Maternal and child undernutrition: effective action at national level

80% of the world's undernourished children live in just 20 countries. Intensified nutrition action in these countries can lead to achievement of the first Millennium Development Goal (MDG) and greatly increase the chances of achieving goals for child and maternal mortality (MDGs 4 and 5). Despite isolated successes in specific countries or for interventions--eg, iodised salt and vitamin A supplementation--most countries with high rates of undernutrition are failing to reach undernourished mothers and children with effective interventions supported by appropriate policies. This paper reports on an assessment of actions addressing undernutrition in the countries with the highest burden of undernutrition, drawing on systematic reviews and best-practice reports. Seven key challenges for addressing undernutrition at national level are defined and reported on: getting nutrition on the list of priorities, and keeping it there; doing the right things; not doing the wrong things; acting at scale; reaching those in need; data-based decisionmaking; and building strategic and operational capacity. Interventions with proven effectiveness that are selected by countries should be rapidly implemented at scale. The period from pregnancy to 24 months of age is a crucial window of opportunity for reducing undernutrition and its adverse effects. Programme efforts, as well as monitoring and assessment, should focus on this segment of the continuum of care. Nutrition resources should not be used to support actions unlikely to be effective in the context of country or local realities. Nutrition resources should not be used to support actions that have not been proven to have a direct effect on undernutrition, such as stand-alone growth monitoring or school feeding programmes. In addition to health and nutrition interventions, economic and social policies addressing poverty, trade, and agriculture that have been associated with rapid improvements in nutritional status should be implemented. There is a reservoir of important experience and expertise in individual countries about how to build commitment, develop and monitor nutrition programmes, move toward acting at scale, reform or phase-out ineffective programmes, and other challenges. This resource needs to be formalised, shared, and used as the basis for setting priorities in problem-solving research for nutrition.     

Maternal and child undernutrition: consequences for adult health and human capital

In this paper we review the associations between maternal and child undernutrition with human capital and risk of adult diseases in low-income and middle-income countries. We analysed data from five long-standing prospective cohort studies from Brazil, Guatemala, India, the Philippines, and South Africa and noted that indices of maternal and child undernutrition (maternal height, birthweight, intrauterine growth restriction, and weight, height, and body-mass index at 2 years according to the new WHO growth standards) were related to adult outcomes (height, schooling, income or assets, offspring birthweight, body-mass index, glucose concentrations, blood pressure). We undertook systematic reviews of studies from low-income and middle-income countries for these outcomes and for indicators related to blood lipids, cardiovascular disease, lung and immune function, cancers, osteoporosis, and mental illness. Undernutrition was strongly associated, both in the review of published work and in new analyses, with shorter adult height, less schooling, reduced economic productivity, and--for women--lower offspring birthweight. Associations with adult disease indicators were not so clear-cut. Increased size at birth and in childhood were positively associated with adult body-mass index and to a lesser extent with blood pressure values, but not with blood glucose concentrations. In our new analyses and in published work, lower birthweight and undernutrition in childhood were risk factors for high glucose concentrations, blood pressure, and harmful lipid profiles once adult body-mass index and height were adjusted for, suggesting that rapid postnatal weight gain--especially after infancy--is linked to these conditions. The review of published works indicates that there is insufficient information about long-term changes in immune function, blood lipids, or osteoporosis indicators. Birthweight is positively associated with lung function and with the incidence of some cancers, and undernutrition could be associated with mental illness. We noted that height-for-age at 2 years was the best predictor of human capital and that undernutrition is associated with lower human capital. We conclude that damage suffered in early life leads to permanent impairment, and might also affect future generations. Its prevention will probably bring about important health, educational, and economic benefits. Chronic diseases are especially common in undernourished children who experience rapid weight gain after infancy.     

