Food and nutrition knowledge, attitudes and practices among children in public primary school with canteens in southern Benin: a case study.

BACKGROUND: Food and nutrition notion among schoolchildren in Benin is still less documented. Few studies have examined the determinants of food and nutrition among schoolchildren while others have attempted to link knowledge, attitudes and practices to diet. The present study aims to evaluate food and nutrition knowledge, attitudes and practices among schoolchildren enrolled in public primary schools canteens in Cotonou and its surroundings. METHODS: A diagnostic study was conducted in twelve public primary schools with canteens. A structured interview questionnaire was used to collect data from 861 schoolchildren aged 7 to 14 years. Three scores were used to assess the level of knowledge, attitude and practice. The overall score was the total of correct responses. The maximum score for all the three parameters was 15, 6 and 4 respectively for knowledge, attitude and practices. Data were analyzed using STATA 16. Logistic regression was performed to identify the relationship between food and nutrition practices and knowledge and attitude. Pearson goodness of fit test was performed to verify the adequacy of the model. A P-value of less than 0.05 (P < 0.05) was considered significant at 95% confidence interval. RESULTS: schoolchildren's nutrition knowledge was low (mean score 2.52 ± 1.33) while attitude and practices were acceptable (mean score 4.08 ± 1.39 and 2.84 ± 0.77). Only 18.2% of schoolchildren knew the different food groups and 3.4% knew that they should eat at least five fruits and vegetables a day. Most of the schoolchildren (93.6%) were favorable to eat at least five fruits and vegetables and 86.8% were willing to eat more than 3 times a day. Among all practices, snacking between meals and eating breakfast were poorly observed by the schoolchildren. Nutrition knowledge was associated with practices observed among schoolchildren but not with attitudes. However, a significant positive association was observed (p < 0.05) between attitudes and practices. CONCLUSION: Knowledge on food and nutrition among schoolchildren from public primary schools with canteen was low. This study suggests implementation of nutritional education to improve schoolchildren's knowledge and attitudes towards healthy diets and nutrition.

Dietary Diversity Predicts the Adequacy of Micronutrient Intake in 6- to 23-Month-Old Children Regardless of the Season in Rural Southern Benin.

BACKGROUND: The Infants and Young Children Dietary Diversity Score (IYC-DDS-7) has been validated to assess dietary quality in children. However, its applicability to predict the adequacy of micronutrient intake remains a challenge in all contexts. DESIGN AND METHODS: A 24-hour dietary recall assessment was conducted on a sample of 628 children aged 6 to 23 months in the plenty season (PS) as well as in the lean season (LS). The IYC-DDS-7 was calculated based on 7 food groups, whereas the mean micronutrient density adequacy (MMDA) for 11 micronutrients. The ß regression models were used to assess the relationship between IYC-DDS and MMDA and differences in nutrient intake between the 2 seasons. A receiver-operating characteristic curve analysis was also performed to determine IYC-DDS-7 cutoff levels that maximized sensitivity and specificity in assessing dietary quality and predicting MMDA below- or above-selected cutoff levels. RESULTS: Participating children's MMDA was 56.9% ± 12.8% versus 61.9% ± 8.6% and IYC-DDS-7 was 3.43 ± 1.5 versus 3.77 ± 1.0 in the PS and LS. The IYC-DDS-7 had a positive correlation with MMDA, irrespective of the season. For a 1-unit increase in IYC-DDS-7, MMDA increased by a mean of 10.7% (CI, 8.3%-13.1%; P < .001). The minimum threshold of the 4 food groups corresponded to a sensitivity of 76% and 61% and a specificity of 75% and 70% for the prediction of inadequate diet in the PS and LS, respectively. CONCLUSIONS: The IYC-DDS-7 predicted MMDA, regardless of seasons for infants and young children. The IYC-DDS-7 cutoff of 4 groups performed well in classifying children with low-diet quality.

Factors Associated With Postpartum Weight Retention in African Women: A Systematic Review.

