IntroductionPostpartum sleep patterns are embedded within complex caregiving environments, including infant feeding, nighttime caregiving demands, and maternal recovery. This cross-sectional study aimed to characterize maternal sleep patterns and explore variation in sleep across infant feeding contexts, exclusive and partial breastfeeding practices among women at 1 month postpartum in Ho Chi Minh City, Vietnam.MethodsSleep patterns were assessed using a commercial wearable device, and reported breastfeeding indicators included exclusive breastfeeding (EBF) status, feeding frequency during day and nighttime, and breast milk expression practices. Adjusted linear and logistic regression analyses were used, adjusting for covariates.ResultsThe average daily sleep duration was 5.53 hours (SD: 1.36), falling substantially below adult recommendations. The prevalence of EBF was 47.7%, with mothers breastfeeding an average of 6.8 times (SD: 1.3) during the day and 2.8 times (SD: 0.6) at night. After adjusting for socio-demographic, reproductive, and caregiving-related covariates, feeding group was not significantly associated with either device-measured sleep duration (adjusted β = −0.31, 95% CI: −0.68, 0.06) or the likelihood of sleeping ≥5 hours (adjusted PR = 0.94, 95% CI: 0.65, 1.36). Also, there were no statistically significant associations between daytime or nighttime breastfeeding frequency or pumping frequency and sleep duration.DiscussionThese findings highlight the complexity of postpartum sleep within real-world caregiving environments, suggesting that factors beyond feeding practices alone may contribute to variation in maternal sleep. This study provides empirical insights into maternal sleep in an urban LMIC setting and highlights the growing role of wearable devices in assessing postpartum sleep.

BACKGROUND:Food insecurity and child undernutrition remain critical challenges in Ethiopia. Recent humanitarian financing reductions have increased interest in low-cost, scalable approaches for preventing acute malnutrition before treatment is required. To prevent acute malnutrition, the community-led complementary feeding and learning sessions (CCFLS) approach targets children at risk of wasting through nutrition education, behavior change, and promotion of locally available foods. OBJECTIVES:This study aims to assess the effectiveness of CCFLS on improving child feeding practices and reducing acute malnutrition risk. METHODS:A quasi-experimental cohort study was conducted across 30 kebeles in Eastern Hararghe Zone, Oromia region, Ethiopia in 2024, enrolling 884 children aged 6-23 mo with mid-upper arm circumference (MUAC) 12.5-13.0 cm. Baseline data were collected immediately before intervention, with follow-up at 3 and 6 mo. Three-level mixed-effect regression models estimated program effects on infant and young child feeding, MUAC, and wasting prevalence. RESULTS:CCFLS was associated with increases of 11.8 percentage points [pp, 95% confidence interval (CI): 4.8 pp, 18.8 pp] in children achieving minimum dietary diversity and 13.3 pp (95% CI: 6.4 pp, 20.3 pp) achieving minimum acceptable diet 6 mo after intervention. After adjusting for baseline MUAC, mean child MUAC increased 0.45 cm (95% CI: 0.34 cm, 0.55 cm) more in the CCFLS group than in controls. CCFLS children had 89% (risk ratio = 0.11; 95% CI: 0.04, 0.32) lower risk of becoming wasted and were 1.40 times (95% CI: 1.14, 1.73) more likely to no longer being at risk of wasting. CONCLUSIONS:CCFLS was associated with improved dietary diversity, minimum acceptable diet, and child nutrition, with benefits sustained over 6 mo. Findings suggest that CCFLS, a low-cost community-based nutrition intervention relying on locally available foods and existing health structures, can help prevent wasting whereas reducing demand for resource-intensive treatment services. In an era of constrained humanitarian financing, preventive approaches such as CCFLS may improve child nutrition outcomes while easing pressure on overstretched nutrition systems.

