Breastfeeding in emergencies with assessment of recent humanitarian crises and the Covid-19 pandemic.

The world is becoming a place where the number of emergencies and humanitarian crises is increasing rapidly due to economic inequality and the gap between developed and underdeveloped countries, as well as climate changes leading to disruption of the natural balance and development of natural disasters. The most vulnerable groups of the population including women and children always are affected by disasters. The younger the child, the more vulnerable he/she is, especially if not naturally fed or having a mother or parents. Various humanitarian organizations have been involved in a number of crises, with the World Health Organization and UNICEF and other United Nations-related organizations leading the way. In the care of mothers, infants and young children, most important is to ensure appropriate nutrition because otherwise it can result in life-threatening health conditions. The lack of protection, support and promotion of natural nutrition (breastfeeding) and its disruption and undermining by uncritical and uncontrolled donations and distribution of infant formula are the biggest challenge due to the lack of information of mothers, those who provide support in emergencies from both governmental and non-governmental sector, without cross-sectoral cooperation, thus causing uncoordinated and sometimes harmful interventions. Therefore, it is recommended that governments issue guidelines on infant and young child nutrition prior to the occurrence of an emergency, and crisis management regulations in which the issue of infant and young child nutrition will be given due consideration.Copyright © 2020 Croatian Paediatric Society. All rights reserved.

Determinant factors of the improvement of nutritional status (based on height-for-age index category) in children during the COVID-19 pandemic: a cohort study of children's growth and development in Bogor

The COVID-19 pandemic is predicted to trigger a global economic and food supply crisis, which further affects children's nutritional status as a vulnerable group. This study aimed to observe alterations in nutritional status before and during the COVID-19 pandemic (during 2019-2021) and determinant factors involved in the improvement of nutritional status (based on the height-for-age Z-score (HAZ) index category) during the COVID-19 pandemic. The findings were intended as evidence-based suggestions for policy formulation concerning the improvement of child nutritional status and stunting reductions. This study was part of a cohort study of children's growth and development conducted by National Institute of Health Research and Development (NIHRD) in Bogor city-Indonesia. The analysis was conducted on 565 children under five in 2019 with height measurement data in 2019 and 2021, environmental conditions, parental education, consumption habits, and social assistance. Children were classified as having an improved nutritional status if the HAZ category increased in 2021 compared to 2019. In addition, multiple logistic regression analyses were performed to predict determinant factors involved in improving the child's nutritional status. In this study, 17.5% of children had improved nutritional status, and 79.3% had a steady nutritional status. However, there were 3.2% of children with decreased nutritional status. Model factors determinant related to improved nutritional status includes consumption more than once per week of red meat (adjusted odds ratio (aOR) = 2.15;95% confidence interval (CI): 1.06-4.35, p=0.034), milk consumption more than once per week (aOR = 1.56;95% CI: 0.89-2.74, p=0.119), and age under 5 years old (aOR = 1.86;95% CI: 1.14-3.15, p=0.016). Children under five years old, the consumption of red meat and milk more than once a week have the opportunity to improve nutritional status (by height-for-age index) in children.

Understanding the Predictors of Low Take-Up of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): A Nationwide Longitudinal Study.

INTRODUCTION: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is among the largest U.S. social safety net programs. Although strong evidence exists regarding the benefits of WIC, take-up (i.e., participation among eligible individuals) has steadily declined in the past decade. This study addresses gaps in our knowledge regarding predictors of WIC take-up during this time. METHODS: Data were drawn from the 1998-2017 waves of the National Health Interview Study (NHIS), a serial cross-sectional study of the U.S. POPULATION: The analytic sample included 23,645 children and 10,297 women eligible for WIC based on self-reported demographic characteristics. To investigate predictors of WIC take-up, we regressed self-reported WIC receipt on a range of individual-level predictors (e.g., age, nativity, income) and state- level predictors (e.g., unemployment rate, governor's political affiliation) using multivariable logistic regression. In secondary analyses, results were additionally stratified by race/ethnicity, time period, and age (for children). RESULTS: For both women and children, older maternal age and higher educational attainment were associated with decreased take-up of WIC. Associations differed by race/ethnicity, time period, and state characteristics including caseload of other social programs (e.g., Medicaid). DISCUSSION: Our study identifies groups that are less likely to take up WIC benefits for which they are eligible, thereby contributing important evidence to inform programs and policies to increase WIC participation among groups with lower take-up. As WIC evolves past the COVID-19 pandemic, special attention will be needed to ensure that resources to encourage and support the participation of racially and economically marginalized individuals are equitably distributed.

