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Existing gestational weight gain (GWG) charts vary considerably in their choice of exclusion/inclusion criteria, and it is unclear to what extent these criteria create differences in the charts’ percentile values. We aimed to establish the impact of including/excluding pregnancies with adverse neonatal outcomes when constructing GWG charts.

Undernutrition during pregnancy increases the risk of giving birth to a small vulnerable newborn. Small-quantity lipid-based nutrient supplements (SQ-LNSs) contain both macro- and micronutrients and can help prevent multiple nutritional deficiencies.

The COVID-19 pandemic caught the world unprepared, with containment measures impacting both global supply chains and agri-commodity flows. The public health crisis raised some urgent questions: “how can fish and other aquatic foods and supply chains be prioritized as health-related interventions to avert both a malnutrition crisis and gender inequality?” Furthermore, “what are the integrated responses, investment opportunities, and governance mechanisms to effectively address the pandemic?” As “super foods,” diets of fish and aquatic foods provide animal-source protein, omega-3 fatty acids, and micronutrients, including both vitamins and minerals, necessary for both the ill and the healthy. The affordability and accessibility of fish could address food and nutrition security needs under lockdown and border closures, boost immune systems, and increase commodity trade. This analytical piece focuses on the continent of Africa, where malnutrition is pervasive, but also where local aquatic food supplies can be utilised during lockdowns and border closures. The paper provides governance insights on national budget support programs and portfolio restructuring to strengthen local aquatic foods production systems to meet dietary needs. Furthermore, the authors advocate for a coordinated multi-sectoral intervention across several well-being domains in the immediate and medium-term involving various partnerships. These integrated responses will mutually limit the contagion while providing support to functional fish value chains for healthy diets, livelihoods, cross-border trade, and long-term macroeconomic recovery.

Since the adoption of United Nations’ Sustainable Goal 4.2 to ensure that all children have access to quality early child development (ECD) so that they are ready for primary education, the demand for valid ECD assessments has increased in contexts where they do not yet exist. The development of early language ability is important for school readiness. Our objective was to evaluate the validity of a method to develop vocabulary checklists in new languages to assess early language development, based on the MacArthur-Bates Communicative Development Inventories. Through asking mothers of young children what words their children say and through pilot testing, we developed 100-word vocabulary checklists in multilingual contexts in Malawi and Ghana. In Malawi, we evaluated the validity of the vocabulary checklist among 29 children age 17–25 months compared to three language measures assessed concurrently: Developmental Milestones Checklist-II (DMC-II) language scale, Malawi Developmental Assessment Tool (MDAT) language scale, and the number of different words (NDW) in 30-min recordings of spontaneous speech. In Ghana, we assessed the predictive validity of the vocabulary checklist at age 18 months to forecast language, pre-academic, and other skills at age 4–6 years among 869 children. We also compared the predictive validity of the vocabulary checklist scores to that of other developmental assessments administered at age 18 months. In Malawi, the Spearman’s correlation of the vocabulary checklist score with DMC-II language was 0.46 (p= 0.049), with MDAT language was 0.66 (p= 0.016) and with NDW was 0.50 (p= 0.033). In Ghana, the 18-month vocabulary checklist score showed the strongest (rho = 0.12–0.26) and most consistent (8/12) associations with preschool scores, compared to the other 18-month assessments. The largest coefficients were the correlations of the 18-month vocabulary score with the preschool cognitive factor score (rho = 0.26), language score (0.25), and pre-academic score (0.24). We have demonstrated the validity of a method to develop vocabulary checklists in new languages, which can be used in multilingual contexts, using a feasible adaptation process requiring about 2 weeks. This is a promising method to assess early language development, which is associated with later preschool language, cognitive, and pre-academic skills.

Low-quality monotonous diet is a major problem confronting resource-constrained settings across the world. Starchy staple foods dominate the diets in these settings. This places the population, especially women of reproductive age, at a risk of micronutrients deficiencies. This study seeks to examine the association between women’s decision-making autonomy and women’s achievement of higher dietary diversity (DD) and determine the socio-demographic factors that can independently predict women’s attainment of higher DD. The study used data from the 2008 Ghana Demographic and Health Survey. The participants comprised of 2262 women aged 15–49 years and who have complete dietary data. The DD score was derived from a 24-h recall of intake of foods from nine groups. The score was dichotomized into lower DD (DD ≤4) and higher (DD ≥5). Logistic regression was used to assess the association between women decision-making autonomy (final say on how to spend money, making household purchases, own health care, opinions on wife-beating, and sexual intercourse with husband) and the achievement of higher DD. The logistic regression models were adjusted for covariates at the individual and household levels. The analysis showed that women participation in decision-making regarding household purchases was significantly associated with higher DD, after adjusting for individual and household level covariates. The odds of achieving higher DD were higher among women who had a say in deciding household purchases, compared to women who did not have a say (OR = 1.74, 95 % CI = 1.24, 2.42). Women who had more than primary education were 1.6 times more likely to achieve higher DD, compared to those with no education (95 % CI = 1.12, 2.20). Compared to women who lived in polygamous households, those who lived in monogamous households had higher odds of achieving higher DD (OR = 1.42, 95 % CI = 1.04, 1.93). Net other covariates, women who have a say in making household purchases are more likely to achieve higher DD compare to those who do not have a say. This may indicate autonomy to buy nutritious foods, suggesting that improving women decision-making autonomy could have a positive impact on women dietary intake.

