Action Against Hunger

Abstract Background Preventive nutrition interventions (PNI) are usually implemented without understanding how multilevel factors affect uptake. Undernutrition is defined as inadequate intake of nutritious foods. Pastoral populations coupled with conflicts are seen to have low uptake. The study assessed level and multiple factors influencing uptake of PNI in caregivers of children under 5 years (CU5) in Kapoeta South County of South Sudan. Methods The study was multidimensional and recruited 405 caregivers of CU5. Quantitative data were obtained through a structured questionnaire. Qualitative data were obtained through Key Informant Interviews (KII). Quantitative data were classified; Personal, interpersonal, and community factors and analyzed using Stata version 16.0. Factor analysis categorized uptake levels; low, medium, and high and logistic binary regression model used to evaluate associations. Result Uptake of preventive nutrition interventions was low (51.4%). In a combined regression model, caregivers who had ever heard about PNI (OR=0.16, C.I.=0.10-0.25), number of children in a household (OR=0.40, C.I.=0.26-0.63), and caregivers who made joint decisions (OR=0.31, C.I.=0.19-0.50) were negatively associated with low uptake of PNIs. Similarly, having an undernourished child (OR=2.59, C.I.=1.73-3.89), time to reach health facility (OR=1.70, C.I.=1.30-2.23) and absence of a health facility in community (OR=1.63, C.I.=1.02-2.59) were positively associated with uptake. KIs confirmed undernourishment and time to reach health facilities as barriers influencing low uptake. Conclusion Uptake of preventive nutrition interventions among caretakers of CU5 in a pastoral setting of South Sudan is low. Nutrition stakeholders should target caregivers with information, benefits and availability of PNIs and role of spousal-supported joint decision-making.

Humanitarian crises such as disease outbreaks, conflict and displacement and natural disasters affect millions of people primarily in low- and middle-income countries. Here, they often reside in areas with poor environmental health conditions leading to an increased burden of infectious diseases such as gastrointestinal and respiratory infections. Water, sanitation, and hygiene behaviours are critical to prevent such infections and deaths. A scoping review was conducted to map out what is known about the association between three mental health disorders and people's perceived and actual ability to practice hygiene-related behaviours, particularly handwashing, in humanitarian and pandemic crises. Published and grey literature was identified through database searches, humanitarian-relevant portals, and consultations with key stakeholders in the humanitarian sector. 25 publications were included, 21 were peer-reviewed published articles and four were grey literature publications. Most of the studies were conducted in mainland China (n = 12) and most were conducted in an outbreak setting (n = 20). Six studies found a positive correlation between handwashing and anxiety where participants with higher rates of anxiety were more likely to practice handwashing with soap. Four studies found an inverse relationship where those with higher rates of anxiety were less likely to wash their hands with soap. The review found mixed results for the association between handwashing and depression, with four of the seven studies reporting those with higher rates of depression were less likely to wash their hands, while the remaining studies found that higher depression scores resulted in more handwashing. Mixed results were also found between post-traumatic stress disorder (PTSD) and handwashing. Two studies found that lower scores of PTSD were associated with better hygiene practices, including handwashing with soap. The contradictory patterns suggest that researchers and practitioners need to explore this association further, in a wider range of crises, and need to standardize tools to do so.

Women empowerment is about promoting their sense of self-worth and ability to make choices which may create social influence in society. Moreover, it emphasises sharing equal responsibility in the family as well as society in terms of accessing their choices without any hindrances, contributing economically to the family and society, and representing equally everywhere in the process of development. World’s largest employment guarantee programme, i.e. Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) has provisioned providing 100 days of jobs to one-third of women in the country to ensure livelihood security and asset creation. The current paper tries to highlight the experiences of the beneficiaries from Ladnu block of Rajasthan about their improved lifestyles in terms of qualitative research and suggests ways to bridge the existing gaps to achieve the goal. In other words, it tries to explore whether women, as a beneficiary of the MGNREGA, are contributing to the programme or not, and creating assets for maintaining a better lifestyle. To answer this question, a blended methodology was implemented in two villages of Ladnu block of Rajasthan with 97 respondents. The results are positive from the numbers; however, to achieve the real goal of the Act, the government must actively mull over creating awareness among the community through Gram Panchayat (GP), orient the GP members towards implementing the Act with transparency, timely payment, increase the wage as per the inflation rate and converge different schemes with MGNREGA .