Child Nutrition Prior and During Early Pandemic and its Relation to Socio-Economic Status of Households in Bogor City

This study aimed to examine the socio-economic status (SES) of households and child nutrition prior to and during early pandemic. The SES measured the objective well-being of the households, and the subjective well-being measured the family's perception of wealth satisfaction. The child nutrition data before the pandemic was collected using a growth card and measured during pandemic using anthropometrics assessment (weight per age). Before the pandemic (January-March) in 2020, the percentage of underweight children increased. Then, it decreased consecutively in March and one month later. In addition, the study showed that mothers' education related to children's nutrition before and during early pandemic. © 2023 UPM Press. All rights reserved.

COVID-19 Disruptions of Food Systems and Nutrition Services in Ethiopia: Evidence of the Impacts and Policy Responses.

Background: Since its first case of COVID-19 on March 13, 2020, Ethiopia has exerted efforts to curb the spread of SARS-CoV-2 (COVID-19) without imposing a nationwide lockdown. Globally, COVID-19 related disruptions and mitigation measures have impacted livelihoods and food systems, nutrition, as well as access and use of health services. Objective: To develop a comprehensive understanding of the impacts of the COVID-19 pandemic on food systems, health services, and maternal and child nutrition and to synthesize lessons from policy responses to the COVID-19 pandemic in Ethiopia. Methods: We conducted a review of literature and 8 key informant interviews across government agencies, donors, and non-governmental organizations (NGOs), to map the impacts of the COVID-19 pandemic on the food and health systems in Ethiopia. We summarized policy responses and identified recommendations for future actions related to the COVID-19 pandemic and other future emergencies. Results: The impacts of the COVID-19 pandemic were felt across the food system and include limited agriculture inputs due to travel restrictions and closed borders restricting trade, reduced in-person support by agriculture extension workers, income losses, increases in food prices, and the reduction in food security and dietary diversity. Maternal and child health services were disrupted due to fear of contacting COVID-19, diversion of resources, and lack of personal protective equipment. Disruptions eased over time due to the expansion of social protection through the Productive Safety Net Program, and the increased outreach and home service provision by the health extension workers. Conclusion: Ethiopia experienced disruptions to food systems and maternal and child nutrition services due to the COVID-19 pandemic. However, by expanding existing social protection programs and public health infrastructure and leveraging partnerships with non-state actors, the extent of the impact of the pandemic was largely minimized. Nevertheless, vulnerabilities and gaps remain and there is a need for a long-term strategy that considers the potential for future pandemics and other shocks.

Effects of the COVID-19 crisis on household food consumption and child nutrition in Mozambique

This study investigates the short-term impacts of an aggregate socioeconomic shock on household food consumption and children's nutrition using the case of the COVID-19 pandemic in Mozambique. In response to the economic downturn, households are expected to adjust their food choices both in terms of quality, towards cheaper and unhealthier food, and quantity, reducing diet diversification and increasing the exposure to malnutrition, mainly for children. Empirical evidence on such immediate effects is still scarce, mainly due to a lack of data. This paper aims to fill the evidence gap by relying on household survey data from 2019-20, which includes a detailed consumption module and anthropometric measures for children under five. We use a repeated cross-sectional econometric analysis to look at the variation in household food consumption and child nutrition before and after the pandemic. The results show that there has been a significant reduction in household food consumption and per capita caloric intake and an increase in stunting, especially among newborn children.

