Explore the vast range of titles available.

Objective:This study investigates and measures whether the association of childhood stunting with household socio-economic position (SEP) differs in Sri Lanka compared with other South Asian countries.Design:Secondary analysis of data of children from the latest available Demographic and Health Surveys data (survey years, 2016–2018). The exposures (SEP) were maternal education and wealth. The outcome was stunting. Binary logistic regression models incorporated SEP, country and SEP-by-country interaction terms.Setting:A nationally representative sample of children from Bangladesh, India, Nepal, Pakistan and Sri Lanka.ParticipantsMothers/caregivers of children under 36 months (133 491).Results:The prevalence of stunting in Sri Lanka of 19 % was much lower than that observed for all the other low- to low–middle income South Asian countries (37 % in Bangladesh, 36 % in India, 31 % in Nepal and 30 % in Pakistan). The association of SEP with odds of stunting was similar in Sri Lanka compared with other South Asian countries. The only exception was weaker associations of wealth with stunting in Sri Lanka compared with Bangladesh. For example, in Sri Lanka, the poorest group had 2·75 (2·06, 3·67) times higher odds of stunting compared with the richest group, but in Bangladesh, this estimate was 4·20 (3·24, 5·44); the difference between these two estimates being 0·65 (0·44, 0·96) on the OR scale.Conclusions:The lower prevalence of stunting in Sri Lanka is unlikely to be due to less inequality. It is more likely that the lower prevalence of stunting in Sri Lanka is related to there being fewer mothers belonging to the lowest SEP groups.

Background Physical activity (PA), sedentary behaviour (SB) and diet play an important role in the physical and mental health of young people. Understanding how these behaviours cluster, and the impact of clusters on health is important for the development of public health interventions. This review examines the prevalence of clusters of PA, sedentary time, and dietary behaviours, and how clusters relate to physical and mental health indicators among children, adolescents and young adults. Methods Electronic (PubMed, Web of Science and Scopus) and manual searches were conducted for articles that were (i) observational studies including children, adolescents and/or young adults aged 5–24 years, (ii) examined the 'patterning', ‘clustering’, or ‘co-existence’ of each of PA, dietary behaviour and SB, and (iii) published in English up to and including July 2022. In addition to information on clustering, data on physical and mental health outcomes were extracted where reported. Included studies were assessed using the Cochrane risk of bias for observational studies. A narrative synthesis was conducted due to high heterogeneity. This review was registered with PROSPERO (CRD42021230976). Results Forty-nine cross-sectional studies and four prospective cohort studies from eighteen countries reporting data from 778,415 individual participants were included. A broad range of clusters ( n  = 172) were found (healthy, unhealthy, and mixed). Mixed clusters were common ( n  = 98), and clusters of high diet quality, low PA and high SB were more prevalent in girls, while mixed clusters of high PA, high SB and low diet quality were more prevalent in boys. Unhealthy clusters comprising low moderate to vigorous PA, low consumption of fruits and vegetables, and high screen time were prevalent, particularly in those from lower socioeconomic status families. Compared to those with healthy behavioural clusters, those with unhealthy and mixed clusters had a higher adiposity, higher risk of cardiovascular disease, poorer mental health scores, and lower cardiorespiratory fitness. Conclusions PA, SB and diet cluster in healthy, unhealthy and mixed patterns in young people that differ across sociodemographic characteristics. Unhealthy clusters are associated with poorer health outcomes. Intervention strategies targeting un-clustering multiple unhealthy behaviours should be developed and evaluated for their impact on health outcomes.

