Kate Dickin and Cornell Researchers collaborate on USAID Advancing Nutrition

An article published in December 2018 in the Cornell Chronicle  highlights Dr. Kate Dickin’s new role leading a team of researchers from Cornell’s Division of Nutritional Sciences who are collaborating with John Snow International on USAID Advancing Nutrition, a global multi-sectoral nutrition project. USAID Advancing Nutritionwill provide technical assistance to country-led nutrition efforts in multiple low income countries to develop and scale up effective nutrition interventions, build capacity for multi-sectoral nutrition action, and contribute to global learning on innovative practices. CENTIR is excited to contribute to these efforts!

New publication: Child feeding practices of motivated, low-income parents reflect trade-offs between psychosocial- and nutrition-oriented goals

Roseanne Schuster and co-authors Megan Szpakc, Elizabeth Klein, Kelsey Sklar, and Kate Dickin published a paper, I try, I do”: Child feeding practices of motivated, low-income parents reflect trade-offs between psychosocial- and nutrition-oriented goals, in the journal “Appetite.”

Although there is increased focus on behavior change programs targeting parents to promote healthy child feeding, success of these programs has been limited. To close this gap, we sought to understand parents’ goals for child feeding and their motivations, abilities, and contextual environment that challenged or enabled goal achievement, with a focus on parents’ own childhood food experiences. We conducted semi-structured qualitative interviews (n = 21) with low-income parents of at least one child aged 3–11 years in three semi-rural counties in upstate New York to explore their emic perspectives on child feeding goals and practices. Transcripts were coded by at least two researchers using the constant comparative approach. Emergent themes were identified and interpreted in the context of the Motivation-Ability-Opportunity framework. Low-income parents articulated and were clearly motivated to achieve both nutrition- and psychosocial-oriented goals. Salient psychosocial goals (e.g., family meals to promote family relationships, help child feel secure), often led to different child feeding practices than indicated by parents’ nutrition-oriented child feeding goals (e.g., nutritious diet, healthful relationship with food). Sometimes these psychosocial goals were in conflict with the nutrition-oriented goals; for example, some parents gave into child food preferences to avoid conflict or hesitated to introduce changes in diets of overweight children to preserve child self-esteem. Prominent contextual barriers included child preferences, life disruptions, and the inflexible time and financial restrictions of poverty. Parents exhibited awareness and motivation to achieve healthy eating goals but success was often thwarted by the salience of psychosocial goals that often motivated less-healthy practices. Thus, behavior change programs should acknowledge the value and relevance of both types of goals and help parents develop strategies to address the tensions between them.

New publication on Life course influences on food provisioning among Mexican-born mothers in New York State

In September 2018, Amanda McClain and co-authors Kate Dickin and Jamie Dollahite published a paper on “Life course influences on food provisioning among low-income, Mexican-born mothers with young children at risk of food insecurity” in the journal “Appetite.”

Dr. McClain’s doctoral research at Cornell explored life course and ecological system influences on food provisioning among low-income, Mexican-born mothers in the U.S. to identify target influences and behaviors for interventions. Life Course Perspective and Ecological Systems Theory guided this qualitative study of women born in Mexico who had lived ≤10 years in U.S., had  at least one child 5 years old or younger, and household incomes <200% of the federal poverty line. Participants completed two semi-structured interviews, including a participant-driven photo elicitation interview.  Five themes emerged that were related to three key life course concepts: social context in Mexico (food insecurity experiences, agrarian experiences, and traditional foods and flavors), transitions (motherhood), and turning points (health events). All themes related to mothers’ overall priority of providing home-cooked meals, and demonstrated life course influences shaping food provisioning values and strategies.

 

 

Multi-Sectoral Nutrition Action

Multi-Sectoral Nutrition Action

District nutrition officers, mentors, and community stakeholders gather at a nutrition engagement workshop in Tanzania.

