Promising trends and influencing factors of complementary feeding practices in Côte d'Ivoire: An analysis of nationally representative survey data between 1994 and 2016.

Poor complementary feeding (CF) challenges early childhood growth. We examined the trends and influencing factors of CF practices among children aged 6-23 months in Côte d'Ivoire. Using data from Demographic and Health Surveys (DHS, 1994-2011) and Multiple Indicator Cluster Surveys (MICS, 2000-2016), the trends and predictors of World Health Organization-United Nations International Children's Emergency Fund CF indicators including the timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD) and minimum acceptable diet (MAD) were determined. Using 2016 MICS data, we applied multivariate logistic regression models to identify factors associated with CF indicators. Between 1994 and 2016, the mean proportion of children aged 6-8 months achieving INTRO was 56.9% and increased by about 25% points since 2006. Over 2011-2016, the proportion of children aged 6-23 months meeting MMF, MDD and MAD increased from 40.2% to 47.7%, 11.3% to 26.0% and 4.6% to 12.5%, respectively. Older children and those from urban households had higher odds of meeting MDD and MAD. Maternal TV watching was associated with higher odds of meeting MDD. The secondary or higher education levels of mothers significantly predicted higher odds of meeting INTRO and MDD. Currently, breastfeeding was also positively associated with odds of meeting MMF and MAD. Children from poorer households had lower odds of meeting MMF, MDD and MAD. Despite the improvements, CF practices remain suboptimal in Côte d'Ivoire. Influencing factors associated with CF were distributed across individual, household and community levels, calling for future programmes and policies to implement multi-level strategies to improve young children's diet in Côte d'Ivoire.

Acceptance and challenges of the introduction of the routine community-based vitamin A supplementation strategy: the case of Burkina Faso.

OBJECTIVES: With the phase-out of the polio campaigns, Burkina Faso has developed a new strategy for routine community-based vitamin A supplementation (VAS) by institutionalising community-based health workers (CBHW) to sustain the gain of two decades of successful programming. Formative research was conducted soon after the strategy was introduced to solicit feedback on the acceptability of the new approach by the implementing actors while identifying the main implementation challenges for improving its effectiveness and sustainability. DESIGN: This qualitative study was conducted in 2018 through (i) document review, (ii) individual interviews with key informants at the central, regional and district levels, and (iii) focus groups with CBHW and caregivers. SETTING: Data collection was carried out at six levels of sites covering the entire country and selected based on VAS coverage rates with the community routine. A total of six health districts were selected. PARTICIPANTS: We conducted 46 individual interviews with health workers and 20 focus groups with 59 CBHW and 108 caregivers. RESULTS: The study showed good acceptability of the strategy by all stakeholders. In the first 2 years of implementation, the national coverage of VAS was maintained at a high level (above 90 %) and there was a reduction in operational costs. The main challenges included delayed CBHW remuneration and weak communication and supervision. CONCLUSIONS: The acceptability of the community-based routine VAS was good and was perceived to have a high potential for sustainability. Addressing identified challenges will allow us to better manage the expectations of community stakeholders and maintain the initial results.

Policy overview of the multisectoral nutrition planning process: The progress, challenges, and lessons learned from Burkina Faso.

INTRODUCTION: Malnutrition is a multifactorial problem, and multisectoral planning is an indispensable tool. The objective of this study was (a) to evaluate the extent to which nutrition is integrated into policies and (b) to describe the process used by the government of Burkina Faso to reform its policy frameworks and multisectoral nutrition planning. METHODS: This was a qualitative study, and data were collected in two key steps: first, through a policy overview conducted in 2015 and, second, in November 2017, through a document review and individual stakeholder interviews with 32 key actors involved in national nutrition planning. RESULTS: The extent to which nutrition is integrated into development policies varied from one sector to another. Since 2014, Burkina Faso has initiated nutrition planning through a multisectoral approach involving six sectors. This process was implemented in three key stages. Progress includes revision of national nutrition policy towards multisectoral perspective, formulation of a consensual and quality multisectoral nutrition strategic plan, creation of nutrition budget line, and establishment of nutrition technical secretariat. CONCLUSION: To improve the anchoring of multisectoral coordination bodies at the supra-ministerial level, mobilizing resources and promoting sector accountability are key next steps that would contribute to the success of the implementation.

