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Undernutrition in infants and young children is a global health priority while overweight is an emerging issue. Small-scale studies in low- and middle-income countries have demonstrated consumption of sugary and savoury snack foods and soft drinks by young children. We assessed the proportion of children 6-23 months of age consuming sugary snack foods in 18 countries in Asia and Africa using data from selected Demographic and Health Surveys and household expenditures on soft drinks and biscuits using data from four Living Standards Measurement Studies (LSMS). Consumption of sugary snack foods increased with the child's age and household wealth, and was generally higher in urban vs. rural areas. In one-third of countries, >20% of infants 6-8 months consumed sugary snacks. Up to 75% of Asian children and 46% of African children consumed these foods in the second year of life. The proportion of children consuming sugary snack foods was generally higher than the proportion consuming fortified infant cereals, eggs or fruit. Household per capita daily expenditures on soft drinks ranged from $0.03 to $0.11 in three countries for which LSMS data were available, and from $0.01 to $0.04 on biscuits in two LSMS. Future surveys should include quantitative data on the purchase and consumption of snack foods by infants and young children, using consistent definitions and methods for identifying and categorising snack foods across surveys. Researchers should assess associations between snack food consumption and stunting and overweight, and characterise household, maternal and child characteristics associated with snack food consumption.

Insufficient growth during childhood is associated with poor health outcomes and an increased risk of death. Between 2000 and 2015, nearly all African countries demonstrated improvements for children under 5 years old for stunting, wasting, and underweight, the core components of child growth failure. Here we show that striking subnational heterogeneity in levels and trends of child growth remains. If current rates of progress are sustained, many areas of Africa will meet the World Health Organization Global Targets 2025 to improve maternal, infant and young child nutrition, but high levels of growth failure will persist across the Sahel. At these rates, much, if not all of the continent will fail to meet the Sustainable Development Goal targetto end malnutrition by 2030. Geospatial estimates of child growth failure provide a baseline for measuring progress as well as a precision public health platform to target interventions to those populations with the greatest need, in order to reduce health disparities and accelerate progress., Author(s): Aaron Osgood-Zimmerman [1]; Anoushka I. Millear [1]; Rebecca W. Stubbs [1]; Chloe Shields [1]; Brandon V. Pickering [1]; Lucas Earl [1]; Nicholas Graetz [1]; Damaris K. Kinyoki [1]; Sarah [...]

Objectives. We assessed the association between exposure to an educational intervention that emphasized safer breastfeeding practices and postnatal HIV transmission among 437 HIV-positive mothers in Zimbabwe, 365 of whom did not know their infection status. Methods. Mothers were tested for HIV and were encouraged--but not required--to learn their HIV status. Intervention exposure was assessed by a questionnaire, Turnbull methods were used to estimate postnatal HIV transmission, and multivariate Cox proportional hazard models were constructed to assess the association between intervention exposure and postnatal HIV transmission. Results. Cumulative postnatal HIV transmission was 8.2%; each additional intervention contact was associated with a 38% reduction in postnatal HIV transmission. HIV-positive mothers who were exposed to both print and video materials were 79% less likely to infect their infants compared with mothers who had no exposure. These findings were similar for mothers who did not know their HIV status. Conclusions. The promotion of exclusive breastfeeding has the potential to reduce postnatal HIV transmission among women who do not know their HIV status, and child survival and HIV prevention programs should support this practice.

Mother-to-child transmission of HIV occurs during pregnancy, at the time of delivery, and through breastfeeding (BF). WHO recommends avoidance of all BF when replacement feeding (RF) is affordable, feasible, acceptable, sustainable, and safe. Otherwise, exclusive breastfeeding (EBF) followed by early BF cessation is recommended. Governments are currently scaling up programs to prevent infant HIV infection. Few data exist to guide policy decisions about the allocation of resources to prevent postnatal HIV transmission while minimizing the non-HIV--related risks of these policies. This paper presents an analysis of the impact of WHO infant feeding ] recommendations in different settings characterized by infant mortality rate (IMR). Mathematical simulation modeling is used to estimate the effects on HFS (HFS) through 24 mo of 3 intervention scenarios: RF from birth by HIV-positive mothers (RF24), EBF up to 6 mo followed by early BF cessation (EBF6), and the default scenario where there is no postnatal intervention (BF24). This analysis differs from earlier reports in that it uses the most recent data on risks of postnatal HIV transmission for mixed and exclusive BF. These simulations suggest that in settings where IMR is 25/1000 live births. RF24 results in lower HFS than no postnatal intervention where IMR [greater than or equal to] 101/1000. IMR-based analyses can help to guide government policy decisions about which infant feeding strategies to invest in and emphasize for HIV-positive mothers in different settings. KEY WORDS: * mother-to-child transmission * HIV type 1 * breastfeeding * policy * antiretroviral prophylaxis