The Impact of the COVID-19 Pandemic on the Experiences and Operations of Sponsors of the Summer Food Service Program in Maryland, USA: A Multiphase Mixed Methods Study.

During the COVID-19 pandemic, the Summer Food Service Program (SFSP) was allowed to operate in untraditional non-summer months to ensure children did not lose access to free and reduced-priced nutritious meals when schools were mandated to close in the United States. This study assessed the impact of the pandemic on the operations and experiences of Summer Food Service Program (SFSP) sponsors in the state of Maryland during the COVID-19 pandemic in 2020 (Phase I) and 2021 (Phase II). This study used a multiphase explanatory sequential mixed methods design with qualitative prioritization. Maryland SFSP sponsors completed an online survey (Phase I: n = 27, Phase II: n = 30), and semi-structured in-depth interviews were conducted with a subset of sponsors who completed the survey (Phase I: n = 12, Phase II: n = 7). Inductive and deductive analyses were used for qualitative data, and descriptive statistics were used for quantitative data. The COVID-19 pandemic caused SFSP sponsors to change their operations. Sponsors were primarily concerned about staff safety/burnout and decreased participation. Sponsors perceived waivers implemented by the United States Department of Agriculture to be crucial in enabling them to serve meals to children during the pandemic. The findings from our study support advocacy efforts to permanently implement waivers and provide free school meals for all children.

Impacts of Covid-19 School Closures on School Food Service Revenue: Analysis of Public Local Education Agencies in Maryland.

BACKGROUND: The public health policies and school closures in response to the Covid-19 pandemic have created disruptions in school meal programs. Research is needed to understand the changes in school food service revenue before and during the initial Covid-19-related school shutdowns. METHODS: A longitudinal cohort study examining federal and state reimbursements as well as sales revenues for all public local education agencies (LEAs) in Maryland from school years (SY) 2018-2019 and 2019-2020 was conducted. Monthly changes in federal and state reimbursements for Child Nutrition Programs, including the National School Lunch Program (NSLP), School Breakfast Program (SBP), Summer Food Service Program (SFSP), and Child and Adult Care Food Program (CACFP) were examined. RESULTS: In the SY 2018-2019, the total revenues from federal and state reimbursements for SBP, NSLP, SFSP, and at-risk CACFP were $272.9 million; in comparison, for the SY 2019-2020, the total revenues were $241.8 million (11.4% reduction from SY 2018-2019). On average, the school shutdown (during March to June 2020) was associated with a $450,385 (p-value < .01) reduction in federal and state reimbursements per LEA-month (41% reduction). CONCLUSIONS: The school shutdown during the Covid-19 pandemic was associated with a statistically significant reduction in school food service revenues across Maryland's public LEAs.

Food Insecurity, Federal Nutrition Support, and Parent Feeding Practices During COVID-19: A 1-Year Follow-up Study.

OBJECTIVES: COVID-19 caused stark increases in food insecurity. To maintain food provision, policy changes to the National School Lunch Program (NSLP) and Supplemental Nutrition Assistance Program (SNAP) were instated. This longitudinal study examined (1) food security patterns across the timeline of COVID-19; (2) the relationship among food security patterns, NSLP/SNAP use, and parent feeding practices; and (3) parent perceptions of NSLP/SNAP policy changes. METHODS: A total of 333 US parents completed online surveys during the COVID-19 pandemic: May 2020 (T1), September 2020 (T2), and May 2021 (T3). Food security and parent feeding practices were reported at each time point; pre-COVID-19 behaviors were retrospectively reported at T1. Use and perceptions of NSLP/SNAP policy changes were reported at T3. We examined associations between food security and parent feeding practices using repeated-measures mixed models. RESULTS: The percentage of parents with very low food security increased from pre-COVID-19 (9.6%) to T1 (29.1%) and remained elevated at T3 (16.8%). One-third (31.2%) of families fluctuated between food security and food insecurity, with 27.0% remaining food insecure at T3. Thirty percent of consistently food-insecure families reported not receiving school-provided meals, and 45% did not receive SNAP benefits. Most parents reported that pickup school meal sites (71.4%), Pandemic Electronic Benefit Transfer cards (51.4%), and increased SNAP benefits (79.6%) were beneficial. Initial changes in parent feeding practices reported at T1 returned to pre-COVID-19 levels by T3, yet concern for child overweight remained significantly elevated. CONCLUSION: Continued policy efforts to support food-insecure families via expanded food access in NSLP/SNAP are critical.

