Browsing by Person "Scherbaum, Veronika"

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Anemia among Syrian refugee children aged 6 to 23 months living in Greater Beirut, Lebanon, including the Voices of Mothers’ and Local Healthcare Staff: A mixed-methods study
(2023) Jeremias, Theresa; Abou-Rizk, Joana; Burgard, Leonie; Entenmann, Isa; Nasreddine, Lara; Jomaa, Lamis; Hwalla, Nahla; Frank, Jan; Scherbaum, Veronika
Globally, the prevalence of anemia among children during the period of complementary feeding is high. A cross-sectional, mixed-methods study was conducted to examine the main determinants of anemia among Syrian refugee children aged 6 to 23 months (n = 215) and to illuminate the knowledge, attitudes and perceptions of their mothers and Lebanese healthcare staff on its causes and available treatment options. 42% of the children and 20% of their mothers were anemic. Determinants of child anemia were the mother having anemia or not knowing that fish/seafood is a source of iron; the child having been acutely ill the last two weeks or receiving cow’s milk, but not consuming iron-rich infant formula, added fats/oils, or fruits in the previous 24 hours. Several Syrian mothers knew some causes of anemia and named dizziness as a leading symptom but did not mention flesh foods as a key source of heme iron. They reported financial constraints in accessing iron-rich foods and supplements. Lebanese doctors largely gave appropriate dietary advice and prescribed iron supplements as treatment. Multisectoral interventions are needed that combine medical and financial support with nutrition counseling for mothers to reduce the high burden of anemia among young children living in a multiple crises situation.
Epidemiology and social determinants of chronic diseases attributed adult mortality and its influence on maternal and young child nutrition in Tigray, 2009-2015: evidence from Kilte Awlaelo- Health and Demographic Surveillance Site
(2023) Abera, Semaw Ferede; Scherbaum, Veronika
In Ethiopia, the burden of disease related to communicable diseases has recently decreased significantly, while morbidity and mortality due to non-communicable diseases (NCDs) have increased. At the same, maternal and child malnutrition remained a major public health problem of Ethiopia. In developing countries, where health insurance is largely unavailable, individual medical conditions can also affect the overall and nutritional well-being of household members. In particular, the occurrence of disease and adult mortality in households can affect the nutritional well-being of the most vulnerable household members, especially lactating mothers and their young children. If the diseases are of chronic nature, which usually are costly and adult household members die from it in the long-term, this can be devastating for the family. The aim of this Ph.D. project was to investigate the epidemiology and social determinants of NCDs-attributed adult mortality, and to examine the association of chronic diseases attributed adult mortality with undernutrition of lactating mothers and their young children in rural population of Kilte Awlaelo-Health and Demographic Surveillance Site (KA-HDSS), Eastern Zone of Tigray, Ethiopia. During the data analysis, causes of death in adults were classified into chronic and non-chronic causes. The category of adult mortality due to chronic diseases refers to all causes that may be characterized by a long duration of illness. This group includes all deaths caused by NCDs and chronic communicable diseases such as tuberculosis and HIV/AIDS. The thesis has three articles, all published in peer-reviewed journals. The first article reports findings on the epidemiology and social-determinants of adult mortality caused by NCDs among 45,982 adult residents of KA-HDSS using population-based longitudinal data collected from 2009 to 2015. The second article tested whether the burden of undernutrition was higher among lactating mothers who were living in households with adult mortality from chronic diseases than among lactating mothers living in households with no adult mortality from chronic diseases. The third article examined whether there was an association between undernutrition of children and adult mortality from chronic diseases. Both longitudinal and cross-sectional data were used in the second and third articles. To our knowledge, this study showed for the first time that adult mortality caused by NCDs varied according household members’ relationship to their household head: extended family and non-family members of the household head had higher hazard of mortality compared to the household heads. In addition, this work can be considered as the first study from a low-income setting to examine whether mortality of an adult household member from chronic diseases is associated with undernutrition of lactating mothers and their young children. The results of the first study indicate a double mortality burden from both communicable diseases and NCDs in the study population. Between 2009 and 2015, the leading causes of NCDs-attributed adult mortality were cardiovascular diseases, cancer and renal failure. Compared to heads of households, extended family and non-family co-residents