvement in HIV counseling and testing within prevention of mother‐to‐child transmission (PMTCT) programs, but there is no corresponding data on male involvement in infant and young child feeding (IYCF) decision‐making and its relation to adherence to HIV and infant feeding guidelines. Adherence to IYCF guidelines remains important for limiting HIV transmission through breast milk and improving child survival. We explored wives’ and husbands’ perceptions of husbands’ roles in feeding decision‐making and practice in the context of Malawi's Option B+ PMTCT program through in‐depth interviews conducted in the catchment areas of 2 urban and 2 rural government clinics in Lilongwe District. Participants were 15 wife‐husband pairs (interviewed separately), where the wife was ≥ 18 years, HIV‐positive, and had a child < 24 months. The interviews were analyzed using thematic content analysis. Husbands were generally less well‐informed about IYCF recommendations than their wives, who were advised on IYCF during antenatal and PMTCT clinic visits. Most husbands and wives agreed that the wife was largely responsible for IYCF decision‐making and few husbands were involved in decisions about complementary feeding. Some husbands participated in decisions about when to stop breastfeeding the child because of their fears about the child becoming HIV infected, even if the wife was on antiretroviral therapy. In couples where the husband advised the wife on feeding, the wife usually said that she followed his wishes. Both wives and husbands wanted to avoid disagreements about IYCF because they were worried that such disagreements would harm the child's health and well being. For wives and husbands, the most important role of husbands in relation to IYCF was to purchase food or provide money for food for the child. Wives appreciated it when their husbands offered verbal support to encourage them to continue with the recommended IYCF practices. Wives whose husbands were supportive found it easier to follow breastfeeding recommendations, but adequate complementary feeding remained a challenge in the face of household food insecurity. In conclusion, Malawian husbands and wives reported highly gendered roles in relation to IYCF decision‐making in the context of HIV, but some women flagged their interest in having verbal, in addition to monetary, support from their husbands for IYCF practices. To address this gap, strategies should be tested for getting messages on IYCF to husbands through male‐friendly radio and community‐based programs or by encouraging them to participate in PMTCT visits with their wives.Support or Funding InformationNIH BIRCWH K12 program, UNC CFAR developmental award
Nutrient adequacy among illegal drug users in the Greater Accra Region of Ghana
Authors: Setorglo Jacob Yaw , Gavor‐Kwashie Cyril , Pereko Kingsley Kwadwo Asare , Klevor Moses Kwashie , Steiner‐Asiedu Matilda 
Published: November 2023

BackgroundDietary diversity (DD) is a proxy for determining quality and nutrient adequacy of diet. Illegal drug user populations are believed to have poor dietary patterns which may compromise their nutritional health. The study assessed the diversity of the diets of illegal drug users in the Greater Accra Region of Ghana.DesignA snowball sampling technique was used to select the sample whilst dietary data was collected using the 24‐hour recall method and background data through a questionnaire. Data were analysed using SPSS software (Version 16, Chicago Illinois). Foods consumed were grouped into 9 groups, and mean counts of groups were scored. Consumption of foods from less than 3 of the 9 food groups was considered as low DD whilst middle DD was classified as consuming foods from 4 to 5 different food groups. High DD was classified as consuming foods from more than 5 food groups. Ethical approval was provided by the Institutional Review Board of the University of Cape CoastResultsThose aged less than 20 years had higher DD scores compared with those aged 20 years and above (P= 0.03). The mean sample DD score was 4.1. Both males and females had high scores for starchy staples and the least scores for milk and milk products. Marijuana users had higher mean DD scores compared with cocaine users (P= 0.03)ConclusionThe sample studied had middle level nutrient adequacy. Younger drug users had better nutrient adequacy.
Influences of Early Child Nutritional Status and Home Environment on Child Development in Vietnam
Authors: Nguyen Phuong , Casanova Ines Gonzalez , DiGirolamo Ann , Pham Hoa , Truong Truong V , Truong Son V , Martorell Reynaldo , Ramakrishnan Usha 
Published: November 2023

