ABSTRACT In Ethiopia, malnutrition reflects stark nutritional disparities across residences and regions, with young children in rural areas exhibiting markedly poorer outcomes than their urban counterparts. This systematic review and meta‐analysis evaluated the effectiveness of context‐specific social and behaviour change (SBC) interventions, including nutrition education, on child nutrition, measured through changes in Minimum Dietary Diversity (MDD), Dietary Diversity Score (DDS), and child weight gain. We systematically searched PubMed, Scopus, HINARI, and Google Scholar for studies on SBC interventions in Ethiopia. After screening for eligibility, data were extracted on MDD, DDS, and weight gain. Using random‐effects models, pooled risk ratios (RR) and mean differences (MD) were calculated, heterogeneity was assessed, and subgroup analyses were conducted by region to examine variations in effectiveness. A total of 33 studies met the inclusion criteria. Overall, SBC interventions were associated with improvements in child dietary diversity and weight outcomes. Children in intervention groups were 67% more likely to meet MDD (RR = 1.67; 95% CI: 1.42–1.96). Dietary diversity scores increased (MD = 0.80; 95% CI: 0.51–1.08), and child weight gain improved (MD = 1.32; 95% CI: 0.49–2.15) compared with controls. Effects were strongest in urban settings, particularly in Addis Ababa. By region, the Southern Nations, Nationalities, and Peoples' Region (SNNPR) showed the highest weight gain (MD = 2.01), while effects in Oromia and Amhara were more moderate and occasionally non‐significant. Heterogeneity was high (I² = 99.64%), indicating substantial variability in effectiveness attributable to contextual differences, implementation modalities, and programme intensity across Ethiopia. In Conclusion, SBC interventions significantly improved dietary diversity and child growth outcomes in Ethiopia, although effects varied across regions. Tailoring approaches to local cultural and environmental contexts may achieve stronger impacts. Integrating SBC with initiatives that strengthen food security, enhance health service delivery, and address structural barriers is essential for maximizing effectiveness.
ABSTRACT Excessive added sugars intake in early childhood has been associated with an increased risk of obesity and other non‐communicable diseases. In Brazil, packaged foods form a substantial part of children's diets, yet no studies have examined the presence of added sugars in products specifically marketed to this population. This study assessed the prevalence and types of added sugars in packaged foods targeted at infants and children in Brazil, comparing two definitions: the current Brazilian food labelling regulation (ANVISA's definition) and a broader definition aligned with the World Health Organization's free sugars concept. A total of 1118 packaged foods and beverages from a 2020 Brazilian supermarket database featuring child‐targeted marketing strategies were analysed. Ingredient lists were screened to identify the presence of added sugar ingredients, and products were classified into 18 food categories. Comparison analyses of the prevalence of presence, number, and types of added sugar ingredients across definitions were conducted. Overall, 73.2% of products contained at least one added sugar ingredient according to ANVISA's definition, increasing to 78.0% under the broader definition. The largest differences between definitions were observed for “Fruit and vegetable purées, pulps, and soups for infants” (0% vs. 54.8%) and “Fruit juices and other fruit‐based beverages” (37.3% vs. 67.8%). “Sugars,” including cane sugar and its derivatives, were the most common type of added sugar used, followed by “syrups,” and “maltodextrin.” These findings reveal the widespread presence of added sugars in Brazilian packaged foods targeted at children. Broader definitions can uncover hidden sources, particularly in processed fruit‐based and infant products, underscoring the need for a comprehensive definition that includes all sugars with potential harm to health, to strengthen monitoring efforts and protect children's health.
ABSTRACT Early childhood development (ECD) is essential across life courses, yet many children lack adequate nurturing care needed for optimal ECD. The Nurturing Care Framework (NCF) is designed to optimize ECD outcomes through evidence‐based programs and interventions. Therefore, the NCF is key to identify and characterize programs and interventions and to determine key challenges and enabling factors for their effective large‐scale implementation. A systematic review following the PRISMA reporting guidance was conducted. PubMed Central, Web of Science, Science Direct, Scopus and MEDLINE databases were used. Studies in English and Spanish, from 2014–2024, 2014 to 2024, addressing interventions or programs based on NFC in low‐ and middle‐income countries (LMICs)(LMICs) were included. Exclusion criteria were studies focused only on caregivers. Quality was assessed with the NICE checklist. A narrative synthesis was conducted by NCF domains. A total of 34 studies were included (from 784 identified), representing five ECD programs and 29 interventions across 19 LMICs. Overall, most elements delivered were aligned with the early learning and nutrition NCF domains. Key implementation challenges and enablers identified were related to logistical constraints, heterogeneity in program fidelity, resistance among implementers to adopt new practices, and low attendance to sessions. Based on 10 interventions, the average annual cost per child was $197.4; 6 reported that the interventions were cost‐effective. Despite the need for comprehensive ECD interventions and programs, these remain fragmented and insufficiently address the NCF domains. Addressing these evidence implementation gaps and assessing their cost‐effectiveness is essential to inform policy and guide decision‐making for scalable and sustainable ECD programs in LMICs.