Comparative Validation of Five Quantitative Rapid Test Kits for the Analysis of Salt Iodine Content: Laboratory Performance, User- and Field-Friendliness.

BACKGROUND: Iodine deficiency has important health and development consequences and the introduction of iodized salt as national programs has been a great public health success in the past decades. To render national salt iodization programs sustainable and ensure adequate iodization levels, simple methods to quantitatively assess whether salt is adequately iodized are required. Several methods claim to be simple and reliable, and are available on the market or are in development. OBJECTIVE: This work has validated the currently available quantitative rapid test kits (quantRTK) in a comparative manner for both their laboratory performance and ease of use in field settings. METHODS: Laboratory performance parameters (linearity, detection and quantification limit, intra- and inter-assay imprecision) were conducted on 5 quantRTK. We assessed inter-operator imprecision using salt of different quality along with the comparison of 59 salt samples from across the globe; measurements were made both in a laboratory and a field setting by technicians and non-technicians. Results from the quantRTK were compared against iodometric titration for validity. An 'ease-of-use' rating system was developed to identify the most suitable quantRTK for a given task. RESULTS: Most of the devices showed acceptable laboratory performance, but for some of the devices, use by non-technicians revealed poorer performance when working in a routine manner. Of the quantRTK tested, the iCheck® and I-Reader® showed most consistent performance and ease of use, and a newly developed paper-based method (saltPAD) holds promise if further developed. CONCLUSIONS: User- and field-friendly devices are now available and the most appropriate quantRTK can be selected depending on the number of samples and the budget available.

Reliable method to estimate characteristics of sleep and physical inactivity in free-living conditions using accelerometry.

PURPOSE: The purpose of this study is to use a new method to assess the characteristics of sleep and diurnal physical inactivity in human beings by means of accelerometry, noninvasively and in free-living conditions. METHODS: Forty girls and 40 boys aged 13 to 15 years, randomly selected from rural Senegal, wore an accelerometer for a 72-hour period during the dry season in 1998 and 2000. An algorithm already tested in another study was used to objectively calculate the characteristics of sleep and physical inactivity from movement registration provided by accelerometry. RESULTS: Adolescent girls slept for a longer time and more quietly than adolescent boys (8 hours 45 minutes versus 8 hours 9 minutes). Girls were more inactive than boys (4 hours 23 minutes versus 2 hours 49 minutes). Reliability estimates of physical inactivity period measures were excellent (0.74 to 0.78), and those of sleep period and length measures were acceptable (0.45 to 0.61). Girls and boys had the same levels of reliability, except for sleep efficiency measures. CONCLUSIONS: These findings could be explained by the nature and sex division of habitual tasks within the community. The accelerometer is a valid and useful epidemiologic tool for measuring characteristics of sleep and physical inactivity in free-living conditions. This innovative tool opens new prospects in epidemiology and public health, especially in the worldwide epidemic of chronic diseases associated with physical inactivity and sleep disorders.

Longitudinal estimates of puberty timing in Senegalese adolescent girls.