Effectiveness of the Eggs Make Kids demand-creation campaign at improving household availability of eggs and egg consumption by young children in Nigeria: A quasi-experimental study.

Using a quasi-experimental design, our study aimed to determine the effectiveness of the 'Eggs Make Kids Sharp & Bright and Strong & Active' demand-creation campaign in Nigeria. The intervention arm received emotionally compelling radio and television advertisements about eggs, and was exposed to promotional activities and advertising about eggs at points of purchase, schools and health facilities; the comparison arm received no intervention. Children 6-59 months of age (intervention: n = 1359; comparison: n = 1485) were assessed 14 months apart. Intent-to-treat analyses with analysis of covariance method assessed the impact of the intervention on caregivers' behaviour towards eggs, caregivers' willingness to pay for eggs, availability of eggs in households, and consumption of eggs by children 6-59 months of age. Analyses were adjusted for possible confounders and perceived effects of COVID-19 on finances and food consumption. Compared to the comparison arm, the intervention arm showed a greater prevalence of household egg acquisition (odds ratio = 1.34, p < 0.0001), and larger improvements in caregiver self-efficacy (ß = 0.242, p = 0.004) and intent to feed eggs to children (ß = 0.080, p = 0.021). No effects were found on children's egg consumption or caregivers' reported willingness to pay for eggs. The lack of impact on child egg consumption despite increased acquisition of eggs and caregiver self-efficacy suggests that other barriers to child consumption may exist. Additional research should further investigate factors that may influence intrahousehold distribution of eggs and whether these may also influence other nutritious foods.

Paediatricians' perspectives regarding breastfeeding during the Covid-19 pandemic: A cross-sectional study

Introduction: Covid-19 pandemic has raised queries regarding implications for breastfeeding (BF). Data are limited and recommendations for initial days after birth differ. Parents count on paediatricians for optimal information about feeding their infants, especially when the mother is infected. Objectives: To estimate knowledge of paediatricians about BF in suspected or confirmed maternal cases of Covid-19, its association with demographic variables, and participants' opinions about factors influencing their guidance to parents regarding infant nutrition in Covid-19 infected mothers. Method: This was a prospective cross-sectional study based on an online questionnaire administered to paediatricians in Uttar Pradesh, India, from February to March 2021. A total of 389 paediatricians participated. Knowledge questions were based on the World Health Organization guidance on BF for Covid-19. Results: Among the 389 participants, 44.5% had adequate knowledge, 38.3% had average knowledge, and 17.2% had inadequate knowledge;96.4% paediatricians preferred mothers' milk for infants with Covid-19 infected mothers. Fear of transmission of infection to infant was the major restraint, while the low risk of transmission to the infant if infection prevention and control practices were followed was the most useful factor perceived while counselling an infected mother for BF.Conclusions: Knowledge of paediatricians about BF in suspected or confirmed maternal cases of Covid-19 was adequate in 44.5%, average in 38.3% and inadequate in 17.2%. Majority (96.4%) of paediatricians favoured BF in maternal Covid-19 cases. © 2022,Sri Lanka Journal of Child Health. All Rights Reserved.

Caregiver perceptions of England's universal infant school meal provision during the COVID-19 pandemic.