Social protection programs (SPPs) are commonly used in South Asia to address inequities in meeting basic needs. Provision of both SPP benefits and essential health/nutrition interventions to mothers and children is a goal toward optimal health and development outcomes, but co-coverage of SPPs and health/nutrition interventions among beneficiary households is poorly described. Using six population-based surveys in Bangladesh, India, and Nepal (n = 253,703 women with children under 5 years of age), we examined data availability for SPPs (food and cash transfers) and health/nutrition interventions, and estimated their coverage and co-coverage during a woman's last pregnancy (interventions: take-home food rations plus at least four antenatal care visits, receipt of iron-folic acid tablets, deworming, and tetanus injections), after delivery (cash benefit plus the interventions above), and in children (take-home ration for the child plus vitamin A supplementation, deworming, iron syrup, growth monitoring, and nutrition counseling). In India, 52% and 51% of women and children, respectively, received food transfers, but only 3% and 8% received food plus all health/nutrition interventions. In India and Nepal, respectively, cash after delivery was received by 41% and 86% of women, but only 4% and 22% received cash after delivery plus all health/nutrition interventions. There were insufficient data to estimate co-coverage in Bangladesh, which only had data on cash/food transfers but not on health/nutrition interventions. Our findings highlight the need for data on both SPP and health/nutrition intervention coverage in household surveys to be able to estimate co-coverage. Estimates of co-coverage help identify missed opportunities to reach women and children with interventions across multiple sectors.
Breastfeeding beyond 1 year is recommended by the World Health Organisation and is linked to multiple maternal, infant, and environmental benefits. However, rates frequently remain low in high-income countries, which may relate to social stigma, work commitments and insufficient support. This review aimed to explore the experiences of women who breastfeed beyond 1 year. Accordingly, a qualitative systematic review following the Joanna Briggs Institute meta-aggregation approach and reported to the ENTREQ statement was undertaken. Searches were conducted in Ovid MEDLINE, Ovid EMBASE, CINAHL, and Web of Science from database inception to June 2026. Two reviewers were involved in the search, extraction, quality assessment and synthesis process. A total of 6831 articles were screened, and 36 studies were included, most of which were conducted in high-income countries. One hundred and thirty extracted findings were used to form 10 categories, which were developed into four synthesised findings: (1) society and culture impact acceptability and visibility of breastfeeding beyond 1 year; (2) structural and institutional constraints undermine breastfeeding beyond 1 year; (3) social networks and peer support influence breastfeeding beyond 1 year; and (4) breastfeeding beyond 1 year involves an interplay of bonding, empowerment, challenges, and adaptation. This review highlights the complex and often challenging contexts women face when breastfeeding beyond 1 year. Multi-level efforts to normalise and validate this practice are essential to better align with global health guidance. Future research should explore experiences of breastfeeding beyond 1 year in countries where it is more commonly practised.