had an increased hazard of mortality from NCDs. Literacy and younger age were protective factors against adult mortality caused by NCDs. However, the protective role of literacy against adult mortality from NCDs decreased with increasing age. Next, we assessed the level of undernutrition among the lactating mothers and examined its association with household-level occurrence of adult mortality from chronic diseases by controlling the effect of a wide range of epi-demographic and agro-ecological variables. Nearly two-fifths (38%; 95% CI: 36.1, 40.1%) of the mothers were undernourished. We found an increased risk of maternal undernutrition for lactating mothers who were living in households which experienced adult mortality from chronic diseases. In addition, maternal undernutrition was strongly associated with recent history of household-level morbidity, poor health-seeking practice, lack of diverse food crops, and a low index score for housing and environmental factors. In the third article, we determined the burden of undernutrition among children of complementary feeding age (6 to 23 months) and its factors within the context of nutrition-specific and -sensitive drivers of young child undernutrition. Here, mortality from chronic diseases were constructed as a nutrition-specific factor. We found high prevalence of wasting (13.7%; 95% CI: 12.1, 15.5%) and inadequate child dietary diversity (81.3%; 95%CI: 79.2, 83.1%). Adult mortality history from chronic diseases was not associated with young child undernutrition and child dietary diversity. However, child undernutrition was strongly associated with recent history of household-level morbidity, maternal undernutrition, low child dietary diversity, poverty, larger family size, insecure employment of household heads, and living in highland areas. Poor household wealth status and lack of diverse food crops production, particularly in highland areas, were also strongly associated with lower child dietary diversity. Overall, this thesis has shown that an epidemiological transition is ongoing in the surveillance population. Population-based intervention measures are recommended that aim to reduce NCD-related adult mortality by targeting the leading causes of death and focusing on vulnerable population subgroups, such as the extended family and nonfamily household members. In this study, there was no association between the occurrence of chronic diseases attributed adult mortality and young child undernutrition. However, adult mortality from chronic diseases was associated with maternal undernutrition. Our findings appear to call for multi-sectoral interventions, mainly by the agriculture, nutrition and health sectors, to promote nutritional well-being of lactating mothers and their dyads in the long-term.
Food and nutrition security and associated health aspects of Syrian refugee mothers and their offspring : a mixed-method study in Greater Beirut, Lebanon
(2023) Abou-Rizk, Joana; Scherbaum, Veronika
Nutrition during the first 1000 days of life – from conception to two years of age – lays the foundation for optimal health, cognitive and social development, and well-being of children and mothers. Malnutrition and hidden hunger in mothers and their offspring during the perinatal period can have long-lasting and irreversible consequences on human capital and increase the risk to non-communicable diseases among adulthood through intergenerational effects. Since the Arab Spring in 2011, the Syrian humanitarian crisis has escalated to become the world’s largest by the end of 2018, forcing 6.7 million to flee, mainly to neighboring countries. In 2015, Lebanon was the host of more than 1.5 million refugees and displaced persons from Syria, reaching the highest per capita concentration of refugees worldwide. The protracted crisis has increasingly weakened Lebanon, in turn exposing vulnerable groups, especially women of reproductive age and children below five years, to increased risks of inadequate nutrition and health status. To date, there has been a lack of studies among refugees that examine the nutritional and health situation and investigate the underlying and immediate determinants of malnutrition among women of reproductive age and children below five years. Therefore, knowledge gaps regarding the prevalence of anemia and nutritional status of Syrian refugee mothers and children were identified as important research areas in this dissertation. Assessing the food security and mental health of Syrian refugee mothers, examining the dietary intake and infant feeding practices, and investigating their respective determinants and associated risk factors were also important areas of focus. This research project was conducted between July and October 2018 in collaboration with the American University of Beirut in primary healthcare centers in the Greater Beirut area in Lebanon using quantitative and qualitative surveys (mixed-methods survey) among Syrian refugee mothers and their child aged below five years of age. This work comprises a total of three research articles that have been published in peer-reviewed international journals. The first article (Chapter 3) describes the prevalence of anemia and the nutritional status of