Introduction In contexts of chronic crisis, such as wars, the population is affected by prolonged traumatic exposure. In this type of context, it is sometimes difficult to provide psychological support to work through the trauma because the environment is neither stable nor reassuring. It is about finding care devices that despite the complexity of the situation, manage to bring relief and improve the ability to manage negative emotions and stress. Objectives The objective of the intervention was to relieve people in distress, to help them contain their reactions to moments of anxiety so that they are more available and calm in their daily lives. Since the intervention could not provide long-term treatment for the potential traumatic stress, due to the abuses still in progress, it aimed to prevent the appearance and installation of the symptoms. Methods A group protocol based on emotional stabilization exercises was offered to children and adults from communities affected by the fighting in the civil war in the Central African Republic in 2021. In addition to giving elements of psychoeducation, participants could practice exercises aimed at stabilizing emotions and managing stress. People could benefit from this psychosocial support with daily frequency for four consecutive days. At the beginning and at the end of the care device, psychometric scales were administered in order to be able to measure the improvement in well-being (WHO5) the reduction in symptoms of anxiety and depression (HAD) as well as traumatic symptoms in adults (PCL -5) and children (CPTS-RI). Results Between February and April 2021, 1,200 adults and 400 children were able to participate in the emotional stabilization device. 90% of the participants showed an improvement in well-being and a reduction in stress and axiety reactions. The participants particularly appreciated the exercises for the ease with which they could be reproduced in daily life and transmitted to other members of the family and the community. Despite the fact that exposure to stress remained significant and daily, they expressed the feeling of having regained some control, at least over their own emotions and reactions. Conclusions In situations of chronic stress, where psychic traumatic symptoms cannot be treated sustainably, this emotional stabilization protocol can be an effective option to regulate the emotional states of exposed people and give them tools to cope with anxiety. Two important points to emphasize are also the fact that this device can reach a large part of the population without a lot of means and that it can be provided by non-professionals in mental health, if properly trained and constantly supervised by experts. Disclosure of Interest None Declared

The pandemics of obesity, undernutrition, and climate change represent severe threats to child health. They co-occur; interact with each other to produce sequelae at biological, psychological, or social levels; and share common underlying drivers. In this paper, we review the key issues concerning child diet and nutritional status, focusing on the interactions with climate and food systems. Inadequate infant and young child feeding practices, food insecurity, poverty, and limited access to health services are the leading causes of malnutrition across generations. Food system industrialization and globalization lead to a double burden of malnutrition, whereby undernutrition (i.e., stunting, wasting, and deficiencies in micronutrients) coexists with overweight and obesity, as well as to harmful effects on climate. Climate change and the COVID-19 pandemic are worsening child malnutrition, impacting the main underlying causes (i.e., household food security, dietary diversity, nutrient quality, and access to maternal and child health), as well as the social, economic, and political factors determining food security and nutrition (livelihoods, income, infrastructure resources, and political context). Existing interventions have the potential to be further scaled-up to concurrently address undernutrition, overnutrition, and climate change by cross-cutting education, agriculture, food systems, and social safety nets. Several stakeholders must work co-operatively to improve global sustainable nutrition.

Background: Psychosocial research in humanitarian settings has been historically dominated by a focus on distress and disorder. As such, there is a need to establish the validity of instruments for a broad range of psychosocial outcomes, particularly among highly affected and under-represented populations. The current study describes the adaptation and testing of multiple psychosocial instruments among displaced Rohingya mothers in Bangladesh. Methods: We used baseline data from 600 mothers of malnourished children aged 2 and under enrolled in an intervention study in Cox’s Bazar, Bangladesh. Instruments assessed distress (International Depression Symptom Scale [IDSS] and Kessler-6 [K-6]); functional impairment (World Health Organization Disability Assessment Schedule [WHODAS]); subjective wellbeing (global Satisfaction With Life [SWL] and Personal Wellbeing Index [PWI]; and, coping (Brief COPE and locally developed coping items). Instruments were piloted and refined, then used for data collection by Bangladeshi-Rohingya interviewer pairs. We conducted exploratory factor analysis, evaluated internal consistency, examined construct validity through correlation with other scales, and used regression models to explore demographic factors associated with psychosocial health. Results: Both the WHODAS and coping items fit 2-factor models; other scales were unidimensional. Cronbach’s alphas ranged from .76 to .90 for the refined scales. With the exception of coping, scale correlations supported construct validity; separate measures of the same construct were highly correlated, distress and impairment were moderately correlated, and both were inversely correlated with wellbeing. Correlates of poorer psychosocial health included relative socioeconomic disadvantage, current pregnancy, and being unmarried. Conclusions: Most of the standard psychosocial assessment tools performed adequately, but they did not appear to fully capture local experiences and included items of little local relevance. Findings highlight the need for further mixed methods research to develop a rich battery of instruments with cross-cultural validity, particularly for positive outcomes such as coping which was particularly challenging to assess.

