CENTIR collaborates with UNICEF South Asia on breastfeeding and maternal nutrition research

CENTIR is excited for the new collaboration with the UNICEF South AsiaPromise to Impact Office! Dr. Rukundo Kambarami Benedict will lead this collaboration to examine the epidemiology of breastfeeding in South Asia, explore the effectiveness of strategies to support optimal breastfeeding practices and assess the quality of maternal nutrition and infant feeding counseling during antenatal care. This work will contribute to nutrition policy and programming in the region and directly address some of the calls to action in the recent Global Nutrition Report 2016, available here.

Use of formative research to develop a behaviour change strategy to promote iron-folic acid and calcium supplementation in pregnancy

UntitledA new article published in Maternal and Child Nutrition by Stephanie Martin, Gretchen Seim, Salome Wawire, Gina Chapleau, Sera Young and Kate Dickin, describes conducting in-depth interviews with pregnant and postpartum women and health workers in western Kenya to examine barriers and facilitators to adherence to prenatal micronutrient supplements (Click here for the full article). Findings were used to develop a multi-level behavior change approach with activities targeting the health system, health facility, community, household, and individual levels (Click here to access the supplementary behavior change materials).

“Fungal toxins are poisoning Africa’s children,” says new report

Science 2016

Fungal toxins on food is a massive problem especially for children; refugee camp, eastern DRC, Kate Holt/Oxfam (CC BY 2.0)

Professor Rebecca Stoltzfus and collaborators contributed to a recent report released by the International Agency for Research on Cancer (IARC), discussing the “invisible” epidemic of fungal toxins in food that stunt growth and delay development in many children in Africa and parts of Asia:

“The toxins have long been known to cause liver cancer and, in high enough concentrations, death. But this is the first time that they have been shown by multiple studies to contribute significantly to childhood development.”

The report was highlighted in an article by Science magazine (Click here for the full article) and recommends strategies including field treatment, improved approaches to food storage, and diet diversification which will likely be part of the solution moving forward. For more information on mycotoxin control, please see the full report by IARC here.

IMMANA Fellow, Dr. Cynthia Matare, on measuring women’s time use to improve implementation of nutrition programs

Cyth

Men in a focus group discussion & women attending routine growth monitoring. Phikalamaza Health Centre, Lundazi District. Photo by C. R. Matare

CENTIR alumna Dr. Cynthia Matare (PhD International Nutrition, Cornell University, 2015) shares her postdoctoral work as an IMMANA Fellow on measuring women’s time use to improve implementation of nutrition programs:

“…Previous estimates suggest that women in rural Africa average 18-hour work days, with very little rest or leisure time. It has also been recognized that their time is zero-sum in that any new activity is added at the expense of another, usually sleep or rest time. These constraints on women’s time could potentially have a negative effect on their capabilities to: (1) access agriculture and nutrition interventions; (2) choose to make use of these interventions; and (3) eventually implement the recommended practices in their homes.”

For Cynthia’s full article, click here for the IMMANA blog.

Using Qualitative Research to Improve Nutrition Education Programs for Low-Income Families in New York State

By Megan Szpak and Kelsey Sklar

Megan interviewing

Megan interviewing a primary caregiver in upstate New York

During June and July 2015, we collaborated with Dr. Kate Dickin and Cornell Cooperative Extension (CCE) to conduct in-depth interviews as part of a qualitative study investigating the antecedents of child feeding practices. Previous research revealed that past experiences with food insecurity can influence parents’ current attitudes and practices related to feeding their children. For example, emotionally charged memories of food insecurity may install a “finish your plate mentality” that motivates parents to push their children to eat. While this approach is understandable in very low-resource situations, it is inconsistent with current recommendations to prevent childhood obesity. The Healthy Children, Healthy Families Curriculum: Parents Making a Difference! (HCHF) program promotes responsive feeding practices such as attending to children’s internal cues of hunger and satiety.