Bangladesh continues to experience high levels of child undernutrition, with stunting affecting approximately 24% of children under 5 years of age. Environmental enteric dysfunction (EED), a subclinical intestinal disorder characterized by chronic inflammation, immune activation, and nutrient malabsorption, may reduce the effectiveness of nutritional interventions. Identifying factors that may enhance resilience to EED could guide intervention design. This study measured two biomarkers of EED, fecal calprotectin (CAL) and myeloperoxidase (MPO), among 160 Bangladeshi children 9-11 months of age and assessed associations between these biomarkers and indicators of child growth, micronutrient status, and inflammation using multivariate logistic regression. Outcomes were defined as CAL, MPO, or both biomarkers below the 25th percentile. CAL (> 160 µg/g) and MPO (> 2000 ng/mL) were elevated in over 90% and 70% of children, respectively, indicating widespread intestinal inflammation. In multivariable models, higher mid-upper arm circumference-for-age Z-scores (MUAC-Z) were associated with lower CAL (OR 1.51, 95% CI 1.04-2.18) and combined low CAL and MPO values (OR 1.72, 95% CI 1.06-2.81). Higher retinol-binding protein (RBP) was strongly associated with lower MPO (OR 4.91, 95% CI 1.28-18.83), while lower α-1-acid glycoprotein (AGP) levels were associated with lower MPO values (OR 0.53, 95% CI 0.27-1.04). Better ponderal growth, adequate vitamin A status, and lower systemic inflammation characterized children with lower concentrations of EED biomarkers. Reducing the burden of EED may help to enhance the effectiveness of nutrition interventions.
In the digital age, misinformation about infant feeding threatens decades of public health efforts to revive breastfeeding. Increasingly sophisticated marketing exploits cultural knowledge gaps, serving commercial interests and exacerbating food insecurity from climate change and migration. Public health literature acknowledges that suboptimal breastfeeding rates are due to systemic failures, not personal ones. However, our social responsibility to parents includes promoting public literacy in infant feeding and breastfeeding and lactation science. Recognizing breastfeeding misinformation as science denialism unlocks field-tested communication tools from domains long-targeted by denialism, such as climate change and vaccines. We describe five breastfeeding denialism strategies that echo tactics historically used to manufacture doubt about scientific consensus: minimization of breastfeeding's importance, misrepresenting research, misrepresenting clinical standards, appeals to individualist values, and leveraging authority through influencers and industry credentials. These practices contradict evidence that lack of breastfeeding access increases disease risk, costing over $500 billion annually. We call for research and suggest actions for clinicians, public health professionals, policymakers, and organizations to protect parents from misinformation. Supporting informed decision-making requires comprehensive medical curricula, organizational statements addressing denialism, policies enacting parental leave and education, and cultural normalization of breastfeeding.
Despite global recommendations, less than 40% of infants ≤ 6 months are exclusively breastfed (EBF) reflecting socio-economic, cultural, and systemic barriers. Mobile health (mHealth) interventions (delivered through mobile phone applications to support medical/public health practices) have been developed to support breastfeeding, but their effectiveness remains unclear. In this systematic review we searched PubMed, Embase, CINAHL, Web of Science, and Cochrane Library from 1 January 2010 to 1 May 2025 for randomised controlled trials in English involving pregnant or postpartum women up to 1 year, assessing the effectiveness of any form of mHealth intervention aimed at the mother, excluding qualitative studies (PROSPERO: CRD420251032811). The main outcome was EBF ≤ 6 months; Secondary outcomes were EBF at later time points, overall breastfeeding duration and breastfeeding self-efficacy up to 12 months. Quantitative synthesis used Harvest plots, binomial calculations, and meta-analysis. Of 3102 retrieved records, 13 studies (3269 women) were included. Interventions typically combined mobile apps with text messaging or telelactation. Binomial calculations/harvest plots suggested strong evidence for improved breastfeeding self-efficacy, knowledge, and confidence, with less evidence for effects on initiation, exclusivity, and duration. Meta-analysis suggested increased breastfeeding self-efficacy (Hedges' g = 1.08, 95% CI 0.07-2.1, p = 0.04) but with high heterogeneity (I2 = 90.7%), reflecting diverse populations, intervention types, and contexts. Engagement was affected by maternal, socio-cultural, and structural factors, underscoring the need for tailored, accessible, context-sensitive interventions. mHealth interventions may improve breastfeeding self-efficacy, knowledge and confidence, particularly when incorporating interactive, personalised features such as real-time feedback or telelactation.