This study aimed to assess the timing of sexual maturation (breast development and menarche occurrence) among sub-Saharan African adolescent girls from rural areas. In the framework of a longitudinal study of growth at puberty, the stages of pubertal development (Tanner classification) and menarche occurrence were recorded at intervals between 1995 and 2000 in a sample of 406 Senegalese adolescent girls from a rural area. Nutritional status was estimated during infancy, childhood, and adolescence within this sample, and body composition was estimated only during adolescence. At the beginning of the study (1995), the adolescent girls were 11.4 years old (SD = 0.6). At the end of the study, they were 16.5 years old (SD = 0.6). Median and quartile ages at entry into each maturity stage and its confidence limits were estimated by a lognormal parametric survival model. These adolescent girls were shorter and thinner than girls of the same age from developed countries. Median age at the onset of breast development was 12.6 years (95% CI = 12.5-12.8). Median age at the end of sexual maturation and median age at menarche were estimated respectively at 15.8 years (95% CI = 15.7-15.9) and 15.9 years (95% CI = 15.7-15.9). These adolescent girls were less mature than other adolescent girls of the same age from other developing countries. Their puberty was extremely delayed compared to that of adolescent girls of the same age from industrialized countries. Puberty in these Senegalese adolescent girls is delayed by about 3 years. This may be due to malnutrition, significant energy expenditure, and poor diet and living conditions, and possibly to genetic control.

Cross-cultural comparison of growth, maturation and adiposity indices of two contrasting adolescent populations in rural Senegal (West Africa) and Martinique (Caribbean).

OBJECTIVES: To stress the importance of social and environment (nutritional) factors in determining the growth spurt during puberty and the risk of excessive adiposity, two contrasting adolescent populations, one from a rural area of Senegal (West Africa) and the other from Martinique (French West Indies), were compared. DESIGN: Cross-cultural comparison of contrasting populations. Adolescents from Senegal belonged to a cohort followed up since 1995. Adolescents from Martinique participated in a cross-sectional nutritional survey that covered the entire island. SUBJECTS: A total of 507 adolescents (mean age: 14.3+/-0.7 years) from Senegal (319 girls and 188 boys) and 703 adolescents from Martinique (351 boys and 352 girls) were surveyed. RESULTS: Differences in growth and maturation were striking: boys in Martinique were 22.7 kg heavier and 20.1 cm taller than boys in Senegal. Differences were less important for girls but still evident: 12.6 kg in weight and 10.5 cm in stature. In Senegal, there were virtually no overweight adolescents, but 18% of girls and 50% of boys could be considered as malnourished. In Martinique, 19% of girls and 23% of boys were overweight or obese. Adolescent girls from Martinique were also sexually more mature than adolescent girls from Senegal. When comparisons were repeated after Senegalese girls reached menarche, differences in weight and body mass index disappeared, but Senegalese girls were still shorter than girls from Martinique. CONCLUSIONS: Adolescents are extremely susceptible to nutritional changes and their particular situation needs to be incorporated into nutritional prevention programmes.

Impact of the health and living conditions of migrant and non-migrant Senegalese adolescent girls on their nutritional status and growth.

OBJECTIVE: To describe the living conditions of Senegalese adolescent girls according to their migration status, and to define the main socio-economic and biological determinants of their nutritional and growth status. DESIGN: Health and living conditions, sexual maturation, and nutritional and growth status of adolescent girls were determined within the framework of a longitudinal study on growth. SETTINGS: The capital city of Senegal (Dakar) and a rural community (Niakhar), 120 km south-east of Dakar. SUBJECTS: Three hundred and thirty-one girls, 14.5-16.6 years of age, were recruited from the same villages. Thirty-six per cent of the sample remained in the villages to attend school and/or to help with household subsistence tasks (non-migrants). The remaining (64%) migrated to cities to work as maids (migrants) and lived in two different socio-economic environments: at the home of a guardian during the night and in the house of the employer during the daytime. RESULTS: Family rural environment and guardian and employer urban environments were socio-economically different (P < 0.001). Living conditions in urban areas were better than in rural areas and the employer's environment was socio-economically more favourable. Migrants had more advanced sexual maturation and higher body mass index (BMI), fat mass index (FMI) and mid-upper arm circumference than non-migrants. However, migrants were smaller than non-migrants. BMI, FMI and weight-for-age were related to socio-economic levels and duration of migration. Schooling was positively related to height and negatively related to BMI. CONCLUSIONS: Migrants enjoyed better living conditions than non-migrants. This could be partly due to the better socio-economic environment of the employer. It was associated with earlier puberty and better nutritional status, but not with a better growth.