BACKGROUND: The obesity epidemic among women in Africa is a health problem, and many studies attribute it to childbearing. However, most studies of postpartum weight retention (PPWR) occur in high-income countries. OBJECTIVE: Therefore, this review sought to identify the potential factors affecting PPWR among African women. METHODS: Four databases were searched from January 2000 to December 2020: Medline/PubMed, Google scholar, Ajol research, FreeFullPDF. The quality of included studies was assessed using the Newcastle Ottawa Scale. RESULTS: Fifteen studies (5 from west, 4 from south, 3 from east, 2 from central, and 1 from north) were included: 8 cohort and 7 prospective cohort studies. Two studies examined the effect of obesity and weight gain during pregnancy on PPWR, 3 studies assessed the effect of childbirth, 4 examined the effect of breastfeeding, 4 assessed the impact of morbidities such as HIV, and 2 looked at food insecurity. Five studies demonstrated that postpartum weight is due to residual pregnancy weight gain and childbirth weight gain and is accentuated as parity increases (n = 2). Breastfeeding has a controversial effect, while morbidity (n = 4) and food insecurity (n = 4) contributed to weight loss. The variation in weight was also influenced by cultural practices (n = 1), prepregnancy weight (n = 1), and socioeconomic status (n = 1). On all domains, only 3 included studies were of good quality. CONCLUSIONS: Pregnancy weight gain, childbirth, breastfeeding, morbidity, and food insecurity were associated with PPWR. However, preexisting factors must be considered when developing PPWR modification strategies. In addition, due to the limited number of studies included, robust conclusions cannot be drawn.

Knowledge, attitude, practice and associated factors among patients with type 2 diabetes in Cotonou, Southern Benin.

BACKGROUND: Type 2 diabetes (T2D) is becoming an epidemic with significant disability and premature death in Sub-Saharan Africa, including Benin. However, little is known about the level of knowledge, attitude, and practice (KAP) necessary for diabetic patients to enhance therapeutic outcomes and prevent diabetes complications. The study aimed to assess patients' KAP levels and identify the factors associated in Cotonou, southern Benin. METHODS: A cross-sectional study was conducted from July to August 2019 among 300 diabetic patients from four health centers. Data was collected using validated questionnaires. KAP levels were determined by calculating the scores, and multivariate logistic regression was used to explore factors influencing KAP scores. RESULTS: About 53, 52, and 47% of all patients had good knowledge, attitude, and practice towards diabetes. In logistic regression, factors such as being female, married, educated, government/non-government employee, and longer duration of diabetes were significantly associated with good knowledge. Being married, having a longer duration of diabetes, and good knowledge were significantly associated with a good attitude while being educated, having a longer duration of diabetes, and good knowledge with good practice. CONCLUSIONS: Lack of knowledge, poor attitude, and inadequate practice were found in this surveyed community, suggesting a need for structured educational programs to assist diabetic patients. However, education should be considered a priority for male, newly diagnosed, and uneducated patients.

Participation in the "nutrition at the Centre" project through women's group improved exclusive breastfeeding practices, as measured by the deuterium oxide dose-to-mother technique.

BACKGROUND: Evidence of interventions that are effective in improving exclusive breastfeeding (EBF) practices is needed to help countries revise their strategies. To assess whether mothers who had participated in the Nutrition at the Centre (N@C) project effectively demonstrated better EBF practices than did those who did not participate, we documented the processes of this nutritional intervention in Benin. METHODS: This study was a cross-sectional design comparing the intervention group, namely, the Village Saving and Loan Association (VSLA-N@C), to the control group. The N@C project was an educational intervention based on behavioural and social changes related to nutrition. Through VSLA groups installed in communities, mothers were connected to the project; had weekly discussions around the process, benefits and challenges linked to EBF, and advocated during Breastfeeding Week celebrations. The study participants were mothers with children aged 4-5.5 months from the VSLA-N@C group (n = 53) and mothers (n = 50) from non-intervention areas who served as controls. With the deuterium oxide dose-to-mother technique, we quantified human milk intake (HMI) and non-milk oral intake (NMOI) and compared both groups using Student's t-test. A child is considered to be exclusively breastfed if the NMOI is less than 86.6 g/day. Multivariate regression logistics adjusted for VSLA membership, mothers' body mass index, and children's age, weight-for-age and weight-for-length, thus enabling us to measure differences in EBF rates. RESULTS: Children of mothers from the VSLA-N@C group consumed significantly more human milk than those of mothers in the control group (900.2 ± 152.5 g/day vs 842.2 ± 188.6 g/day, P = 0.044). Children in the VSLA-N@C group had significantly less non-milk oral intake than did those in the control group (difference: 148.2 g/day, P = 0.000). Therefore, the EBF rate was significantly higher in the VSLA group (38% vs 8%, P < 0.0001), and mothers in VSLAs were 14 times more likely to practise EBF than were those in the control group (adjusted odds ratio [AOR] = 13.9, 95% CI 1.9-116.5, P = 0.015). CONCLUSION: The EBF rate was significantly higher in the group of mothers who participated in the VSLA-N@C project than in those who did not receive the intervention. The N@C model could be promoted as a strategy for increasing EBF practices in poor and rural contexts, where it is possible to organize mothers into VSLA groups to discuss the process, benefits and challenges of EBF.