Adequate nutrition during pregnancy is critical for mothers and newborns, but few studies have characterized maternal diets. The Global Diet Quality Score (GDQS) is a new metric to evaluate population diets. This study examined GDQS during pregnancy and its influencing factors in rural Uttar Pradesh, India. Data were from the Alive & Thrive (A&T) impact evaluation study, a cluster-randomized trial testing behavior change communication delivered through the antenatal care (ANC) platform. We analyzed multi-pass 24-h dietary recalls combined from two cross-sectional surveys, at baseline (2017, n = 660) prior to intervention and endline (2019, n = 674). The GDQS was constructed based on grams/day of 25 food groups consumed (range 0-49); for 16 healthy food groups (GDQS+), higher scores indicated higher consumption, whereas for 9 unhealthy food groups (GDQS-), scoring was reversed with higher scores reflecting lower consumption. Maternal and household factors influencing GDQS examined in a multivariable linear regression model included age, education, parity, nutrition knowledge, ANC visits, household size, religion, caste, socio-economic status (SES), and food insecurity, adjusted for pregnancy duration, survey time, and A&T intervention. The mean (SD) at 18.5 (3.4) for overall GDQS, 7.3 (3.2) for GDQS+, and 11.2 (1.6) for GDQS- was low. Factors positively associated with overall GDQS and GDQS+ were 4+ ANC visits (β = 0.83 and 0.78), nutrition knowledge (β = 0.12 and 0.13), and SES (β = 0.82 and 0.96). Maternal education (β = 0.66) and caste (β = -0.66) were significantly associated with GDQS+ while no factors were associated with GDQS-. This study highlights poor diet quality during pregnancy in this context.
Despite socio-economic progress, prevalence of childhood stunting remains high in South Asia-a phenomenon often referred to as the "Asian Enigma." This paradox stems from suppressed women's empowerment, poor water, sanitation, and hygiene (WaSH) conditions and inadequate child-feeding. Evidence shows that women's empowerment improves these underlying factors associated with improved stunting. We examined how domains of women's empowerment relate to the risk of childhood stunting in South Asia directly and indirectly in interaction with household improved WaSH facility and age-appropriate food consumption. Using recent Demographic and Health Survey data from Bangladesh, India, Nepal, and Pakistan, we analyzed a sample of 37,620 married women, aged 15-49 years, currently cohabiting with husbands and having an under-five child. We constructed three domains of survey-based women's empowerment index-global: social independence, intrinsic agency, and instrumental agency, by confirmatory factor analysis, using generalized structural equation modelling. We developed three different models by using generalized linear mixed-effects models with robust error variance to estimate the relative risk (RR) of stunting with 95% confidence interval (CI). We found social independence [RR: 0.86, 95% CI: 0.83, 0.90], intrinsic agency [0.98 (0.97, 0.99)] and instrumental agency [0.99 (0.98, 0.99)] were associated with reduced risk of stunting in South Asia. Though interaction between social independence and WaSH was associated with reduced risk [0.92 (0.86, 0.99)], interaction between social independence [1.12 (1.07, 1.17)] and instrumental agency [1.03 (1.01, 1.05)] and food consumption increased risk of stunting in South Asia. Interactions between women's empowerment and WaSH and food consumption reveal complex effects including both synergy and trade-offs, highlighting the need for integrated strategies combining women's empowerment, WaSH improvements, and targeted nutrition specific interventions in South Asia.
Micronutrient deficiencies in pregnancy remain a critical public health issue in Nepal, where iron-folic acid (IFA) supplementation alone has not fully addressed maternal and neonatal risks. Multiple micronutrient supplements (MMS) promise broader nutritional benefits; however, real-world guidance for their effective and equitable integration into routine maternal care is lacking. A qualitative study, guided by the ExpandNet scaling-up framework, was conducted from February to March 2025, including 28 focus group discussions with antenatal care (ANC) providers and female community health volunteers (FCHVs) and 40 key informant interviews with policymakers at different levels of the health system. Data was analyzed thematically to identify perceived facilitators and barriers to MMS adoption, institutionalization, and scale-up, and equitable implementation. Stakeholders viewed MMS as offering clear advantages over IFA, citing broader micronutrient coverage and fewer side effects that could improve adherence. However, they identified several system-level requirements for successful scale-up, including formal policy integration, sustainable financing, strengthened procurement and supply chains, and adequate storage capacity at facilities. FCHVs and ANC providers emphasized the need for clearer role definitions, improved training, and manageable counseling workloads. Persistent community-level barriers-such as concerns about tablet size, misconceptions about fetal growth, and low trust in free medicines-were seen as risks to equitable uptake. Respondents highlighted community engagement, culturally tailored counseling, and consistent support for FCHVs and ANC providers as essential to ensuring effective and equitable MMS adoption. Stakeholders in Nepal view MMS as a promising strategy to improve maternal and newborn nutrition, but its potential depends on strong policy commitment, adequate and sustainable financing, and community-centered implementation. Addressing product-related concerns, strengthening counseling and trust in public services, and ensuring uninterrupted supply chains are essential to MMS scale-up, including translating its introduction into equitable and meaningful gains in maternal and child nutrition.
