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Introduction: In response to the COVID-19 pandemic, restrictions were imposed on various activities including nutritional services. This study was conducted with the objective to explore the status of the nutritional services and to identify the hardship and barriers faced by the vulnerable population and challenges for service providers and program managers during the initial phase of pandemic. Materials and Methods: A community-based cross-sectional qualitative study was conducted among three vulnerable population groups (slum dwellers, tribal population, and residents of disaster-prone area) in three districts of West Bengal, the reference period being April–September 2020. To assess the status of nutritional services and identify existing barriers or challenges, the study employed a mixed-methods approach utilizing focus group discussions (FGDs) as well as in-depth interviews (IDIs) conducted with beneficiaries, service providers and program managers. One habitation in each district was selected to obtain case scenarios on food insecurity and hardship. Descriptive analysis of household surveys and thematic analysis of FGDs and IDIs were done, and the findings were triangulated. Results: Different nutritional services (supplementary nutrition, micronutrient supplementation, growth monitoring, nutrition counseling, and nutrition rehabilitation) were disrupted. Shifting from hot-cooked meals to dry take-home ration was the most conspicuous change during restoration phase. Food security was absent in majority of the households. Reduction of income affected their affordability, which along with difficult accessibility to diverse food items contributed to their hardship. Service providers identified several challenges, including increased workload due to both COVID-19 activities and a rise in beneficiaries, transportation difficulties, and experiences of stigma and discrimination. Long administrative decision-making process, additional hurdles due to cyclone, and containment zones were identified as challenges by the program managers. Conclusion: As the hardship of vulnerable population was pervasive, it is necessary to formulate mitigating measures in light of the identified challenges and to combat similar crises in future.

Frontline workers are instrumental in bridging the gap in the utilization of maternal health services. We performed a qualitative cross-sectional study with medical officers, accredited social health activists (ASHA), and auxiliary nurse midwifes (ANM), across 13 districts of India, in order to understand the barriers and enablers, at the system and population levels, for improving access of adolescents and mothers to services. The data were collected by means of in-depth interviews (IDI) with medical officers and focus group discussions (FGD) with ASHA and ANM in 2016. The interview guide was based on the conceptual framework of WHO health interventions to decrease maternal morbidity. Content analysis was performed. In total, 532 frontline workers participated in 52 FGD and 52 medical officers in IDI. Adolescent clinics seemed nonexistent in most places; however, services were provided, such as counselling, iron tablets, or sanitary pads. Frontline workers perceived limited awareness and access to facilities among women for antenatal care. There were challenges in receiving the cash under maternity benefit schemes. Mothers-in-law and husbands were major influencers in women’s access to health services. Adolescent clinics and antenatal or postnatal care visits should be seen as windows of opportunities for approaching adolescents and women with good quality services.

Amaha Kahsay,1 Hadush Gebregziabher,1 Znabu Hadush,2 Dejen Yemane,2 Abebe Hailemariam,3 Afework Mulugeta1 1Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; 2Department of Environmental Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; 3UNICEF Head Office, Addis Ababa, EthiopiaCorrespondence: Amaha KahsayDepartment of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, PO Box: 1871, Ayder, Mekelle, Tigray, EthiopiaTel +251 920322629Email amahakahsay@gmail.comBackground: Adolescence is a time of tremendous physical growth and mental development, with high nutrient requirements. Ethiopia is among the countries with a high prevalence of nutritional deficiencies among the women of reproductive age group, whilst adolescent girls from rural areas suffered disproportionately. However, there is a dearth of evidence regarding the barriers that hinder adolescent girls to utilize the available nutritional services.Purpose: The current study aimed to qualitatively explore the range of barriers for the uptake of nutritional interventions among adolescent girls in rural communities of Tigray, Northern Ethiopia.Methods and Participants: We employed an explorative qualitative study among purposively selected adolescent girls and school teachers from rural districts of Tigray region. We conducted 11 focused group discussions with adolescent girls, 17 in-depth interviews (seven with teachers, seven with in-school adolescent girls, and three with out-of-school adolescent girls) using a semi-structured guide. Data was audio-taped, transcribed verbatim in local language, translated into English, and imported into ATLAS.ti version 7.5 qualitative data analysis software for analysis.Results: Adolescents perceived that stunting, anemia, and thinness are among the main nutritional problems in their community. Food insecurity, limited nutrition awareness in the community, limited access to a water source, high workload, service provider’s little attention for adolescents’ nutrition, and food taboo have emerged as barriers for the uptake of adolescent girls’ nutritional interventions. Though limited in reach, available nutritional interventions include awareness creation, nutritional supplementation, and disease prevention.Conclusion: Food insecurity poses a strong challenge to adolescent girls’ nutrition. As access to safe drinking water continues to be a considerable bottleneck for nutritional interventions, a multi-sectoral response to integrate water, sanitation, and hygiene (WASH) services is required. Bounded by food taboo, high burden of workload among the adolescent girls, women empowerment and nutritional status seem to be the unfinished agenda in resource limited settings such as the rural areas of Tigray region.Keywords: adolescent girls, barriers, nutritional services, rural, Tigray, Ethiopia