Poor nutrition can have irreversible health effects and economic and social consequences for individuals, communities, and nations. While nutrition-specific interventions target the immediate causes of poor nutrition, multi-sectoral nutrition (MSN) action seeks to address underlying determinants of poor nutrition by integrating nutrition efforts across various sectors, including agriculture; education; social welfare; and water, sanitation and hygiene. In doing so, MSN action incorporates nutrition-sensitive programming and maximizes the potential to improve nutrition, health, and development while creating an enabling environment for improved nutrition across sectors.

Our work aims to strengthen multi-sectoral partnerships and support the capacity of council officers and civil society to improve nutrition action across sectors. Specifically, our research projects examine MSN action in Tanzania to complement the National Multisectoral Nutrition Action Plan (NMNAP), a five-year strategy launched by the Tanzanian government in 2017. We explore the impact of mentoring District Nutrition Officers (DNuOs) on their ability to plan, coordinate, and carry out MSN action. An additional project in Zambia explores the use of livestock intervention based on a community agribusiness model to change the community food environment and sustainably provide animal source food.

Projects

BSNS: Building Strong Nutrition Systems in Tanzania (completed)

Small Scale Egg ProductionAssessing the effect of sustainable small-scale egg production on maternal and child nutrition in rural Zambia (completed)

The ASTUTE ProjectAddressing Stunting in Tanzania Early (current)

People

Katherine L. DickinGina ChapleauDadirai FundiraHope Craig, Ibukun OwoputiStephanie Martin, Sarah Dumas

Resources

Multi-sectoral Nutrition Manual

Tanzania Food and Nutrition Centre. “Building a strong nutrition system across sectors: A manual for strengthening district capacity to improve multi-sectoral nutrition planning and action.” Manual. Dar es Salaam. Jan. 2018.

Evidence-based Practice Briefs

Tanzania Food and Nutrition Centre. “Multi-sectoral nutrition: A case for joint action.Evidence-based practice brief [#1]. Dar es Salaam. Jan. 2018.

Tanzania Food and Nutrition Centre. “Mentored district nutrition officers put training into practice.” Evidence-based practice brief [#2]. Dar es Salaam. Jan. 2018.

Tanzania Food and Nutrition Centre. “Mapping community-stakeholders improves nutrition collaboration across sectors.” Evidence-based practice brief [#3]. Dar es Salaam. Jan. 2018.

Tanzania Food and Nutrition Centre. “Engagement workshops help district nutrition officers expand a nutrition network.” Evidence-based practice brief [#4]. Dar es Salaam. Jan. 2018.

Research Brief

IMA World Health. Scaling up Growth: Addressing Stunting in Tanzania Early (ASTUTE). Operations Research Brief. 2015.

CENTIR undergraduate presents research at Cornell

Undergraduate researcher Luiza Chempkemoi ’18 (pictured right) presents her research to Katherine Dickin (pictured left) and the larger Cornell community at the Global and Public Health Experiential Learning Symposium in Fall 2017. Titled “Community-based stakeholder mapping: An approach to explore district challenges and opportunities for multi-sectoral nutrition action in Tanzania,” Luiza’s research was an extension of the Building Strong Nutrition Systems (BSNS) project to identify potential community-based actions for scaling up nutrition in Tanzania. Click here for a closer look at her poster. Way to go, Luiza!

Baby WASH

Baby WASH

Attracted to food in the household, small livestock bring fecal contamination into the play areas of infants and toddlers.

There is scarce research and programmatic evidence on the effect of poor water, sanitation, and hygiene (WASH) conditions of the physical environment on early child cognitive, sensorimotor, and socio-emotional development. Furthermore, many common WASH interventions are not specifically designed to protect babies in the first 3 years of life, when gut health and linear growth are established. Our current research, known as “Baby WASH,” works to link WASH, anemia, and child growth. Our research also seeks to highlight pathways through which WASH may affect early child development, primarily through inflammation, stunting, and anemia.