This study explores the risk of delayed psychomotor development (PMD) in children treated for severe acute malnutrition (SAM) in the Democratic Republic of Congo. The present research is a sub-study of the EfRAMAS clinical trial conducted in health zones in the province of Kasaï Oriental. Children aged 6-59 months with SAM according to WHO criteria and no congenital malformations affecting child development were enrolled in the study. The risk of delayed psychomotor development was assessed among repeated cross-sectional samples of children at admission, discharge and 6 months after recovery, using the Ages and Stages Questionnaires (ASQ3). Mixed-effects linear regression with health center as random intercept was performed to identify potential predictors of the risk of psychomotor delay in children. A total of 413 children were included at admission, 143 at discharge and 581 at 6 months post-discharge. At admission, the risk of delayed psychomotor development was greatest in the domains of fine motor skills (21.3%), gross motor skills (23.7%) and problem solving (21.5%). At discharge, the risk of delay was considerably reduced, with 0% risk of delay in communication, while the three most affected domains hovered around 2%. At 6 months post-discharge, the risk of delay in gross motor skills and problem-solving was still present in over 10% of children. Age, sex, MUAC < 115 mm or WHZ < -3 as admission criteria, breastfeeding, episodes of illness during treatment, measles vaccination, mother's education level, and living in a female-headed household were predictors of the risk of psychomotor development delay. Globally, gross and fine motor skills and problem solving were the domains most affected for children with SAM. Regarding our findings, we recommend investing in the integration of children's psychosocial stimulation within the undernutrition management care pathway by trained health care workers, as well as in caregivers' parental skills. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Network (ISRCTN15258669). Registered 25/01/2022.
Commercial foods for infants and young children are widely available and often introduced early, including before 6 months, raising concerns about their often high levels of sugar and sodium, limited micronutrient content, and sweet flavours that may shape future taste preferences. Product packaging further influences caregiver choices through child-appealing images and claims. This study examined changes in child-appealing marketing appearing on packaged commercial infant and young children's foods available in Australia in 2015 (n = 311) and 2024 (n = 298). Products were coded using a validated framework comprising 11 core techniques (child-targeted, e.g., bright colours, cartoon characters, fun themes) and 9 broad techniques (caregiver-targeted, e.g., nutrition/health, texture claims). Marketing power was calculated as the sum of techniques per product. The proportion of products featuring child-appealing marketing increased from 73.0% in 2015 to 89.9% in 2024, with significant increases in appeals to fun (48.2% to 79.2%), branded characters (33.8% to 62.4%), and child-appealing visuals on the package (60.5% to 72.5%). Claims regarding texture were high in both years (99.7% in 2015 and 100.0% in 2024), and there was a notable growth in messages promoting value, convenience, or sustainability (from 50.2% to 62.1%). Marketing power scores rose significantly over time, indicating an intensification of persuasive techniques on packaging. These findings highlight systemic commercial strategies that promote nutritionally poor foods to infants, young children and caregivers, undermining public health efforts. Stronger, government-led regulation is urgently needed to address the widespread use of both child-targeted and caregiver-targeted marketing on commercial foods for infants and young children.
Despite sustained, multisectoral investment in stunting reduction, childhood stunting prevalence in Tanzania's Njombe region has remained persistently elevated, declining only modestly from approximately 53% in 2014 to 50% by 2022. This perspective argues that the gap between intervention coverage and anthropometric impact reflects structural and conceptual limitations in current programs rather than an absence of effort or political will. Four interrelated mechanisms are examined: the conflation of stunting a lagging cumulative outcome indicator with short-term program success criteria; near exclusive reliance on anthropometric monitoring without biochemical assessment, which obscure the biological heterogeneity underlying growth faltering; the misalignment between short funding cycles and the biological time scales required for growth recovery; and fragmentation between community-based prevention and clinical nutrition services. Drawing on Njombe-specific evidence alongside global implementation literature, this paper contributes to a growing call to reframe stunting reduction as a biologically informed, adaptive process. Where the evidence base is limited, these are explicitly identified as hypotheses warranting further investigation. The recommendations advanced targeted integration of simple biochemical screening, redesigned monitoring frameworks that capture intermediate biological outcomes, and strengthened referral systems, which are practical, contextually grounded and aligned with Tanzania's existing health system architecture.
