Scaling up an Integrated Strategy for Attention to Nutrition (EsIAN) to Prevent Stunting, Micronutrient Deficiency and Obesity in Mexico.

Objectives: Describes the scaling-up process of the EsIAN to prevent stunting, micronutrient deficiency and obesity during the 1,000 days of life. Methods: A case study that used participant observation and document review as primary methods for data collection. Results: Lessons learned and recommendations from the pilot study were incorporated. The training was enhanced with a computer training course to facilitate that it reaches all levels of the cascade. The behavior change communication strategy was pilot tested and further reformulated to better provide answer to the needs of health providers, community volunteers and target populations. A supportive supervision system was designed and will be implemented to follow up. The political will of the new government and its need to show short-term results played a key role in the scaling-up process. Time, coordination and budget constraint represent major challenges for the scaling up and its impact. Conclusions: Strategy will reach about 80,000 health providers and volunteers and more than six million beneficiaries' families. The scaling-up of this evidence-based intervention in to the window of opportunity for healthy growth and development is a promising way to impact the health and survival of the nation´s children.

The Integrated Strategy for Attention in Nutrition (EsIAN) Reduces the Prevalence of Anemia in Children 6 to 59 Months in the Context of a Conditional Cash-transfer Program in Mexico.

Objectives: EsIAN is designed to improve nutritional outcomes through a strong behavior change campaign and free distribution of nutritional products (micronutrient powders, MNP and/or a fortified complementary food, FCF) for children 6 m to 5 y of age living in poverty. Both products were distributed in rural areas and MNP only in urban. We assessed changes in the prevalence of anemia in children, in a pre-post effectiveness trial. Methods: EsIAN was implemented in 2008 in 91 health care centers in central Mexico. Effectiveness was assessed in 2012 using a mixed methods approach. Data from two crosssectional samples of children aged 6 to 59 months (Rural: 2008 n=802, 2012 n=356; 2008 n=569, Urban: 2012 n=546) were analyzed adjusting standard errors by health care center clusters. Results: In rural areas, the concentration of hemoglobin increased from 12.0±0.1 (mean±SE) in 2008 to 12.7±0.1 g/dL in 2012 (P˂0.001). The prevalence of anemia dropped significantly both in urban (23.1±2.5% in 2008; 16.1±2.0% in 2012; P<0.05) and rural areas (23.5±2.0% in 2008; 7.0±1.3% in 2012; P˂0.001). The drop was largest among children aged 6 to 23 months in rural areas (28.3±4.5% percentage points reduction). Conclusions: We document here a dramatic reduction in the prevalence of anemia in communities where EsIAN was implemented. Although this pre-post design does not allow for direct causal attribution, impact pathway review suggests that these changes are likely to be due to the EsIAN.

An Integrated Strategy for Attention in Nutrition (EsIAN) Increases Physicians' and Nurses' Nutrition Knowledge and Perceptions in Mexico.

Objectives: To assess changes in physicians' and nurses nutrition knowledge and perceptions from EsIAN. EsIAN was developed to attend to the nutritional needs of Oportunidades beneficiary families. Oportunidades is the Mexican conditional cash transfer program. In Mexico, appropriate attention to undernutrition and anemia is needed simultaneous with attention to overweight and obesity. EsIAN includes nutritional supplements and a behavior change communication strategy with nutrition counseling tools. The strategy was implemented on pilot scale; we report here the effects on health-care providers' nutrition knowledge and perceptions. Methods: EsIAN was implemented in 2008 in 91 clinics in central Mexico. Effectiveness was assessed in 2012 using a mixed methods approach. Data from two cross-sectional samples were analyzed adjusting standard errors by health care center clusters. Results: Physicians' and nurses' (PN) perceived they have more than 90% capacity to implement the EsIAN in their everyday's practice. Compared to baseline, in 2012 a significantly higher proportion of PN reported recommending exclusive breastfeeding for 6 months (85.7% vs. 23.4%) and breastfeeding techniques (79.8% vs. 12.8%) (p<0.001). More than 88% monitored children growth using weight-for-height and height-for-age indicators as recommended by EsIAN. Nutritional supplements seemed appropriate to 97.8% and 92.3% urban and rural PN, respectively. Conclusions: EsIAN is a highly accepted strategy that can be nationally implemented and is effective to improve providers knowledge and perceptions of essential nutrition actions.

