A systematic review of recruitment and retention of ethnic minorities and migrants in obesity prevention randomised controlled trials.

BACKGROUND: Participants' recruitment and retention into community-based interventions can be challenging, especially in research involving ethnic minorities and migrants. Despite known challenges, there are limited reviews that probe recruitment and retention strategies involving ethnic minorities and migrants in the Organisation for Economic Cooperation and Development (OECD) countries. This systematic review aimed to measure recruitment and retention rates and identify the barriers and facilitators to effective recruitment and retention of ethnic minorities and migrants in community-based obesity prevention Randomised Control Trials (RCTs) in OECD countries. METHODS: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five databases (CINAHL, Cochrane, Embase, Medline and PsychInfo) were searched from January 2000 to March 2022, in addition to Google and Google Scholar. Methodological quality and risk of bias were assessed, and pooled analysis and meta-ethnographic analysis were conducted on the included studies. RESULTS: Twenty-five studies were included in the review. The pooled analysis found a 64% rate of recruitment of ethnic minorities in RCTs, with a retention rate of 71%. Key facilitators identified were-use of multiple communication channels, incentives, recruiting community champions, participant convenience and employing culturally sensitive strategies. Key barriers to participation were limited access to study sites, time constraints, limited trust, perceived fear, and anxiety. CONCLUSION: Findings suggest the importance of undertaking culturally appropriate recruitment and retention strategies to minimise barriers and facilitate effective recruitment and retention of low-income ethnic minorities and migrants in community-based research.

Mapping of nutrition policies and programs in South Asia towards achieving the Global Nutrition targets.

BACKGROUND: South Asia continues to host the triple burden of child malnutrition with high levels of child undernutrition, hidden hunger (micronutrient deficiencies) and childhood overweight/obesity. To combat malnutrition, the international community along with the National governments have launched initiatives to track the country's progress towards achieving the Global Nutrition targets by 2025. This review captures the country-specific efforts of nutrition-specific and nutrition-sensitive sectoral programs and policies towards achieving these targets for eight South Asian countries. METHODS: A systematic internet search was undertaken to search relevant policies and programs from Government websites and twelve International Organisations working in the region. The authors developed a template to map the policies against the following criteria: (i) enabling supportive environment; (ii) Initiatives targeted at nutrition-specific interventions; and (iii) Initiatives targeted at nutrition-specific interventions that impact child malnutrition. A narrative descriptive approach was used to present findings. RESULTS: All eight countries had relevant policies and programs to address child malnutrition and macronutrient deficiencies with targets for significant reductions in stunting and improved breastfeeding. However, despite the outlined there are major challenges of implementation, monitoring, evaluation and quality that persist with increased dependency on international donors and organisations for funding and/or implementation of nutrition plans. CONCLUSION: There is a need to contextualise efforts designated to donors and governments to improve the tracking of efforts that impact nutrition.

A Scoping Review of Aging Experiences Among Culturally and Linguistically Diverse People in Australia: Toward Better Aging Policy and Cultural Well-Being for Migrant and Refugee Adults.

BACKGROUND AND OBJECTIVES: Australia's population is growing, aging, and becoming more ethnically diverse, resulting in barriers and challenges around social inclusion for non-English-speaking migrants and refugees. This scoping review investigates the experiences of aging within Australia among older adults from culturally and linguistically diverse (CALD) migrant and refugee backgrounds to identify barriers to social integration. RESEARCH DESIGN AND METHODS: A scoping review of English language literature and gray literature on the experiences of aging among CALD migrants and refugees living in Australia was conducted from January 2000 to January 2021, according to Arksey and O'Malley's review process. A total of 34 studies were identified for analysis. RESULTS: Three primary themes were identified: (a) sociocultural similarities in settlement experiences, (b) engagement with technology for social connection, and (c) engagement with family and community networks. DISCUSSION AND IMPLICATIONS: Aging, language, sociocultural, and technology contexts shape attitudes to belonging, as well as access to sociomedical services. We argue a cultural well-being framework may assist in developing policy for improved social integration of older CALD adults. As the focus is on social and cultural experiences, all studies with a primary focus on medical and other chronic conditions were excluded. Future studies could include health-related articles to present a more comprehensive approach regarding older CALD adult needs. Follow-up research could focus on the impact of the coronavirus disease 2019 pandemic on the experiences of older adults in Australia, in particular those of CALD backgrounds.

Hidden hunger and child undernutrition in South Asia: A meta-ethnographic systematic review.

