Are research priorities in Latin America in line with the nutritional problems of the population?

OBJECTIVE: Concordance of nutritional research priorities with the related burden of disease is essential to develop cost-effective interventions to address the nutritional problems of populations. The present study aimed to evaluate whether nutrition research priorities are in agreement with the population's nutritional problems in Latin America. DESIGN: The epidemiological profile was contrasted with the research priorities and research produced by academic institutions for each country. Qualitative analysis of research production by type of contribution to problem solving was also conducted. SETTINGS: Nine Latin American countries. RESULTS: Obesity (high body mass index (BMI)) and micronutrient deficiencies (anaemia) emerged as key problems, followed by stunting, breast-feeding/lactation and low birth weight. Wasting in children and women (low BMI) was uncommon. Concordance of ranked research priorities with the epidemiological profile of the country was generally good for nutrition-related chronic diseases, micronutrients and low birth weight, but not for undernutrition, stunting and breast-feeding. Studies on the efficacy and effectiveness of interventions were uncommon. CONCLUSIONS: The present research agenda insufficiently supports the goal of public health nutrition, which is to ensure the implementation of cost-effective nutrition programmes and policies. A more rational approach to define research priorities is needed

Functions of Social Networks in Maternal Food Choice for Children in Mexico

Food choice for children has important implications in establishing early-life dietary habits and preferences. Food choice for children has been studied as parent–child dyad dynamics, but little is known about the extended system of relationships in maternal food choice for children. The objective of this study was to understand the functions of mothers\u27 social networks in the food choices that mothers make for their children ages 1 to 5 years old in rural Mexico. In-depth interviews were conducted with 46 participants in three rural communities. The interviews inquired about participants\u27 child-feeding practices, personal and local beliefs about child feeding and the individuals with whom they had conversations about food and child feeding. All interviews were conducted in Spanish, audio-recorded, transcribed verbatim, verified for quality and analysed using the constant comparative method. Five interconnected networks emerged, consisting of household family, non-household family, community, children\u27s initial school and health and nutritional programme personnel. Each network had functions in food choice that ranged from shared food decision-making in the household family network to imparting formal dietary guidance in the health and nutritional programme personnel network. Across the networks, professionals, participants\u27 mothers and mothers-in-law, community senior women and other women with children emerged as prominent figures whom participants would turn to for child-feeding advice. These findings provide empirical evidence that social networks, as an organized system of interconnected relationships, have vital functions in establishing social norms for food choices made for children that can be leveraged to promote healthy food choices

Desigualdades y COVID-19: Impacto en la Salud Materna en Municipios Indígenas de Chiapas, México

In Mexico, women use healthcare services more and face a higher burden of diseases than men. COVID-19 became the leading cause of maternal mortality in 2020. Objective: To identify and analyze differences in maternal care during the pandemic in municipalities in Chiapas, Mexico, with a high indigenous population compared to municipalities without an indigenous population. Methodology: This is a longitudinal and explanatory study that analyzes data from the National Birth Registry Subsystem (SINAC) in Chiapas from 2010 to 2022. Results: An increase of 16% in the lack of prenatal visits and a 25.4% rise in cesarean sections were observed in indigenous municipalities. In contrast, non-indigenous municipalities saw cesarean sections reach 43.9%, a higher proportion than before the COVID-19 pandemic.Conclusions: During the pandemic, there was a decrease in births, raising questions about its impact on reproductive behavior. Additionally, starting in 2020, significant changes were observed in variables such as prenatal visits, cesarean deliveries, and the presence of midwives compared to previous years.En México, las mujeres usan más los servicios de salud y enfrentan una mayor carga de enfermedades que los hombres. El COVID-19 se convirtió en la principal causa de muerte materna en 2020. Objetivo: Identificar y analizar las diferencias en la atención materna durante la pandemia en los municipios de Chiapas, México, con alta población indígena en comparación con los municipios sin población indígena. Metodología: Es un estudio longitudinal y explicativo que analiza datos del Subsistema Nacional de Registros de Nacimientos (SINAC) en Chiapas desde 2010 hasta 2022. Resultados: Se observó un incremento del 16% en la falta de consultas prenatales y un aumento del 25.4% en las cesáreas en los municipios indígenas. En contraste, en los municipios no indígenas, las cesáreas alcanzaron el 43.9%, una proporción más elevada que antes de la pandemia de COVID-19. Conclusiones: Durante la pandemia, se registró una disminución en los nacimientos, lo que plantea interrogantes sobre su influencia en el comportamiento reproductivo. Además, a partir de 2020, se observaron cambios significativos en variables como consultas prenatales, partos por cesárea y asistencia de parteras en comparación con años anteriores.