Early childhood development plays a key role in a child's future health, educational success, and economic status. However, suboptimal early development remains a global challenge despite recommended interventions that combine stimulation, nutrition, and health programs. This study assesses the role of intra‐uterine growth retardation, child nutritional status in the first year of life and the quality of the home environment on child development in northern VietnamWe used prospective data that were collected as part of a randomized controlled trial evaluating the impact of preconceptional micronutrient supplements (PRECONCEPT) on maternal and child health in Vietnam. This study sample comprised of 935 singleton infants with child development data at 24 months of age. The Bayley Scales of Infant Development‐III were used to assess three developmental domains: cognition, language and motor. The raw summary scores for each of the domains were computed and then transformed to standardized Z‐scores for easy to comparison across domains. The main independent variables included small for gestational age (SGA) at birth, height‐for‐age z‐score (HAZ) and quality of the home and learning environment based on the HOME inventory at 12 months of age. We used multivariate generalized linear regression models that adjusted for potential confounding factors (maternal education, maternal anemia, maternal depression, child gender and household socioeconomic status) and structural equation modeling to assess the direct and indirect effect of child growth and home environment quality on child development.At birth, 12% infants were born SGA. Mean HAZ at 12 months was −0.91 ±1.03. Child HAZ at 12 months was a significant independent predictor of all child development domains at 24 months. A 1 standard deviation (SD) increase in HAZ was associated with 0.10, 0.11 and 0.13 SD increase in cognition, language and motor scores, respectively. SGA has both direct and indirect effects on motor development (total effect size = −0.28), but its influence on cognitive and language development is indirect though child HAZ at 12 months. Living in a high quality learning environment at home is associated with an average of 0.3 SD higher in each of the developmental domains, but this association was attenuated after controlling for maternal education and SES.In conclusion, poor growth during the first 500 days of life (pregnancy and the first year) negatively influenced child development at 24 months. Early interventions aimed at improving pregnancy outcomes and child growth, along with promoting a good quality home environment, are critical to ensure optimal child development.Support or Funding InformationFunded by Mathile Institute for the Advancement of Human Nutrition, Micronutrient Initiative, and The Nestlé Foundation.
Pica is Associated with Lower Hemoglobin Concentration in a Cohort of Pregnant Kenyan Women of Mixed HIV Status
Authors: Miller Joshua D. , Collins Shalean , Krumdieck Natalie R. , Wekesa Pauline , Onono Maricianah , Young Sera L. 
Published: November 2023

Pica is the craving and purposeful consumption of non‐food substances. Although the practice has been well documented globally, its social, psychological, and biological covariates are not well understood. Further, little is known about the relationship between pica and HIV. Therefore, in a cohort of pregnant Kenyan women of mixed HIV status (n=370), we sought to 1) assess the prevalence and types of pica; 2) describe the sociodemographic characteristics associated with pica; 3) describe psychological covariates; and 4) understand its relationship with physiological outcomes including HIV status, anemia, and symptoms of gastrointestinal distress at enrollment into the study.Survey data were collected by clinic‐based study nurses and included information about: pica behavior (both current and during childhood), sociodemographic background, depression (using the Center for Epidemiologic Studies‐Depression Scale, CES‐D), stress (using the Perceived Stress Scale, PSS), hemoglobin (Hb, using Hemocue), and gastrointestinal distress (nausea, vomiting, or diarrhea in the prior 24 hours). Pica was operationalized as a dichotomous variable, based on 24‐hour dietary recall.Of the 370 participants, 22.4% had engaged in pica in the previous 24 hours. Eating earth was the most common form of pica (geophagy, 19.5%), followed by raw starches (amylophagy, 2.4%), and other non‐food items, e.g. ash, charcoal (0.5%). There were no significant differences in pica behavior by demography (tribe, religion, relationship status) or household asset index. However, urban women were more likely to practice any pica (25.9% vs 16.7%, p=0.04). A greater proportion of women who reported practicing pica as children engaged in it during pregnancy (35.0% vs 20.7%, p=0.01). In terms of psychological covariates, CES‐D and PSS scores among women with pica were higher than those without, (mean±SD, 20.5±7.8 vs 17.8±8.4, p=0.009) and (20.9±4.2 vs 19.7±4.4, p=0.02), respectively. Women practicing pica had lower Hb levels than those who did not (10.5 g/dL ±1.89 vs 11.3±1.71, p<0.005). A greater proportion of HIV positive women practiced pica (28.6% vs 17.9%, p=0.02). Gastrointestinal symptoms did not differ by pica. In a multivariate logistic model of any pica, only Hb (OR=0.78, p=0.008) and pica during childhood (OR=2.42, p=0.009) were significant.In sum, we observed strong, biologically significant relationships between current pica and both physiological (Hb) and behavioral (pica in childhood) covariates. Indeed, for each g/dL lower of Hb, the odds of a woman engaging in pica increased by 22%. This relationship between pica and lower Hb, together with the prevalence during pregnancy, suggests that discovering the etiology is a public health priority, and that inquiry into the consequences of pica should be biocultural.Support or Funding InformationNIH K01 MH098902
Urinary Aflatoxin M1 Concentrations among Pregnant Women in Bishoftu, Ethiopia
Authors: Tsegaye Workneh , Fereja Mengistu , Gebreegziabher Tafere , Stoecker Barbara J. 
Published: November 2023

