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The protection and support of breastfeeding is the most effective intervention to prevent child morbidity and mortality especially in humanitarian crisis. During the Palestine-Israel conflict healthcare services are understaffed and lack basic resources, with frequent power cuts and stock-outs of essential drugs and equipment. This case study seeks to answer the questions: (1) How does the protracted crisis in Gaza affect the breastfeeding practices of the most vulnerable population; and (2) What is the role that midwives can play in improving breastfeeding practices? The study was conducted using a mixed method approach with quantitative and qualitative methods. Purposeful selection of women and children was conducted utilising eligibility criteria, women with children less than 2 years of age were included. All the respondents were asked if they agreed to participate in the survey. A total of 63% practice early initiation of breastfeeding and 42% confirmed that their new-borns were given liquids other than breast milk during the first 3 days of life. Fifty percent of mothers addressed breast milk insufficiency by drinking additional fluids and 40% by using infant formula. Only 18% of women said that they received breastfeeding information during contact with health professionals throughout labour, delivery, and subsequent post-natal care visits. Many mothers during the focus group discussions (FGDs) confirm using milk to top up or replace breast milk. Myths and misconceptions around breastfeeding remain, while women do access antenatal care services and deliver in the health facilities. There is a need to a) adapt the recommendations of the operational guidance for infant and young child feeding in emergencies (IYCF-E) in the Gaza strip, to protect, promote and support breastfeeding and b) include skilled breastfeeding counselling in the pre-service and in-service training for midwives. Lessons learned included the importance of a) allocating additional research time, to account for interruption b) daily coordination with security officers to ensure safe access to localities c) identification of extra sites, in case of conflict escalation d) training of additional enumerators in case conflict escalation e) negotiation with authorities to ensure compliance with requirements.

The COVID‐19 pandemic caused a crisis that jeopardized food consumption and dietary diversity. This study aimed to: (1) investigate relationship between COVID‐19 and women's and children's diets in India; (2) examine how this varies by socioeconomic status and mothers' vegetarianism; and (3) assess whether mobility restrictions during India's national lockdown influenced these dietary changes. The analysis drew on data from India's National Family Health Survey 2015–16 and 2019–21, focusing on 11 states surveyed before and during COVID‐19 ( N  = 567,727 women, 141,905 children). COVID‐19 exposure was defined as interviews after 24 March 2020 (national lockdown). Outcomes included child feeding practices and women's food consumption and dietary diversity. The impact of COVID‐19 on diets was estimated using a difference‐in‐difference model; effect of mobility reduction on diets was examined using linear regression. All analyses were adjusted for confounders, interview month, state fixed effects, and sampling weights. Results showed that COVID‐19 exposure was linked to significant declines in child feeding practices (−6.9 percentage points [pp] for minimum dietary diversity, −5.0 pp for minimum acceptable diet, and −6.1 pp for fruit consumption) and women's diet (−5.7 pp for dietary diversity and green vegetable consumption). While magnitude of impact varied across socioeconomic sub‐strata and mothers’ vegetarianism status, the differences were not statistically significant. The diets of women and children were greatly impacted by mobility reduction. COVID‐19 has worsened the diets of women and children in India. More research is needed on the impact of relief measures to strengthen food safety nets nationwide. Before the pandemic, the diets of children and women in Indian districts were suboptimal. The COVID‐19 pandemic further deteriorated the dietary status of both mothers and children. Exclusive breastfeeding improved & complementary feeding declined following the pandemic. The effect of the pandemic on dietary intake and diversity among children and women did not show significant variation across different socioeconomic groups or vegetarianism categories. Mobility reduction during lockdown affected food consumption & diet diversity.