Childhood obesity is an increasing concern in Indonesia, yet little is known about the content and sources of foods offered in Indonesian school food environments. This study aimed to examine the composition and preparation of foods sold in primary school canteens, and to identify potential modifications to address diet-related obesity risk. A cross-sectional survey of canteen vendors (n = 10) and structured observations of prepared foods (n = 112) sold in canteens were conducted across eight private and public primary schools in Central Java, Indonesia. Foods were categorized by food group, preparation method, and meal type, and associations with factors such as cost, location of sale, and the individual responsible for preparation were analysed using chi-square and t-test analyses. Among all prepared foods observed, 73.2% were classified as main meals and 26.8% as desserts, with parents often playing a central role in food preparation. Nearly half (47.3%) of non-beverage items were deep-fried, and the majority of dishes did not align with Indonesian Balanced Nutrition Guidelines. A compositional analysis of each main meal’s ingredients revealed that 29.3% lacked protein and 90.2% did not contain vegetables. Foods that were not deep-fried were priced significantly higher than deep-fried foods (x̄ = Rp.1846 ($0.11) vs Rp.1406 ($0.09); p < 0.001). Overall, the majority of prepared foods available to schoolchildren were low in nutritional quality, with limited fruits and vegetables and heavy reliance on frying. These findings highlight the need for strategies that combine parent education on healthy food preparation with economic incentives to increase the accessibility of healthier food options within Indonesian school canteens.

Abstract Background High-quality antenatal care (ANC) can improve the detection, management, and monitoring of pregnancy-related complications. International guidelines recommend at least 8 antenatal care contacts during pregnancy. Interventions to improve the quality of antenatal care may promote positive pregnancy outcomes. Objectives To assess the impact of enhanced nutrition and infection intervention packages on antenatal quality of care indicators among pregnant women in rural Amhara, Ethiopia Methods Pregnant women presenting at 12 rural health centers at <24 weeks of gestation were enrolled in this pragmatic clinical effectiveness study. Using 2×2 factorial design, health facilities were allocated to provide an Enhanced Nutrition Package (ENP) or routine nutrition care (non-ENP), followed by individual-level randomization into Enhanced Infection Management Package (EIMP) or routine care (non-EIMP). The composite antenatal quality of care (QoC) score was calculated and compared between arms using cluster-level analyses, at the health center level (for ENP marginal effects), multivariate regression analyses (for EIMP marginal effects), and generalized estimating equations (for combined effects versus routine care). All models were adjusted for imbalanced individual and household factors. Results From August 2020 to December 2021, a total of 2392 women were randomized (604 ENP+EIMP, 600 ENP alone, 593 EIMP alone, 595 neither package) and followed until June 2022. There was a significant difference in the number of ANC contacts in the ENP group (vs non-ENP: adjusted mean difference [aMD]=1.67, 95% CI: 1.18 to 2.16), EIMP (vs non-EIMP: aMD=0.38, 95% CI: 0.14 to 0.62), and ENP+EIMP (vs routine: aMD=1.92, 95% CI: 1.48 to 2.36). There was also a significant difference in ANC quality of care (ANC QoC) score in ENP (vs non-ENP: aMD=2.13, 95% CI: 0.54 to 3.72); EIMP (vs non-EIMP: aMD=0.89, 95% CI, 0.44 to 1.34), and ENP+EIMP (vs routine: aMD=2.77, 95% CI: 1.28 to 4.27). Conclusions Combination of enhanced nutrition and infection management interventions had the largest effect on the number of ANC contacts and ANC QoC score. Bolstering nutrition and infection management services during pregnancy could encourage additional ANC contacts, providing an opportunity to provide targeted care.

BACKGROUND:A new health monitoring device called Fitbit Charge 6 has appeared on the Vietnamese market. This study aimed to evaluate the consistency between Fitbit Charge 6 and structured interview questions in measuring sleep quality among breastfeeding mothers. RESEARCH DESIGN AND METHODS:A cross-sectional study utilizing random convenience sampling was conducted in Ho Chi Minh City, Vietnam, involving 208 breastfeeding women one month postpartum. The participants used the Fitbit Charge 6 device continuously for four days and three nights to gather daily sleep information; then, they were administered a structured sleep questionnaire via home interviews. RESULTS:The correlation between the total sleep time (TST) recorded by both the device and interview was weak (r = 0.28), as was the correlation for short nap duration (r = 0.25). The agreement between the Fitbit Sleep Score and sleep satisfaction from the questionnaire was 79.9%, with a notably low kappa coefficient (0.02), indicating a lack of strong agreement. CONCLUSION:The Fitbit Charge 6 did not show reliable correlation with the subjective sleep data reported by one-month postpartum breastfeeding women. Further research employing rigorous comparative studies is necessary to assess the validity and reliability of sleep data collection methods for this demographic.

