Considerations When Measuring Exclusive Breastfeeding.

Exclusive breastfeeding, as recommended by the World Health Organization (WHO) for the first 6 months of life, is a critical metric for evaluating maternal and infant feeding practices and health outcomes. Despite its importance, inconsistencies in defining and measuring breastfeeding exclusivity present challenges for research comparability and interpretation. Equally, research design, outcomes of interest, and study resources are necessary considerations when collecting and analyzing exclusive breastfeeding data, and may require the adaption of standardized questions and techniques to individual situations.

Estimating food consumption, micronutrient intake and the contribution of large-scale food fortification to micronutrient adequacy in Tanzania.

Objective: To assess the potential contribution of large-scale food fortification (LSFF) towards meeting dietary micronutrient requirements in Tanzania.

Design: We used household food consumption data from the National Panel Survey 2014-15 to estimate fortifiable food vehicle coverage and consumption (standardised using the adult female equivalent approach) and the prevalence at risk of inadequate apparent intake of five micronutrients included in Tanzania's fortification legislation. We modelled four LSFF scenarios: no fortification, status quo (i.

The impact of a counselling intervention on nutrition practices among caregivers of children under two in the Kyrgyz Republic.

Objective: To evaluate the impact of a counselling programme to strengthen the health and nutrition behaviours of caregivers of children under 2 and the sustainability of that impact through reduced intervention intensity one year later.

Design: The programme trained community- and facility-based health staff to provide nutrition counselling. We conducted an impact evaluation with a modified stepped-wedge design using difference-in-differences analysis to compare indicator changes in an intervention group to a comparison group (midterm survey) and then a full intervention group to a light intervention group (final survey).

Promoting responsive care and early learning practices in Northern Ghana: results from a counselling intervention within nutrition and health services.

Objective: This study assesses change in caregiver practices after integrating responsive care and early learning (RCEL) in nutrition and health services and community platforms in northern Ghana.

Design: We trained health facility workers and community health volunteers to deliver RCEL counselling to caregivers of children under 2 years of age through existing health facilities and community groups. We assessed changes in caregivers' RCEL practices before and after the intervention with a household questionnaire and caregiver-child observations.

Estimating minimum dietary diversity for children aged 6-23 months: a comparison of agreement and cost of two recall methods in Cambodia and Zambia.

Objective: To compare the agreement and cost of two recall methods for estimating children's minimum dietary diversity (MDD).

Design: We assessed child's dietary intake on two consecutive days: an observation on day one, followed by two recall methods (list-based recall and multiple-pass recall) administered in random order by different enumerators at two different times on day two. We compared the estimated MDD prevalence using survey-weighted linear probability models following a two one-sided test equivalence testing approach.

Assessing the performance of national sentinel food lists at subnational levels in six countries.

Objective: To assess how well national sentinel lists of the most frequently consumed foods in each food group capture data at subnational levels to measure minimum diet diversity (MDD).

Design: We analysed data from seven surveys with 24-h open dietary recalls to evaluate: (1) the percentage of reported foods that were included in each sentinel food list; (2) whether these lists captured consumption of some food groups better than others and (3) differences between estimates of dietary diversity calculated from all food items mentioned in the open 24-h recall . only food items included in the sentinel lists.

A rapid landscape review of postpartum anaemia measurement: challenges and opportunities.

Background: Anaemia is a reduction in haemoglobin concentration below a threshold, resulting from various factors including severe blood loss during and after childbirth. Symptoms of anaemia include fatigue and weakness, among others, affecting health and quality of life. Anaemic pregnant women have an increased risk of premature delivery, a low-birthweight infant, and postpartum depression.

Women's status, breastfeeding support, and breastfeeding practices in the United States.

The objective of this study is to examine associations between state-level breastfeeding support and breastfeeding practices, controlling for women's status, in the U.S. We used publicly available data on state-level breastfeeding practices and support (international board-certified lactation consultants (IBCLC), births in Baby-Friendly hospitals, and La Leche League Leaders) for births in 2015 from the CDC Breastfeeding Report Card (2018) and other CDC reported data, and indicators of women's status from the Institute for Women's Policy Research reports (2015).