Maternal undernutrition contributes to 800 000 neonatal deaths annually through small for gestational age births; stunting, wasting, and micronutrient deficiencies are estimated to underlie nearly 3·1 million child deaths annually. Progress has been made with many interventions implemented at scale and the evidence for effectiveness of nutrition interventions and delivery strategies has grown since The LancetSeries on Maternal and Child Undernutrition in 2008. We did a comprehensive update of interventions to address undernutrition and micronutrient deficiencies in women and children and used standard methods to assess emerging new evidence for delivery platforms. We modelled the effect on lives saved and cost of these interventions in the 34 countries that have 90% of the world’s children with stunted growth. We also examined the effect of various delivery platforms and delivery options using community health workers to engage poor populations and promote behaviour change, access and uptake of interventions. Our analysis suggests the current total of deaths in children younger than 5 years can be reduced by 15% if populations can access ten evidence-based nutrition interventions at 90% coverage. Additionally, access to and uptake of iodised salt can alleviate iodine deficiency and improve health outcomes. Accelerated gains are possible and about a fifth of the existing burden of stunting can be averted using these approaches, if access is improved in this way. The estimated total additional annual cost involved for scaling up access to these ten direct nutrition interventions in the 34 focus countries is Int$9·6 billion per year. Continued investments in nutrition-specific interventions to avert maternal and child undernutrition and micronutrient deficiencies through community engagement and delivery strategies that can reach poor segments of the population at greatest risk can make a great difference. If this improved access is linked to nutrition-sensitive approaches—ie, women’s empowerment, agriculture, food systems, education, employment, social protection, and safety nets—they can greatly accelerate progress in countries with the highest burden of maternal and child undernutrition and mortality.

The Codex Alimentarius is a collection of internationally recognized standards, codes of practice, guidelines, and other recommendations relating to foods, food production, and food safety. Among other functions, it is responsible for setting international standards for safety and hygiene. Codex food standards and guidelines directed at foods produced primarily for young infants and children have important implications for maintaining nutritional status and health, especially given the positioning of these products as components of established World Health Organization (WHO)/UNICEF-recommended feeding strategies. Recently, new products targeted at this age group (e.g., lipid-based nutrient supplements and micronutrient powders) have been produced and used, but these are not totally covered under existing Codex guidelines or standards. The objective of this paper is to review the role of the Codex process and specifically to suggest revisions to existing Codex guidelines on formulated complementary foods (Guidelines for Formulated Supplementary Foods for Older Infants and Young Children, CAC/GL 08–1991) to encompass this new category of fortified complementary foods and home fortificants. In reviewing the existing guidelines, potential areas for revision included the sections on the recommended nutrients in these foods and their intended use. Updating the Codex guidelines provides the opportunity to encourage production and use of new products for children and help ensure that such foods, when used as directed, do not interfere with breastfeeding. The revised guidelines would help governments develop national regulations covering all forms of formulated complementary foods. They would also lessen impediments to international trade by providing clear guidance for foods used in feeding programs and for young children, particularly in developing countries.

AbstractObjective:This study determined the effect of subclinical mastitis (SCM) on infant breastmilk intake.Design:Participants (60 Ghanaian lactating mothers and their infants) were from periurban communities in the Manya Krobo district of Ghana in 2006––2007. Bilateral breastmilk samples were obtained once between months 3 and 6 postpartum and tested for SCM using the California mastitis test (CMT) and the sodium/potassium (Na/K) ratio. Infants' 12-hour breastmilk intake was assessed by test weighing. CMT scoring for SCM diagnosis was scaled as ≥≥1 = positive (n= 37) and <1 = negative (n= 23). SCM diagnosis was confirmed as a Na/K ratio of >1.0 (n= 14).Results:Breastmilk intake was nonsignificantly lower among infants whose mothers had elevated Na/K ratios of >1.0 (−−65.1 g; 95% confidence interval −−141.3 g, 11.1 g). Infants whose mothers were positive for SCM with both CMT and Na/K ratio criteria had significantly lower breastmilk intake (−−88.9 g; 95% confidence interval −−171.1 g, −−6.9 g) compared to those whose mothers tested either negative with both tests or positive on only one. Infant weight (p< 0.01) and frequency of feeding (p= 0.01) were independently associated with breastmilk intake. However, the effect of SCM on breastmilk intake disappeared when infant weight and feeding frequency were included in a multiple linear regression model.Conclusions:The results of this study did not show an effect of SCM on breastmilk intake among 3––6-month-old infants. A larger sample size with a longitudinal design will be needed in future studies.