Aspiraciones educativas y familiares como condicionantes en la prevención de embarazos tempranos en México / Mexican adolescentes' goals as determinants in the prevention of early pregnancies

Objetivo. Analizar las intenciones de adolescentes de formar una familia a edad temprana. Material y métodos. Estudio transversal con cuestionarios a estudiantes de ocho secundarias y preparatorias en Morelos y Ciudad de México, en 2010. Se exploraron intenciones de casarse y tener un hijo y se ajustó de manera exploratoria un modelo de rutas para identificar predictores en el plan de tener un hijo antes o después de los 20 años (n=2 974). Resultados. El 77% espera tener su primer hijo a los 20 años/después; 21% se muestra indeciso y 2% antes de los 20 años. Las expectativas de los padres influyen en la importancia que el adolescente le otorga a alcanzar un alto nivel de estudios, mismo que promueve las intenciones de tener hijos hasta los 20 años o después (β=0.13). Conclusiones. En la prevención de embarazos tempranos es imprescindible apoyar a los adolescentes para que se fijen metas de desarrollo personal.

Objective. This study aims to explore adolescents' intentions related to the early formation of a family. Materials and methods. We administered a survey to students in eight schools in Morelos and Mexico City, in 2010. We analyzed intentions of marrying or having a child and fitted an exploratory path model to assess predictors of the intentions of having a child before the age of 20 (n=2974). Results. Around 77% of adolescents expect to have their first child at 20 years or later; 21% show ambivalence or incongruence regarding this, whereas 2% expect to have a child before the age of 20. Parents' expectations for their child's education influence the importance that adolescents give to education. The latter promotes the idea of postponing childbearing until 20 years or later (β=0.13). Conclusions. In order to prevent early pregnancies, interventions and programs should encourage the construction of personal and professional goals.

Patrones dietarios en adolescentes mexicanas. Una comparación de dos métodos. Encuesta Nacional de Nutrición, 1999 / Dietary patterns in Mexican adolescent girls. A comparison of two methods. National Nutrition Survey, 1999

OBJETIVO: El estudio de patrones dietarios ha demostrado su utilidad en la investigación para entender la relación entre dieta y salud. En este trabajo se buscó identificar patrones de dieta en adolescentes mexicanas a través de dos métodos estadísticos. MATERIAL Y MÉTODOS: Se llevó a cabo un estudio transversal con 477 mujeres de 12-19 años (Encuesta Nacional de Nutrición 1999). Se caracterizaron patrones dietarios por medio de análisis de factores y de conglomerados. RESULTADOS: Se identificaron tres patrones dietarios por conglomerados "urbano"[U], 9.7 por ciento, "rural" [R], 47.9 por ciento y "occidental" [O], 42.3 por ciento. Por aporte energético, los principales grupos de alimentos en el patrón [U] fueron el maíz (20 por ciento) e industrializados (17 por ciento). En el patrón [R] predominaron el maíz (48 por ciento), los alimentos de trigo y leguminosas (~6 por ciento c/u). En [O] el trigo (19 por ciento) y las carnes rojas (11 por ciento). Asimismo, se identificaron cuatro patrones dietarios por el método de factores. En el factor uno predominaron los productos de trigo, postres, botanas y carnes. El factor dos se caracterizó por consumo alto de lácteos bajos en grasas y cereal de caja. El factor tres se caracterizó por consumo alto de refrescos e industrializados. En el factor cuatro predominaron el café, los dulces y las leguminosas. CONCLUSIONES: Se identificaron patrones dietarios en adolescentes mexicanas y los resultados de los dos métodos utilizados fueron comparables.

OBJECTIVE: To identify dietary patterns in Mexican female adolescents by two statistic methods. MATERIAL AND METHODS: Cross-sectional study of 477 women 12 to 19 years of age -National Nutrition Survey, 1999. Dietary patterns were obtained by factor and cluster analyses. RESULTS: Three dietary patterns were identified by cluster analysis: "Urban-poor" [U] (9.7 percent), "Rural" [R] (47.9 percent), and "Western" [W] (42.3 percent). Pattern [U] was characterized by a sizeable intake of maize products (20 percent) and industrialized foods (17 percent). Maize products and legumes predominated in the [R] pattern (48 percent and 6 percent of total energy, respectively). In the [W] pattern, wheat products and meat contributed 19 percent and 10.6 percent of energy, respectively. Moreover, four dietary patterns were identified through factor analysis. Factor 1 had a positive loading factor on wheat products, desserts, and meat. Factor 2 was characterized by a high consumption of low-fat dairy and low-fiber breakfast cereals. Factor 3 had a high loading for sweetened beverages and industrialized foods. Factor 4 had a moderate loading on maize products and legumes. CONCLUSION: We identified dietary patterns in Mexican adolescent girls by two methods, obtaining comparable results between methods.