Our interviews examined the link between food insecurity and child-feeding practices, along with additional barriers to adopting responsive feeding practices that support healthy child weight. We developed an open-ended question guide to facilitate in-depth interviews exploring parents’ approaches toward feeding their children, including goals, challenges, and antecedents of current practices. The interviews take a life-course approach and place a special focus on parents’ childhood experiences with food insecurity. We ask about how the cost or availability of food influenced how they were fed as a child, prompting parents to think about how these experiences impact their current eating behaviors and child feeding practices. Participants conclude the interview by making suggestions for nutrition education programs and completing two quantitative surveys, the U.S. Household Food Security Survey and the HCHF Behavior Checklist.

Kelsey interviewing

Kelsey conducting a primary caregiver interview

With the help of CCE staff in two counties in upstate NY, we recruited low-income parents of children between the ages of 3 and 11 years and conducted 12 in-depth interviews. We are currently coding the verbatim transcripts for emergent themes using ATLAS.ti qualitative data analysis software, and hope to connect additional interviews with local parents. Ultimately, our qualitative data will help build a conceptual framework of the antecedents of child feeding practices to inform strategies to improve nutrition education programs delivered to low-income families.

Recent event: Cornell Undergraduate Research Board Fall Forum Poster Session in the Physical Sciences Building Clark Atrium on November 4th, 2015 from 5:30-7:00 PM.

Tanzanian Experts in Health & Nutrition Visit Cornell University for 2-Week Collaborative Symposium on Scaling Up Nutrition

CornellNM MUHAS KCMCOSUATFNC

We are pleased to announce the arrival of ten distinguished guests from five leading Tanzanian institutions for a 2-week symposium: Building Strong Nutrition Systems: Implementation Science for Scaling up Nutrition in Tanzania.

Participants come from The Nelson Mandela African Institute of Science and Technology, Muhimbili University of Health and Allied Sciences, Tanzania Food and Nutrition Centre, Sokoine University of Agriculture, and Kilimanjaro Christian Medical University College.

Group photo

The goal of this collaborative workshop is to provide the opportunity for experts in nutrition to actively engage across individuals and organizations. Participants will identify gaps in the capacity to deliver effective life-saving interventions and jointly create a strategic plan which will strengthen the frontline workforce at the district and community level in Tanzania, utilizing a multi-sectoral approach to scale up nutrition. Participants will be visiting through the end of October 2015.

This project is supported by the Bill and Melinda Gates Foundation

Linking Wildlife Conservation and Nutrition Goals: A New Frontier in One Health

From Sarah Dumas
OneHealthThe “One Health” paradigm promotes transdisciplinary research that recognizes the interactions between human, animal, and environmental health. One Health research has largely focused on the emergence of zoonotic, food-, and vector-borne diseases, comparative medicine, climate change, and the development of antimicrobial resistance. I would argue, however, that research investigating the impact of livestock production in low-income countries on human nutrition and ecological resilience deserves a place in the One Health discussion.

Poaching is one of the greatest threats to biodiversity in tropical regions, and yet wildlife consumption plays a critical role in the diets of hundreds of millions of rural people around the world.

ANIMAL SOURCE FOODS (ASF) ARE A MAIN DETERMINANT OF DIETARY QUALITY

Wildlife meat and other ASF (meat, milk, and eggs) are rich in protein, micronutrients, and fatty acids, critical for physical growth and cognitive development in children. In fact, evidence suggests that ASF plays a central role in alleviating undernutrition in low-income countries.

Research from Madagascar found that wildlife consumption predicts children’s hemoglobin concentrations, demonstrating a clear link between the nutrients derived from wildlife and undernutrition. The authors further argued that a sudden loss of access to wildlife would most affect the poorest households, who are unable to afford domestic meat and therefore depend more on wildlife (Golden et al. 2011, PNAS).

These findings suggest that conservation laws that restrict hunting may have negative public health implications if they are enforced in the absence of a clear alternative – implications which will be disproportionately experienced by individuals that are already the poorest and most vulnerable in their community.