Clusters of health behaviours could impact changes in adiposity among adolescents over time. This study examines the clustering of screen time, physical activity, dietary behaviours and sleep, and the associations with 3-year changes in indicators of adiposity. Data from the UK's Millennium Cohort Study were utilised when participants were aged 14 and 17 years respectively. At age 14, demographics, screen time, dietary behaviours and sleep duration were measured via self-report, and physical activity using wrist worn accelerometers. Height, weight, and percent body fat were measured at age 14 and 17 years. Behavioural clusters were determined using k-means clustering analysis, and associations with change in indicators of adiposity between age 14 and 17 years were examined using multivariate regression models. Three clusters were identified at age 14, a 'healthy cluster', a 'mixed cluster', and an 'unhealthy cluster' in the analytical sample of 3,065 participants (52.5% girls). The 'unhealthy' cluster was the most prevalent cluster among boys (53%), while the 'healthy cluster' was most prevalent among girls (55.9%). Adolescents in healthy clusters had a lower BMI z-score and percent body fat at age 14 compared to those in the unhealthy and mixed clusters, and maintained lower scores at age 17. Boys in the mixed and unhealthy clusters at 14 years had a lower change in BMI z-score between 14 and 17 compared to boys in the healthy cluster. Adolescents in the healthy cluster had lower BMI z-scores and percent body fat at age 14 years than those in the unhealthy cluster, and they maintained this lower level at age 17. Given the upward trend in BMI during this period, this maintenance could be interpreted as a positive outcome. Further prospective research is needed to better understand these associations as well as research examining the stability of cluster membership over time.

Background The COVID-19 pandemic led to decline in access and utilization of the baby-friendly community initiative (BFCI) which is being implemented in Kenya. The impact of the pandemic on the BFCI and on maternal and child health and nutrition has not been documented. We undertook a qualitative study that assessed the effect of the COVID-19 pandemic on the baby-friendly community initiative (BFCI) activities, maternal and child health (MCH) services and maternal, infant and young child nutrition (MIYCN) practices in Kenya. Methods Data on the impact of the pandemic on the BFCI activities, provision and access to MCH services and MIYCN practices were collected using key informant interviews ( n  = 57), in-depth interviews ( n  = 31), and focus group discussions ( n  = 15) with government officials, civil society organizations and community members in BFCI implementing and non-implementing urban and rural areas. Results Our study found that BFCI activities, such as home visits, support group meetings and MCH services such as nutrition counselling, growth monitoring and vaccination were interrupted by the pandemic due to fear of contracting the virus, lack of personal protective equipment (PPEs) and movement restrictions. This meant that mothers did not have access to basic community and health services. Food insecurity attributed to financial difficulties resulted in coping strategies such as skipping meals and negatively affected MIYCN practices. Positive measures to prevent COVID-19 spread such as remote working enabled some mothers to adequately feed their children because they were better able to balance working and the demands of feeding young children from home. Conclusion On balance, the pandemic negatively impacted the BFCI, MCH services and MIYCN practices in Kenya. In such a context, there is a need for innovative approaches to ensure continued provision of and access to facilities and community health services in the future if the country finds itself in a similar position with the challenges of a pandemic. The pandemic revealed that remote working support policies could have the potential to improve breastfeeding and complementary feeding for working women but further evidence is needed to fully evaluate this.

Rapid urbanisation in the Asia‐Pacific region is associated with complex changes to urban food environments. The impact of changing food environments on food purchasing and consumption and the diets and nutritional status of vulnerable groups, especially women and young children, is not well researched in low‐ and middle‐income country cities. This paper aimed to examine: the risks and opportunities for healthy diets for low income populations offered by modernising urban centres; the concept of food deserts in relation to urban food environments in the Asia‐Pacific region and how these could be mitigated; and measures to strengthen the resilience of food environments in the region using a case study of the impact of COVID‐19 on informal food vendors. Our findings indicate that the dynamic changes in urban food environments in the Asia‐ Pacific region need to be understood by examining not only modern retail food outlets but also wet markets and informal food outlets, including street foods. Efforts should be made to ensure both modern and traditional outlets provide complementary platforms for convenient, affordable and accessible nutritious foods for urban populations. The resilience of urban food environments to environmental, physical and socio‐economic shocks can be strengthened by shortening food supply chains and maximising food production in cities. Support mechanisms targeting urban informal food outlets and street vendors can also strengthen resilience and improve food security. Further research is needed on the impact of urbanising food environments on consumer choices, preferences, diets and health outcomes. Urban food retail outlets in low‐ and middle‐income countries in Asia and the Pacific are undergoing rapid modernisation which brings risks as well as opportunities for healthy diets among vulnerable groups including women and children. With rapid modernisation of food retail outlets, steps should be taken to prevent food deserts and food swamps in low income urban neighbourhoods. Informal food retailers and street food vendors, a key component of urban food environments in the region, were particularly adversely affected during the COVID‐19 pandemic. Shorter food supply chains and the promotion of food production in cities and surrounding areas can further strengthen the resilience of urban food environments.