ABSTRACT Pre‐pregnancy overweight or obesity delays the onset of lactogenesis II, posing an early barrier to achieving optimal infant nutrition and long‐term health. However, the underlying pathophysiological mechanisms remain incompletely elucidated. This prospective cohort study conducted in China aimed to delineate the distinct pathways through which pre‐pregnancy overweight/obesity, compared to normal body mass index (BMI), leads to delayed lactogenesis II. Guided by an expanded biopsychosocial framework, we enrolled and stratified 296 primiparous women into pre‐pregnancy overweight/obese (n = 146) and normal BMI (n = 150) groups. Data on biological, psychological, social, and infant‐related factors were collected prospectively at prenatal, delivery, and one‐week postpartum stages. Structural equation modeling was used to identify and compare the mediating pathways between the two groups. Results demonstrated that the association between pre‐pregnancy overweight/obesity and delayed lactogenesis II was primarily mediated through four distinct pathways: biological (e.g., breastfeeding difficulties: β = 0.203, 95% CI: 0.144−0.265, p < 0.001), psychological (e.g., internalized weight stigma: β = 0.095, 95% CI: 0.016−0.181, p = 0.026), social (e.g., reduced pro‐breastfeeding practices: β = 0.076, 95% CI: 0.017−0.144, p = 0.019), and infant‐related (e.g., higher formula intake: β = 0.114, 95% CI: 0.047−0.195, p = 0.003). This study validates the expanded biopsychosocial model by elucidating the distinct pathways through which pre‐pregnancy overweight/obesity contributes to delayed lactogenesis II. These findings underscore the necessity for clinical practice to move beyond a purely biological focus and advocate for a paradigm shift in clinical support towards integrated, multi‐faceted interventions tailored to this vulnerable population. Trial Registration This study was registered at the Chinese Clinical Trial Registry (registry number: ChiCTR2200057038). The trial was registered on February 26, 2022.
Informal human milk sharing (IHMS) is a contemporary and evolving infant feeding practice. In the qualitative phase of a sequential explanatory mixed methods study, this research explored the experiences, practices, and perceived psychological and emotional impacts of IHMS from the perspectives of donors and recipients in Ireland. Fifteen participants were interviewed: ten donors, three recipients, and two who were donors and recipients. The study is reported according to the standards for reporting qualitative checklist (SRQR). Utilizing reflexive thematic analysis, five themes were identified: (1) Motivations for IHMS, (2) Formal milk banking: invisible, rigid and faceless, (3) The healthcare professional paradox, (4) Navigating risk and safety assurance by the "wee subculture," (5) Emotional and psychological impact of IHMS. Our findings reveal that participation in IHMS was propelled by personal imperatives and contextual motivations. Formal human milk bank's (HMB's) were described as rigid, invisible and "quite the effort." Participant narratives depict a culture where CMF was "pushed left, right and centre" in maternity settings as well as the intentional concealment of IHMS from healthcare professionals. Safety and risk mitigation were framed through "a huge trust network." IHMS has profound emotional and perceived psychological outcomes that were represented as a "light switch" release of maternal stress and anxiety for recipients while fostering a sense of pride and a "nice, warm, fuzzy feeling" for donors. There is an imminent need for policy reform and robust clinical frameworks to facilitate healthcare professional engagement, risk mitigation and enhancement of the visibility and accessibility of formal HMBs. Future research should evaluate HCP understanding of HMBs and IHMS in Ireland and similarly under-researched regions.
Human milk is the recommended feeding standard for preterm and low-birth-weight infants. The 2022 World Health Organization (WHO) guidance prioritizes mother's milk, donor human milk (DHM) when mother's milk is insufficient, early feeding initiation, and potential fortification for the smallest infants. However, evidence on current practices and alignment with these recommendations in Nigeria is limited. This scoping review examined human milk utilization practices, perceptions, and experiences in Nigerian neonatal intensive care units (NICUs) populations. A systematic search was conducted in March 2025 following PRISMA guidelines using PubMed and African Journals Online. Articles from 2008 onward were included to align with WHO resolutions on DHM use. Eligible studies were original research or reviews from Nigeria addressing infant feeding, milk pumping or storage, lactation support, infant health outcomes, and attitudes toward DHM. Of 137 records identified, 15 studies (2008-2025) met the inclusion criteria. Human milk was valued for NICU feeding, yet major knowledge gaps persist regarding recommended practices. There was a dearth of information related to lactation support and milk expression practices. Only one study mentioned fortification, and no included studies reported the use of donor human milk. Awareness of DHM among mothers was low, though willingness to donate exceeded willingness to receive. Critical gaps in the published literature exist regarding lactation support, milk expression practices, infant feeding protocols, and DHM availability in Nigerian NICUs. Given the high rates and numbers of preterm births in Nigeria annually, more research into NICU feeding practices is warranted.