Environmental enteropathy, damage to the intestines caused by chronic exposure to bacterial pathogens, may be a key pathway between poor hygiene and developmental deficits. Current early child development research and programs lack evidence-based interventions to provide a clean play and infant feeding environment in addition to established priorities of nutrition, stimulation, and child protection. Solutions to this problem will require appropriate behavior change and technologies that are adapted to the social and physical context and conducive to infant play and socialization.

Projects

One Health for Babies & Livestock: Preventing Fecal Exposure and Environmental Enteropathy in rural Zambia (completed)

Small Scale Egg ProductionAssessing the effect of sustainable small-scale egg production on maternal and child nutrition in rural Zambia (completed)

The SHINE Trial: Sanitation, Hygiene and Infant Nutrition Efficacy (SHINE) Trial in rural Zimbabwe (current)

People

Rebecca Stoltzfus, Dadirai Fundira, Sarah Dumas, Rukundo Kambarami Benedict

Resources

Reid B, J Orgle, K Roy, C Pongolani, M Chileshe, & R Stoltzfus. 2018. Characterizing Potential Risks of Fecal–Oral Microbial Transmission for Infants and Young Children in Rural Zambia. Am J Trop Med Hyg. 98 (3), pp 816-823.

CARE Zambia and Cornell University. August 2015. One Health Report.

Understanding Caregiver Capabilities

Understanding Caregiver Capabilities

Effective interventions for improving maternal and child nutrition have been documented and have led the Scaling Up Nutrition movement. These efforts have focused on increasing coverage of the interventions, yet there is lack of evidence regarding a caregiver’s understanding and sustained practice of positive nutrition practices at the household level.  UNICEF’s original conceptual model of child survival, growth, and development identifies the role of care as practices performed by caregivers that affect nutrient intake, health, and the cognitive and psychosocial development of the child. In order to perform care practices that influence nutrition, the caregiver needs sufficient education, time, and support.

Our current research on caregiver capabilities explores the impacts of mental health, physical health, stress, social support, parenting self-efficacy, autonomy (access to and control of household resources) and workload (including perceived time stress) on understanding and utilization of maternal and child nutrition interventions.

Projects

MICa Prenatal Calcium Supplementation: Implementation research on prenatal micronutrient supplementation to prevent preeclampsia and anemia.

Child Feeding Practices in New York StateThe Influence of Past Food Insecurity on Parents’ Use of Child Feeding Practices Recommended to Prevent Child Obesity.

Healthy Children, Healthy Families: Parents making a difference!

The SHINE Trial: Sanitation, Hygiene and Infant Nutrition Efficacy (SHINE) Trial in rural Zimbabwe.

One Health for Babies & Livestock: Preventing Fecal Exposure and Environmental Enteropathy in rural Zambia.

People

Katherine L. DickinRebecca StoltzfusGina ChapleauDadirai Fundira, Stephanie Martin, Rukundo Kambarami Benedict, Brie Reid, Cynthia Matare

Resources

Zongrone, A. (2015). Behavior change intervention research in infant and young child feeding: understanding caregiver capabilities, self-efficacy, and the critical decisions that define infant feeding trajectories in Bangladesh (Doctoral dissertation). Retrieved from eCommons.

Community-Based Programs

Community-Based Programs

The CENTIR group recognizes the essential role of community in improving community health and developing sustainable programs. We work with national and local governments and community members to improve agriculture, health, and nutrition.

Village Health Workers

This includes working to improve dietary diversity through community projects led by agricultural extension workers; training, monitoring, and evaluating frontline healthcare workers to understand pathways to delivering high quality services; and identifying social support networks to assist pregnant women with medication adherence. We use this information to feed back into local programs and inform local and national policy.