Breastfeeding practices, beliefs, and social norms in low-resource communities in Mexico: Insights for how to improve future promotion strategies

IntroductionBreastfeeding is recommended exclusively for the first 6 months after birth, with continued breastfeeding for at least 2 years. Yet prevalence of these recommendations is low globally, although it is an effective and cost-effective way to prevent serious infections and chronic illness. Previous studies have reported that social support greatly influences breastfeeding, but there is little evidence on perceived social norms in Mexico and how they affect actual behavior.ObjectiveOur objective was to investigate breastfeeding intention, practices, attitudes, and beliefs, particularly normative, among low-resource communities in central and southern Mexico.MethodsWe performed a secondary analysis using the theory of planned behavior with cross-sectional data, which included semi-structured individual interviews with fathers (n 10), 8 focus groups with mothers (n 50), and 8 focus groups with women community leaders (n 44) with a total of 104 participants. Our data also included a quantitative survey among pregnant women and mothers (n 321).ResultsWomen reported supplementing breast milk with water and teas soon after birth, as well as introducing small bites of solid food a few months after birth. Social norms appeared to support breastfeeding, but not exclusive breastfeeding or breastfeeding for periods longer than about a year. This may be partially explained by: a) behavioral beliefs that for the first 6 months breast milk alone is insufficient for the baby, and that water in addition to breast milk is necessary to hydrate an infant and b) normative beliefs related to the appropriateness of breastfeeding in public and as the child gets older.ConclusionsFuture strategies should focus on positively influencing social norms to support recommended practices, and emphasize the specific reasons behind the recommendations. Future efforts should take a multi-pronged approach using a variety of influences, not only directed at healthcare providers but close family members, including fathers

Representaciones sociales relacionadas con la alimentación escolar: el caso de las escuelas públicas de la Ciudad de México

México está confrontando una epidemia de sobrepeso/obesidad sin precedentes, en particular entre los niños. El objetivo de este trabajo fue identificar las principales representaciones sociales relacionadas con la alimentación en la escuela, presentes en los discursos de los diferentes actores escolares. Se realizaron 20 entrevistas con actores escolares y 10 grupos de discusión con niños y niñas de 12 escuelas. Se identificaron tres principales concepciones, representaciones en las que estructuran su relación con la alimentación en la escuela, 1) comida "chatarra" versus comida casera, 2) valoración de la fruta desde diferentes perspectivas, 3) función placentera de la comida escolar. Se argumentará la contribución de esta información para entender mejor la oferta y el consumo de los escolares. El estudio permitió identificar algunos elementos que estructuran profundamentela relación de los diferentes actores escolares con la alimentación escolar y que se relacionan con, 1) presencia en los discursos de ideas y conocimientos sobre la alimentación, a veces opuestos y generados por diferentes campos de saberes, que muestran el carácter dinámico y complejo del hecho alimentario, 2) interiorización por parte de los niños de un sistema de jerarquización de los alimentos, 3) carácter identitario de la alimentación

Perceptions, knowledge, and practices of breastfeeding in indigenous regions of Mexico during Covid-19 pandemic

Objective. To explore the perceptions, knowledge, and practices of breastfeeding in the context of Covid-19 of pregnant and postpartum women, midwives, and health providers in an indigenous region of Chiapas, Mexico. Materials and methods. Qualitative thematic analysis study involving semi-structured interviews (n = 46) with pregnant women (n = 19), postpartum women (n = 6), health providers (n = 10, i.e., doctors/nurses), and midwives (n = 11). Results. Among mothers, 47% (n = 11) did not know if Covid-19 is transmitted through breastfeeding. They mentioned that they would stay away from their newborns if infected. Health providers and midwives have not received education or any supporting material on the value of breastfeeding during Covid-19 infection. Conclusion. Breastfeeding mothers’ promotion and counseling remain poor in indigenous communities and have worsened during the Covid-19 pandemic. Breastfeeding training among health providers and midwives should be provided or strengthened even more in emergency situations

Are research priorities in Latin America in line with the nutritional problems of the population?