mothers and children below five years of age and indicates a moderate public heath significance among Syrian refugees in the Greater Beirut area, Lebanon. The existence of the so-called double burden of malnutrition and hidden hunger (micronutrient deficiencies) has been documented, as mothers and children from the same household were affected by undernutrition, overnutrition, and / or anemia. A strong association between maternal and child anemia in the same household and an association between anemia and overweight / obesity among mothers has also been demonstrated. Analysis of the 24-hr dietary recalls of pregnant, lactating, non-pregnant non-lactating mothers revealed inadequate dietary intake and nutrient deficiencies during pregnancy and lactation. The second article (Chapter 4) presents data on the prevalence of food insecurity, low dietary diversity, and poor mental health among Syrian refugee mothers in Greater Beirut, Lebanon. A significant association between food insecurity and low dietary diversity as well as poor mental health status was found. Low household monthly income and a high household crowding index were significantly associated with low dietary diversity and food insecurity. In addition, the results showed that low-income households consumed monotonous diets, characterized by a high consumption of refined starchy staples and grains. The third paper (Chapter 5) focused on the nutritional and health status of infants under six months. Overall, the public heath significance for anemia and wasting was moderate. Inadequate infant feeding practices, such as the intake of pre-lacteal feeding and liquids, were demonstrated in newborns, which in turn contributed to delayed initiation of breastfeeding and low rates of exclusive breastfeeding. Factors supporting infant feeding practices included proper knowledge on maternal nutrition and exclusive breastfeeding and support from healthcare professionals or family during breastfeeding. Identified barriers included cultural practices such as the early introduction of foods, breastmilk substitutes, and giving water or herbal tea to infants under six months of age. Maternal health issues and social factors such as misinformation from family members and violations of the Code of Marketing of Breastmilk Substitutes also affected breastfeeding. A conceptual framework was also developed in this dissertation to provide a comprehensive understanding of the linkages and pathways between the enabling, underlying, and immediate determinants and the nutritional and health outcomes in the context of humanitarian crises. Based on this conceptual framework, three principal pathways were identified to explain the following associations: (1) from the enabling determinants to anemia and nutritional status, (2) from socio-economic status and host country resources to food consumption and diets, and (3) from pre-resettlement experiences and dietary acculturation to food consumption and diets. In addition, the concluding discussion (Chapter 6) presented the role of maternal mental health status and health services and their impact on maternal nutrition and anemia status as well as infant feeding. In summary, this dissertation contributes to the knowledge about the anemia and nutritional status of Syrian refugee women and children as well as on the food security and mental health status of mothers living in an urban setting of a protracted humanitarian crisis in Lebanon. It also provides insights into the emergence of malnutrition among women and children in the context of refugees and shows the pathways between different levels of determinants of nutrition and health. Implications for practice can be drawn from this dissertation, such as the development or strengthening of evidence-based culture-specific nutritional interventions that are targeted to the refugee context. Priorities for future research were also identified, including the need to improve the effectiveness of nutritional interventions in conflict settings.
Infant feeding practices, nutrition, and associated health factors during the first six months of life among Syrian refugees in Greater Beirut, Lebanon: A mixed methods study
(2022) Abou-Rizk, Joana; Jeremias, Theresa; Nasreddine, Lara; Jomaa, Lamis; Hwalla, Nahla; Frank, Jan; Scherbaum, Veronika
The objective was to describe infant feeding practices, nutrition and related health aspects of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with infants under six months in July–October 2018 (N = 114). Additionally, eleven focus group discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding was low (31%), and exclusive breastfeeding very low (24.6%). One-fifth of the infants were anemic (20.5%) and 9.6% were wasted. A significantly higher proportion of non-exclusively breastfed infants had a fever and took medicines than those who were exclusively breastfed. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and exclusive breastfeeding, along with receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes’ distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees, awareness on proper breastfeeding practices, maternal nutrition, and psychosocial support should be provided to mothers and family members alike.