Projects

Adherence Partners in Pregnancy: Evaluating the feasibility and acceptability of adherence partners for the prevention of preeclampsia and anemia in pregnant women

One Health for Babies & Livestock: Preventing Fecal Exposure and Environmental Enteropathy

Preventing Preeclampsia & Anemia: Integrating Strategies for the Prevention of Preeclampsia and Anemia into Community-Based Programs

Responsive Feeding Practices: Remembering Childhood Food Insecurity: Influences on Parents’ Current Feeding Practices

The Sanitation, Hygiene and Infant Nutrition Efficacy (SHINE) Trial 

People

Katherine DickinRebecca StoltzfusBrie ReidJessica SparlingSarah DumasDadirai FundiraRukundo KambaramiStephanie MartinLanre Omotayo Gina ChapleauCynthia Matare(alumna)

Resources

Scaling Up Nutrition Movement

The United Republic of Tanzania, National Nutrition Social and Behavior Change Communication Strategy, July 2013 – June 2018

 

Infant and Young Child Feeding

Infant and Young Child Feeding

Undernutrition contributes to over 3 million deaths in children under the age of 5 years annually, and causes millions more to suffer from life-long physical and cognitive disabilities. Optimal infant and young child feeding (IYCF) practices play a large role in the goal of reducing child mortality and morbidity. The World Health Organization (WHO) and UNICEF issued a global strategy for IYCF in 2002, emphasizing sustained interventions to improve poor feeding practices.

Community-based infant and young child feeding (Image from UNICEF; Click here for more information).

Our group’s efforts contribute to addressing this problem through innovative behavior change interventions to support exclusive breastfeeding in the first 6 months, continued breastfeeding after 6 months, appropriate timing and quality of complementary feeding between 6 and 24 months, and improved availability and access to animal-source foods. Ultimately, our research aims to ensure and accelerate the promotion, protection and support of good IYCF practice.

Projects

Small Scale Egg Production: Assessing the effect of sustainable small-scale egg production on maternal and child nutrition in rural Zambia (completed)

The ASTUTE Project: Addressing Stunting in Tanzania Early (current)

The SHINE Trial: The Sanitation, Hygiene and Infant Nutrition Efficacy (SHINE) Trial in rural Zimbabwe (current)

People

Katherine L. Dickin, Rebecca StoltzfusDadirai Fundira, Stephanie L. MartinGina Chapleau, Hope CraigIbukun Owoputi, Sarah Dumas, Rukundo Kambarami Benedict, Cynthia Matare.

Resources

Zongrone, A. (2015). Behavior change intervention research in infant and young child feeding: understanding caregiver capabilities, self-efficacy, and the critical decisions that define infant feeding trajectories in Bangladesh (Doctoral dissertation). Retrieved from eCommons.

Mycotoxins & Child Health

Mycotoxins & Child Health

Mycotoxins in cornMycotoxins are produced by molds (fungi) that contaminate foods. The consumption of mycotoxins has been linked to adverse health effects in human studies and immune suppression and growth faltering in animal studies. Our work is focused on aflatoxin, fumonisin and deoxynivalenol, mycotoxins that are widespread in diets based on maize and groundnuts, especially where those foods are grown in small plots of land under stress of drought, pests, or poor soil.

We want to describe the extent that African mothers and young children consume these toxins, and whether this affects the growth, health, and development of the child, before or after birth.  In order to study mycotoxins and child health, we are collaborating with plant pathologists, engineers, and toxicologists to find low-cost accurate ways to identify the toxins in foods and in human biosamples.  We are also building a network of collaborators to develop interventions to prevent these toxins from entering human diets.

Projects

Mycotoxins & Birth Outcomes: Mycotoxin Exposure in Pregnancy and Birth Outcomes (current)

Mycotoxins & Child Growth: Exploring potential causal link between mycotoxins, gut dysfunction and stunting in young children (current)

Mycotoxin Mitigation & Stunting: A Planning Grant for Trial of Mycotoxin Mitigation and Stunting in the First 1000 Days (current)

People

Rebecca StoltzfusLaura Smith, Erica Philips.