Infants experience significant changes in gut microbiota during the first year of life as they transition from exclusive milk consumption to solid foods. The purpose of this study is to explore how dietary changes in infancy influence gut microbiota composition and diversity. A scoping review was conducted using databases including PubMed, Web of Science, Ovid Medline, Science Direct, and ProQuest. English-language studies published between 2003 and 2023 were included if they focused on mothers and caregivers with children aged 0 to 23 months involved in Infant and Young Child Feeding practices. A total of 561 studies were identified, with 15 articles included for data extraction. Significant differences in gut microbiota diversity related to feeding practices were observed. Infants who were exclusively breastfeding (EBF) exhibited lower phylogenetic diversity (5.8 ± 1.3, P < 0.05) compared to non-EBF infants (6.4 ± 1.8, P < 0.05). The EBF infants showed significantly (P < 0.05) higher levels of beneficial bacteria, such as Bifidobacterium, while non-EBF infants had elevated levels of potentially pathogenic genera, including Bacteroides and Clostridium. Additionally, earlier introduction of complementary foods was associated with increased alpha diversity (mean difference = 0.40, 95% CI: 0.25, 0.55), and dietary factors such as total energy intake, carbohydrate, and fiber significantly correlated with gut microbial diversity (P < 0.05). These results imply that the type of feeding, timing of introduction, and type of food intake during complementary feeding have a significant impact on the infant’s gut microbiota diversity and composition. Future research could explore the long-term implications of these early dietary exposures on metabolic function and immune system health.

Background Maternal and child undernutrition remain prevalent in developing countries with 45 and 11% of child deaths linked to poor nutrition and suboptimal breastfeeding, respectively. This also has adverse effects on child growth and development. The study determined maternal dietary diversity, breastfeeding and, infant and young child feeding (IYCF) practices and identified reasons for such behavior in five rural communities in South Africa, in the context of cultural beliefs and social aspects. Methods The study used mixed methodology technique. Questionnaires were administered to 84 households, pairing mother/caregiver and a child (0–24 months old) to obtain information on maternal dietary diversity, IYCF and breastfeeding practices. Qualitative data on breastfeeding perceptions, IYCF practices, perceived eating habits for lactating mothers and cultural beliefs related to mothers’ decision on IYCF and breastfeeding practices were obtained through focus group discussions. Results Maternal dietary diversity was very low and exclusive breastfeeding for the first 6 months of life was rarely practiced, with young children exposed to poor-quality diets lacking essential nutrients for child growth and development. Social circumstances including lack of income, dependence on food purchasing, young mothers’ feelings regarding breastfeeding and cultural beliefs were the major drivers of mothers’ eating habits, breastfeeding behaviour and IYCF practices. Fathers were left out in breastfeeding and IYCF decision making and young mothers were unwilling to employ indigenous knowledge when preparing food (especially traditional foods) and feeding their children. Conclusion The study provides comprehensive information for South African context that can be used as an intervention measure to fight against malnutrition in young children. Finding a balance between mothers’ income, dietary diversity, cultural beliefs, breastfeeding and considering life of lactating mothers so that they won’t feel burdened and isolated when breastfeeding and taking care of their children is crucial. Paternal inclusion in breastfeeding decisions and safeguarding indigenous knowledge on IYCF practices is recommended.

Background: Minimum Acceptable Diet (MAD), developed by the WHO and UNICEF, is a binary indicator of infant and young child feeding practice that assesses the quality and sufficiency of a child’s diet between the ages of 6 and 23 months. Identifying factors associated with MAD among children can inform policymakers to improve children’s nutritional status. Methods: We extracted data of 1930 children aged 6–23 months from the Nepal Multiple Indicator Cluster Survey 2019. Multilevel analysis was performed to identify factors associated with MAD. Results: Only 30.1% of the children received MAD. Children aged 13–18 months [aOR (Adjusted odds ratio): 2.37, 95% CI (95% Confidence Interval): 1.77, 3.17] and 19–23 months (aOR: 2.6, 95% CI: 1.95, 3.47) were more likely to receive MAD than children aged 6–12 months. Early breastfed children (aOR: 1.34, 95% CI: 1.05, 1.72), those currently breastfeeding (aOR: 4.13, 95% CI: 2.21, 7.69) and children without siblings aged under five (aOR: 1.33, 95% CI: 1.03, 1.73) were more likely to receive MAD. Younger maternal age (aOR: 0.97, 95% CI: 0.95–1.0), higher level of mother’s education (aOR: 1.04, 95% CI: 1.0–1.08) and more media exposure among mothers (aOR: 1.66, 95% CI: 1.24, 2.21) were positive predictors of MAD. Relatively disadvantaged ethnicity/caste (aOR: 0.71, 95% CI: 0.53, 0.94), rural residence (aOR: 1.45, 95% CI: 1.06, 2.00) and residing in Madhesh province (aOR: 0.61, 95% CI: 0.37, 1.0) were also significant predictors of MAD. Conclusions: Children aged 6–12 months, without appropriate breastfeeding, having under-five years siblings, with older mother or mother without media exposure or low education, from relatively disadvantaged ethnicity/caste, from urban areas and residing in Madhesh Province were less likely to receive MAD. Our findings can inform infant and young child feeding policies and practices in Nepal.