Maternal psychosocial stressors, depression and its implications on maternal and infant nutrition : a longitudinal birth cohort study in South West Ethiopia
(2022) Woldetensay, Yitbarek Kidane; Scherbaum, Veronika
This thesis draws on theoretical background and a conceptual model of how selected psychosocial stressors (household food insecurity and intimate partner violence) and coping strategies (maternal social support) are linked to psychological distress (maternal depression) which can influence the nutritional status of mothers and infants. The scientific contribution of this work is threefold. First, it adds to the existing literature on the links between psychosocial stressors, social support and depression, by showing the degree to which household food insecurity and intimate partner violence during pregnancy are associated with the risk of antenatal depressive symptoms, and whether maternal social support plays a buffering role in this process. Second, it describes the longitudinal relationship of prenatal and postnatal depressive symptoms with infant feeding practices. Finally, this work contributes to the literature on depression by validating one of the most commonly applied depression measurement tools, the patient health questionnaire (PHQ-9), in a new culture and language. This thesis includes three research articles; two were published in peer-reviewed journals and the third manuscript is currently under peer review. The first article is a validation study of the depressive symptoms measurement tool in a new culture and language in a rural setting. The other two papers are based on ENGINE birth cohort data, a prospective community-based birth cohort study conducted by Tufts University in collaboration with Jimma and Hawassa Universities and the Ethiopian Public Health Institute in the southwest part of Ethiopia. The first article validated an Afaan Oromo language version of the Patient Health Questionnaire (PHQ-9). PHQ-9 is one of the most commonly used depressive symptoms measurement scales. Few validation studies have been conducted in sub-Saharan Africa for scales seeking to detect depression in pregnant women and to the author’s knowledge this is the first validation of the PHQ-9 in this language. The main finding of the first paper was that the PHQ-9 scale has acceptable reliability and validity as a screening instrument for depressive symptoms among Afaan Oromo speaking Ethiopian pregnant women. The PHQ-9 score of eight or above was found to be an optimal cut-off point to diagnose prenatal depressive symptoms with a sensitivity and specificity of 80.8% and 79.5% respectively. The second article tested hypotheses derived from Lazarus and Folkman’s stress and coping theory. This theory provides a basis for understanding the impacts of psychosocial stressors on the development and prognosis of depression and the buffering effect of coping mechanisms. The hypotheses are as follows: increased psychosocial stressors, specifically intimate partner violence and household food insecurity during pregnancy, lead to higher prenatal depressive symptoms, and strong social support from friends,families and partners have a buffering effect. The present results supported these hypotheses by demonstrating that both household food insecurity and intimate partner violence were positively associated with prenatal depressive symptoms. Simultaneously, strong social support from friends, families and partners was negatively associated with prenatal depressive symptoms. The second article tested another hypothesis that the risk of prenatal depression is higher in anemic pregnant women. The current study supported this hypothesis by demonstrating that anemic pregnant women experienced a higher risk of prenatal depressive symptoms than their non-anemic counterparts. The second paper also investigated the degree to which socio-demographic factors such as age, marital status, educational status, and family size predicted the risk for prenatal depression among pregnant women. The results suggested that unmarried pregnant women and women living in households with large family size were at higher risk of prenatal depressive symptoms. The third paper tested one hypothesis that infants born to mothers with maternal depressive symptoms (prenatal and postnatal) are more likely to have poor infant feeding practices than their counterparts. The present study findings supported this hypothesis by showing that immediate postnatal depressive symptoms are negatively associated with infant feeding practices. However, there was no association between prenatal depressive symptoms and infant feeding practices. The results also showed that intimate partner violence was negatively associated with infant feeding practices. In this study, strong maternal social support and active social participation were positive predictors of infant feeding practices. Contrary to expectations, the present study also found that household food insecurity and infant morbidity episodes were positively associated with infant feeding practices. Finally, the third article’s findings suggested that maternal educational status was positively associated with infant feeding practices and preterm babies were at higher risk of poor infant feeding practices. Infant gender did not affect infant feeding practices in this study. Overall, this PhD thesis provided support for Lazarus and Folkman’s stress and coping theory by demonstrating that psychosocial stressors were positively associated with prenatal depressive symptoms and perceived maternal social support was negatively associated with prenatal depressive symptoms. The thesis also found that anemia during pregnancy is a predictor of prenatal depressive symptoms. Additionally, early postnatal depression and intimate partner violence negatively affect infant feeding practices, whereas perceived maternal social support and active social participation predict appropriate infant feeding practices. The study has a number of implications for practice and future research including prioritization of early screening for maternal depressive symptoms and intimate partnerviolence, and promotion of social support and active social participation as a means of preventing maternal depression and improving maternal and infant nutritional status.