When facing challenging nutrition decisions, parents experience tension between their personal values and those they have for their child. These tensions a risk of leading to unhealthy nutrition decisions, particularly in disadvantaged environments where resources for healthy nutrition are scarcer. Prioritising one value over another, i.e., a 'trade-off' such as a child's dietary health over the parent's convenience, can cause stress due to unsatisfactory outcomes and recurring value tension. Drawing on Paradox theory, this qualitative study examines how parents cope with nutrition-related value tensions. Paradox theory explains how individuals manage persistent tensions between competing values by adopting 'both/and' strategies that address both values simultaneously rather than choosing one over the other, i.e., 'either/or' strategies. In the present study, semi-structured interviews were held with 20 parents of children aged 0-5 living in disadvantaged neighbourhoods. Using abductive thematic analysis, we identified coping responses classified as 'either/or' (value trade-offs) and 'both/and' (compromise and paradoxical resolution). While trade-offs were more common, paradoxical resolution strategies, those that address competing values simultaneously, were less frequently employed during challenging moments related to nutrition decisions. Three main themes of 'both/and' coping responses emerged from the analysis: planning and preparing food, managing stressful child behaviours, and supporting children's healthy food acceptance. Factors facilitating these coping responses ranged from individual, interpersonal, to community levels, including time availability, social support, and healthy routines encouraged by daycare. Our findings suggest that 'both/and' coping, aligned with parents' values and context, can support parents in managing food provision and feeding challenges while upholding their values, provided there are sufficient facilitating factors available.
Responsive feeding is widely recognized as a best practice in infant and young child feeding, yet the gap between its recommendation and its consistent implementation among caregivers remains a persistent challenge. Mindful feeding, which is defined as present-centered mental and emotional awareness in the feeding context, has emerged as a related but distinct construct that may help explain this gap. While research on mindful feeding is still developing, early evidence suggests it is associated with similar positive outcomes for child nutrition and development as responsive feeding, including improved diet quality and decreased negative mealtime behaviors. This Perspective argues that mindful feeding may function as a promising adjunct to support the intrapersonal conditions that facilitate responsive feeding. By cultivating awareness, emotional regulation, and nonjudgmental receptivity, caregivers may be better equipped to perceive and appropriately respond to children's hunger and satiety cues. Drawing on a comparison of definitions, theoretical frameworks, and measurement tools, we propose that mindful feeding be considered for integration into infant and young child feeding guidance and interventions alongside responsive feeding and identify priorities for research needed to support this integration.
ABSTRACT Human milk banks rely on voluntary donations from lactating individuals producing more milk than their baby needs, to make pasteurised donor human milk (PDHM) for preterm babies. Demand for PDHM is increasing, as is the need for donors. Few Australian studies have explored potential donors' awareness and perceived feasibility of donating to a milk bank. We aimed to survey women breastfeeding their own child (< 24 months) or pregnant (and intending to breastfeed), and residing in major metropolitan areas of Australia, to determine their awareness of milk banks, and interest in and perceived feasibility (ease, eligibility) of donating to a milk bank. 1221 participants completed the survey (112 pregnant women, 1109 breastfeeding women). Most (78%) had heard of milk banks, and 81.7% lived in an area eligible to donate to a milk bank, yet only 11% were aware of a milk bank in their area. Most (60%) pregnant women would prefer to use online sources or health professionals to find information about donation. Most breastfeeding women (77%) were interested in donating milk, however only 26% thought it would be easy to meet milk bank requirements, and that they would be eligible to donate. Barriers to donating for breastfeeding women involved having no excess milk to donate, lack of time to express/donate, and lack of space to store milk. Awareness raising of local milk banks, promotion of donation information amongst healthcare professionals, and modifications to improve feasibility of donation will likely engage new potential donors and ensure sustainability of milk banks.