Exclusive breastfeeding: Measurement to match the global recommendation.

The World Health Organization (WHO) and United Nations Children's Fund (UNICEF) recommend exclusive breastfeeding (EBF) for the first 6 months of life. To estimate the proportion of infants that are exclusively breastfed, many agencies use the point prevalence of EBF among infants currently 0-5.9 months of age, as recommended by WHO and UNICEF.

Systematic review of metrics used to characterise dietary nutrient supply from household consumption and expenditure surveys.

Objective: To review existing publications using Household Consumption and Expenditure Survey (HCES) data to estimate household dietary nutrient supply to (1) describe scope of available literature, (2) identify the metrics reported and parameters used to construct these metrics, (3) summarise comparisons between estimates derived from HCES and individual dietary assessment data and (4) explore the demographic and socio-economic sub-groups used to characterise risks of nutrient inadequacy.

Design: This study is a systematic review of publications identified from online databases published between 2000 to 2019 that used HCES food consumption data to estimate household dietary nutrient supply. Further publications were identified by 'snowballing' the references of included database-identified publications.

Modeling food fortification contributions to micronutrient requirements in Malawi using Household Consumption and Expenditure Surveys.

Large-scale food fortification may be a cost-effective intervention to increase micronutrient supplies in the food system when implemented under appropriate conditions, yet it is unclear if current strategies can equitably benefit populations with the greatest micronutrient needs. This study developed a mathematical modeling framework for comparing fortification scenarios across different contexts. It was applied to model the potential contributions of three fortification vehicles (oil, sugar, and wheat flour) toward meeting dietary micronutrient requirements in Malawi through secondary data analyses of a Household Consumption and Expenditure Survey.

The development and initial validation of the Health and Reproductive Survey (HeRS).

Background: Due to the diversity in profiles associated with the female reproductive cycle and their potential physiological and psychological effects, monitoring the reproductive status of exercising females is important from a practical and research perspective. Moreover, as physical activity can influence menstrual function, the effects of physical activity energy expenditure on reproductive function should also be considered.

Aim: The aim of this study was to develop and establish initial face and content validity of the Health and Reproductive Survey (HeRS) for physically active females, which is a retrospective assessment of menstrual function from menarche (first menstruation) to menopause (cessation of menstruation).

Breastfeeding practices after a counselling intervention for factory workers in Bangladesh.

Breastfeeding may be particularly challenging for female factory workers who have long working hours and inadequate access to health information and care. In Chattogram, Bangladesh, a peer counselling intervention was undertaken to improve infant feeding practices of factory workers. Counselling started during pregnancy and continued until children were 18 months old.

Trends, determinants, and newborn mortality related to thermal care and umbilical cord care practices in South Asia.

Background: Although child mortality has decreased over the last several decades, neonatal mortality has declined less substantially. In South Asia, neonatal deaths account for the majority of all under-five deaths, calling for further study on newborn care practices. We assessed five key practices: immediate drying and wrapping, delayed bathing, immediate skin-to-skin contact after birth, cutting the umbilical cord with a clean instrument, and substances placed on the cord.

Integrated community case management: planning for sustainability in five African countries.

Background: The World Health Organization (WHO) launched an initiative to plan for the sustainability of integrated community case management (iCCM) programmes supported by the Rapid Access Expansion (RAcE) Programme in five African countries in 2016. WHO contracted experts to facilitate sustainability planning among Ministries of Health, WHO, nongovernmental organisation grantees, and other stakeholders.

Methods: We designed an iterative and unique process for each RAcE project area which involved creating a sustainability framework to guide planning; convening meetings to identify and prioritise elements of the framework; forming technical working groups to build country ownership; and, ultimately, creating roadmaps to guide efforts to fully transfer ownership of the iCCM programmes to host countries.

