To explore mothers’ perceptions of malnutrition and its causes in U-5’s in Mozambique, as well as their ability to recognise, prevent and act on signs of malnutrition.

A qualitative exploratory inquiry using focus group discussions and individual interviews analysed using Nutbeam’s health literacy themes.

Manhiça District Hospital in Manhiça, Mozambique.

Mothers of U-5’s (n 53) attending the in- and out-patient paediatric wards.

Different malnutrition literacy levels were identified in mothers’ responses. Mothers’ reflections on the causes of malnutrition in U-5’s were more elaborate compared to those of recognition, prevention and treatment strategies. Only severe forms of acute malnutrition were recognised by mothers, while early signs of undernutrition and stunting largely went undetected or unmentioned. Limited knowledge, time and financial resources were mentioned as contributors to suboptimal practices resulting in malnutrition. The district hospital, rather than community resources or local health posts, was indicated as the place mothers would go to seek advice and treatment for malnutrition. All mothers requested additional information on how to prevent and treat malnutrition.

The varying literacy levels among mothers, the lack of references to community health workers as a resource in identifying and managing malnutrition, and the identification of poverty and sociocultural conditions as contributors to suboptimal practices indicate the need for in-depth research focused on the social determinants of malnutrition. A more comprehensive understanding of mothers’ health literacy would contribute to the development of holistic programmes aiming to improve community management of malnutrition.

To examine minimum dietary diversity (MDD) trends and determinants among children aged 6–23 months.

Secondary analysis of the Indonesia Demographic and Health Surveys (IDHS) between 2007 and 2017. The primary outcome was MDD, the consumption of at least five out of eight food groups (MDD-8). We included a total of 5015 (IDHS 2007), 5050 (IDHS 2007) and 4925 (IDHS 2017) children aged 6 to 23 months to estimate trends of MDD-8 and to identify factors associated with MDD-8. We used multiple logistic regression analysis adjusted for the complex sampling design to investigate the association between the study factors and MDD-8.

Indonesia.

A total of 14 990 children aged 6–23 months.

Over the 10 years, the percentage of children who consumed a diversified diet was 53·1 % in 2007, 51·7 % in 2012 and 53·7 % in 2017. Multivariate analyses showed that older age children, higher maternal education, maternal weekly access to media, paternal non-agricultural occupation, history of at least four antenatal care visits and wealthier households were associated with the increased odds of MDD-8. Children living in rural areas, Sulawesi and Eastern Indonesia, were less likely to eat a diversified diet.

The proportion of children meeting MDD-8 has stagnated in the last decade. Child, parental, health care, household and community factors are associated with MDD-8. Therefore, nutrition education programmes and behaviour change communication activities should target mothers and families from socio-economically and geographically disadvantaged populations.

Food literacy is the knowledge, skills and behaviours needed to meet food needs and determine intake and is conceptualised as eleven components under four domains of planning and managing, selecting, preparing, and eating. Previous measures of food literacy vary in their adherence to the conceptualisation and ability to capture totality of eating. This study aimed to determine items for inclusion and exclusion in a food literacy item pool and capture the general public’s interpretation of everyday food literacy practices.

Beginning with an item pool from previous studies, cognitive interviews were conducted using think-aloud and verbal probing methods. Data were first analysed for applicability, clarity, ambiguity and logic, then for emergent themes to ensure items captured the totality of the participant’s eating.

Australia

Australian residents over 18 years of age recruited via Facebook residential groups (n 20).

Of the original 116 items, 11 items had limited applicability; 13 items had unclear references; 32 items had lexical problems and 11 items had logical problems. In total, 29 items were deleted, 31 retained and 56 revised. Thematic analysis revealed participants limited their responses to consider only conventional practices such as grocery shopping, cooking and planned meals rather than the totality of their eating. An additional eighty-four items were developed to address eating out, incidental eating occasions and inconsistencies between participants assumed correct knowledge and that of public health guidelines. This resulted in a refined 171-item pool.

This study progresses the development towards a comprehensive, validated food literacy questionnaire.

To assess the cost-effectiveness of prophylactic Zn supplementation for preventing diarrhoea in young children in Tanzania.

Cost-effectiveness analysis using decision-analytic modelling. Cost-effectiveness ratios were calculated as the incremental cost (2019 USD) per disability-adjusted life year (DALY) averted, from a societal perspective, and with a 3 % discount rate applied to future outcomes. Sensitivity analyses were performed to test the robustness of results to alternative assumptions.

Tanzania.

A hypothetical cohort of 10 000 children aged 6 weeks to 18 months.

The intervention costs of Zn supplementation were estimated as $109 800 (95 % uncertainty interval: 61 716, 171 507). Zn supplementation was estimated to avert 2200 (776, 3737) diarrhoeal episodes, 14 080 (4692, 25 839) sick days, 1584 (522, 2927) outpatient visits, 561 (160–1189) inpatient bed days, 0·51 (0·15, 1·03) deaths and 19·3 (6·1, 37·5) DALY (discounted at 3 % per year). Zn supplementation reduced diarrhoea care costs by $12, 887 (4089, 25 058). The incremental cost per DALY averted was $4950 (1678, 17 933). Incremental cost-effectiveness ratios (ICER) estimated from a health system perspective were similar to the results from the societal perspective. ICER were substantially lower (more favourable) when future outcomes were not discounted, but all ICER were above contemporary thresholds for cost-effectiveness in this setting.

Prophylactic Zn reduced diarrhoea incidence and associated healthcare utilisation; however, it did not appear to be cost-effective for prevention of childhood diarrhoea in the scenario examined in this study. Reducing intervention costs, or identifying high risk groups for intervention targeting, may be needed to improve cost-effectiveness in this setting.