For children in Zambia’s Luangwa Valley, we found that the consumption of ASF is limited by its high cost and the lack of local availability. Farmers raise village poultry, pigs, sheep, and cattle, but their productivity is severely restricted by endemic infectious diseases, low quality forages, poor genetics, and poor access to veterinary care. As a result, livestock production in the Valley is almost entirely composed of small flocks or herds on “low input, low output” farms.

In response to poor domestic ASF production, many households rely on illegal wildlife hunting as the primary source of ASF, which is readily available in the region. We found that 27% of 853 households surveyed estimated that their neighbors ate illegal bushmeat at least twice per month, because “bushmeat is cheaper”, “it is the only type of meat available”, and “there is a shortage of livestock.”

To my knowledge, there is no published research on the ability of livestock interventions to replace wildlife consumption. However, the literature and our formative research suggest that improvements in the Luangwa Valley’s local livestock production will increase the availability of domestic ASF and will dramatically reduce the demand for wildlife as a source of nutrients.

Chicken

The Isa Brown is a hybrid chicken known for its high egg production of approximately 300 eggs per hen in the first year of laying

To test this hypothesis, we have rolled out an intervention that supports small community-owned and -operated egg production facilities at twenty sites throughout the Valley. Each facility is operated by 4-5 farmers from the community who have been intensively trained in hen health, biosecurity and disease prevention, hen nutrition and husbandry, food safety, and business management. Each facility was stocked this month with 40 Isa Brown commercial layers, an efficient and highly adaptable layer with proven success in this environment.

We will measure the impact of this intervention on wildlife consumption in the community surrounding each facility versus wildlife consumption in control communities over the next two years.

Nutrition & Neuroscience: Better Together [Part 2]

Nutrition & Neuroscience: Better Together [Part 2]

From Brie Reid

At the recent Aspen Brain Forum at the New York Academy of Sciences, there was much talk of neuroscience and a little of nutrition — what quickly became clear was the need for cross-disciplinary discussions about the intersection of these two (large) fields.

This post series will…

  • [Part 1] give a little bit of a background on how nutrition and neuroscience connect,
  • [Part 2] pull together a little snapshot of the Aspen Brain Forum discussions around how brain development and malnutrition (specifically iron deficiency) interact, and
  • [Part 3] briefly discuss some of the challenges we face when working across nutrition and neuroscience disciplines in research.

Learn more about the nutrition and neuroscience talks at the NYAS eBriefing — especially the presentations from Dr. Michael Georgieff and Dr. Betsy Lozoff.

To continue our last discussion on critical periods, we’ll use the example of iron deficiency to understand how nutrients can negatively impact a child’s brain in a critical period of development. Iron deficiency occurs when a baby is in the womb through their toddlerhood and results in long-term, potentially permanent, neurobehavioral impairments.

iron deficiency’s effect on the brain

One brain structure we see impacted by iron deficiency is the hippocampus, which is responsible for memory. The hippocampus needs iron at specific points in time to develop properly. Iron helps the brain build cells called dendrites in the hippocampus. The hippocampus in your brain can be thought of as an ecosystem of trees — much like a real forest, you need a certain density of trees for the ecosystem to work. The tree roots need to hold the soil together, the trees themselves are producing oxygen, and animals within the forest need space and protection to thrive.

What do deforestation and iron deficiency have in common?

source: dendrite diagrams          source: deforestation diagram

In a healthy hippocampus that has plenty of iron, this “forest” of dendrites is lush with well-grown branches. In a hippocampus without enough iron, the forest of dendrites is sparser, with shorter trees that have stunted branches, so the hippocampus is less effective at memory tasks. Additionally, iron deficient infants appear to have learning and behavioral deficits that last long past toddlerhood (learn more).

