Browsing by Subject "Infant nutrition"

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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.
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.