BACKGROUND:Suboptimal gestational weight gain (GWG) is associated with adverse pregnancy outcomes; however, evidence on the impact of nutritional interventions on GWG in low-income settings remains limited. OBJECTIVES:This study aims to examine the effectiveness of an enhanced nutrition package (ENP), including a balanced energy protein (BEP) supplement, on GWG compared with routine care. METHODS:We conducted a pragmatic cluster-randomized effectiveness study among pregnant women <24 wk of gestation in rural Amhara, Ethiopia. Twelve health centers were randomized to provide either ENP, including a daily BEP supplement for women with mid-upper arm circumference ≤23 cm, or routine care. GWG and GWG rate (kg/wk) were calculated from enrollment to late pregnancy weight measurement. Intention-to-treat (ITT), cluster-level analysis compared GWG outcomes between study arms. Primary analyses were restricted to women with observed third-trimester weights. Secondary dose-response analysis within the ENP arm examined associations between BEP consumption duration and GWG outcomes. RESULTS:A total of 2392 women were enrolled and randomly assigned (n = 1210 ENP; n = 1189 routine care), with 2170 followed up until birth. In the ENP arm, 37% were eligible for BEP supplementation. ITT analysis showed no differences between arms in GWG rate [diff = -0.006 kg/wk; 95% confidence interval (CI): -0.042 kg/wk, 0.030 kg/wk] or observed GWG (diff = 0.009 kg; 95% CI: -0.687 kg, 0.706 kg). Among BEP-eligible women, GWG outcomes also did not differ between arms (ΔGWG rate = 0.006 kg/wk; 95% CI: -0.027 kg/wk, 0.030 kg/wk); observed ΔGWG = 0.201 kg (95% CI: -0.443 kg, 0.845 kg). In dose-response analysis within the ENP arm, women consuming BEP for 61-90 and >90 d had a higher GWG rate (61-90 d: 0.46 kg/wk, 95% CI: 0.003 kg/wk, 0.090 kg/wk); >90 d: 0.059 kg/wk; 95% CI: 0.018 kg/wk, 0.099 kg/wk) and observed GWG (61-90 d: 0.895 kg, 95% CI: 0.004 kg, 1.786 kg; >90 d: 1.206 kg, 95% CI: 0.331 kg, 2.081 kg) compared with those consuming BEP for <30 d. CONCLUSIONS:The ENP package, including BEP, did not improve GWG compared with routine care in this pragmatic study in the Ethiopian health system. Longer duration of prenatal BEP adherence (≥60 d) may benefit GWG and GWG rates among undernourished women. This trial was registered as ISRCTN15116516.

Background Little is known about text messaging's influence on child retention in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Objective This study aimed to evaluate the influence of WICBuzz, a WIC agency drip marketing texting campaign, on retention and participation compared with a comparison WIC agency and to assess WIC participants' perceptions of the campaign's added value. Design A quasi-experimental design, with pre- and postimplementation measurement, was used to compare innovation and comparison groups' outcomes. Outcome evaluation integrated quantitative analysis of WIC management information system data and survey data of WICBuzz recipients' perceptions. Participants/setting Data obtained for baseline (2019 calendar year) and implementation periods (March 1, 2020, to February 28, 2021), included WIC participation for children who were WIC active at the beginning of each period. WIC agency sample sizes were 6780 to 7452 children from 5189 to 5832 households (baseline) and 4599 to 5004 children from 3186 to 4297 households (implementation). Intervention WICBuzz, a drip marketing text message campaign with targeted nutrition education and WIC brand awareness messages was the intervention. The comparison agency received standard WIC care. Main outcome measures Main outcome measures included recertification (re- enrollment during the implementation period), timely recertification (within 60 days of prior certification's termination), retention (WIC active at the study period's end), household WIC participation (continuous benefit issuance), and WICBuzz recipients' WIC perceptions. Statistical analyses performed Statistical analysis included propensity score weighting and difference-in-difference modeling. Thematic analysis using a deductive approach was used to analyze the process evaluation findings. Results The influence of WICBuzz on outcomes included 6.7% (95% CI 3.8% to 9.5%) higher recertification, 7.4% (95% CI 4.5% to 10.3%) higher retention, and 10.9% (95% CI 8.0% to 13.8%) higher participation compared with the comparison agency. Most WIC- Buzz recipients reported added value regarding WIC knowledge and perceptions. Conclusions WIC text message campaigns can improve participation and retention and improve participant perceptions of WIC's value. J Acad Nutr Diet. 2025;125(3):323-334.