Nutrition and health aspects of mothers and their infants in Bukavu region, Democratic Republic of the Congo : a follow-up study with cross-sectional analyses and nutrition interventions
(2024) Beitze, Damaris Elisabeth; Scherbaum, Veronika
Hintergrund: Mangelernährung in verschiedenen Ausprägungen ist eine Herausforderung für die Bevölkerungsgesundheit in der Demokratischen Republik Kongo, einem Land, das von politischer Instabilität, Gewalt, Nahrungsmittelunsicherheit und Armut geprägt ist. Vor allem verborgener Hunger und Anämie machen einen großen Teil davon aus. Unzureichende Ernährung während der ersten 1000 Lebenstage beeinträchtigt die Gesundheit und Entwicklung eines Kindes kurz- und langfristig. Das Ernährungsverhalten der Mütter spielt sowohl für ihren eigenen Ernährungszustand als auch für den ihrer Kinder eine wichtige Rolle, insbesondere während dieser sensiblen Phase. Der Ernährungszustand und das Ernährungsverhalten können durch vielfältige Faktoren auf verschiedenen Ebenen beeinflusst werden. Diese müssen untersucht und berücksichtigt werden, um zielführende Interventionen zu gestalten. Zielsetzung: Diese Dissertation hatte zum Ziel, den Ernährungsstatus, insbesondere Anämie, stillender Frauen und ihrer Säuglinge zu untersuchen, ebenso wie damit assoziierte Faktoren. Des Weiteren sollte der Einfluss von Ernährungsschulungen und Lipid-basierten Nährstoffsupplementen auf Anämie, Ernährungswissen und Ernährungsverhalten von unter- und übergewichtigen Müttern ermittelt werden. Methoden: Eine Follow-up-Studie mit Querschnittserhebungen und inkludierter Interventionsstudie wurde mit 471 stillenden Müttern und ihren Säuglingen in der Region von Bukavu, Demokratische Republik Kongo von Dezember 2017 bis Juni 2019 durchgeführt. Mutter-Kind-Paare wurden nach der Entbindung in einem von drei Krankenhäusern der Studie (zwei davon semi-urban und eines im ländlichen Gebiet) in der ersten Woche postpartum rekrutiert. Die erste Datenerhebung beinhaltete anthropometrische Messungen der Mütter und Neugeborenen sowie ein strukturiertes Interview zu sozio-demographischen Faktoren und Ernährungsaspekten während der Schwangerschaft. Folgeerhebungen, die 3-6 und 6-9 Monate nach der Geburt stattfanden, umfassten die Messung von anthropometrischen Parametern und der Hämoglobin-Konzentration (Hb) von Müttern und ihren Säuglingen, ein 24-Stunden Ernährungsprotokoll der Mütter sowie ein strukturiertes Interview zu Ernährungswissen und -verhalten. Die randomisierte kontrollierte Interventionsstudie fand zwischen diesen beiden Folgeerhebungen statt. Vor der Intervention wurden die Mütter anhand ihres mittleren Oberarmumfangs (MUAC) in niedrigen (≥ 21 und < 25 cm), normalen (≥ 25 und < 28 cm) und hohen MUAC (≥ 28 cm) eingestuft. Anschließend wurden sie zufällig den folgenden Interventions- und Kontrollgruppen zugeteilt: niedriger MUAC – Ernährungsschulung; niedriger MUAC – Supplement; niedriger MUAC – Kontrolle; mittlerer MUAC – Kontrolle; hoher MUAC – Ernährungsschulung; hoher MUAC – Kontrolle. Über drei Monate erhielten Mütter mit Ernährungsschulungen vier theoretische und zwei praktische Einheiten zu ausgewogener Ernährung, Eisen, Vitamin A und Nährstoffmängeln. Mütter in der Supplement-Gruppe erhielten ein tägliches Lipid-basiertes Nährstoffsupplement. Für 416 Mütter und Säuglinge waren Daten vor und nach der Intervention vorhanden. Ergebnisse: Die Studie zeigte die Koexistenz verschiedener Formen von Mangelernährung in der Studienpopulation. Ernährungs- und Gesundheitsaspekte unterschieden sich zwischen