The United Nations (UN) recognises free school meals as critical, yet widely disrupted by COVID-19. We investigate caregiver perceptions and responses to interruptions to the universal infant free school meal programme (UIFSM) in Cambridgeshire, England, using an opt-in online survey. From 586 responses, we find 21 per cent of respondents' schools did not provide UIFSM after lockdown or advised caregivers to prepare packed lunches. Where provided, caregivers perceived a substantial decline in quality and variety of meals, influencing uptake. Direction to bring packed lunches, which caregivers reported to have contained ultra-processed foods of lower nutritional quality, influenced caregiver behaviour rather than safety concerns as claimed by industry. The quality and variety of meals, and school and government policy, had greater impact than concerns for safety. In the UK and at the international level, policymakers, local governments, and schools must act to reverse the trend of ultra-processed foods in packed lunches, while improving the perceived quality of meals provided at schools.

Child Survival Crisis Due to Maternal Undernourishment During the COVID Era.

The coronavirus disease 2019 (COVID-19) pandemic caused a global crisis, creating the most challenging times faced by any country. The pandemic created a situation that shocked the whole world. It led to a condition of fear, and the ones to take the major hit were the vulnerable groups: children, pregnant women, and the elderly, as well as those belonging to low socio-economic groups who lost their source of daily income. It increased the pressure on already burdened healthcare and information systems and led to a situation where the well-being of even children and pregnant women could not be maintained. COVID-19 increased the risk of undernutrition in children. Though children are observed to be less affected by the virus, they are the hidden victims of the pandemic in terms of falling prey to undernutrition. Child undernutrition can also be linked to maternal malnutrition, starting from the preconception period through the postpartum period. The situation arose due to the rapid steps of mitigation taken to tackle the pandemic, leading to decreased food security, healthcare, and education. Maternal undernutrition leads to complications for the mother during childbirth and has long-term effects on both. It can lead to low birth weight (LBW) babies, postpartum complications, chronic child undernourishment, and even increased maternal and child mortality and morbidity. Because of the pandemic's disruption of immunization facilities, it appears that even preventable childhood diseases will worsen in the coming years. In these post-COVID-19 times, it has become necessary to take measures to improve the overall health status of the population, with special regard to these vulnerable groups. Proper maternal and child health should be targeted at community levels by introducing interventions that prioritize antenatal and postnatal care, nutritional education, immunization of both mother and child, and proper health and sanitation practices. The purpose of this narrative review is to create awareness about the child survival crisis that may occur in the coming years due to undernutrition and the failure of immunization.

Mid-term evaluation of Maternal and Child Nutrition Programme (MCNP II) in Kenya.

BACKGROUND: Kenya is faced with a triple burden of malnutrition which is multi-faceted with health and socio-economic implications. Huge geographical disparities exist, especially, in the arid and semi-arid lands exacerbated by inadequate resource allocation to the nutrition sector and challenges in multi-sectoral coordination and nutrition governance. UNICEF's Maternal and Child Nutrition Programme is a four-year (2018-2022) resilience-building, multi-sectoral program focused on pregnant and lactating women, mothers of children under five years and children under five years. The objective of the mid-term evaluation was to establish the relevance, effectiveness, efficiency, and sustainability of the programme. METHODS: The field evaluation conducted between June and July 2021, adopted a concurrent mixed-methods approach, where qualitative information was gathered through 29 key informant interviews and 18 focus group discussions (6 FGDs per population group; women of reproductive age, adolescent girls and men). Quantitatively, data were obtained through desk review of secondary data from programme reports, budgets, and project outputs where descriptive analysis was undertaken using Excel software. Qualitative information was organized using Nvivo software and analyzed thematically. RESULTS: The findings provide evidence of the relevance of the Maternal and Child Nutrition Programme II to the nutrition situation in Kenya and its alignment with the Government of Kenya and donor priorities. Most planned programme targets were achieved despite operating in a COVID-19 pandemic environment. The use of innovative approaches such as family mid-upper arm circumference, integrated management of acute malnutrition surge model, Malezi bora and Logistic Management Information Management System contributed to the realization of effective outputs and outcomes. Stringent financial management strategies contributed toward programme efficiencies; however, optimal utilization of the resources needs further strengthening. The programme adopted strategies for strengthening local capacity and promoting ownership and long-term sustainability. CONCLUSION: The programme is on track across the four evaluation criteria. However, a few suggestions are recommended to improve relevance, effectiveness, efficiency, and sustainability. A formal transition strategy needs to be developed in consultation with multi-stakeholder groups and implemented in phases. UNICEF Nutrition section should explore a more integrated  programming mode of delivery through joint initiatives with other agencies under the Delivery as One UN agenda, along the more gender transformative approaches with more systematic involvement of males and females in gender-based discussions.