Frequent drought has heightened nutritional concerns in Ethiopia. This study retrospectively assesses the prevalence and risk factors of severe food insecurity and poor food consumption in Productive Safety Net Programme households in drought-prone Ethiopia. Data was from the USAID-funded Resilience Food Security Activity baseline survey in East Hararghe, Ethiopia. Severe food insecurity (n = 4628; multivariate n = 4335) was defined as Food Insecurity Experience Scale (≥7) and poor food consumption (n = 4554; multivariate n = 4268) was defined as Food Consumption Score (≤21). Logistic regression identified adjusted odds ratio and 95% confidence interval of risk and protective factors. Severe food insecurity prevalence was 77.79% and poor food consumption was 69.74%. Risk factors for severe food insecurity included women/girls aged 15-19 (1.79; 1.36-2.34), current pregnancy (1.51; 1.17-1.96), history of pregnancy (3.46; 2.76-4.33), cash-earning work (1.35; 1.12-1.61), daily-per-capita food consumption <1.61USD (2.98; 1.91-4.66), crop-planting (1.67; 1.31-2.13), and handwashing facilities (3.83; 1.92-7.63); protective factors included two or more children-under-5 (0.72; 0.60-0.88), raising livestock/crops to sell (0.50; 0.42-0.60), and raising oxen (0.34; 0.26-0.45). Risk factors for poor food consumption included woman/girl (1.44; 1.15-1.81) and household-head no education (1.46; 1.18-1.79), daily-per-capita food consumption <1.61USD (4.01; 2.58-6.21), and financial services (2.10; 1.69-2.59); protective factors included women/girls aged 15-19 (0.59; 0.46-0.76) and 30-49 (0.76; 0.63-0.91), two or more children-under-5 (0.77; 0.64-0.91), current pregnancy (0.57; 0.47-0.70), history of pregnancy (0.70; 0.55-0.89), crop-planting (0.57; 0.44-0.75), raising livestock/crops to sell (0.40; 0.34-0.48) and raising oxen (0.68; 0.52-0.90). Vulnerable households included those with pregnant/lactating women, mothers, adolescent girls/women, no education, low assets, and no livestock. Our findings highlight a conceptual distinction, women/girls pregnancy and/or age status may influence household perception and/or definitions of food security despite reporting adequate consumption. The dual burden of food insecurity and poor consumption threatens current and future generations, and data-driven action can help progress towards the goal of zero hunger in Ethiopia.

Abstract Objectives Massive influx of Rohingya refugees increases the risk of food insecurity in host communities in Bangladesh. This study explores intervention-related factors associated with food insecurity in the Bangladesh host households living near Rohingya refugees. Methods This secondary data analysis used the endline survey data from 660 host households who participated in the World Vision US Emergency Food System Security Project from 2019 to 2021. Logistic regression analysis was performed to explore the associations between program interventions and household dietary diversity score [HDDS: low (≤ 8) vs high (> 8)] and reduced coping strategy index [rCSI: high (> 3) vs. low (≤ 3)]. Results A total of 64.7% of households (n = 427) had low HDDS, and 10.6% (n = 70) had high rCSI. Purchasing food using cash transfer was associated with higher odds of high rCSI (adjusted odds ratio [AOR] = 2.10; 95% CI 1.25–3.53) and low HDDS (AOR = 1.57; 95% CI 1.13–2.18). Those who received food aid had higher odds of low HDDS (AOR = 3.16; 95% CI 1.69–5.89). Participants who farmed had lower odds of having high rCSI and low HDDS [AOR = 0.41 (95% CI 0.21–0.77) and AOR = 0.57 (95% CI 0.34–0.98), respectively]. Conclusion Our findings suggest that interventions focused on livelihood or farming training may yield the greatest reduction in food insecurity among host communities experiencing refugee influx. Humanitarian organizations should consider interventions that develop these farming skills over direct cash or food transfers to promote long-term self-sufficiency in the host population.