To quantify the extent of food and beverage advertising on bus shelters in a deprived area of the UK, to identify the healthfulness of advertised products, and any differences by level of deprivation. The study also sought to assess the creative strategies used and extent of appeal to young people.

Images of bus shelter advertisements were collected via in person photography (in 2019) and Google Street View (photos recorded in 2018). Food and beverage advertisements were grouped into one of seventeen food categories and classified as healthy/less healthy using the UK Nutrient Profile Model. The deprivation level of the advertisement location was identified using the UK Index of Multiple Deprivation.

Middlesbrough and Redcar and Cleveland in South Teesside.

N/A

Eight hundred and thirty-two advertisements were identified, almost half (48·9 %) of which were for foods or beverages. Of food and non-alcoholic beverage adverts, 35·1 % were less healthy. Most food advertisements (98·9 %) used at least one of the persuasive creative strategies. Food advertisements were found to be of appeal to children under 18 years of age (71·9 %). No differences in healthiness of advertised foods were found by level of deprivation.

Food advertising is extensive on bus shelters in parts of the UK, and a substantial proportion of this advertising is classified as less healthy and would not be permitted to be advertised around television programming for children. Bus shelter advertising should be considered part of the UK policy deliberations around restricting less healthy food marketing exposure.

To reduce children’s sugar-sweetened beverage intake, California’s Healthy-By-Default Beverage law (SB1192) mandates only unflavoured dairy/non-dairy milk or water be the default drinks with restaurant children’s meals. The objective of this study is to examine consistency with this law for meals sold through online platforms from restaurants in low-income California neighbourhoods.

This observational, cross-sectional study examines beverage availability, upcharges (additional cost) and presentation of beverage options consistent with SB1192 (using four increasingly restrictive criteria) within a random sample of quick-service restaurants (QSR) in Supplemental Nutrition Assistance Program Education eligible census tracts selling children’s meals online from November 2020 to April 2021.

Low-income California neighbourhoods (n 226 census tracts).

QSR that sold children’s meals online via a restaurant-specific platform, DoorDash, GrubHub and/or UberEats (n 631 observations from 254 QSR).

Seventy percent of observations offered water; 63 % offered unflavoured milk. Among all beverages, water was most likely to have an upcharge; among observations offering water (n 445), 41 % had an upcharge (average $0·51). Among observations offering unflavoured milk (n 396), 11 % had an upcharge (average $0·38). No observations upcharged for soda (regular or diet). Implementation consistency with SB1192 ranged from 40·5 % (using the least restrictive criteria) to 5·6 % (most restrictive) of observations.

Based on observations from restaurant websites and three of the most popular online ordering platforms, most California QSR located in low-income neighbourhoods are not offering children’s meal beverages consistent with the state’s Healthy-By-Default Beverage law. As the popularity of online ordering increases, further work to ensure restaurants offering healthy default beverages with children’s meals sold online is necessary.

A core function of the public health nutrition workforce is advocacy. Little is known of the nutritionists’ role in policymaking from a policy process theory perspective. The current study analyses the nutritionists’ role in advocating for a six-year governmental plan on obesity prevention in Quebec, Canada.

We conducted qualitative research using Quebec’s obesity policy as a case study to understand the role of nutritionists in advocating for obesity prevention policies. A conceptual framework combining the Advocacy Coalition Framework with a political analysis model based on the Theory of the Strategic Actor was developed to analyse the beliefs, interests and strategies of policy actors including nutritionists. Data sources comprised semi-structured open-ended interviews with key policy actors (n 25), including eight nutritionists (32 %) and policy-related documents (n 267). Data analysis involved thematic coding and analysis using NVivo 11 Pro.

Quebec, Canada.

Key policy actors including nutritionists.

Nutritionists formed the core of the dominant public health coalition. They advocated for an inter-sectoral governmental plan to prevent obesity through enabling environments. Their advocacy, developed through an iterative process, comprised creating a think tank and reinforcing partnerships with key policy actors, conducting research and developing evidence, communicating policy positions and advocacy materials, participating in deliberative forums and negotiating an agreement with other coalitions in the policy subsystem.

Nutritionists’ advocacy influenced agenda setting and policy formulation. This research may contribute to empowering the public health nutrition workforce and strengthening its advocacy practices. It informs practitioners and researchers concerned with obesity policy and workforce development.

This study aimed to critically analyse Australia’s current and proposed policy actions to reduce added sugar consumption. Over-consumption of added sugar is a significant public health nutrition issue. The competing interests, values and beliefs among stakeholders mean they have disparate views regarding which policy actions are preferable to reduce added sugar consumption.

Semi-structured interviews using purposive, snowball sampling and policy mapping. Policy actions were classified by two frameworks: NOURISHING (e.g. behaviour change communication, food environment and food system) and the Orders of Change (e.g. first order: technical adjustments, second order: reforming the system, third order: transforming the system).

Australia.

Twenty-two stakeholders from the food industry, food regulation, government, public health groups and academia.

All proposed and existing policy actions targeted the food environment/behaviour change; most were assessed as first-order changes, and reductionist (nutrient specific) in nature. Influences on policy actions included industry power, stakeholder fragmentation, government ideology/political will and public pressure. Few stakeholders considered potential risks of policy actions, particularly of non-nutritive sweetener substitution or opportunity costs for other policies.

Most of Australia’s policy actions to reduce added sugar consumption are reductionist. Preferencing nutrient specific, first-order policy actions could reflect the influence of vested interests, a historically dominant reductionist orientation to nutrition science and policy, and the perceived difficulty of pursuing second- or third-order changes. Pursuing only first-order policy actions could lead to ‘regrettable’ substitutions and creates an opportunity cost for more comprehensive policy aimed at adjusting the broader food system.