Background and Aims: Specialist nutritional support is important during treatment for oesophagogastric (OG) cancer yet current practice remains unstandardised across the UK. The National Oesophagogastric Nutrition Audit (NONA) aimed to describe the current landscape of OG dietetic services in the UK and Ireland, with a specific focus on resource allocation, barriers to dietetic support, and the provision of support throughout the cancer pathway., Methods: Tertiary cancer units, secondary care, and community services across the UK and Ireland were invited to complete a 28-point electronic questionnaire. Team leaders and senior specialist OG dietitians were the target respondents. All data points were peer-reviewed, piloted, and revised by the NONA steering committee before distribution. Data points covered a range of areas related to resources, skill mix, provision of support throughout the cancer pathway, and involvement with national audit and research., Results: Complete responses were received from 50 individual units (tertiary surgical units, n = 35 and tertiary oncology units, n = 10). Secondary care and community services were underrepresented (n = 5). Of the units proving tertiary cancer care, the majority (77%) agreed or strongly agreed they were able to provide adequate nutritional care in the post-operative period. However, confidence dropped significantly in the early diagnostic phase and in the neoadjuvant period, with 52% and 67% of tertiary units disagreeing that they could provide adequate dietetic support during these parts of the cancer pathway, respectively. Inadequate funding, understaffing, and the prioritisation of inpatients were commonly reported barriers. There was significant variation in practice regarding nutritional assessment, service structure, and staffing resource allocation across specialist units., Conclusion: The NONA survey provides a 'real-world' landscape of nutritional care for patients with OG cancer. Lack of funding, resource, and evidence-base may explain the variation seen in services provided across the UK. Further research and consensus is required to help standardise nutritional care, guide service specification, and improve nutritional outcomes for patients with OG cancer., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest related to the contents of this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Goal 2 of United Nation's Sustainable Development Goals exhorts countries to provide guidelines on better nutrition for all children. In response, the United Arab Emirates (UAE) government designed a national nutrition framework to encourage better eating habits. However, large body of literature has reported that children with ASD are at high risks of malnutrition and poor eating habits. Yet, in the UAE and other contexts, there is limited research on accessibility of nutritional services to adults in the lives of children with ASD. As parents and teachers spend the most time with children with ASD, this study sought to understand their perceptions of the availability of nutritional services for such children in the UAE. Penchansky and Thomas' (1981) health access theory served as the theoretical framework; its five tenets (geography, finance, accommodation, resources and acceptability) informed the design of a semi-structured interview guide. Data were collected from 21 participants, comprising 6 parents and 15 teachers of children with ASD. Thematic analysis revealed that participants perceived accommodation, acceptability, and human resource availability as barriers to accessibility. However, geographical and financial accessibility were not identified as challenges. The study calls for health policymakers to formalise nutritional services as an integrated part of the UAE health system, while also extending services to children with ASD. This study makes a substantial contribution to the literature. First, it addresses the needs for nutritional services for children with ASD. There is a limited body of knowledge on whether children with ASD have access to the requisite nutrition for development This study sheds light on an area that has received limited scholarly insight. Second, it adds to the usage of health access theory in studies on nutritional services for children with ASD. • The UAE has a well-developed health system to promote the health of all. • However, the extent to which the health service provide accessible nutritional needs to children with Autism Spectrum Disorder is unclear. • The study reported unavailability of nutritional services to many parents. • There was low awareness among teachers about nutritional needs of children with Autism. • The study recommends proper coordination of health services towards provision of nutritional services to all. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to evaluate the crucial role that nutritional services provided both to public or private health-care systems on dietary habits among older people. Methods During 2005-2009, 744 men and 742 women (>65 years) from nine Greek Islands and Cyprus Republic were voluntarily enrolled in the Mediterranean Islands study ( MEDIS). Sociodemographic, clinical and lifestyle characteristics has been recorded. Information regarding practicing dietitians (n = 88) and nutritional services provided in these islands were also recorded. Results It has been demonstrated that the long-term presence of dietitian on an island increase the adherence to the Mediterranean diet by the participants ( P = 0.03). A positive association was also found between level of adherence to the Mediterranean diet by the older people and dietitian's education status (i.e. basic vs postgraduate, P = 0.003). According to the dietitians' reports, 40% of older adults have improved their dietary habits after the nutritional consultation. Conclusions Implementing nutritional services within the healthcare system seems to contribute to healthier dietary habits among older adults that may lead to a better quality of life. [ABSTRACT FROM AUTHOR]