Introduction We aimed to determine the impact of antenatal interventions to optimise maternal nutrition and infection management on birth outcomes in Ethiopia.Methods We conducted a pragmatic, open-label, 2×2 factorial randomised clinical effectiveness study among pregnant women enrolled <24 weeks gestation in 12 rural health centres in Amhara, Ethiopia. Eligible health centres were randomised to deliver an enhanced nutrition package (ENP) (iron-folic acid, iodised salt and targeted micronutrient fortified balanced energy protein (BEP) supplementation for undernourished women) or routine nutrition care (iron-folic acid only). Individual women were randomised to receive an enhanced infection management package (EIMP) (genitourinary tract infection screening-treatment and enhanced deworming) or routine infection care (syndromic management). The primary outcomes were birth weight and length; secondary outcomes were gestational age, preterm delivery, small-for-gestational-age, low birth weight, stillbirth, newborn weight-for-age and length-for-age z-scores, newborn head circumference, and maternal anemia. Analysis was intention to treat.Results From August 2020 to December 2021, 2392 women were randomised (604 ENP+EIMP, 600 ENP alone, 593 EIMP alone and 595 neither package) and followed until June 2022, with 2170 pregnancy outcomes analysed (565 ENP+EIMP, 549 ENP, 525 EIMP, 531 neither). In the ENP arm, 427 (36%) women were eligible for BEP and consumed on average 74 days. The prevalence of genitourinary tract infection was low (4.9%), while parasitic stool infections were common (31%). There was no difference in birth weight (ENP vs not-ENP: adjusted mean difference −4 g (−83 to 75); EIMP vs not-EIMP: 18 g (−35 to 70); ENP+EIMP vs neither: 14 g (−81 to 109)) or birth length (ENP: −0.3 cm (−1.1 to 0.5); EIMP: 0.2 cm (−0.1 to 0.5); ENP+EIMP: −0.1 cm (−1.2 to 1.1)) between study arms. In the ENP+EIMP group, the stillbirth rate was lower compared with the arm receiving neither package (7.1/1000 vs 24.7/1000 births; adjusted relative risk: 0.29 (0.09 to 0.94)). The packages did not significantly affect other secondary outcomes.Conclusions In this pragmatic study implemented within the Ethiopian health system, enhanced nutrition and infection packages did not affect birth weight or length. While stillbirth rates were lower in the group receiving both packages, these findings need to be supported by additional studies.Trial registration number ISRCTN15116516.

Purpose: This study explores the enabling, inhibiting, and sustaining factors of timed and targeted home visit counseling provided by Barangay Health Workers (BHWs) from pregnancy until the child reaches two years of age in the Eastern Visayas region of the Philippines. Originality: This study is the first qualitative study on the delivery and practice of the ttCF program and its impact on behavioral and cognitive changes in the Philippines. Methodology: Twenty-two mothers, nineteen family members, and twenty BHWs were interviewed using purposive sampling. Data were collected through focus group discussions and in-depth interviews exploring ttCF home visits, program delivery factors, and perceived or observed changes among BHWs and beneficiaries. Thematic analysis was used to identify, interpret, and report key patterns. Result: Enablers that supported BHW’s work encompassed capacity and knowledge building, provision of incentives and strong commitment to serving the community. Inhibiting factors involved, among others, unwelcoming household attitudes and limited support from health systems. For mothers, increased knowledge of positive caregiving practices and family support enabled the practice of recommended behaviors, while financial constraints and lack of interest from household members acted as barriers. Overall, ttCF home visits contributed to positive behavioral changes among mothers and families. Conclusions and Implication: The ttCF program strengthened awareness of maternal and child health and encouraged health-seeking behaviors among beneficiaries. These findings may inform strategies for sustaining and scaling up the ttCF program.