Risks to the delivery of essential nutrition services in Eastern and Southern Africa in the context of the COVID-19 pandemic.

Introduction: without timely action, the global prevalence of child wasting could rise by a shocking 14.3% as a result of disruption of nutrition services by fear, stigma, and various government restrictions to curb COVID-19. Therefore, timely action should be emphasized to ensure continued provision of essential health and nutrition services such as vitamin A supplementation, timely identification and treatment of wasting, provision of micronutrients, and promotion of improved infant and young child feeding (IYCF) in the region. Methods: this study analyzed the routine nutrition data from HMIS, comparing continuity of essential nutrition services in the region before and during COVID-19. Two online questionnaires were also administered to UNICEF staff in all the 21 ESA countries in May and June 2020. Results: the Eastern and Southern Africa (ESA) region experienced reduced coverage of vitamin A supplementation among children 6-59 months, while wasting treatment recorded a mixed picture with a 14% overall decline in new admissions, but some countries also reflecting increases. Compared to 2019 there was an increase in the number of mothers and caregivers reached with counselling for improved IYCF. All the countries adopted the revised nutrition programming guidelines in the context of COVID-19. Conclusion: the impact of COVID-19 to the health and nutrition wellbeing of children and women can't be underestimated. Countries in the region should strive to continue providing essential nutrition services while protecting children and women against the spread of COVID-19. Necessary response measures should be established to build resilience in the health and nutrition sectors to cope with the impact of COVID-19.

Effects of the revised WIC food package on women's and children's health: a quasi-experimental study.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was revised in 2009 to be more congruent with national dietary guidelines. There is limited research examining effects of the revision on women's and children's health. The objective of this study was to evaluate whether the revised WIC food package was associated with various indicators of physical and mental health for women and children. METHODS: We used 1998-2017 waves of the National Health Interview Survey (N = 81,771 women and 27,780 children) to estimate effects of the revised WIC food package on indicators of health for both women (self-reported health and body mass index) and children (anemia, mental health, and parent-reported health). We used difference-in-differences analysis, a quasi-experimental technique that assessed pre-post differences in outcomes among WIC-recipients while "differencing out" the secular underlying trends among a control group of non-recipients. RESULTS: For all outcomes evaluated for women and children, we were unable to rule out the null hypothesis that there was no effect of receiving the revised WIC food package. These findings were confirmed across several secondary analyses conducted to assess heterogeneity of effects and robustness of results. CONCLUSION: While we did not find effects of the revised WIC food package on downstream health indicators, studies using similarly robust methods in other datasets have found shorter-term effects on more proximal outcomes related to diet and nutrition. Effects of the modest WIC revisions may be less impactful on longer-term indicators of health, and future studies should examine the larger COVID-19-era expansion.

Systems Mapping of the New Zealand Free and Healthy School Lunch Programme: Perspectives from Lunch Providers.

As part of the COVID-19 economic recovery package, the Aotearoa New Zealand Government rolled out a universal free and healthy lunch programme to the 25% least advantaged schools nationwide. This study explored experiences of school lunch providers in the Hawke's Bay region. The aim was to create a systems map identifying points of intervention through which the lunch programme could be improved to meet the goal of reducing child food insecurity. Twelve lunch providers were interviewed to generate casual loop diagrams which were examined and integrated to form a single systems map. Seven themes arose during analysis: teacher support, principal support, nutrition guidelines and government support, supply chain, ingredient suppliers, student feedback and food waste. Teacher support was important for getting students to try new foods and eat the nutritious lunches. Principal support was a strong theme impacting opportunities for broader student engagement. This study employed systems science to highlight the importance of support from different stakeholders within the lunch programme to achieve the goal of reduced child food insecurity. Further work is needed to ensure the programme meets the wider goals of the government and community, and to determine the potential broader benefits of the programme.