Background: Stunting is primarily a public health concern in Low- and Middle-Income Countries (LMIC). The involvement of Integrated Health Service Post (Indonesian: Posyandu) cadres is among the strategies to combat stunting in Indonesia. Objective: This study aimed to determine the effect of a short course on cadres’ knowledge. Method: A single group pre-test post-test design was conducted in Yogyakarta, Indonesia, from March to May 2022. Thirty cadres were selected based on the following criteria: willingness to participate, the number of stunted children in their Posyandu, able to read and write, and full attendance at the short course. The knowledge scores were measured by a questionnaire using true and false answers after a short course (post-test 1) and 4 weeks later (post-test 2). We apply STATA 16 to calculate the Mean Difference (MD) using a t-test and a Generalized Estimated Equation (GEE). Furthermore, the adequacy of the short course was evaluated with in-depth interviews. Result: GEE analysis showed that after controlling for age, education, occupation, and years of experience, the short course improved cadres’ knowledge significantly on post-tests 1 and 2, i.e., knowledge regarding Children Growth Monitoring (CGM) (Beta = 6.07, 95%CI: 5.10–7.03 and Beta = 8.57, 95%CI: 7.60–9.53, respectively), Children Development Monitoring (CDM) (Beta = 6.70, 95%CI: 5.75–7.65 and Beta = 9.27, 95%CI: 8.31–10.22, respectively), and Infant Young Children Feeding (IYCF) (Beta = 5.83, 95%CI: 4.44–7.23 and Beta = 11.7, 95%CI: 10.31–13.09, respectively). Furthermore, the short course increased their self-efficacy, confidence, and ability to assist stunted children through home visits. Conclusion: The short courses consistently and significantly boosted cadres’ knowledge of CGM, CDM, and IYCF, and appropriately facilitated cadres in visits to the homes of stunted children’s home.

Introduction: Infant health and nutrition in South Africa are a priority, as evidenced by the political commitment and policy development history of the last 25 years. Current efforts focus on improving breastfeeding rates, but the action plan for complementary feeding receives less attention and resourcing. A thorough analysis of the current infant feeding situation is required to assist with policy and targeted programmes associated with complementary feeding. Aim: The aim of this review was to identify and collate all published research in South Africa on the complementary feeding practices of infants and young children, aged 0-24 months. Methodology: Searches included English-language research published between 2006 and 2017, within PubMed, Scopus, Web of Science and Google Scholar. All papers included in the review had to meet defined eligibility criteria. Papers older than 11 years were excluded. In total 34 papers relevant to South Africa were identified and included in this review. Main findings: Early introduction of foods and liquids other than breast milk is a common practice. Maize porridge is a common first food for infants, but there is also a high reliance on commercial infant cereal. Water and other liquids (e.g. tea, herbal mixtures) are commonly given to infants younger than six months. There is little information on the number of meals per day. The diets of many older infants do not meet the criteria for a minimally acceptable diet. Few animal source foods are used in complementary feeding. There are indications that processed meats, soft drinks, sweets and salty crisps are given regularly to older infants between six months and one year. Conclusion: Complementary feeding practices in South Africa are suboptimal and appropriate action is needed to improve this situation. Further investigation is needed on whether older infants and young children can achieve their required dietary intakes from the food that is available to them. If a change in older infant and young child feeding behaviour is desired, then existing methods and approaches need to change.