Background:Maternal and child undernutrition and poor mental health remain public health concerns in the Philippines. We evaluated the impact of home visits with timed and targeted care for family (ttCF) strategies for maternal and child nutrition and mental health during the first 1000 days of life. Methods:We designed a quasi-experimental study encompassing 12 municipalities (six intervention and six comparison) and enrolling 1518 pregnant women or mothers with children <12 months. Trained Barangay health workers (BHWs) conducted 12 scheduled home visits from pregnancy through child's second year in the intervention areas, while comparison areas received routine health services. We estimated the intervention's impact using multilevel mixed-effect models and generalised linear models, adjusting for socioeconomic covariates. The outcomes of interest included frequency of BHW's home visits, maternal message recall scores, possible depressive symptoms (Edinburgh Postnatal Depression Scale (EPDS) score >9), maternal and child diet, and child nutritional status. Results:We assessed 1313 women and children (655 in comparison; 658 in intervention) at 12-month follow-up. Women in the intervention areas received higher home visits during pregnancy (mean (x̄) = 3.2, standard deviation (SD) = 2.7 vs. x̄ = 1.7, SD = 2.0; P < 0.001) and postpartum (x̄ = 2.6, SD = 2.1 vs. x̄ = 1.3, SD = 1.4; P < 0.001), and they had higher recall of health and nutrition messages across the intervention period: prenatal care (adjusted mean difference (AMD) = 2.25; 95% CI = 1.57, 2.94), birth (AMD = 1.83; 95% CI = 1.24, 2.41), and postpartum care (AMD = 2.20; 95% CI = 1.43, 2.96). The intervention reduced maternal potential depressive symptoms by 9.16 percentage points (95% CI = -15.7, -2.62) and a reduction of 1.20 points in EPDS score (95% CI = -1.88, -0.52). There were no significant differences between intervention and comparison groups for maternal dietary diversity or child diet and nutrition indicators. Conclusions:The ttCF strategy improved the frequency and quality of BHW home visits and demonstrated promising impacts on maternal mental health. However, additional enabling interventions are needed to improve maternal and child diet and nutrition outcomes.

This study aimed to assess the prevalence of intestinal parasitic infections among pregnant women in the third trimester who received prior presumptive deworming in 12 health centers in the Amhara region, Ethiopia. This sub-study was part of the parent Enhancing Nutrition and Antenatal Infection Treatment (ENAT) study; a randomized clinical effectiveness study conducted to determine the effectiveness of packages of antenatal interventions to enhance maternal nutrition and infection management on birth outcomes. Three hundred fifty women provided a stool sample in their 3rd trimester for screening using wet mount microscopy. All women had previously received 500 mg of presumptive mebendazole in the 2nd trimester. One in three women (109/350, 31.0%) were found to have a parasitic stool infection after prior deworming and 15% of women reported gastrointestinal symptoms. The most common infections were Giardia lamblia (n = 43, 37.4%), Entamoeba histolytica (n = 40, 34.8%), and Hookworm (n = 25, 21.7%). Six mothers had co-infections with at least two parasites with trophozoites of Giardia lamblia and Entamoeba histolytica co-infection being dominant.

Introduction:Timed and targeted care for families (ttCF) is a community-based intervention implemented under the Maternal, Newborn, and Child Health (MNCH) project (2021-2025) in Eastern Visayas, Philippines. The ttCF aims to improve maternal and child health during the first 1,000 days of life. The study presents the design of impact and implementation process evaluations of the ttCF program. Methods:A comprehensive evaluation framework was developed, including (1) a quasi-experimental study with 6 intervention and 6 comparison municipalities, (2) multiple cross-sectional surveys only in 16 intervention municipalities, and (3) a process evaluation guided by the RE-AIM framework (reach, impact/outcomes, adoption, implementation and maintenance). In intervention areas, barangay health workers (BHWs) conducted 12 structured home visits from pregnancy through the child's second birthday. Comparison areas received standard government health services. The outcomes include continued health and nutrition during the first 1,000 days of life, and the utilization of antenatal and postnatal health services. Data sources include household surveys, monitoring records, and qualitative data collection. Results:In the quasi-experimental study, 1,518 pregnant or mothers with children under 2 years were enrolled, with 1,313 followed up 1 year later. For the cross-sectional surveys, 720 women were assessed at baseline and 896 at midline. As of December 2024, over 6,280 women were registered in the monitoring database. A total of 61 participants, including mothers, husbands, family members, and BHWs, were assessed at focus group discussions and in-depth interviews. Discussion:The comprehensive evaluation will provide an in-depth understanding of the ttCF impact pathway, strategic monitoring, and the quality of program implementation. The evidence will inform the strengthening of community health system by promoting BHW engagement and guiding community interventions to improve maternal and child health outcomes in the Philippines.