BACKGROUND AND OBJECTIVES: South Asia hosts the largest proportion of undernourished children in the world. Hidden hunger and undernutrition continue to be a major global health concern in the region. A systematic review looking at factors and drivers for hidden hunger and child undernutrition was undertaken. METHODS AND STUDY DESIGN: This review was conducted using the 2020 Preferred Reporting Items for Systematic reviews and Meta- Analysis guidelines. Five computerized databases were searched: CINAHL, EMBASE, PubMed, PsycINFO and Scopus, in addition to various grey literature sources. RESULTS: A total of 3601 articles were retrieved from databases and 25 studies from grey literature, 98 studies met our inclusion criteria. Included studies were assessed for quality by validated tools. A Meta-ethnographic narrative approach was used to analyse the findings. The most commonly reported factors for child undernutrition were maternal education, poor dietary diversity and rural residence. CONCLUSIONS: Based on findings we propose a model to mainstream context specific nutrition behavioural change along with nutrition specific and sensitive interventions aimed at targeting gender, social and cultural factors and norms. Findings from the review add to the extant literature of child undernutrition to inform policy and program.

The effectiveness of interventions on nutrition social behaviour change communication in improving child nutritional status within the first 1000 days: Evidence from a systematic review and meta-analysis.

This systematic review and meta-analysis aimed to assess the robustness of designs and tools used in nutrition social behaviour change communication (NSBCC) interventions and establish their effectiveness. EBSCOhost as an umbrella database including Medline (Ovid) and CINAHL, EMBASE, and ProQUEST databases were searched for peer-reviewed articles from January 1960 to October 2018. Additional sources were searched to identify all relevant studies including grey literature. Studies' biases were assessed according to Cochrane handbook. Pooled estimate of effectiveness of interventions on infant and young child feeding (IYCF) practices and child nutritional status with 95% confidence intervals were measured using random-effects models. Eighty studies were included in this review: Fifty-one (64%) were cluster randomised controlled trials (RCTs), 13 (16%) were RCTs and 16 (20%) quasi-experimental. Of the included studies, 22 (27%) measured early initiation of breastfeeding, 38 (47%) measured exclusive breastfeeding, 29 (36%) measured minimum dietary diversity, 21 (26%) measured minimum meal frequency, 26 (32%) measured height for age z-scores (HAZ), 23 (29%) measured weight for height z-scores (WHZ), 27 (34%) measured weight for age z-scores (WAZ), 20 (25%) measured stunting, 14 (17%) measured wasting, and 11 (14%) measured underweight. The overall intervention's effect was significant for exclusive breastfeeding (EBF) (odds ratio = 1.73; 95% confidence interval [CI]: 1.35-2.11, p < 0.001), HAZ (standardized mean differences [SMD] = 0.19; 95% CI: 0.17-0.21; p < 0.001), WHZ (SMD = 0.02; 95% CI: 0.004-0.04; p < 0.001), and WAZ (SMD = 0.04; 95% CI: 0.02-0.06; p < 0.001). Evidence shows the effectiveness of NSBCC in improving EBF and child anthropometric outcomes. Further research should test the impact on child nutritional status with clearly specified and detailed NSBCC interventions.

Wasting and Associated Factors among Children under 5 Years in Five South Asian Countries (2014-2018): Analysis of Demographic Health Surveys.

Child wasting continues to be a major public health concern in South Asia, having a prevalence above the emergency threshold. This paper aimed to identify factors associated with wasting among children aged 0-23 months, 24-59 months, and 0-59 months in South Asia. A weighted sample of 564,518 children aged 0-59 months from the most recent demographic and health surveys (2014-2018) of five countries in South Asia was combined. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. Wasting prevalence was higher for children aged 0-23 months (25%) as compared to 24-59 months (18%), with variations in prevalence across the South Asian countries. The most common factor associated with child wasting was maternal BMI [adjusted odds ratio (AOR) for 0-23 months = 2.02; 95% CI: (1.52, 2.68); AOR for 24-59 months = 2.54; 95% CI: (1.83, 3.54); AOR for 0-59 months = 2.18; 95% CI: (1.72, 2.77)]. Other factors included maternal height and age, household wealth index, birth interval and order, children born at home, and access to antenatal visits. Study findings suggest need for nutrition specific and sensitive interventions focused on women, as well as adolescents and children under 2 years of age.

Do interventions to improve adherence to antiretroviral therapy recognise diversity? A systematic review.