den semiurbanen und ländlichen Gegenden. Das Erhalten von Leistungen während der Schwangerschaftsbetreuung (Malaria-Medikamente, Entwurmung, Supplemente, Ernährungsinformationen durch Gesundheitspersonal) und das Wissen zu sowie die Umsetzung von Familienplanung waren im ländlichen Gebiet geringer als im semi-urbanen Gebiet, ebenso anthropometrische Parameter wie der mütterliche MUAC und das Geburtsgewicht. Eine multiple lineare Regression ergab zunehmenden mütterlichen MUAC, Alter und Gestationsalter als positive Einflussfaktoren auf das Geburtsgewicht, während die ländliche Lage, eine erstgebärende Mutter, eine Tätigkeit der Mutter in der Landwirtschaft und das weibliche Geschlecht des Neugeborenen negative Prädiktoren des Geburtsgewichts waren. Die Anämieraten 3-6 Monate nach der Geburt waren mit 28,2 % bei den Müttern von mittlerer Relevanz für Bevölkerungsgesundheit, lagen bei den Säuglingen mit 74,3 % jedoch im schwerwiegenden Bereich. Sowohl das mütterliche Ernährungswissen als auch ihre Ernährungsvielfalt waren gering ausgeprägt. Im Median hatten die Mütter ein Wissen von 0,39 in einem möglichen Bereich von 0 bis 1 und eine Ernährungsvielfalt von 3,0 (möglicher Bereich 0-10). Ernährungswissen und mütterlicher Hb waren leicht positiv korreliert, aber es bestanden keine signifikanten Korrelationen der Ernährungsvielfalt mit einem dieser beiden Parameter. Geschmack (68,1 %), Aussehen (42,5 %), die Wirkung von Lebensmitteln auf die Gesundheit (29,0 %) und Verfügbarkeit (25,6 %) waren häufige Kriterien der Lebensmittelauswahl. Nach der Intervention hatten Mütter, die Ernährungsschulungen erhalten hatten, ein signifikant höheres Ernährungswissen als diejenigen ohne Schulungen, aber keine verbesserte Ernährungsvielfalt. Außerdem modifizierten mehr Mütter mit Schulungen die Beikost für ihr Kind als die anderen Mütter, häufig im Zusammenhang mit Inhalten der Ernährungsschulungen. Weder der mütterliche Hb nach der Intervention noch die Hb-Entwicklung über die Interventionsphase unterschieden sich signifikant zwischen den sechs Interventions- und Kontrollgruppen. Allerdings war der Anteil an Müttern mit einer Verbesserung des Hb in den Gruppen mit Ernährungsschulungen größer, wenn auch nicht statistisch signifikant. Bei Betrachtung ausschließlich der Frauen, die zu Beginn der Intervention an Anämie litten, zeigte sich eine größere Zunahme des Hb in den Gruppen, die entweder Schulungen oder Supplemente erhielten, allerdings nicht statistisch signifikant. Schlussfolgerungen: Der Ernährungsstatus stillender Frauen und ihrer Säuglinge im Studiengebiet war mangelhaft. Verschiedene Faktoren, die die Mangelernährung befördern könnten, wurden identifiziert: Unzureichende Nahrungsaufnahme und eingeschränkte Leistungen in der primären Gesundheitsversorgung können den Ernährungsstatus beeinflussen. Zu ihren möglichen, vielschichtigen Determinanten gehören geringes Ernährungswissen, die ländliche Gegend und Nahrungsmittelunsicherheit, aber auch persönliche Präferenzen. Um den Ernährungszustand effektiv zu verbessern, müssen Ernährungsinterventionen diese verschiedenen Einflussfaktoren der Nahrungsaufnahme adressieren. Ernährungsschulungen und Lipid-basierte Nährstoffsupplemente könnten einen positiven Effekt haben, vor allem bei Müttern mit Anämie. Sie sollten weiter untersucht werden. Es wird empfohlen, das Bewusstsein und die Qualifikation von Gesundheitspersonal in der primären Gesundheitsversorgung hinsichtlich Ernährung zu stärken und praktische Elemente in Maßnahmen mit Ernährungsschulungen zu integrieren.
