Publications by authors named "Kristen Hurley"

This study examined relations between caregiver feeding behaviours, child dietary diversity and anthropometry at 24 months of age in rural Bangladesh. Twenty-four hours dietary recall, weight and length data were collected on 4733 children. Factor analysis was applied to an 11-item caregiver feeding behaviours scale administered at 24 months, revealing two constructs: responsive/involved (five items) and forceful (six items); each dichotomised to reflect low and high use.

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Background: Few studies have evaluated the dietary impact of complementary food supplements (CFSs) designed to deliver macro- and micronutrients to children at risk for undernutrition. In a randomized controlled trial in rural Bangladesh, we previously reported that CFSs increased children's micronutrient adequacy.

Objectives: To longitudinally characterize energy and macronutrient intakes and inadequacies and evaluate the extent to which CFSs fill intake gaps.

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Parental feeding practices are associated with children's eating, but little is known about how childcare staff feeding practices relate to children's eating. The study examined the associations between childcare staff feeding practices and children's willingness-to-try-new-foods. Participants included children (n = 460), ages 3-5 years, and childcare staff (n = 91) recruited from 51 childcare centers in 10 Maryland counties.

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Mali national policy recommends that women take iron and folic acid supplements (IFA) from the time of the first antenatal care (ANC) visit, throughout pregnancy and during the first 3 months after delivery. In 2020, the World Health Organization (WHO) updated their ANC guidelines to recommend the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) formulation of multiple micronutrient supplements (MMS) in the context of rigorous research, including implementation research. In Bamako, Mali, a codesign process was used to tailor antenatal care MMS packaging and counselling materials aimed at optimizing delivery and uptake of and adherence to MMS.

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Undernutrition and a lack of learning opportunities can jeopardize long-term growth and development among infants in low- and middle-income countries. We conducted a 6-month 2 × 2 cluster-randomized trial to assess the effects of multiple micronutrient-fortified beverages and responsive caregiving interventions among infants 6-18 months in 72 community sectors in southwest Guatemala. We administered baseline and endline assessments of childhood development (Bayley Scales of Infant and Toddler Development) and socioemotional development (Brief Infant Toddler Socio-Emotional Assessment) and measured ferritin and hemoglobin on a subsample.

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Translating agricultural productivity into food availability depends on food supply chains. Agricultural policy and research efforts promote increased horticultural crop production and yields, but the ability of low-resource food supply chains to handle increased volumes of perishable crops is not well understood. This study developed and used a discrete event simulation model to assess the impact of increased production of potato, onion, tomato, brinjal (eggplant), and cabbage on vegetable supply chains in Odisha, India.

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Article Synopsis
  • The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) aims to support breastfeeding among low-income women, but previous reviews indicated negative effects on breastfeeding outcomes prior to 2009.
  • This systematic review assessed the relationship between WIC participation and breastfeeding outcomes, comparing the effects of WIC participants before and after revised food package guidelines implemented in 2009.
  • Results indicated no significant difference in breastfeeding initiation due to WIC participation, with limited evidence suggesting that the 2009 changes may improve breastfeeding exclusivity and that WIC support services may positively influence initiation and duration.
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Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is intended to improve maternal and child health outcomes. In 2009, the WIC food package changed to better align with national nutrition recommendations.

Purpose: To determine whether WIC participation was associated with improved maternal, neonatal-birth, and infant-child health outcomes or differences in outcomes by subgroups and WIC enrollment duration.

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Objective: To evaluate the impact of a youth-led nutrition intervention on youth-leaders themselves.

Design: Mixed methods, including: in-depth interviews and a quasi-experimental quantitative study comparing youth-leaders and nonparticipant comparison youth.

Analysis: Qualitative analysis using direct content analysis.

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Background: Anemia is a global public health problem that undermines childhood development. India provides government-sponsored integrated nutrition/child development preschools.

Objectives: This double-masked, cluster-randomized controlled trial examines whether point-of-use multiple micronutrient powder (MNP) compared with placebo fortification of preschool meals impacts child development and whether effects vary by preschool quality (primary outcome) and biomarkers of anemia and micronutrients (secondary outcomes).

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Background: Growth failure in sub-Saharan Africa leads to a high prevalence of child stunting starting in infancy, and is attributed to dietary inadequacy, poor hygiene, and morbidity.

Objectives: To evaluate the impact of a program in Malawi providing a lipid-based nutrient supplement to infants from 6-23 months of age, accompanied by a social and behavior change communication intervention to optimize caregiver feeding and handwashing practices.

Methods: This impact evaluation was a quasi-experimental, longitudinal study with 1 program and 1 comparison district.