Background Optimal breastfeeding and complementary feeding practices are critical to prevent child undernutrition. Despite the occurrence of child undernutrition and widespread suboptimal feeding practices in Malawi, the association of breastfeeding and complementary feeding practices and undernutrition among Malawian children remains unclear. The purpose of the study was to determine the current breastfeeding and complementary feeding practices, to identify maternal determinants of each practice, and to analyze the associations between breastfeeding and complementary feeding practices with stunting, underweight, and wasting. Methods The most recent Malawi Demographic Health Survey (2015–2016) was used and data for 2294 children aged 0–23 months were included. A conceptual framework of five maternal domains: sociodemographic, health status, health behaviors, women’s empowerment, and media exposure was used. Each domain contained exposure variables and the WHO Infant and Young Child Feeding indicators were used as outcome variables. All analyses were adjusted for clustering, and variables that reached a p -value of < 0.05 were considered significant in the final model. Results Among children, 30.8% were stunted, 9.9% were underweight, and 3.7% were wasted. Many (78%) were breastfed within the first hour of birth, 89% were breastfed until their first birthday, yet 40% were not exclusively breastfed to 6 months. Only 32% met minimum dietary diversity, 23% met minimum meal frequency, 12% met minimum acceptable diet and 12% consumed iron-rich foods. Children whose mothers lived in urban areas were less likely to be breastfed within 1 hour of birth but more likely to meet minimum dietary diversity. Children whose mothers listened to radio were more likely to meet minimum meal frequency. Children (13–23 months) who met minimum meal frequency and minimum acceptable diet were less likely to be underweight. Conclusions Optimal breastfeeding and complementary feeding practices in Malawi remain suboptimal and child undernutrition remains problematic. Maternal characteristics from the five domains were significantly associated with optimal breastfeeding and complementary feeding indicators. Knowledge of these maternal determinants can assist in improving nutrition policies and interventions that aim to impact breastfeeding and complementary feeding practices and child growth in Malawi.

We investigated the relationship between socio-economic status and child undernutrition in West Africa (WA), and further examined the mediating role of dietary practices (measured as minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD)) and household environmental quality (HEQ) in the observed relationship. Thirteen countries were included in the study. We leveraged the most recent Demographic and Health Surveys datasets ranging from 2010 to 2019. Poisson regression model with robust standard errors was used to estimate prevalence ratios and their corresponding 95 % CI. Structural equation modelling was used to conduct the mediation analysis. West Africa. 132 448 under-five children born within 5 years preceding the survey were included. Overall, 32·5 %, 8·2 %, 20·1 % and 71·7 % of WA children were stunted, wasted, underweight and anaemic, respectively. Prevalence of undernutrition decreased with increasing maternal education and household wealth (Trend -values < 0·001). Secondary or higher maternal education and residence in rich households were associated with statistically significant decrease in the prevalence of stunting, wasting, underweight and anaemia among children in WA. MAD was found to mediate the association of low maternal education and poor household wealth with childhood stunting and underweight by 35·9 % to 44·5 %. MDD, MMF and HEQ did not mediate the observed relationship. The study findings enables an evaluation and improvement of existing intervention strategies through a socio-economic lens to help address the high burden of child undernutrition in WA and other developing regions.

Background Integrated Child Development Services (ICDS) is India’s flagship programme to improve the nutritional and health status of children. Appropriate complementary feeding is essential for young children age 6 and 23 months to meet additional nutrient needs. However, there are limited evidence on how ICDS utilization affects complementary feeding practices in India. Methods This study used a sample of 59,115 children age 6–23 months from the National Family Health Survey 2019-21. Modified Poisson regression analysis was performed to evaluate the association between the utilization of ICDS services and complementary feeding practices, estimating the adjusted prevalence ratio (aPR). Results Children age 6–23 months receiving ICDS services had a 19% high probability of consuming diverse diet (95% CI 1.13–1.25, p  < 0.001), a 27% high probability of consuming egg and flesh foods (95% CI 1.20–1.34, p  < 0.001), and a 3% higher probability of consuming vegetables and fruits (95% CI 1.00–1.06, p  < 0.05). However, ICDS utilization is not significantly associated with the timely introduction of semi-solid foods (6–8 months) and the minimum acceptable diet (6–23 months). The probability of achieving recommended meal frequency is significantly 14% lower (95% CI 0.83–0.90, p  < 0.001) among ICDS beneficiaries. Conclusion Despite the programme expansion, ICDS have limited influence on improving complementary feeding practices in India. Targeted efforts to improve service delivery to young children by Integrated Child Development Services could potentially support better complementary feeding practices.