Nutrition-related knowledge, attitudes, practices, and anemia status of lactating mothers in Bukavu, Democratic Republic of the Congo - A cross-sectional analysis
(2024) Beitze, Damaris Elisabeth; Kavira Malengera, Céline; Barhwamire Kabesha, Theophile; Scherbaum, Veronika
Maternal nutrition is impacted by personal and environmental factors including dietary intake, knowledge, food availability, and affordability. This cross-sectional analysis aimed to evaluate nutrition-related knowledge, attitudes, practices, and associations with hemoglobin concentration among lactating mothers in the Bukavu region, Democratic Republic of the Congo. In 444 lactating mothers, nutrition-related knowledge and practice were assessed by questionnaires and translated into knowledge and practice scores ranging from 0 to 1, attitudes and drivers of food choice were assessed, the Dietary Diversity Score (DDS) was assessed with 24 h dietary recalls in a potential range from 0 to 10, and hemoglobin (Hb) was measured in mothers and their infants. Anemia prevalence was 28.2% among mothers and 74.3% among infants aged 3–8 months. Nutritional knowledge and practice were limited (the median total knowledge score was 0.39, median DDS was 3.0). While there were slight positive correlations between knowledge and maternal Hb, DDS did not significantly correlate with either knowledge or Hb. Although half of the mothers stated a perception about their own susceptibility to anemia or vitamin A deficiency (56.4%, 47.4%), less than half of those could justify their estimation (40.9%, 44.2%). Taste (68.1%), appearance (42.5%), availability (29.0%), and health effects (25.6%) were important drivers of food choice. In conclusion, interventions on the different influencing factors including nutrition education strategies are needed.
What factors are associated with maternal undernutrition in eastern zone of Tigray, Ethiopia? Evidence for nutritional well-being of lactating mothers
(2020) Abera, Semaw Ferede; Kantelhardt, Eva Johanna; Bezabih, Afework Mulugeta; Tsadik, Mache; Lauvai, Judith; Ejeta, Gebisa; Wienke, Andreas; Frank, Jan; Scherbaum, Veronika
Background: Maternal undernutrition is a pervasive health problem among Ethiopian mothers. This study aims at identifying the level of maternal undernutrition and its associated factors in Kilte Awaleo-Health and Demographic Surveillance Site (KA-HDSS), Tigray region, Ethiopia. Methods: Nutritional status of 2260 lactating mothers was evaluated using the mid-upper-arm circumference (MUAC). Data from the vital events and verbal autopsy databases were linked to the survey and baseline recensus data to investigate the association of adult mortality from chronic causes of death (CoD) on maternal undernutrition. We employed a generalized log-binomial model to estimate the independent effects of the fitted covariates. Results: The overall prevalence of maternal undernutrition based on MUAC < 23 cm was 38% (95% CI: 36.1, 40.1%). Recent occurrence of household morbidity (adjusted prevalence ratio (adjPR) = 1.49; 95%CI: 1.22, 1.81) was associated with increased risk of maternal undernutrition. In addition, there was a 28% higher risk (adjPR = 1.28; 95%CI: 0.98, 1.67) of maternal undernutrition for those mothers who lived in households with history of adult mortality from chronic diseases. Especially, its association with severe maternal undernutrition was strong (adjusted OR = 3.27; 95%CI: 1.48, 7.22). In contrast, good maternal health-seeking practice (adjPR = 0.86; 95%CI: 0.77, 0.96) and production of diverse food crops (adjPR = 0.72; 95%CI: 0.64, 0.81) were associated with a lower risk of maternal undernutrition. Relative to mothers with low scores of housing and environmental factors index (HAEFI), those with medium and higher scores of HAEFI had 0.81 (adjPR = 0.81; 95%CI: 0.69, 0.95) and 0.82 (adjPR = 0.82; 95%CI: 0.72, 0.95) times lower risk of maternal undernutrition, respectively. Conclusions: Efforts to ameliorate maternal undernutrition need to consider the influence of the rising epidemiology of adult mortality from chronic diseases. Our data clearly indicate the need for channeling the integrated intervention power of nutrition-sensitive development programs with that of nutrition-specific sectoral services.