孕产期心理保健干预研究

目的探讨孕产期心理保健重要性及对高危因素干预的必要性。方法把200名孕妇随机分为进孕妇学校组和未进孕妇学校组,并对其进行分析。结果两组比较差异有统计学意义(χ2≥3.84,P<0.01)。结论产褥期母体的精神变化相当复杂,据研究42%～76%的产妇表现为兴奋-抑郁过程。及时的发现,对产妇的生理、心理应激因素进行指导,有助于产妇产褥期的身心健康。     

Effects of prenatal exposure to the Dutch famine on adult disease in later life: an overview.

Chronic diseases are the main public health problem in Western countries. There are indications that these diseases originate in the womb. It is thought that undernutrition of the fetus during critical periods of development would lead to adaptations in the structure and physiology of the fetal body, and thereby increase the risk of diseases in later life. The Dutch famine--though a historical disaster--provides a unique opportunity to study effects of undernutrition during gestation in humans. This thesis describes the effects of prenatal exposure to the Dutch famine on health in later life. We found indications that undernutrition during gestation affects health in later life. The effects on undernutrition, however, depend upon its timing during gestation and the organs and systems developing during that critical time window. Furthermore, our findings suggest that maternal malnutrition during gestation may permanently affect adult health without affecting the size of the baby at birth. This may imply that adaptations that enable the fetus to continue to grow may nevertheless have adverse consequences of improved nutrition of pregnant women will be underestimated if these are solely based on the size of the baby at birth. Little is known about what an adequate diet for pregnant women might be. In general, women are especially receptive to advice about diet and lifestyle before and during a pregnancy. This should be exploited to improve the health of future generations.     

Impact of moving into poverty on maternal and child mental health: longitudinal analysis of the Millennium Cohort Study

BackgroundThe UK Government has recently questioned whether relative measures of income poverty effectively reflect children's life chances. Although relative poverty is associated with poor maternal and child mental health, few studies have assessed the impact of moving into poverty on mental health outcomes. To inform this debate, we explored the association between transitions into poverty and mental health among children and their mothers using a nationally representative sample of children in the UK followed up between 2000 and 2012.MethodsOur analysis of the UK Millennium Cohort Study was based on 5877 singletons who participated in sweeps of the study at ages 9 months to 11 years and were not in relative poverty nor had maternal and child mental health problems when these measures were first recorded at 3 years old. The main outcomes were maternal psychological distress (Kessler Psychological Distress scale, K6) and child socioemotional behavioural problems (Strengths and Difficulties Questionnaire) at ages 5, 7, and 11 years. The main exposure of interest was moving into relative poverty, defined as household equivalised income less than 60% of median household income, according to the Organisation for Economic Co-operation and Development equivalence scale. Using discrete time-hazard models, we estimated odds ratios for subsequent maternal and child mental health of new transitions into poverty, while adjusting for baseline confounding. We further assessed how maternal mental health mediated any impact on child mental health.FindingsOverall 904 families (15·4%) experienced a new transition into poverty. After adjustment for confounders, transition into relative poverty increased the odds of maternal psychological distress (odds ratio 1·86, 95% CI 1·51–2·29) and socioemotional behaviour problems in children (1·37, 1·02–1·85). Controlling for maternal psychological distress reduced the odds of socioemotional behavioural problems in children, and rendered the association non significant (adjusted odds ratio 1·26, 95% CI 0·92–1·72).InterpretationIn this UK cohort, transitions into relative poverty, by use of the currently contested income-based definition, were associated with an increase in the risk of child and maternal mental health problems. Maternal mental health appeared to mediate the association between poverty transitions and child mental health. Actions to address child poverty are needed to tackle the mental health crisis in children in the UK.FundingSW, BB, and DT-R are funded by the Wellcome Trust.     