A conceptual framework is presented for enhancing food security and nutrition in urban areas in low- and middle-income countries, highlighting key influencing factors, including food supply chains, community food environments, community infrastructure and services, and numerous underlying individual and household determinants, such as behaviours and dietary practices.

Given the recent, rapid urbanisation in Asia and the Pacific region, coupled with increases in the triple burden of malnutrition, we need to better understand maternal, infant and young child nutrition (MIYCN) for populations living in urban slum environments. This research used existing large‐scale datasets to explore MIYCN indicators for those living in urban slum, compared with urban nonslum, areas. Data since 2015 from available Demographic and Health Surveys (DHS; Afghanistan, India, Indonesia, Myanmar, Pakistan and the Philippines) and Multiple Indicator Cluster Surveys (MICS; Bangladesh, Fiji, Kiribati, Mongolia, Nepal, Thailand and Tuvalu) were analysed. Most urban children in the 13 countries from the region were breastfed within 24 h of birth, with slightly higher rates for those living in slums. Conversely, almost all indicators of infant and young child malnutrition were worse for those in urban slums. For mothers living in slums, underweight prevalence and iron deficiency anaemia were higher while maternal overweight and obesity prevalence were lower. Analysis revealed disparities across countries in the wealth status of those living in slum versus nonslum areas. What is currently missing is representative sampling of households, adequate collection of data both within and across countries, and accurate representation of slum‐dwellers in large‐scale surveys. Given that limited data for the region show urban poor slum populations are vulnerable to poor nutrition indicators, more data are needed on the poorest urban slum populations to enable effective resource allocation to support optimal MIYCN. Maternal, infant and young child nutrition (MIYCN) indicators were generally worse for those living in urban slum households compared to those in nonslum urban areas. The MIYCN data collected were highly variable across surveys and countries of the Asia‐Pacific region. This paper highlights that data are missing/not collected from numerous countries in the region which limited analysis to 13 countries. Slum populations are underrepresented in large‐scale surveys. More data are needed on the poorest urban slum populations for more countries in the region to enable resources to be allocated appropriately to support optimal MIYCN.

Background Screen-time and eating behaviours are associated in adolescents, but few studies have examined the clustering of these health behaviours in this age group. The identification of clustered health behaviours, and influences on adolescents’ clustered health behaviours, at the time when they are most likely to become habitual, is important for intervention design. The purpose of this study was to assess the prevalence and clustering of health behaviours in adolescents, and examine the sociodemographic, individual, behavioural, and home social and physical environmental correlates of clustered health behaviours. Methods Adolescents aged 11–12 years ( n  = 527, 48% boys) completed a questionnaire during class-time which assessed screen-time (ST), fruit and vegetable (FV), and energy-dense (ED) snack consumption using a Food Frequency Questionnaire. Health behaviours were categorised into high and low frequencies based on recommendations for FV and ST and median splits for ED snacks. Adolescents reported on their habits, self-efficacy, eating at the television (TV), eating and watching TV together with parents, restrictive parenting practices, and the availability and accessibility of foods within the home. Behavioural clustering was assessed using an observed over expected ratio (O/E). Correlates of clustered behaviours were examined using multivariate multinomial logistic regression. Results Approximately 70% reported having two or three health risk behaviours. Overall, O/E ratios were close to 1, which indicates clustering. The three risk behaviour combination of low FV, high ED, and high ST occurred more frequently than expected (O/E ratio = 1.06 95% CI 1.01, 1.15. Individual, behavioural, and social and physical home environmental correlates were differentially associated with behavioural clusters. Correlates consistently associated with clusters included eating ED snacks while watching TV, eating at the TV with parents, and the availability and accessibility of ED snack foods within the home. Conclusions There is a high prevalence of screen time and unhealthy eating, and screen time is coupled with unhealthy dietary behaviours. Strategies and policies are required that simultaneously address reductions in screen time and changes to habitual dietary patterns, such as TV snacking and snack availability and accessibility. These may require a combination of individual, social and environmental changes alongside conscious and more automatic (nudging) strategies.

