中国部分地区婴幼儿喂养状况及国际比较研究

【目的】 了解我国研究地区婴幼儿喂养现状,比较该地区与全球发展中国家的婴幼儿喂养水平,探索我国婴幼儿喂养中存在的问题。 【方法】 采用横断面调查设计和多阶段分层随机抽样的方法,使用联合国儿童基金会(UNICEF)标准化问卷对我国中西部40个县3 708名2岁以下儿童看护人的喂养情况进行调查,分析世界卫生组织(WHO)2008年版《婴幼儿喂养评估指标》中的8个指标并与世界卫生组织 2010年公布的46个发展中国家的数据进行比较。 【结果】 调查地区早开奶率、6个月以下儿童纯母乳喂养率、1岁和2岁时持续母乳喂养率均低于发展中国家平均水平,在47个国家中分别位列第34、39、44和45名。辅食及时添加率、辅食添加种类合格率位列前20%,辅食添加普遍过早。 【结论】 调查地区婴幼儿喂养中主要存在开奶不及时、母乳喂养伴随喂水、过早添加辅食和母乳喂养持续时间短的问题。加强健康宣教,传播喂养知识,对婴幼儿喂养状况的改善具有积极作用。     

Caregivers' responses to an intervention to improve young child feeding behaviors in rural Bangladesh: a mixed method study of the facilitators and barriers to change

Behavior change communications regarding child feeding have met with mixed success. The present study analyzes responses of 34 Bangladeshi caregivers seven months after they received a responsive feeding intervention. The intervention communicated and demonstrated five feeding interactions: hand-washing, self-feeding, verbal responsivity, managing refusals non-forcefully, and dietary diversity. Seventeen caregivers who adopted key behaviors addressed by the intervention and 17 who did not were compared in terms of socio-demographic variables, but more importantly in terms of their recall of the messages, their reported practice, and reported facilitators and barriers. Both those who changed and those who did not reported similar facilitators and barriers to practicing the new behaviors; there was also no difference in recall or in socio-demographic variables. Key themes identified through a constant comparative analysis helped to focus on common features of the lives of caregivers that made it easy or difficult to perform the practices. Some of these were household constraints such as poverty, shortage of time in which to complete chores, and avoiding waste and messiness; others related to the child's demands. Many caregivers misinterpreted instructions about talking to one's child in response to signals, as opposed to more common forms of supervision. Facilitators such as the child's evident pleasure and the caregiver's satisfaction did not always outweigh the barriers. Recommendations for improving interventions include helping caregivers solve problems tied to barriers and including more family members in the intervention.     

广东省6～18月龄婴幼儿喂养指数分布及与体格发育的相关性研究

目的分析广东地区6—18月龄婴幼儿喂养指数（ICFI）及与体格发育指标之间的相关性,以探讨ICFI应用于定量评估和比较婴幼儿喂养习惯的有效性。方法整群抽取广东省广州市荔湾区（城市）、佛山市南海区（城镇）、江门市新会区（农村）所有已建立健康档案的6—18月龄婴幼儿,问卷凋查喂养现况及测查体格发育。以中国疾病预防控制中心营养与食品安全所提出的ICFI评分体系为依据,计算评价ICFI。使用WHO推荐的Anthro软件计算婴幼儿的年龄别身长z评分（HAZ）、年龄别体重z分（wAz）、身长别体重z分（WHZ）。分析ICFI与各类z评分的相关性。结果共调查6～18月龄婴幼儿1771人,其中男997人,女774人。全省ICFI为（7．05±2．47）,高于全国平均值（5．9±2．6）,其中城市（474人）、城镇（658人）ICFI分别为（7．29±2．25）和（7．39±2．53）,明显高于农村（639人）ICFI（6．52±2．49）（P〈0．05）。6—8月龄（606人）、9～11月龄（317人）、12—18月龄（848人）ICFl分别为（6．59±2．47）、（6．87±2．45）、（7．44±2．42）,ICFI随月龄增加而增加（P〈0．01）。ICFI总合格率49．2％（872／1771）,其中城市、城镇和农村分别为53．0％（251／474）、56．7％（373／658）和38．8％（248／639）,城市、城镇合格率高于农村（P〈0．01）,6—8、9～11、12～18月龄合格率分别为37．6％、46．7％和58．5％,随月龄增加,合格率明显提高（P〈0．01）。城市ICFI与HAZ、WHZ相关（r=0．108、0．117,均P〈0．05）,城镇ICFI与WHZ相关（r=0．104,P〈0．01）。12～18月龄组ICFI与WAZ和HAZ相关（,=0．110、0．136,均P〈0．01）。结论广东省6～18月龄婴幼儿ICFI高于全国平均值。ICFI可在一定程度上反映出婴幼儿群体的生长发育状况,并可用于婴幼儿喂养方法的综合评判,但其应用效度有待改善。     