Symptoms of attention deficit hyperactivity disorder and quality of life of mothers of school-aged children: The roles of child,mother, and family variables

This study examined the impact of inattention and hyperactivity symptoms in children and mothers, opposition problems in children, maternal depression, and perceived family support on the quality of life (QOL) of mothers. Mothers of children in one elementary school were contacted. The relationship between sociodemographic variables, the levels of inattention and hyperactivity symptoms in children and mothers, oppositional symptoms in children, maternal depression, perceived family support, and maternal QOL were examined. Three hundred and eighty-two participants were included in this study. Consistent factors related to the mother's QOL in the four domains were maternal depression, perceived family support, and housing status after controlling for several family, maternal, and child variables. Maternal QOL was more related to her own and family factors including maternal inattention, hyperactivity and depression symptoms, perceived family support, and housing status, instead of parent-rated inattention and hyperactivity symptoms of the child. Screening for maternal inattention, hyperactivity and depression symptoms, and mental health services for these mothers are warranted based on these findings.     

No health without mental health

About 14% of the global burden of disease has been attributed to neuropsychiatric disorders, mostly due to the chronically disabling nature of depression and other common mental disorders, alcohol-use and substance-use disorders, and psychoses. Such estimates have drawn attention to the importance of mental disorders for public health. However, because they stress the separate contributions of mental and physical disorders to disability and mortality, they might have entrenched the alienation of mental health from mainstream efforts to improve health and reduce poverty. The burden of mental disorders is likely to have been underestimated because of inadequate appreciation of the connectedness between mental illness and other health conditions. Because these interactions are protean, there can be no health without mental health. Mental disorders increase risk for communicable and non-communicable diseases, and contribute to unintentional and intentional injury. Conversely, many health conditions increase the risk for mental disorder, and comorbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis. Health services are not provided equitably to people with mental disorders, and the quality of care for both mental and physical health conditions for these people could be improved. We need to develop and evaluate psychosocial interventions that can be integrated into management of communicable and non-communicable diseases. Health-care systems should be strengthened to improve delivery of mental health care, by focusing on existing programmes and activities, such as those which address the prevention and treatment of HIV, tuberculosis, and malaria; gender-based violence; antenatal care; integrated management of childhood illnesses and child nutrition; and innovative management of chronic disease. An explicit mental health budget might need to be allocated for such activities. Mental health affects progress towards the achievement of several Millennium Development Goals, such as promotion of gender equality and empowerment of women, reduction of child mortality, improvement of maternal health, and reversal of the spread of HIV/AIDS. Mental health awareness needs to be integrated into all aspects of health and social policy, health-system planning, and delivery of primary and secondary general health care.     

Unintentional Role Models: Links Between Maternal Eating Psychopathology and the Modelling of Eating Behaviours

This study explored the relationships between maternal modelling of eating behaviours with reported symptoms of maternal eating psychopathology, anxiety and depression. Mothers (N = 264) with a child aged 1.5 to 8 years completed three self‐report measures designed to assess modelling of eating behaviours, eating psychopathology and levels of anxiety and depression. The study found that higher levels of maternal eating psychopathology were positively associated with eating behaviours that were unintentionally modelled by mothers but that maternal eating psychopathology was not associated with more overt/intentional forms of parental modelling. In addition, higher levels of maternal depression were associated with lower levels of both unintentional and intentional forms of maternal modelling, whereas maternal anxiety was not found to correlate with modelling behaviours. This study highlights the possible detrimental influences of maternal mental health in relation to mothers providing their child with a positive parental role model around eating and feeding. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.     

Feeding patterns of children with protein-energy malnutrition in Nigeria

Feeding patterns of 115 cases of children suffering from protein-energy malnutrition (PEM) were investigated to determine the feeding patterns and practices of children who succumb to PEM. The study was conducted at the Ile-Ife University Teaching Hospital in Nigeria between December, 1978 and May, 1979. 3 main clinical symptoms associated with PEM are Kwashiorkor, marasmus, and undernutrition. A questionnaire was given to mothers to record area of residence, age and sex of child, occupation and education level of parents, and mothers' feeding practices (breastfeeding, use of artificial milk, food taboos.) Tables present data on social characteristics of parents and age and sex distribution of malnourished children. 30.4% of mothers stopped breastfeeding before children were 1 year old, and 69.5% stopped before 17 months. 91.3% of the children were introduced to corn pap, a gruel made from corn, before they were 6 months, and were fed exclusively on it until after 12 months. 83.5% of mothers believed that meat and fish would cause intestinal worms and stomach pains, and 69.6% believed eggs would make a child steal. Mean age of onset of Kwashiorkor was 27 months. With appropriate nutritional health education and practical demonstrations, parents beliefs about food might be changed, possibly by reaching families through home visiting by community health workers.     