People living with HIV (PLWH) are often culturally and linguistically diverse populations; these differences are associated with differing barriers to antiretroviral therapy (ART) adherence. Cultural competence measures the extent to which trial design recognises this diversity. This systematic review aimed to determine whether adherence trial participants represent the diversity of PLWH. Randomised Controlled Trials in Organisation for Economic Co-operation and Development countries to improve ART adherence were eligible. We searched MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews. For all included trials, we searched for their development, testing and evaluation studies. We compared trial participant characteristics with nationally reported PLWH data. We appraised trial cultural competence against ten criteria; scoring each criterion as 0, 1 or 2 indicating cultural blindness, pre-competence or competence respectively. For 80 included trials, a further 13 studies presenting development/testing/evaluation data for the included trials were identified. Only one of the 80 included studies reported trial participants representative of the country's population of PLWH. The median (IQ) cultural competence score was 2.5 (1.0, 4.0) out of 20. HIV adherence trial participants are not reflective of the population with HIV, which may be due to limited adoption of culturally competent research methods.

Factors Associated with Stunting among Children under 5 Years in Five South Asian Countries (2014-2018): Analysis of Demographic Health Surveys.

South Asia continues to be the global hub for child undernutrition with 35% of children still stunted in 2017. This paper aimed to identify factors associated with stunting among children aged 0-23 months, 24-59 months, and 0-59 months in South Asia. A weighted sample of 564,518 children aged 0-59 months from the most recent Demographic and Health Surveys (2014-2018) was combined of five countries in South Asia. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. The common factors associated with stunting in three age groups were mothers with no schooling ([adjusted odds ratio (AOR) for 0-23 months = 1.65; 95% CI: (1.29, 2.13)]; [AOR for 24-59 months = AOR = 1.46; 95% CI: (1.27, 1. 69)] and [AOR for 0-59 months = AOR = 1.59; 95% CI: (1.34, 1. 88)]) and maternal short stature (height < 150 cm) ([AOR for 0-23 months = 2.00; 95% CI: (1.51, 2.65)]; [AOR for 24-59 months = 3.63; 95% CI: (2.87, 4.60)] and [AOR for 0-59 months = 2.87; 95% CI: (2.37, 3.48)]). Study findings suggest the need for a balanced and integrated nutrition strategy that incorporates nutrition-specific and nutrition-sensitive interventions with an increased focus on interventions for children aged 24-59 months.

Past drivers of and priorities for child undernutrition in South Asia: a mixed methods systematic review protocol.

BACKGROUND: South Asia has one of the largest proportions of undernourished children in the world, especially stunting, wasting, and underweight as well as micronutrient deficiencies such as the deficiency of iron, vitamin A, and zinc. Undernutrition continues to pose a major threat to this region's economic and social growth. This systematic review aims to assess the drivers and identify priorities for child undernutrition in South Asia. It aims to appraise, synthesise, and summarise literature to create an evidence base that looks at multiple faces of macro and micro child undernutrition in South Asia. METHODS: A systematic review of published and grey literature on child undernutrition, including macro and micronutrient deficiencies, in South Asia covering the period January 2000 to September 2019 will be undertaken. Studies with all relevant study designs and those published in English will be considered for inclusion. Five academic databases will be searched: CINAHL, EMBASE, PubMed, PsycINFO, and Scopus, in addition to various grey literature sources. The analysis will incorporate a narrative synthesis, meta-ethnography or a meta-analysis as appropriate, depending on the nature of the retrieved data. Quality of the included studies will be assessed by validated tools. The UNICEF conceptual framework on child undernutrition will be used to frame findings. DISCUSSION: This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. The protocol gives an insight into the scope and parameters for the systematic review to be carried out. SYSTEMATIC REVIEW REGISTRATION: The protocol was registered by the PROSPERO international prospective register of systematic reviews, reference CRD42018112696 .

"Our riches are our family", the changing family dynamics & social capital for new migrant families in Australia.

Immigration from collectivist cultures to Western countries often results in loss of social capital and changing family dynamics leading to isolation and acculturative stress. This study explored the impact of social and cultural changes experienced by seven migrant communities residing in Greater Western Sydney, Australia. It deconstructed the role of local community and networks in their initial settlement in absence of traditional forms of community support. Data were collected through fourteen focus group discussions (164 participants). Five major themes emerged: (i) changing gender roles and women empowerment; (ii) sending money home; (iii) culture shock and increased intercultural conflict; (iv) change in lifestyle from collective to individual culture; and (v) role of extended community in mitigating culture shock. These findings suggest that community interventions aimed at improving cultural and social engagement of migrants employ social capital framework. This will ensure enhanced communication within migrant families and communities from different cultural and linguistic backgrounds.

Integrating human rights approaches into public health practices and policies to address health needs amongst Rohingya refugees in Bangladesh: a systematic review and meta-ethnographic analysis.

