Sight and Life

Background/Objectives: Emerging evidence suggests that multiple micronutrient supplements (MMS) provide additional benefits for maternal and neonatal health compared with iron and folic acid (IFA) supplements. To achieve effective coverage, acceptability, and adherence—and to inform a nationwide rollout of MMS—it is essential to understand the context-specific factors that shape implementation. This study evaluated the pilot implementation of MMS in Rwanda to identify key enablers, areas for improvement, and challenges related to antenatal care (ANC) attendance and MMS use. Methods: Data were collected through a survey of 3257 women who attended ANC services, seven focus group discussions with 35 ANC attendees, and key informant interviews with 20 ANC nurses and 21 community health workers. Results: Pregnant women reported high ANC attendance (74%) and MMS consumption (79%), largely driven by strong motivation and awareness of MMS benefits. Strategies to remember daily intake and to manage side effects supported adherence, as did reminders, motivation, and information from family members and healthcare providers. Limited patient-centered counselling, financial constraints, barriers to accessing ANC services, and product stock-outs were key areas for strengthening service delivery in Rwanda. Conclusions: Sustaining high ANC attendance and MMS adherence as the program transitions from the pilot phase to national scale-up is essential. Improving counseling quality and strengthening supply chains may reinforce ANC services and support sustained MMS adherence, with benefits for maternal and child health.

BackgroundOptimal nutrition during adolescence is critical to growth and development. While several adolescent nutrition frameworks exist, a comprehensive reference framework is needed, which reflects the priorities and views of young people and guides action to improve adolescent nutrition. We believe that partnering with young people is key to enabling agency and empowering change. This collaborative project between the Global Adolescent Nutrition Network (GANN) and youth partners aimed to develop a conceptual and actionable framework for adolescent nutrition. This paper presents the methods used to identify the need for and to prioritise the key components of a new framework.MethodsA literature review was conducted to identify and summarise available frameworks for adolescent nutrition (10–19 years). GANN members (N=7) and youth partners (N=4, 18–26 years) used nominal group technique (NGT) methodology to reach consensus on: (1) key characteristics, strengths and limitations of available frameworks; (2) key characteristics of an ideal framework; (3) the best available framework and (4) the need for a new framework.ResultsNGT participants listed 37 strengths and limitations of the 15 frameworks identified in the review. These were classified into three themes: theory, usability and visibility. According to NGT participants, the most important (‘top’) theoretical features of an ideal framework were considering all forms of malnutrition’ and including all levels of influence in adolescent nutrition’. Most top usability and visibility features were applicable at global, regional and country levels, and a clear structure to depict levels of influence, respectively. The Innocenti Framework was deemed the best available framework. Most of the participants (90%) agreed that a new framework was needed. Youth partners advocated for greater representation of youth voices in frameworks and programmes related to adolescents. The salient features of the new framework, reached by consensus, emphasise an action-oriented approach that provides practical guidance to improve adolescent nutrition rather than solely explaining its determinants. It will be designed to be adaptable to different contexts, ensuring its visual design, language and content are accessible and engaging for a broad range of stakeholders.ConclusionThrough a novel youth codesign process, we identified key components to inform the development of a new conceptual framework to improve adolescent nutrition. While no new framework is presented in this article and is part of ongoing work, these findings provide guidance for future efforts to create a framework that can effectively inform actions and investments in global adolescent nutrition.

Despite progress in improving maternal and child nutrition, there are still high levels of stunting and anemia in Ethiopia, primarily caused by dietary diversity and low consumption of animal-sourced foods (ASFs). One promising solution is the utilization of egg powder, for it requires reduced transport and storage costs, has an extended shelf life, and versatile usage compared to whole eggs. A consumer research study conducted by Sight and Life (SAL) and the Ethiopian Public Health Institute (EPHI) aimed to explore opportunities for introducing powdered egg products targeting pregnant and lactating women (PLW) and children 6-60 months old in Ethiopia. The qualitative study assessed participants' usage of egg powder across four prototypes: (i) plain egg powder, (ii) Shiro with egg powder, (iii) porridge mixed with egg powder, and (iv) egg powder scrambled with the local flatbread (injera). The research focused on participants' reactions to each prototype, considering preparation, cooking, and consumption experience, and gauged perceptions regarding each prototype's relevance, pricing, packaging, and place of purchase. A total of 38 participants were recruited across four regions with the following criteria: (1) Mothers with at least one child under 5; (2) PLW; (3) Decision-makers in their households regarding food purchases; (4) Literate, to ensure comprehension of the recipe booklet and label elements; (5) Not averse to the consumption of eggs; (6) No history of egg allergies (including family members); and (7) Belonging to lower-income categories. Overall, the egg powder received positive feedback, with identified areas for improvement indicated, mostly from an organoleptic point of view (unpleasant smell during the preparation stage). An in-home usage study of egg powder revealed positive reactions, particularly for the Shiro and baby porridge prototypes. The results are critical in identifying and introducing the most appropriate egg powder product for women and children in Ethiopia.