Traditional beliefs against weighing children regularly

Weighing children is one of the simplest, cheapest, and quickest methods of assessing the nutritional status of children. Regular weighing of children and recording the results on growth charts can be used to monitor the growth pattern of individual children and may promote early detection and prevention of growth-faltering due to illness or malnutrition. This paper considers the traditional beliefs against weighing children regularly among some populations in Tamil Nadu, India. The reason why mothers were reluctant to have their children weighed was most commonly the fear that the investigator might cast an evil eye. Every time the evil eye was suspected, a traditional purification ritual had to be followed. Other reasons given were that the child would lose weight and might suffer other illnesses, such as fever or diarrhea. 1 mother felt there was no use in weighin the child. Most mothers gave a combination of reasons. It has been abserved that mothers often allow their children to be weighed in exchange for some benefit each time. Another feeling among mothers is that weighin is related to sale of goods, be it meat or other materials: they do not want to sell their children. Regular weighing is only a diagnostic tool, and for credibility it needs to be seen to be connected with health care and nutrition intervention programs, in the form of food or nutrition education on the best use of available food.     

Caregiver mental health and HIV-infected child wellness: perspectives from Ugandan caregivers

Prior studies indicate a substantial link between maternal depression and early child health but give limited consideration to the direction of this relationship or the context in which it occurs. We sought to create a contextually informed conceptual framework of this relationship through semi-structured interviews with women that had lived experience of caring for an HIV-infected child while coping with depression and anxiety symptoms. Caregivers explained their role in raising healthy children as complex and complicated by poverty, stigma, and isolation. Caregivers discussed the effects of their own mental health on child well-being as primarily emotional and behavioral, and explained how looking after a child could bring distress, particularly when unable to provide desired care for sick children. Our findings suggest the need for investigation of the reciprocal effects of child sickness on caregiver wellness and for integrated programs that holistically address the needs of HIV-affected families.     

Maternal Substance Abuse: Infant Psychiatric Interest: A Review and a Hypothetical Model of Interaction

Substance abuse problems have strongly increased among Finnish women during the last decade. The negative effects that maternal substance abuse is thought to have on the quality of early mother-baby interaction are an area of interest and concern to specialists in infant mental health. During pregnancy and the newborn period of the infant, substance-abusing women have been shown to be especially willing and able to reduce use once the problem is identified. The desire to stop abusing substances appears to be predicated on a strong desire to be a good mother to the child. Interventions that focus on abstaining during pregnancy and on the early mother-child relationship have shown promise in helping these mothers improve the developmental prognosis of the child and become better parents through sobriety.     

Maternal substance abuse: infant psychiatric interest: a review and a hypothetical model of interaction.

Substance abuse problems have strongly increased among Finnish women during the last decade. The negative effects that maternal substance abuse is thought to have on the quality of early mother-baby interaction are an area of interest and concern to specialists in infant mental health. During pregnancy and the newborn period of the infant, substance-abusing women have been shown to be especially willing and able to reduce use once the problem is identified. The desire to stop abusing substances appears to be predicated on a strong desire to be a good mother to the child. Interventions that focus on abstaining during pregnancy and on the early mother-child relationship have shown promise in helping these mothers improve the developmental prognosis of the child and become better parents through sobriety.     