Anemia is a major public health problem in children under 2 years old in Peru and other low- and middle-income countries. We aimed to explore facilitators and barriers to anemia prevention through feeding strategies in the Cuna Mas day-care centers in urban Peru among infants and young children (IYC) aged 6-23 months. Qualitative research in day-care services (  = 14) in Peru. We conducted direct observations and semi-structured interviews about consumption of animal source foods (ASF) and iron supplementation with day-care staff (technical managers, nursery caregivers and 'mother guides') and caregivers of IYC. We applied a grounded approach to data analysis. Cuna Mas staff facilitated ASF consumption by introducing small portions of iron-rich foods and serving organ meats in tasty stews. Staff also avoided giving carbohydrate-rich foods to IYC prior to giving organ meats. Staff facilitated giving daily iron supplement by using standardized and personalized strategies, such as using a timed reminder, praising and cheering a child or giving supplements whilst washing a child's hands and face. These strategies were also shared with primary caregivers to use at home. Some barriers reported by caregivers included difficulties in accessing and preparing specific ASF at home. The Peruvian Cuna Mas complementary feeding program facilitated consumption of iron-rich ASF and iron supplements through a range of strategies which they then shared with caregivers for implementation at home. These institutional behavioral change initiatives could be replicated in other settings whilst considering the facilitators and barriers identified in this study.

This study developed, validated, and evaluated a framework of factors influencing dietary behaviours in urban African food environments, to inform research prioritisation and intervention development in Africa. A multi-component methodology, drawing on concept mapping, was employed to construct a framework of factors influencing dietary behaviours in urban Africa. The framework adapted a widely used socio-ecological model (developed in a high-income country context) and was developed using a mixed-methods research approach that comprised: i. Evidence synthesis consisting of a systematic review of 39 papers covering 14 African countries; ii. Qualitative interview data collected for adolescents and adults (n = 144) using photovoice in urban Ghana and Kenya; and iii. Consultation with interdisciplinary African experts (n = 71) from 27 countries, who contributed to at least one step of the framework (creation, validation/evaluation, finalisation). The final framework included 103 factors influencing dietary behaviours. Experts identified the factors influencing dietary behaviours across all the four levels of the food environment i.e. the individual, social, physical and macro levels. Nearly half (n = 48) were individual-level factors and just under a quarter (n = 26) were at the macro environmental level. Fewer factors associated with social (n = 15) and physical (14) environments were identified. At the macro level, the factors ranked as most important were food prices, cultural beliefs and seasonality. Factors ranked as important at the social level were household composition, family food habits and dietary practices. The type of food available in the neighbourhood and convenience were seen as important at the physical level, while individual food habits, food preferences and socioeconomic status were ranked highly at the individual level. About half of the factors (n = 54) overlap with those reported in an existing socio-ecological food environment framework developed in a high-income country context. A further 49 factors were identified that were not reported in the selected high-income country framework, underlining the importance of contextualisation. Our conceptual framework offers a useful tool for research to understand dietary transitions in urban African adolescents and adults, as well as identification of factors to intervene when promoting healthy nutritious diets to prevent multiple forms of malnutrition.