The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) African site was Accra, Ghana. Its sample was drawn from 10 affluent residential areas where earlier research had demonstrated the presence of a child subpopulation with unconstrained growth. This subpopulation could be identified on the basis of the father's education and household income. The subjects for the longitudinal study were enrolled from 25 hospitals and delivery facilities that accounted for 80% of the study area's births. The cross-sectional sample was recruited at 117 day-care centers used by more than 80% of the targeted subpopulation. Public relations efforts were mounted to promote the study in the community. The large number of facilities involved in the longitudinal and cross-sectional components, the relatively large geographic area covered by the study, and the difficulties of working in a densely populated urban area presented special challenges. Conversely, the high rates of breastfeeding and general support for this practice greatly facilitated the implementation of the MGRS protocol.

The objective of the Motor Development Study was to describe the acquisition of selected gross motor milestones among affluent children growing up in different cultural settings. This study was conducted in Ghana, India, Norway, Oman, and the United States as part of the longitudinal component of the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS). Infants were followed from the age of four months until they could walk independently. Six milestones that are fundamental to acquiring self-sufficient erect locomotion and are simple to evaluate were assessed: sitting without support, hands-and-knees crawling, standing with assistance, walking with assistance, standing alone, and walking alone. The information was collected by both the children's caregivers and trained MGRS fieldworkers. The caregivers assessed and recorded the dates when the milestones were achieved for the first time according to established criteria. Using standardized procedures, the fieldworkers independently assessed the motor performance of the children and checked parental recording at home visits. To ensure standardized data collection, the sites conducted regular standardization sessions. Data collection and data quality control took place simultaneously. Data verification and cleaning were performed until all queries had been satisfactorily resolved.

African consumers have purchased increasing amounts of processed food over the past 50 years. The opportunity cost of time of women and men has increased as more of them work outside the home, driving them to buy processed food and food prepared away from home to save arduous home-processing and preparation labor. In the past several decades, this trend has accelerated with a surge on the supply side of the processing sector and small and medium enterprises (SMEs) and large private companies making massive aggregate investments. Packaged, industrialized, ultra-processed foods and sugar-sweetened beverages (SSBs) are a growing proportion of the processed food consumed. Also, in the past several decades, overweight and obesity have joined the long-standing high levels of stunting and wasting among children and extreme thinness among women of childbearing age. Together these phenomena have formed a double burden of malnutrition (DBM). The DBM has emerged as an important health problem in sub-Saharan Africa. The rise of the DBM and the increase in ultra-processed food consumption are linked. Policy makers face a dilemma. On the one hand, purchases of processed food are driven by long-term factors, such as urbanization, increased income, and employment changes, and thus policy cannot change the pursuit of convenience and labor-saving food. Moreover, much processed food, like packaged milk, is a boon to nutrition, and the processed food system is a major source of jobs for women. On the other hand, the portion (some 10–30%) of processed food that is ultra-processed is a public health challenge, and policy must address its detrimental effects on disease burden. The global experience suggests that double duty actions are most important as are selected policies focused on healthy weaning foods for addressing stunting and taxes on SSBs, nutrition labeling, and other measures can steer consumers away from unhealthy ultra-processed foods to addressing obesity and possibly child nutrition and stunting. We recommend that African governments consider these policy options, but note that the current extreme fragmentation of the processing sector, consisting of vast numbers of informal SMEs in sub-Saharan Africa, and the limited administrative/implementation capacity of many African governments require pursuing this path only gradually.

Mothers’ understanding of growth charts is an essential component of growth-monitoring programmes. This study investigated mothers’ interpretation of growth charts as they attended child welfare clinics in the greater Accra region of Ghana. Eight hundred seventy-five mothers were interviewed using questionnaires and sample growth charts. Factors impeding attendance at the clinics included business, forgetting, travel, and lack of knowledge. Nearly 40% of the mothers had no idea of the meaning or purpose of growth charts. Efforts to enhance the awareness of mothers and children's caretakers must be intensified.