Resilience as a moderator between syndemics and depression in mothers living with HIV

Physical and emotional adversities in mothers have rippling effects across the family system. While an association between individual maternal adversities and problematic mental health outcomes has been established, less is known about co-existing adversities in mothers. Consistent with the syndemic conceptual framework, we examined the co-occurrence of Substance Abuse, Violence, and AIDS/HIV (i.e., SAVA), which are three adversities that uniquely affect racial/ethnic minorities, individuals living in poverty, and people in urban communities. We assessed the relationship between SAVA adversities and depressive symptoms among mothers living with HIV, as well as the moderating effect of resilience on this relationship. Participants included 55 mothers (M_age?=?41.24, SD?=?9.01; 81% Black) living with HIV in the U.S. MidSouth. Mothers were recruited from community agencies serving individuals living with HIV and completed hour-long interviews about SAVA, depression, resilience, life stressors, and their child’s mental health. Analyses were conducted in PROCESS for SPSS to test the relationship between SAVA and depression, as moderated by resilience. Analyses controlled for the influence of child maladaptive functioning (given known associations with maternal mental health) and maternal life stressors (given established associations with depressive symptoms). Findings indicated that experiencing more than one SAVA variable was associated with greater depressive symptoms (p?r?=??.45; p?β?=??.80; p?相似文献   

Low to moderate alcohol intake during pregnancy and risk of psychomotor deficits

Background: To examine the effects of low to moderate alcohol consumption during pregnancy on child motor function at age 5. Methods: A prospective follow‐up study of 685 women and their children sampled from the Danish National Birth Cohort based on maternal alcohol consumption during pregnancy. At 5 years of age, the children were tested with the “Movement Assessment Battery for Children” (MABC). Parental education, maternal IQ, prenatal maternal smoking, the child’s age at testing, and gender of child were considered core confounders, while the full model also controlled for prenatal maternal binge drinking episodes, age, maternal prepregnancy body mass index, parity, home environment, postnatal parental smoking, health status, and indicators for hearing and vision impairment. Results: There were no systematic or significant differences in motor function between children of mothers reporting low to moderate levels of average alcohol consumption during pregnancy and children of mothers who abstained. Conclusions: In this study, we found no systematic association between low to moderate maternal alcohol intake during pregnancy and child motor function at age 5.     

Preventing maternal and child malnutrition: the nutrition component of the Mesoamerican Health Initiative 2015

To describe the regional master plan of nutrition to address maternal and child malnutrition in a 5- year period developed by the Nutrition Technical Group. The Nutrition Technical Group developed a situation analysis describing the main nutrition problems, policies and programs in Mesoamerica. The situation analysis and a literature review about effective interventions to address malnutrition were conducted to develop a nutrition master plan. The Nutrition Technical Group held various meetings to develop, discuss and validate the master plan. Theory of change identified problems and barriers, the actions to be developed, the changes and impacts expected. A package of interventions is proposed to reduce undernutrition and micronutrient deficiencies useful under different epidemiological contexts. The nutrition master plan provides a guideline of best practices that can be used for evidence-informed decision making and the development of national policies and programs to reduce malnutrition.     

Predictors of maternal control of feeding at 1 and 2 years of age

OBJECTIVE: To establish the best predictors of maternal use of controlling feeding practices at 1 and 2 years of age. DESIGN: A longitudinal study from birth to 2 years. PARTICIPANTS: Sixty-two mothers of 2-year-old children. MEASURES: Infant weight at birth, 6, 12 and 24 months, breastfeeding history, infant temperament and feeding difficulties at 6 and 12 months, maternal demographics at 12 and 24 months, maternal mental health at 6 and 12 months, maternal controlling feeding practices at 12 and 24 months. RESULTS: Controlling feeding practices at 1 year were predicted by perceptions of infant temperament at 6 months, birth weight, length of breastfeeding, mental health at 6 months, and mealtime negativity at 6 months. Parental control over feeding when their child reached 2 years was predicted by the mother's tendency to use that particular strategy at 1 year in combination with the perceptions of infant temperament and feeding problems at 1 year, weight at 1 year, length of breastfeeding in infancy, and/or maternal mental health at 1 year. CONCLUSIONS: Breastfeeding appears to promote subsequent monitoring, and is associated with reduced use of pressurising and restrictive feeding practices. Infant characteristics are important predictors of control at both 1 and 2 years of age. The use of controlling feeding practices is relatively stable from 1 to 2 years.