婴幼儿喂养指数与辅助食品添加早期婴儿营养状况的相关性研究

【目的】分析婴幼儿喂养指数(infant and child feedingindex,ICFI)与贫困农村及富裕城市5～6月龄婴儿体格生长指标之间的相关性,证实ICFI应用于定量评估和比较不同地区婴儿喂养习惯的有效性。【方法】采用横断面问卷调查方法进行调查。选择其中5个月0 d至6个月29 d婴儿的数据和资料,以母乳喂养及次数、辅助食品添加次数、辅助食品质地和膳食多样性评分,建立并计算5～6月龄婴儿的ICFI。【结果】富裕城市婴儿的体格生长指标、膳食多样化分数均显著优于贫困农村婴儿。两者婴儿的数据合并,ICFI与全体5～6月龄婴儿的年龄别身长的Z-评分、年龄别头围的Z-评分存在显著正相关性,ICFI高组婴儿的年龄别身长的Z-评分显著高于ICFI低组。【结论】ICFI可用于评估和比较贫困农村及富裕城市辅助食品添加早期婴儿的喂养习惯。同时提示在婴儿辅助食品添加早期就应该注意增加食物多样化。     

Understanding the Enablers and Barriers to Appropriate Infants and Young Child Feeding Practices in India: A Systematic Review

Despite efforts to promote infant and young child feeding (IYCF) practices, there is no collective review of evidence on IYCF enablers and barriers in India. This review was conducted using 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Six computerized bibliographic databases, Scopus, PubMed, PsycINFO, CINAHL, Embase, and Ovid MEDLINE, were searched for published studies on factors associated with IYCF practices in India from 1 January 1993, to 30 April 2020. IYCF practices examined were early initiation of breastfeeding, exclusive breastfeeding, continued breastfeeding at one year, introduction to solid semi-solid or soft foods, minimum dietary diversity, minimum meal frequency, minimum acceptable diet, continued breastfeeding at two years, predominant breastfeeding, and bottle feeding. In total, 6968 articles were retrieved, and 46 studies met the inclusion criteria. The common enablers of IYCF were higher maternal socioeconomic status (SES) and more frequent antenatal care visits (ANC) (≥3). Common barriers to IYCF practices were low SES and less frequent ANC. The review showed that the factors associated with IYCF practices in India are largely modifiable and multi-factorial. Improving IYCF practices would require the adoption of both facilities- and community-based policy interventions at the subnational and national levels in India.     

Getting the complete picture: combining parental and child data to identify the barriers to social inclusion for children living in low socio-economic areas

Background Childhood mental health problems are prevalent in Australian children (14–20%). Social exclusion is a risk factor for mental health problems, whereas being socially included can have protective effects. This study aims to identify the barriers to social inclusion for children aged 9–12 years living in low socio‐economic status (SES) areas, using both child‐report and parent‐report interviews. Methods Australian‐born English‐speaking parents and children aged 9–12 years were sampled from a low SES area to participate in semi‐structured interviews. Parents and children were asked questions around three prominent themes of social exclusion; exclusion from school, social activities and social networks. Results Many children experienced social exclusion at school, from social activities or within social networks. Overall, nine key barriers to social inclusion were identified through parent and child interviews, such as inability to attend school camps and participate in school activities, bullying and being left out, time and transport constraints, financial constraints and safety and traffic concerns. Parents and children often identified different barriers. Discussion There are several barriers to social inclusion for children living in low SES communities, many of which can be used to facilitate mental health promotion programmes. Given that parents and children may report different barriers, it is important to seek both perspectives. Conclusion This study strengthens the evidence base for the investments and action required to bring about the conditions for social inclusion for children living in low SES communities.     