Aflatoxins are fungal metabolites that can infect food grains in both developed and developing countries. In Ethiopia aflatoxin has been detected in several staple cereals at concentrations ranging from a trace to 26 μg/kg. However, aflatoxin exposures in the population in general and in pregnant women in particular have not been studied. Exposure to aflatoxin during pregnancy may impair fetal growth and development and result in long term health risks to both mothers and infants. The objective of this study was to quantify aflatoxin M1 (AFM1), a metabolic byproduct of the potent carcinogen aflatoxin B1, in urine from pregnant women. Study participants were 349 pregnant women selected by two‐stage cluster sampling from rural areas in Bishoftu, Ethiopia, in September and October, 2014. AFM1 concentrations in urine were determined as short‐term exposure indicators using ELISA kits. Urinary creatinine concentrations were determined with a clinical analyzer. Detectable urinary AFM1 was found in 72.5% (253) of women. Samples with detectable AFM1 ranged from 4.8 to 4331 pg AFM1/mg creatinine. The median (IQR) AFM1 concentrations in exposed pregnant women were 199.8 (69.5, 406.6) pg/mg creatinine. This high aflatoxin exposure emphasizes the necessity for intervention strategies to decrease aflatoxin in the food supply and to reduce exposure during pregnancy. Further investigation is required to assess specific sources of long‐term aflatoxin exposure as well as aflatoxin associations with birth outcomes.Support or Funding InformationSupported by Oklahoma State University.
Dietary patterns close socioeconomic disparity in adolescents’ height and adiposity level in urban Gambia
Authors: Juwara Alimatou , Chen Hsin‐Jen 
Published: November 2023

BackgroundThere is great disparity in adolescents’ nutritional status between public and private schools in urban Gambia. The present study examined the disparity of adolescents’ hunger experiences and dietary patterns between public and private schools in urban Gambia.MethodsThis school‐based cross‐sectional study took place in six private and six public middle schools in Banjul and Kanifing, the Gambia. In total, 960 students (13–15 years old) were recruited. Standing height and body mass index (BMI) were converted to Z‐score using the WHO growth references. Main outcomes of interest included height‐for‐age Z score (HAZ), BMI‐for‐age Z score (BMIAZ), and percent of body fat (BF%). BF% was measured on Tanita BIA UM‐076. Information on family socioeconomic status were based on parent/guardian's response. Hunger experience was based on participants’ self‐report on ever feeling hungry both at home and in school in the past 30 days. A food frequency questionnaire of 14 common food groups in the Gambia was administered to collect adolescents’ dietary habit in the past 7 days of interview. Factor analysis extracted the dietary patterns by analyzing the commonality of the consumption of 14 food groups.Results52.6% of public school students and 7.7% of private school students reported ever feeling hungry at home and school in the past 30 days. The differences in HAZ, BMIAZ, and BF% by family socioeconomic status were not significant after hunger experience was taken into account, while hunger experience itself was significantly associated with lower HAZ (by −0.17, 95% CI: −0.34, 0.00), BMIAZ (by −0.34, 95% CI: −0.57, −0.11), and BF% (by −1.85%, 95% CI: −3.00%, −0.70%). Factor analysis identified 4 independent dietary patterns. The 1st pattern includes red meat, egg, milk, dairy and sweetened beverage. The 2nd pattern includes vegetables, tubers, fruits and juices. The 3rd pattern includes whole grain and poultry. The 4th pattern is fried foods and seafood. Adolescents in private schools had higher HAZ than those in public schools, but the difference was no longer significant after dietary patterns were adjusted. Meanwhile, hunger was no longer associated with HAZ after dietary patterns was controlled. As for adiposity, disparity in BF% between public and private schools disappeared after dietary patterns were controlled, but hunger was still associated with a lower BF% (−1.38%, 95% CI: −2.49%,−0.26%). However, disparity in BMI‐for‐age between public and private schools remained significant after dietary patterns were taken into account.ConclusionThe observed disparity in nutritional status between public and private schools in the urban Gambia may be eliminated when children have comparable dietary quality.
Weight Status and the Family Meal Environment in India
Authors: Jones Rebecca , Cunningham Solveig , Patil Shailaja 
Published: November 2023