Objectives: Gestational micronutrient deficiencies are common in Palestine refugees. Multiple micronutrient supplements (MMS) can reduce adverse pregnancy outcomes. UNRWA provides antenatal care (ANC) to ∼90,000 refugee women annually. Since 2020, UNWRA has conducted implementation research to align with WHO guidelines for replacing iron-folic acid (IFA) with MMS as standard of ANC. Starting in Jordan, we compared MMS vs IFA program acceptability, adherence and effectiveness in preventing anemia.

BackgroundAnemia poses a significant public health problem, affecting 1.6 billion people and contributing to the loss of 68.4 million disability-adjusted life years. We assessed the impact of a market-based home fortification program with micronutrient powder (MNP) called Pushtikona-5 implemented by Bangladesh Rural Advancement Committee (BRAC) on the prevalence of anemia among children aged 6–59 months in Bangladesh.MethodsWe used a modified stepped wedged design and conducted three baseline, two midline, and three endline surveys to evaluate the Pushtikona-5 program implemented through three BRAC program platforms. We interviewed children’s caregivers, and collected finger-prick blood samples from children to measure hemoglobin concentration. We also collected data on coverage of Pushtikona-5 and infant and young child feeding (IYCF) practices. We performed bivariate and multivariable analysis and calculated adjusted risk ratios (ARRs) to assess the effect of program outcomes.ResultsA total of 16,936 households were surveyed. The prevalence of anemia was 46.6% at baseline, dropping to 32.1% at midline and 31.2% at endline. These represented adjusted relative reductions of 34% at midline (RR 0.66, 95%CI 0.62 to 0.71, value of p <0.001) and 32% at endline (RR 0.68, 95%CI 0.64 to 0.71, value of p <0.001) relative to baseline. Regarding MNP coverage, at baseline, 43.5% of caregivers surveyed had heard about MNP; 24.3% of children had ever consumed food with MNP, and only 1.8% had consumed three or more sachets in the 7 days preceding the survey. These increased to 63.0, 36.9, and 4.6%, respectively, at midline and 90.6, 68.9, and 11.5%, respectively, at endline.ConclusionThese results show evidence of a reduction in the prevalence of anemia and an improvement in coverage. This study provides important evidence of the feasibility and potential for impact of linking market-based MNP distribution with IYCF promotion through community level health workers.

BackgroundBy 2050, approximately 68% of the global population will live in cities, but nutrition data on urban populations of low- and middle-income countries are scarce. Fast growing secondary cities, combining characteristics and hurdles of urban and rural settings, are hotspots for the double burden of malnutrition. The Nutrition in City Ecosystems (NICE) project focuses on 6 secondary cities in Bangladesh, Kenya and Rwanda, to improve health and nutrition, and reduce poverty. To assess the baseline situation and guide future interventions, food insecurity, dietary diversity, nutrition status, and food production and purchasing patterns were explored.MethodsIn a cross-sectional study design, data were collected from urban and peri-urban households of Dinajpur and Rangpur in Bangladesh, Bungoma and Busia in Kenya, and Rubavu and Rusizi in Rwanda. Approximately 1200 households, in neighborhoods prone to malnutrition, were involved from April to June 2021. We assessed Household Food Insecurity Access Score (HFIAS), both current and before COVID-19, Household Dietary Diversity Score (HDDS), Minimum Dietary Diversity for Women (MDD-W), anthropometric measurements, household and socioeconomic information, and questions related to food production and consumer behavior. Further we collected secondary data on low birthweight and anemia during pregnancy.ResultsAll cities experienced a substantial increase in food insecurity during the COVID-19 pandemic. Stunting rates in children under 5 years varied among the cities and ranged from 7.8% in Busia to 46.6% in Rubavu, while half of adult women were overweight (between 42.1% in Rusizi and 55.8% in Bungoma). Furthermore, many women did not consume an adequately diverse diet (MDD-W < 5 for 29.3% in Bangladesh, 47.5% in Kenya, and 67.0% in Rwanda), however many of the urban and peri-urban households were engaged in farming (58–78%).ConclusionsThe double burden of malnutrition is high in secondary cities and the COVID-19 pandemic has exacerbated levels of food insecurity. Demand for, and access to, an affordable healthy diverse diet that comprises local, nutritious, and agroecologically produced foods present a pathway for overcoming the complex challenges of malnutrition.

The camera’s exposure time restricts the reception bandwidth in rolling shutter-based optical camera communication links. Short exposures are preferable for communications, but under these conditions, the camera produces dark images with impracticable light conditions for human or machinesupervised applications. Alternatively, deep learning equalization stages can mitigate the effects of increasing the exposure time. These equalizers are trained using synthetic images based on the camera’s exposure time and row sampling frequency. If these parameters are unknown in advance, another artificial network is used to estimate them directly for the captured images, the estimator. This estimator is trained offline using a vast number (thousands) of representative cases. This work proposes to transfer the attained knowledge from the offline pretrained estimator to the equalizer by using transfer learning techniques. In this way, the equalizers’ training time is significantly reduced (435 times compared to full training). Consequently, transfer learning enables equalizers’ online and on-demand training at reception without interfering with the communications. Results reveal that the complete training requires using exclusively 250 synthetic images to guarantee a communication performance with a bit error rate below 10 <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">-4</sup> after the equalization.