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Prenatal micronutrient supplements are cost-effective in reducing nutritional deficiencies and adverse pregnancy and birth outcomes. However, poor adherence remains a potential barrier to the successful implementation of these supplementation programs. This systematic review assessed the effectiveness of interventions designed to increase adherence to prenatal micronutrient supplementation.

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Rapid weight gain increases risks of obesity and associated co-morbidities. The objective was to reduce the rate of body mass index (BMI) growth (BMI z score), relative to control. Secondary outcomes were toddler-mother physical activity, mealtime interactions and fruit/vegetable intake.

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Background: Nutrient-level intakes from home-prepared complementary foods are rarely estimated among infants and young children in low-income settings. The major constraints are related to lack of standard recipes and ingredients and portion sizes.

Objectives: This article describes the feasibility, applicability, and validity of a post hoc qualitative methodology to estimate nutrient intakes in children using 24-h dietary recall.

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Background: The prevalence of stunting in central rural Malawi is ∼50%, which prompted a multipronged nutrition program in 1 district from 2014 to 2016. The program distributed a daily, fortified, small-quantity lipid-based nutritional supplement, providing 110 kcal and 2.6 g of protein to children aged 6-23 mo, and behavior change messages around optimal infant and young child feeding (IYCF) and water, sanitation, and hygiene.

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Background: Global attention to the study of nutrition program implementation has been inadequate yet is critical for effective delivery and impact at scale.

Objectives: The objective of this mixed-methods process evaluation study was to measure the recruitment, fidelity, and reach of a large-scale, community-based nutrition program in Malawi.

Methods: The nutrition program delivered a small-quantity lipid-based nutrient supplement (SQ-LNS) and social and behavior change communication (SBCC) to improve infant and young child feeding (IYCF) and water, sanitation, and hygiene (WASH) practices in households with children aged 6-23 mo.

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We evaluated the association between maternal anxiety score and diet quality over time among mothers and toddlers in low-income families. Longitudinal data were collected from 267 mother-toddler dyads in an obesity prevention trial. Participants were recruited from the Special Supplemental Nutrition Program for Women, Infants and Children and paediatric clinics between 2007 and 2010.

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Micronutrient supplementation during pregnancy has been shown to be a cost-effective method to reduce the risk of adverse pregnancy and birth outcomes. However, one of the main barriers to the successful implementation of a micronutrient supplementation program in pregnancy is poor adherence. Our review will assess the effectiveness of interventions designed to increase adherence to micronutrient supplements in pregnancy.

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One in four children younger than age five in Guatemala experiences anaemia (haemoglobin <11.0 g/dl). This study characterized the factors and micronutrient deficiencies associated with anaemia in a baseline cross-sectional sample of 182 Guatemalan infants/toddlers and 207 preschoolers, using generalized linear mixed models.

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Objective: Excess gestational weight gain (GWG) in obese women is linked to adverse maternal outcomes and is particularly pervasive among African Americans, who have the highest obesity rates in the USA. A better understanding of culturally relevant attitudes and perceptions of GWG is needed to develop targeted interventions to prevent excess GWG among this group.

Design: Using the constructs of Social Cognitive Theory, we explored attitudes and perceptions surrounding diet and exercise among low-income obese African-American pregnant women in Baltimore.

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Stunting has been negatively associated with children's development. We examined the range of height by testing hypotheses: (a) height is positively associated with children's development, with associations moderated by inflammation and (b) home environments characterized by nurturance and early learning opportunities is positively associated with children's development over time and attenuate associations with height. Data included 513 infants (mean age 8.

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Child stunting is a public health problem in Malawi. In 2014, the Government of Malawi launched the Right Foods at the Right Time (RFRT) program in Ntchisi district delivering nutrition social and behavior change communication, a small-quantity lipid-based nutrient supplement to children 6-23 months, and nutrition sensitive activities. Monitoring and evaluation (M&E) systems are key aspects of successful program implementation.

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Objective: To examine the association between household food insecurity and dietary diversity in the past 24h (dietary diversity score (DDS, range: 0-9); minimum dietary diversity (MDD, consumption of three or more food groups); consumption of nine separate food groups) among pregnant and lactating women in rural Malawi.

Design: Cross-sectional study.

Setting: Two rural districts in Central Malawi.

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Background: Adolescents' dietary intake often fails to meet national dietary guidelines, especially among low-income African-American youth. The dietary habits established in adolescence are likely to continue into adulthood, and a poor-quality diet increases the risk of developing obesity and chronic disease. Based on principles from ecological and social-cognitive behavior change health theories, perceptions of parental beliefs about healthy eating, perceptions of peer eating behaviors, and parental monitoring of what adolescents eat may positively influence adolescent diet quality.

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