International guidance on HIV and infant feeding has evolved over the last decade. In response to these changes, we designed, implemented, and evaluated an education and counseling program for new mothers in Harare, Zimbabwe. The program was implemented within the ZVlTAMBO trial, in which 14,110 mother-baby pairs were enrolled within 96 h of delivery and were followed at 6 wk, 3 too, and 3-mo intervals. Mothers were tested for HIV at delivery but were not required to learn their test results. Infant feeding patterns were determined using data provided up to 3 mo. Formative research was undertaken to guide the design of the program that included group education, individual counseling, videos, and brochures. The program was introduced over a 2-mo period: 11,362, 1311, and 1437 women were enrolled into the trial before, during, and after this period. Exclusive breast-feeding was recommended for mothers of unknown or negative HIV status, and for HIV-positive mothers who chose to breast-feed. A questionnaire assessing HIV knowledge and exposure to the program was administered to 1996 mothers enrolling after the program was initiated. HIV knowledge improved with increasing exposure to the program. Mothers who enrolled when the program was being fully implemented were 70% more likely to learn their HIV status early ( KEY WORDS: * breast-feeding * HIV * exclusive breast-feeding * mother to child transmission * Zimbabwe

The Society for International Nutrition Research sponsored a Symposium titled 'Women's Voices, Women's Choices: The Challenge of Nutrition and HIV/AIDS in Asia and Africa' at Experimental Biology 2004 to highlight the challenges facing HIV-positive women living in resource-poor settings of Asia and Africa, when it comes to the everyday decisions they are forced to make about their own health and nutrition, and the health and the nutrition of their children. This introductory paper summarizes the rationale for this session, including a summary of the evidence for women's increased vulnerability to HIV, the nutritional impacts of HIV infection, and the special infant feeding and nutritional concerns facing HIV-positive pregnant and lactating mothers in Africa and Asia. The issue of nutrition and HIV/AIDS is addressed here from an intergenerational perspective, using new data from qualitative research, clinical trials, and behavioral interventions in India, Malawi, South Africa, Tanzania, and Zimbabwe, to illustrate important concerns, using study participants' own words to convey key messages. The focus is on women, because they are shouldering much of the burden of HIV infection in terms of their numbers and in their responsibilities for providing food and care for orphans and HIV-affected family members. Infant feeding choices are also considered in this review, because of the vast implications that not breast-feeding at all and stopping breast-feeding early have on the nutritional well-being of HIV-exposed children, as well as the positive contribution of breast-feeding to child nutrition and survival worldwide. KEY WORDS: * HIV/AIDS * mother-to-child HIV transmission * women * Africa * Asia

Feeding patterns of 131 low income Peruvian infants were assessed by 1574 single-day studies (12-h observations plus 12-h recall) of dietary intake and by mothers' monthly reports of usual feeding practices to determine whether feeding pattern classification depends on the assessment method used. Results suggest that single-day studies produce a different view of feeding practices than do mothers' reports of usual behavior. Exclusive breast-feeding in infants younger than 4 mo was observed 25% more often than reported. Non-human milk consumption was reported 30% more often than observed. Disagreement between reported and observed practices was related by logistic regression analyses to mother's age and education, number of children younger than 5 y in the home and infant age and illness on the observation day. Most disagreement between reported and observed behavior could have been due to daily variation in feeding practices. Consumption during the past 24 h should not be used alone as the basis for classifying infant feeding practices in survey research. INDEXING KEY WORDS: infant feeding practices; humans; misclassification; nutrition surveys; nutrition assessment