Application of the theoretical domains framework to identify factors influencing catch-up HPV vaccinations among male college students in the United States: A review of evidence and recommendations

BackgroundGenital human papillomavirus (HPV) infection is the most prevalent sexually transmitted infection among young adults ages 15–25 years in the United States (US). Although HPV vaccines are recommended for individuals ages through 26 years, vaccine completion rates remain substantially low.MethodsAccordingly, our study utilized a comprehensive – Theoretical Domains Framework (TDF) of behavior change to systematically identify facilitators and barriers to catch-up HPV vaccinations. Five databases - Medline, Embase, CINAHL, ERIC, and PsycINFO were searched from January 2009 to July 2019 for empirical studies using quantitative and qualitative methods to assess HPV vaccine uptake among males ages 18–26 years within US college and university settings. The TDF analytic process included a content analysis using the mixed deductive-inductive approach to extract, analyze and categorize data into TDF domains/themes and sub-themes.ResultsOverall, 17 studies were selected for data extraction. We identified eleven key TDF domains that influenced HPV vaccination behavior among college male students: ‘knowledge’ (82% of included studies), ‘environmental context and resources’ (53%), ‘beliefs about consequences’ (53%), ‘unrealistic optimism’ (50%) and ‘pessimism’ (6%), ‘emotion’ (50%), ‘social influences’ (50%), ‘beliefs about capabilities’ (41%), ‘intention’ (24%), ‘reinforcement’ (18%), ‘social professional role and identity’(12%), and ‘behavioral regulation’ (12%). Barriers influencing HPV vaccine uptake included lack of knowledge and awareness regarding HPV infections, HPV vaccine safety, effectiveness, side effects, and costs; absence of health providers’ recommendations; lack of healthcare and health insurance; low levels of perceived susceptibility and severity for HPV infections; HPV vaccine misinformation; as well as social stigma and peer influences regarding HPV vaccinations. Enablers for HPV vaccine uptake included high levels of perceived benefits for HPV vaccines.DiscussionOur study theoretically identified factors influencing HPV vaccinations. This could inform the efficient planning, support, and implementation of interventions that facilitate catch-up HPV vaccination practices among high-risk males within college/university settings.     

Developing food-based dietary guidelines to promote healthy diets and lifestyles in the Eastern Caribbean

Obesity, cardiovascular diseases, and diabetes are becoming leading causes of morbidity and mortality in the Eastern Caribbean countries of St. Vincent and the Grenadines, Saint Lucia, Grenada, and Dominica. To promote healthful diets and lifestyles and encourage behavioral changes, Food-Based Dietary Guidelines (FBDG) were developed for the general population in each of these countries. This paper reports on the comprehensive process of developing the guidelines through consensus building among stakeholders, technical assessments and priority setting, and use of qualitative methods to field test messages to ensure public understanding and motivation. Nutritionists in each country received training and support from the Food and Agriculture Organization and the Pan American Health Organization’s nutritionists.     

Total dietary fiber intakes in the US population are related to whole grain consumption: results from the National Health and Nutrition Examination Survey 2009 to 2010

Whole grain (WG) foods have been shown to reduce chronic disease risk and overweight. Total dietary fiber is associated with WG and its health benefits. The purpose was to determine whether associations exist between WG intake (no-WG intake, 0 ounce equivalent [oz eq]; low, >0-<3 oz eq; high, ≥3 oz eq) and total dietary fiber intake among Americans 2 years and older. One-day food intake data from the US National Health and Nutrition Examination Survey 2009 to 2010 (n = 9042) showed that only 2.9% and 7.7% of children/adolescents (2-18 years) and adults (≥19 years) consumed at least 3 WG oz eq/d, respectively. For children/adolescents and adults, individuals in the high WG intake group were 59 and 76 times more likely to fall in the third fiber tertile, respectively, compared with those with no-WG intake. Total dietary fiber intake from food sources varied by WG intake group for children/adolescents and adults with more total dietary fiber consumed from ready-to-eat (RTE) and hot cereals and yeast breads/rolls in the high WG intake group compared with the no-WG intake group. Major WG sources for children/adolescents and adults included yeast bread/rolls (24% and 27%, respectively), RTE cereals (25% and 20%, respectively), and oatmeal (12% and 21%, respectively). Among those with the highest WG intake, WG RTE cereal with no added bran was the greatest contributor to total dietary fiber compared with other RTE cereal types. Whole grain foods make a substantial contribution to total dietary fiber intake and should be promoted to meet recommendations.