Evidence-informed decision making for nutrition: African experiences and way forward.

Although substantial amount of nutrition research is conducted in Africa, the research agenda is mainly donor-driven. There is a clear need for a revised research agenda in Africa which is both driven by and responding to local priorities. The present paper summarises proceedings of a symposium on how evidence can guide decision makers towards context-appropriate priorities and decisions in nutrition. The paper focuses on lessons learnt from case studies by the Evidence Informed Decision Making in Nutrition and Health Network implemented between 2015 and 2016 in Benin, Ghana and South Africa. Activities within these countries were organised around problem-oriented evidence-informed decision-making (EIDM), capacity strengthening and leadership and horizontal collaboration. Using a combination of desk-reviews, stakeholder influence-mapping, semi-structured interviews and convening platforms, these country-level studies demonstrated strong interest for partnership between researchers and decision makers, and use of research evidence for prioritisation and decision making in nutrition. Identified capacity gaps were addressed through training workshops on EIDM, systematic reviews, cost-benefit evaluations and evidence contextualisation. Investing in knowledge partnerships and development of capacity and leadership are key to drive appropriate use of evidence in nutrition policy and programming in Africa.

Evaluation of the international standardized 24-h dietary recall methodology (GloboDiet) for potential application in research and surveillance within African settings.

BACKGROUND: Collection of reliable and comparable individual food consumption data is of primary importance to better understand, control and monitor malnutrition and its related comorbidities in low- and middle-income countries (LMICs), including in Africa. The lack of standardised dietary tools and their related research support infrastructure remains a major obstacle to implement concerted and region-specific research and action plans worldwide. Citing the magnitude and importance of this challenge, the International Agency for Research on Cancer (IARC/WHO) launched the "Global Nutrition Surveillance initiative" to pilot test the use of a standardized 24-h dietary recall research tool (GloboDiet), validated in Europe, in other regions. In this regard, the development of the GloboDiet-Africa can be optimised by better understanding of the local specific methodological needs, barriers and opportunities. The study aimed to evaluate the standardized 24-h dietary recall research tool (GloboDiet) as a possible common methodology for research and surveillance across Africa. METHODS: A consultative panel of African and international experts in dietary assessment participated in six e-workshop sessions. They completed an in-depth e-questionnaire to evaluate the GloboDiet dietary methodology before and after participating in the e-workshop. RESULTS: The 29 experts expressed their satisfaction on the potential of the software to address local specific needs when evaluating the main structure of the software, the stepwise approach for data collection and standardisation concept. Nevertheless, additional information to better describe local foods and recipes, as well as particular culinary patterns (e.g. mortar pounding), were proposed. Furthermore, food quantification in shared-plates and -bowls eating situations and interviewing of populations with low literacy skills, especially in rural settings, were acknowledged as requiring further specific considerations and appropriate solutions. CONCLUSIONS: An overall positive evaluation of the GloboDiet methodology by both African and international experts, supports the flexibility and potential applicability of this tool in diverse African settings and sets a positive platform for improved dietary monitoring and surveillance. Following this evaluation, prerequisite for future implementation and/or adaptation of GloboDiet in Africa, rigorous and robust capacity building as well as knowledge transfer will be required to roadmap a stepwise approach to implement this methodology across pilot African countries/regions.