Abstract: Background: The role of nutritional policy and services on the quality of life of older individuals has not been extensively studied. Thus, the aim of the present study was to evaluate the association between nutritional services within the public health care system and older people''s health status. Methods: During 2010, information of various nutritional services provided in 9 Greek Islands and Cyprus Republic was retrieved through local health care authorities. With the exception of the Cyprus Republic, a large proportion of dieticians in the rest of the studied islands participated in this survey (n=88). The health status of the referent older population was retrieved from the Mediterranean islands'' (MEDIS) study. Results: After various adjustment, islands that had nutritional services offered within the public health care system had lower likelihood of observing the prevalence of hypercholesterolemia, diabetes and obesity above the median rate of the referent population (odds ratio (95% CI), hypercholesterolemia, 0.11 (0.02, 0.55), diabetes, 0.03 (0.02, 0.26), and obesity, 0.10 (0.02, 0.50). Continuous and higher education status of dieticians and the completion of nutrition sessions seem also to contribute to the reduction of the CVD risk burden in these islanders. Conclusions: Active nutritional policy and enhancement of nutritional services within the public health care system may contribute to improved health and quality of life among older populations. [Copyright &y& Elsevier]

Introduction: The world's population is ageing and it has been suggested that improvements to health, wellbeing and lifespan can be attributed to improved standards of living, especially regarding diet and nutritional status. The impact of nutritional services provided by a dietician on an older population's health status has not been well evaluated or documented. This study sought to determine whether an association exists between available nutritional services and older people's health status in selected Greek islands and the Cyprus Republic. Methods: During 2010, information on nutritional services provided in 9 Greek Islands and the Cyprus Republic was retrieved through interviews of almost all dieticians (n=88) working on these islands. The health status (ie prevalence of hypertension, diabetes, hypercholesterolemia, obesity) of the older population studied (aged >65 years) was retrieved from the Mediterranean Islands Study (MEDIS). Results: The main reasons for an older person's visit to a dietician was for the treatment of diabetes (79%), hypercholesterolemia (75%) and obesity (70%); 90% of older individuals visited the dietician on a physician's recommendation and 45% of them completed their consultations. The longer the presence of a dietician on an island, the lower the likelihood of observing the prevalence of hypertension (OR=0.59, 95% CI=0.36-0.94), hypercholesterolemia (OR=0.66, 95%CI=0.46-0.95), diabetes (OR=0.77, 95%CI=0.61-0.96) and obesity (OR=0.66, 95%CI=0.45-0.95) above the median rate of the population studied. Financial concerns and a long distance from home to the dieticians' office were the major reasons for ceasing visits to the dietician. Conclusions: Enhancing nutritional services within the healthcare system may contribute to reducing the burden of disease among older adults and, consequently, improve their quality of life. [ABSTRACT FROM AUTHOR]