Data quality assessments stimulate improvements to health management information systems: evidence from five African countries.

Background: Health service data are used to inform decisions about planning and implementation, as well as to evaluate performance and outcomes, and the quality of those data are important. Data quality assessments (DQA) afford the opportunity to collect information about health service data. Through its Rapid Access Expansion Programme (RAcE), the World Health Organization (WHO) funded non-governmental organizations (NGO) to support Ministries of Health (MOH) in implementing integrated community case management (iCCM) programs in the Democratic Republic of Congo, Malawi, Mozambique, Niger and Nigeria.

iCCM data quality: an approach to assessing iCCM reporting systems and data quality in 5 African countries.

Background: Ensuring the quality of health service data is critical for data-driven decision-making. Data quality assessments (DQAs) are used to determine if data are of sufficient quality to support their intended use. However, guidance on how to conduct DQAs specifically for community-based interventions, such as integrated community case management (iCCM) programs, is limited.

Evidence of Impact: iCCM as a strategy to save lives of children under five.

Background: In 2013, the World Health Organization (WHO) launched the Rapid Access Expansion (RAcE) programme in the Democratic Republic of Congo, Malawi, Mozambique, Niger, and Nigeria to increase coverage of diagnostic, treatment, and referral services for malaria, pneumonia, and diarrhea among children ages 2-59 months. In 2017, a final evaluation of the six RAcE sites was conducted to determine whether the programme goal was reached. A key evaluation objective was to estimate the reduction in childhood mortality and the number of under-five lives saved over the project period in the RAcE project areas.

Toward Consistency: Updating Lactation and Breastfeeding Terminology for Population Health Research.

There has, historically, been a lack of consistency in the use and definition of terms and their associated measurement in breastfeeding research. The purpose of this paper is to promote consistency through a taxonomy and lexicon for population-based breastfeeding research with the modern nursing dyad. The taxonomy organizes concepts in categories related to research on feeding human milk to infants, noting the perspective from the provider of human milk (parent or alloparent) and the receiver of human milk (child).

The Lactational Effects of Contraceptive Hormones: an Evaluation (LECHE) Study.

Objective: To estimate the proportion of women for whom use of hormonal contraception was associated with reporting a decreased breast milk supply.

Study Design: The Lactational Effects of Contraceptive Hormones: an Evaluation ("LECHE") Study was an anonymous, internet-based, exploratory, cross-sectional survey of postpartum women using approximately 70 questions. Women were eligible to participate in the survey if they were 18 years or older, had a singleton infant between 3 and 9 months of age, had breastfed this infant for any amount of time and could read English.

Using geographical analysis to identify child health inequality in sub-Saharan Africa.

One challenge to achieving Millennium Development Goals was inequitable access to quality health services. In order to achieve the Sustainable Development Goals, interventions need to reach underserved populations. Analyzing health indicators in small geographic units aids the identification of hotspots where coverage lags behind neighboring areas.

Interactions among poverty, gender, and health systems affect women's participation in services to prevent HIV transmission from mother to child: A causal loop analysis.

Retention in care remains an important issue for prevention of mother-to-child transmission (PMTCT) programs according to WHO guidelines, formerly called the "Option B+" approach. The objective of this study was to examine how poverty, gender, and health system factors interact to influence women's participation in PMTCT services. We used qualitative research, literature, and hypothesized variable connections to diagram causes and effects in causal loop models.

Early, regular breast-milk pumping may lead to early breast-milk feeding cessation.

Objective: To estimate the effect of early, regular breast-milk pumping on time to breast-milk feeding (BMF) and exclusive BMF cessation, for working and non-working women.

Design: Using the Infant Feeding Practices Survey II (IFPS II), we estimated weighted hazard ratios (HR) for the effect of regular pumping (participant defined) compared with non-regular/not pumping, reported at month 2, on both time to BMF cessation (to 12 months) and time to exclusive BMF cessation (to 6 months), using inverse probability weights to control confounding.

Setting: USA, 2005-2007.