The majority of research on linear growth among children is confined to South Asia and focuses on iron and folic acid (IFA) supplementation during pregnancy, without considering malaria prophylaxis. Similarly, there is limited evidence on the association of antenatal IFA supplementation and malaria prophylaxis with neonatal mortality in sub-Saharan Africa (SSA). This study aims to address these gaps. A pooled analysis of demographic and health survey (DHS) data from 19 countries in SSA was conducted to study the association between IFA supplementation and malaria prophylaxis and linear growth and neonatal mortality. Multivariate logistic and linear regression models were used. Malaria prophylaxis was significantly associated with stunting, height-for-age Z scores (HAZ scores), and neonatal mortality, but IFA supplementation was not associated with these outcomes. When women’s height and body mass index (BMI) were introduced in the model, a significant association between combined malaria prophylaxis and IFA supplementation was found with HAZ scores only. For severe stunting, no significant association was found with either in the two models. In conclusion, this study underscores the importance of antenatal malaria prophylaxis as a potential intervention for nutrition outcomes (linear growth) and neonatal mortality, as well as the importance of coordinating efforts between malaria and the health and nutrition sectors to improve these outcomes in the countries of SSA.

BackgroundIn 2015, the Ministry of Health in Mali included the treatment of severe acute malnutrition (SAM) into the package of activities of the integrated Community Case Management (iCCM). This paper aims to analyze the impact of including community health workers (CHWs) as treatment providers outside the Health Facilities (HFs) on the coverage of SAM treatment when scaling up the intervention in the three largest districts of the Kayes Region in Mali.MethodsA baseline coverage assessment was conducted in August 2017 in the three districts before the CHWs started treating SAM. The end-line assessment was conducted one year later, in August 2018. Coverage was assessed by the standardized methodology called Semi-Quantitative Evaluation of Access and Coverage (SQUEAC). The primary outcome was treatment coverage and other variables evaluated were the geographical distribution of the HFs, CHW’s sites and overlapping between both health providers, the estimation of children with geographical access to health care and the estimation of children screened for acute malnutrition in their communities.ResultsTreatment coverage increased in Kayes (28.7–57.1%) and Bafoulabé (20.4–61.1%) but did not in Kita (28.4–28.5%). The decentralization of treatment has not had the same impact on coverage in all districts, with significant differences. The geospatial analyses showed that Kita had a high proportion of overlap between HFs and/or CHWs 48.7% (39.2–58.2), a high proportion of children without geographical access to health care 70.4% (70.1–70.6), and a high proportion of children not screened for SAM in their communities 52.2% (51.9–52.5).ConclusionsWorking with CHWs in SAM increases treatment coverage, but other critical aspects need to be considered by policymakers if this intervention model is intended to be scaled up at the country level. To improve families’ access to nutritional health care, before establishing decentralized treatment in a whole region it must be considered the geographical location of CHWs. This previous assessment will avoid overlap among health providers and ensure the coverage of all unserved areas according to their population densities need.Trial registration: ISRCTN registry with ID 1990746. https://doi.org/10.1186/ISRCTN14990746

BackgroundHygiene behaviour change programmes are complex to design. These challenges are heightened during crises when humanitarian responders are under pressure to implement programmes rapidly despite having limited information about the local situation, behaviours and opinions—all of which may also be rapidly evolving.MethodsWe conducted in-depth interviews with 36 humanitarian staff involved in hygiene programme design in two crisis-affected settings—one a conflict affected setting (Iraq) and the other amid a cholera outbreak (Democratic Republic of the Congo). Interviews explored decision-making in each phase of the humanitarian project cycle and were thematically analysed.ResultsParticipants considered the design and implementation of hygiene programmes in crises to be sub-optimal. Humanitarians faced sector-specific challenges as well as more general constraints associated with operating within the humanitarian system. Programme-design decisions were made naturalistically and relied heavily on the intuitions and assumptions of senior staff. National organisations were often side-lined from programme design processes despite being in a better position to gather situational data. Consequently, programme design and decision-making processes adopted by humanitarians were similar across the two settings studied and led to similar types of hygiene promotion activities being delivered.ConclusionHygiene programming in crises-affected settings could be strengthened by initiatives targeted at supporting humanitarian staff during the pre-implementation programme design phase. This may include rapid assessment tools to better understand behavioural determinants in crisis-affected contexts; the use of a theory of change to inform the selection of programme activities; and funding mechanisms which encourage equitable partnerships, phased programming, regular adaptation and have programmatic components targeted at sustainability and sector capacity building. Initiatives aimed at sector reform should be cognisant of inter and intra-organisational dynamics, the ways that expertise is created and valued by the sector, and humanitarian habits and norms that arise in response to system constraints and pressures. These micro-organisational processes affect macro-level outcomes related to programme quality and acceptability and determine or limit the roles of national actors in programme design processes.