Data from a longitudinal study of 153 low-income Peruvian infants were used to examine (i) whether infant characteristics such as appetite, illness and past growth performance are related to subsequent changes in their feeding practices (e.g. addition of non-human milks, solid foods, weaning), and (ii) whether this relationship depends on maternal characteristics such as feeding exposure and experience (MFEE). With one exception, infants were breastfed from birth. Feeding practices during the first month of life were related to practices throughout infancy. Most mothers changed their practices once (61%) or twice (34%) from birth to 6 months. Low weight gains from 1 to 2 (P < 0.003) and 2 to 3 (P < 0.04) months were identified as significant predictors of feeding changes during the following months, using logistic regression models that also adjusted for MFEE, infant gender, previous practice, and previous practice change. The interaction between past weight gain and MFEE (objective ii) was not statistically significant in the logistic regression models. However, when analyzed separately, the relationships between low weight gains and subsequent feeding changes were observed for high but not low MFEE mothers. The prevalences of anorexia and infection (diarrhea, respiratory, and/or fever), and poor length gain during the previous month were not related to subsequent changes in feeding practices. These results suggest that poor growth influences feeding practices from 2 to 4 months, when exclusive breastfeeding is recommended.

Objectives. To determine appropriate indicators and age intervals for growth monitoring in this population, the relationship between monthly weight and length indicators and nutritional status at 12 months was evaluated among 102 low-income Peruvian infants. Methods. Cutoffs for defining adequate vs slow growth were obtained from published reference data, and sensitivities and specificities of each indicator were calculated. Results. Low weight gain in early infancy, especially from 1 to 2 months, is useful for predicting low weight at 1 year (sensitivity = 81%, specificity = 65%, 25th percentile cutoff). Use of actual weight at 2 months, however, produces comparable results (sensitivity = 86%, specificity = 57%, 50th percentile cutoff). Monthly length gains were weak predictors of low length for age. Neither weight nor length gains accurately predicted the opposite form of undernutrition. Nonhuman milk consumption before 4 months and poor appetite from 3 to 12 months were related to low early weight gain and subsequent undernutrition, Conclusions. Growth monitoring programs in this population should enroll infants at birth, monitor actual weight, promote exclusive breast-feeding and delayed introduction of nonhuman milk, and provide specific feeding advice to mothers of infants with frequently depressed appetites. (Am J Public Health. 1994, 84:1132-1138), Low weight gain between one and two months after birth appears to be associated with low weight at one year of age among infants in Peru. The length and weight of 102 Peruvian infants were measured monthly for one year. Twenty-seven infants (26.5%) were classified as undernourished at the end of the study. Six of these infants were low in length but not weight. Nine were low in weight but not length and twelve were classified as low in both categories. Infants with low monthly weight gains between one and five months of age had a significantly higher risk of being classified as low weight at one year of age. Low weight gain between one and two months of age was the most sensitive predictor of low weight at one year of age. It appears that infants should be enrolled at birth or shortly thereafter in growth monitoring programs designed to prevent undernutrition.

Abstract Background To prevent postnatal transmission of HIV in settings where safe alternatives to breastfeeding are unavailable, the World Health Organization (WHO) recommends exclusive breastfeeding followed by early, rapid cessation of breastfeeding. Only limited data are available on the attitudes of health workers toward this recommendation and the impact of these attitudes on infant feeding counselling messages given to mothers. Methods As part of the Breastfeeding, Antiretroviral, and Nutrition (BAN) clinical trial, we carried out an in-depth qualitative study of the attitudes, beliefs, and counselling messages of 19 health workers in Lilongwe, Malawi. Results Although none of the workers had received formal training, several reported having counseled HIV-positive mothers about infant feeding. Health workers with counselling experience believed that HIV-infected mothers should breastfeed exclusively, rather than infant formula feed, citing poverty as the primary reason. Because of high levels of malnutrition, all the workers had concerns about early cessation of breastfeeding. Conclusion Important differences were observed between the WHO recommendations and the attitudes and practices of the health workers. Understanding these differences is important for designing effective interventions.

A letter to the editor in response to the article on peruvian infants classification by Roche et al. in the 1993 issue of the journal is presented.