BackgroundChildren's weight status is correlated to that of their mothers, and this pattern is believed to result in large part from family meal and activity environments. It may be that heavier parents create different environments, which have affected their own weight and will affect that of their kids. We explore these patterns in a developing‐country setting, where obesity is believed to be a new phenomenon but already affects almost half of mothers of adolescents.ObjectiveIs the meal environment different in families where the mother is and is not obese, in the context of an Indian town just beginning to experience the nutrition transition?MethodsWe collected data in Vijayapura, India in a developing region of Southern India. A representative school‐based sample of 400 adolescents was collected in‐home with data from adolescents and their mothers including direct anthropometry.ResultsOur results show 50% of overweight/obese adolescents reported eating outside the home, compared to under‐/normal weight adolescents (36%). 82% of overweight/obese adolescents had an obese mother versus whereas none of the overweight/obese adolescents had a under‐/normal weight mother. Significant differences between weight categories of adolescents were demonstrated at every level of family income reported; with higher income groups having significantly higher proportion of overweight/obese adolescents (19% versus 6% under/normal weight). Adolescents who were overweight/obese were forced to eat more by family members (57%) compared to normal/underweight adolescents (28%). A large proportion of all adolescents in the sample reported eating meals in front of the television (69–73%).ConclusionThese findings suggest patterns of unhealthy weight in mothers and their adolescent child as well as overweight/obese adolescents being associated with highly educated, high‐income families.
Influence of Family Mealtime Routines on Preschoolers’ Picky Eating Behaviors and Food Consumption
Authors: Cole Natasha Chong , Musaad Salma M. , Fiese Barbara H. , Lee Soo‐Yeun , Donovan Sharon M. 
Published: November 2023

In the division of responsibility in feeding, parents are responsible for what, when, and where the child is fed, while the child is responsible for how much and whether to eat. Few studies have focused on parent's responsibility for establishing mealtime structure and routine, and how this influences children's eating behaviors, dietary intake, and weight status. The objective of this study was to examine the role of family mealtime routines on children's picky eating behaviors, dietary intake, and body weight. A total of 497 primary caregivers of 2‐ to 5‐year‐old children residing in East‐Central Illinois were recruited as part of the STRONG Kids observational cohort study. Participants responded to survey questions about their family mealtime routines and children's eating habits. Family mealtime routine was measured using a five‐item scale in order to assess the frequency and planning of family mealtimes, and communication during mealtimes. Higher scores on the family routine scale represented a higher sense of positive mealtime climate associated with the family mealtime routine. Child height and weight were measured by trained research personnel and used to calculate body mass index (BMI), BMI percentile, and BMI Z‐score. Frequent struggles with the child over food was positively associated with children's food refusals (r=0.38, p<0.01). Family mealtime routines were associated with fewer food refusals, lower consumption of fatty/sugary foods, and higher consumption of fruits and vegetables (all p<0.05). There was no association between BMI percentile and family mealtime routines. Overall, our findings suggest that family mealtime routines may protect against the development of picky eating behaviors and unhealthy dietary patterns in preschoolers. Further research is needed to define the effects of family mealtime structure and routine on children's long‐term weight‐gain trajectories.Support or Funding InformationMs. Cole was supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, under award number 2011‐67001‐30101.
Association Between Maternal Pre‐Pregnant Body Mass Index and Breast Markers for Lactation Insufficiency Among Mothers With Self‐Reported Low Milk Supply
Authors: Cassar‐Uhl Diana , Liberatos Penny 
Published: November 2023

BackgroundWomen with high pre‐pregnant body mass index (BMI) have lower rates of breastfeeding exclusivity and duration than their normal‐BMI counterparts. Animal models suggest that the physiology of obesity may corrupt normal mammary gland development and function. This study sought to identify an association in humans between pre‐pregnant BMI and physical characteristics that may be predictive of disrupted lactation due to insufficient glandular development of the breast.MethodsThe data for this analysis was drawn from a 2013 study of mothers who intended to exclusively breastfeed but believed they did not produce sufficient milk to do so. The mixed‐methods, 141‐item questionnaire was available online and participants were recruited through Internet platforms for mothers with breastfeeding problems and email listservs for breastfeeding supporters. Pre‐pregnant BMI was calculated from self‐reported pre‐pregnant height and weight. Those with BMI >= 25 were classified as high BMI. Respondents who reported little or no breast changes in pregnancy, little or no breast changes postpartum, wide ( > 1.5 inches or 3.8 cm) intramammary space, and tubular breast shape were classified as having markers of insufficient glandular development. Logistic regression was used to test for an association between pre‐pregnant BMI and breast markers that may be predictive of lactation insufficiency.Results57.5% of respondents (N = 1022) reported a pre‐pregnant BMI of 25 or greater. High pre‐pregnant BMI was strongly and significantly associated (OR = 2.42, 95% CI: 1.79, 3.26; p < .0001) with having the four markers suggestive of insufficient breast gland development.ConclusionWomen with high pre‐pregnant BMI may be more likely to also have insufficiently developed breasts, resulting in reduced capacity for exclusive breastfeeding.Support or Funding InformationNone. This study was undertaken in partial fulfillment of the first author's Master of Public Health thesis project.