BACKGROUND: The Rohingya people of Myanmar are one of the most persecuted communities in the world and are forced to flee their home to escape conflict and persecution. Bangladesh receives the majority of the Rohingya refugees. On arrival they experience a number of human rights issues and the extent to which human rights approaches are used to inform public health programs is not well documented. The aim of this systematic review was to document human rights- human rights-related health issues and to develop a conceptual human rights framework to inform current policy practice and programming in relation to the needs of Rohingya refugees in Bangladesh. METHODS: This systematic review was conducted using the 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Eight computerized databases were searched: Academic Search complete, Embase, CINAHL, JStor, Pubmed, Scopus, SocIndex, and Proquest Central along with grey literature and Google Scholar. Of a total of 752 articles retrieved from the eight databases and 17 studies from grey literature, 31 studies met our inclusion criteria. RESULTS: Using meta-ethnographic synthesis, we developed a model that helps understand the linkages of various human rights and human rights-related health issues of Rohingya refugees. The model highlights how insufficient structural factors, poor living conditions, restricted mobility, and lack of working rights for extended periods of time collectively contribute to poor health outcomes of Rohingya refugees. CONCLUSION: This review provides a human-rights approach to frame actions both at program and policy level in a sustained way to address the health needs of Rohingya refugees in Bangladesh. Such policy actions will focus on finding long term solutions for integrating the Rohingya population while addressing their immediate rights issue. TRIAL REGISTRATION: This systematic review has not been registered.

Resilience to climate-induced disasters and its overall impact on well-being in Southern Africa: a mixed-methods systematic review protocol.

BACKGROUND: Southern Africa has long been vulnerable to climate-induced disasters, especially droughts and floods. The severity and frequency of disasters increased in the early 1980s, continuously eroding livelihoods, which in turn invoked humanitarian intervention. A systematic review of the relationship between resilience to drought and well-being will be undertaken. METHODS: Studies will be included if they were conducted between January 1980 and December 2017; used quantitative and/or qualitative methods; were peer reviewed or comprise grey literature; covered Southern Africa; and measured resilience and its relationship to well-being. Data extraction will be informed by the Cochrane Public Health Group and the Joanna Briggs Institute manuals. The quality of evidence of the studies included will be assessed for risk bias, psychometric properties of tools used, and their suitability. The findings will be summarised into themes and narrated. DISCUSSION: This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. The protocol gives insight of the scope and parameters for the systematic review to be carried out. The systematic review will establish how resilience to climate-induced disasters affects well-being. It will also provide recommendations to improve humanitarian coordination in Southern Africa. SYSTEMATIC REVIEW REGISTRATION: The protocol was registered by the PROSPERO international prospective register of systematic reviews, reference CRD42017064396 .

Perinatal Mortality in South Asia: Systematic Review of Observational Studies.

BACKGROUND: This study aimed to systematically review observational studies on perinatal mortality in South Asia. METHODS: This review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Five computerized bibliographic databases: MEDLINE, CINAHL, Embase, PsycINFO, and Scopus were searched for published studies which reported factors associated with perinatal mortality in South Asia from 1 January 2000 to 20 March 2018. All relevant observational studies (cohort, cross-sectional and case-control) were reviewed. RESULTS: Fourteen studies met the selection criteria. The most common factors associated with perinatal mortality were: low socioeconomic status, lack of quality health-care services, pregnancy/obstetric complications and lack of antenatal care. CONCLUSIONS: Interventions to reduce perinatal mortality in the South Asia should focus on the provision of adequate antenatal care and quality healthcare services which are accessible to women of low socioeconomic status.

Stunting, Wasting and Underweight in Sub-Saharan Africa: A Systematic Review.

Introduction: Child undernutrition is a major public health problem. One third of all undernourished children globally reside in Sub-Saharan Africa (SSA). The aim of this study was to systematically review studies to determine the factors associated with stunting, wasting and underweight in SSA and contribute to the existing body of evidence needed for the formulation of effective interventions. Methods: This systematic review was conducted using the 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Five computerized bibliographic databases were searched: Scopus, PubMed, PsycINFO, CINAHL and Embase. The included studies were rated using eight quality-appraisal criteria derived from the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist: sample size, sampling methodology, response rate, outcome measures, statistical analyses, control for confounding, study limitation, and ethical consideration. Results: Of a total of 2810 articles retrieved from the five databases, 49 studies met our inclusion criteria. The most consistent factors associated with childhood stunting, wasting and underweight in SSA were: low mother's education, increasing child's age, sex of child (male), wealth index/SES (poor household), prolonged duration of breastfeeding (>12 months), low birth weight, mother's age (<20 years), source of drinking water (unimproved), low mother's BMI (<18.5), birth size (small), diarrhoeal episode, low father's education and place of residence (rural). Conclusions: The factors that predispose a child to undernutrition are multisectoral. To yield a sustainable improvement in child nutrition in SSA, a holistic multi-strategy community-based approach is needed that targets the factors associated with undernutrition, thereby setting the region on the path to achieving the WHO global nutrition target by 2025.