[This corrects the article DOI: 10.1016/j.cdnut.2024.102964.].

Many interventions in Cameroon focus on addressing severe wasting rather than targeting moderate wasting, although the latter is more prevalent. The objective of the study was to evaluate dietary outcomes in a program designed to treat moderate wasting using a food voucher program (FVP) tested in the Far North, examining the factors associated with dietary outcomes. A three-month longitudinal study was carried out by an independent team of researchers within the context of a one-year humanitarian project designed to treat children with moderate wasting (middle-upper arm circumference [MUAC] measures 115–125 mm) by providing caretakers with a bi-weekly voucher to redeem for a predefined basket of foods together with essential hygiene and nutrition education. A sample of 474 children were randomly selected from the cohort enrolled in the program for inclusion in the study. Using a pre/post-test design, we evaluate the effect of the receipt of food vouchers on dietary outcomes using as indicators minimum dietary diversity (MDD) for children aged 6–23 months and dietary diversity scores (DDS) for children aged 24–53 months. Mixed logistic and linear regressions were used to identify factors from socio-demographic data and program activities (cooking demonstrations and nutrition education, perception of food safety, food basket sharing, and lasting) associated with these variables. Life table analysis was employed to assess the likelihood of achieving MDD among children aged 6–23 months. The likelihood of children aged 6–23 months meeting MDD increased from 19.9

Background Many eligible infants and children do not participate in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); coverage declines throughout the preschool period of eligibility. National and state-level social marketing campaigns promote the value of WIC and increase enrollment and participation. Local contextualization and targeting of materials may increase effectiveness, considering the diversity of families eligible for the program. However, there are few examples of such approaches and their impact. Objective This study evaluated the impact on child retention of a locally contextualized and targeted social media marketing campaign directed to WIC-eligible families living in the minority-majority population of Miami-Dade County, Florida. Methods The digital marketing campaign geographically targeted low-income families with young children with customized static image and video advertisements on Facebook and Instagram, and a bilingual Google Ads campaign. It was implemented in 2 of 15 clinics operated by the Miami-Dade WIC local agency from May 2020 through April 2021. A before and after evaluation used program administrative data to compare the outcomes for infants and children in 2 innovation clinics (n=6162) with 11 comparison clinics (n=41,074) during a baseline period (2019 calendar year) and the implementation period (n=5636 and n=38,241, respectively). Outcome measures included recertification (re-enrollment during a period), retention (active in the program at the end of a period), and participation (household continuous benefit issuance defined as 11 out of 12 mo). Impact was assessed following cluster-adjusted propensity score weighting and difference-in-difference modeling. Household continuous benefit issuance was estimated in households with only an infant or a child. Results Overall, 1,994,170 people were exposed to the campaign advertisements; 16.68% engaged with an advertisement. There were 22,983 unique visits to the local program website, 69.6% of which were acquired directly from the campaign. Four of the 5 top-performing advertisements were locally tailored messages and in Spanish. The change in recertification over time was 5.2% points (95% CI 3.4%-7.1%), greater for those in the innovation group than those in the comparison group. For retention and continuous benefit issuance, the absolute difference in change was 5.5% points (95% CI 3.7%-7.3%), and 6.6% points (95% CI 3.5%-9.7%), respectively. Differences in change over time associated with the innovation were qualitatively stronger for infants than for children; the difference in change for recertification was 7.6% points (95% CI 5.1%-10.1%) for infants and 4.0% points (95% CI 2.2%-5.9%) for children. Conclusions Engaging low-income families with young children through a locally contextualized targeted media marketing campaign can improve retention of children in WIC.