Implementation of Federal Waivers for Feeding Children in Early Care and Education During the COVID-19 Pandemic.

OBJECTIVE: To capture Child and Adult Care Food Program (CACFP) state directors' experiences implementing federal waivers for feeding children in early care and education (ECE) settings during coronavirus disease 2019. DESIGN: Qualitative semistructured interviews. SETTING: Virtual interviews with state CACFP directors. PARTICIPANTS: Child and Adult Care Food Program directors from 21 states from December 2020 to May 2021. PHENOMENON OF INTEREST: Implementation of state-level waivers. ANALYSIS: Qualitative thematic analysis. RESULTS: State directors reported that the coronavirus disease 2019 waivers allowed ECE programs to continue feeding children despite being closed or having limited enrollment. The meal pattern, noncongregate feeding, parent/guardian meal pick-up, and monitoring waivers were most frequently used by states. Challenges included maintaining integrity to CACFP meal pattern requirements, addressing the limited capacity of ECE to produce and distribute noncongregate meals, and adapting technology for virtual reviews. Suggested improvements included streamlined communication from the US Department of Agriculture, standing waivers for emergencies, ongoing flexibilities for feeding children, and strategies to increase CACFP enrollment and reduce financial viability requirements for ECE. CONCLUSIONS AND IMPLICATIONS: Results indicate the need for the US Department of Agriculture to consider issuing and extending waivers, increasing ECE participation in CACFP, and ensuring timely communication and guidance on waiver tracking.

The contribution of breastfeeding to a healthy, secure and sustainable food system for infants and young children: monitoring mothers' milk production in the food surveillance system of Norway.

OBJECTIVE: The mother-child breastfeeding dyad is a powerful force for achieving healthy, secure and sustainable food systems. However, food system reports exclude breastfeeding and mother's milk. To help correct this omission and give breastfeeding women greater visibility in food systems dialogue and action, we illustrate how to estimate mother's milk production and incorporate this into food surveillance systems, drawing on the pioneering experience of Norway to show the potential value of such analysis. DESIGN: The estimates use data on the proportion of children who are breastfed at each month of age (0-24 months), annual number of live births and assumptions on daily human milk intake at each month. New indicators for temporal and cross-country comparisons are considered. SETTING: It is assumed that a breastfeeding mother on average produces 306 l of milk during 24 months of lactation. PARTICIPANTS: The annual number of live births is from Statistics Norway. Data for any breastfeeding at each month of age, between 0 and 24 months, are from official surveys in 1993, 1998-1999, 2006-2007, 2013 and 2018-2019. RESULTS: Estimated total milk production by Norwegian mothers increased from 8·2 to 10·1 million l per year between 1993 and 2018-2019. Annual per capita production increased from 69 to 91 l per child aged 0-24 months. CONCLUSIONS: This study shows it is feasible and useful to include human milk production in food surveillance systems as an indicator of infant and young child food security and dietary quality. It also demonstrates significant potential for greater milk production.

Addressing the Social Determinants of Childhood Malnutrition: A Review

Social determinants of malnutrition play a significant role in dictating the course of malnutrition outcomes in any population. Sustained efforts to optimize these determinants are indispensable to sustainable changes in the status of nutrition of the affected population. Despite the efforts undertaken, such a high prevalence of child malnutrition in India defies logic. Multiple causes of child mortality exist. Malnutrition accounts for 69% of these under five deaths in India losing up to US$3.5 trillion loss per year, globally. Understanding the social determinants of malnutrition and its impact on child health is crucial to formulate sound and equity-based policies and interventions yielding fruitful outcomes. The situation has further worsened due to the COVID 19 pandemic. The paper emphasizes gaining cognizance of the grim and longstanding issues of malnutrition, its social determinants, and existing interventions to curb the issue. © This work is licensed under a Creative Commons Attribution-No Derivative Works 2.5 India License