The bottom line is that humans are complicated and even low levels of iron deficiency can affect multiple aspects of brain development. Nutrition, neuroscience, and child development researchers  Child development interventions only looking at social development could miss a key understanding of parent-child relationships if they do not take into account iron deficiency, and nutrition interventions only looking at iron status could miss a key component of brain development if they are not also looking at how it impacts caregiving.

Stay tuned for Part 3, where we touch on the difficulties of cross-disciplinary research in international nutrition and neuroscience!
Nutrition & Neuroscience: Better Together [Part 1]

Nutrition & Neuroscience: Better Together [Part 1]

From Brie Reid

At the recent Aspen Brain Forum at the New York Academy of Sciences, there was much talk of neuroscience and a little of nutrition — what quickly became clear was the need for cross-disciplinary discussions about the intersection of these two (large) fields.

This post series aims to:

  • [Part 1] will give a little bit of a background on how nutrition and neuroscience connect,
  • [Part 2] will pull together a little snapshot of the Aspen Brain Forum discussions around how brain development and malnutrition (specifically iron deficiency) interact, and
  • [Part 3] will briefly discuss some of the challenges we face when working across nutrition and neuroscience disciplines in research.

Learn more about the nutrition and neuroscience talks at the NYAS eBriefing — especially the presentations from Dr. Michael Georgieff and Dr. Betsy Lozoff.

why should nutrition interventions care about neuroscience?

Among undernourished children worldwide, about one-third of children suffer from stunted growth, which carries lifelong health implications from more illness later in life to pregnancy complications. Many nutrition interventions look at important markers of child development such as nutrient intake, height-for-age, and weight of growing babies and toddlers. But physical growth is just one slice of a very complicated process of growth.

At the heart of nutrition interventions are goals to support healthy moms & babies, healthy communities, and healthy brains. Beyond survival and signs of external physical growth, undernutrition carries lifelong implications for brain development. In order to reduce the impacts of undernutrition around the world, researchers and policy makers are moving towards a more holistic understanding of how malnutrition shapes both the brain and body of growing children.

what does the environment of brain development look like?

Understanding the basics of brain development is an important first step to creating programs and research agendas that address the challenges that growing babies face. In this post, we’ll look specifically at nutrition from conception to toddlerhood, as early development sets the foundation for later development. I’m going to borrow a metaphor from Dr. Megan Gunnar, at the University of Minnesota’s Institute for Child Development, who explains brain development from the perspective of architecture.

A house built on a weak foundation is likely to have issues later on. Icon by Daniele Catalanotto, from the Noun Project

A house built on a weak foundation is likely to have issues later on. Icon by Daniele Catalanotto/ECAL 

The first few years of brain development are similar to constructing the foundation for a new house — you first need to build a solid, strong foundation that can last for a long time, through various stressors, without cracking or sinking. As childhood and adulthood progress, you are building onto this foundation. Even if you have a shaky or less than ideal foundation, you can build the rest of the house on top — but it takes more work to reinforce issues that could have been resolved when you were building the original foundation.  In brain development, as in architecture, a well-constructed foundation is the key to success later in the building/growing process. In the case of humans, these first “foundational” years impact future physical, cognitive, and socio-emotional success.

To build a strong foundation for brain development, the timing and presence of nutrients, a nurturing environment (caregiving), and protection from stress are key. The brain is an organ with many different functions and parts, and different parts of the brain need different things at different times. To better understand how this works, we’ll look at how these elements interact with brain development through the example of iron deficiency and anemia in infancy and prenatally.Nutrients, Stress, CaregivingThe diagram below highlights the growth of different parts of the brain as a child ages, mapping out the number of neural circuits that form. Notice how early much of the brain cell development is taking place — this early brain development window, highlighted in red, is called a “critical period” of development.

To give an example of how nutrients can negatively impact a child’s brain in a critical period of development, our next post in this series will be taking a quick look at early iron deficiency (ID). Iron deficiency occurs when a baby is in the womb through their toddlerhood and results in long-term, potentially permanent, neurobehavioral impairments.