Objective: Concordance of nutritional research priorities with the related burden of disease is essential to develop cost-effective interventions to address the nutritional problems of populations. The present study aimed to evaluate whether nutrition research priorities are in agreement with the population's nutritional problems in Latin America. Design: The epidemiological profile was contrasted with the research priorities and research produced by academic institutions for each country. Qualitative analysis of research production by type of contribution to problem solving was also conducted. Settings: Nine Latin American countries. Results: Obesity (high body mass index (BMI)) and micronutrient deficiencies (anaemia) emerged as key problems, followed by stunting, breast-feeding/lactation and low birth weight. Wasting in children and women (low BMI) was uncommon. Concordance of ranked research priorities with the epidemiological profile of the country was generally good for nutritio

An Iterative Process for Training Design and Implementation Increased Health Workers\u27 Knowledge for Taking Nutrition Behavior Change to Scale

The shortage of skilled, motivated, and well-supported health workers is a major barrier to scaling up nutrition interventions and services. Objective: The objective of this study is to describe the process for developing and implementing a training of health personnel for the delivery of the Integrated Strategy for Attention to Nutrition (EsIAN), an evidence-based strategy for promoting infant and young child feeding through primary health care in Mexico. The specific objective is to provide a case study and highlight challenges, as well as elements to successfully mitigate these, and discuss potential applications of findings beyond the Mexican context. Methods: The design and implementation of training followed a 5-phase process: situation analysis, formative research, large-scale feasibility study, redesign and scale up, and evaluation. We conducted document reviews, surveys, and focus groups during the first phases to inform and refine the training, as well as a pre- and posttraining telephone survey to evaluate change in knowledge. Results: The initial phases of the design provided a clear understanding of the opportunities and challenges for promoting infant and young child feeding, as well as health workers\u27 routines and practices, which informed training design. The feasibility study allowed tailoring and refinement of training. The vertical coherence and coordination between the federal and state levels during redesign and scale up facilitated compliance with training timeline and process. Evaluation results showed significant improvement in knowledge posttraining of up to 19 percentage points. Conclusions: The EsIAN training component for health providers was developed using a systematic approach to consolidate and generate relevant evidence, following an iterative process to test, learn, and improve both design and implementation. This process allowed for flexibility to take advantage of new opportunities and respond to findings from iterations. Garnering and ensuring political support allowed for continuity and sustainability of actions

Digital marketing of commercial breastmilk substitutes and baby foods: strategies, and recommendations for its regulation in Mexico

Background: Parents are exposed to breastmilk substitutes and baby foods marketing on the internet and social media, which hinders adequate breastfeeding and complementary feeding. This study identifies digital marketing strategies for breastmilk substitutes, specifically commercial milk formula and baby foods used by the industry to influence infant and young children’s feeding practices in Mexico and proposes regulatory recommendations that can be useful for similar countries. Methods: Qualitative study based on the CLICK monitoring framework developed by the World Health Organization, adapted for digital marketing of commercial milk formula and baby foods. Semi-structured interviews (n = 53) with key actors were conducted between November 2020 and March 2021, and used grounded theory for the analysis and interpretation with the MAXQDA 20 software. Results: Commercial milk formula and baby food companies use digital media to contact and persuade parents to use their products by sending electronic newsletters with advertising. Companies hire influencers to market their products because there is no regulation prohibiting the advertisement of breastmilk substitutes on social media, and promote formula among health professionals inviting them to participate in sponsored webinars on infant nutrition, ignoring conflict of interest and the International Code of Marketing of Breastmilk Substitutes. Parents trust formula and baby food advertisements, which use emotional messages and health and nutrition claims to encourage their consumption. Health professionals consider that claims contribute to the indiscriminate use of formula, and some actors propose the use of plain packaging for these products. Conclusions: Breastmilk substitutes companies promote their products in digital media using unethical strategies that fail to comply with the International Code of Marketing of Breastmilk Substitutes. They generate strong conflicts of interest with health professionals, taking advantage of legal framework gaps and the lack of monitoring and effective sanctions for non-compliers. Updating the legal framework and monitoring compliance, including digital media, is urgently needed to protect children’s right to breastfeeding, healthy nutrition and life, and the rights of women to health and informed decision-making