Parenting Practices and Nutrition

Responsive child feeding practices are associated with nutritious dietary intake and healthy weights among children and, as a result, such practices are promoted in nutrition education programs. The determinants of parenting and child feeding practices, however, are not well understood and there has been relatively little research within low-income families. We are involved in two research projects in New York State that begin to fill this gap by exploring how parenting influences child feeding practices.

Previous research has revealed that past experiences with food insecurity can influence parents’ current attitudes and practices related to feeding their children. To help nutrition educators address this barrier in their programming, we seek to develop, cognitively-test and validate a survey tool to assess previous food insecurity experiences in childhood. We conducted in-depth interviews with low-income parents, as well, on how they remember early food insecurity experiences and what they see as the lasting emotional and behavioral impacts. A key goal is to explore how parents’ own views of food experiences over the life course, particularly previous food insecurity, influence current ability to adopt the responsive parenting and feeding practices recommended to prevent childhood obesity.

Projects

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

Healthy Children, Healthy Families: Parents making a difference! (current)

People

Katherine Dickin, Stephanie Ortolano

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.

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.

Nutritional Care in Pregnancy

Nutritional Care in Pregnancy

Women who are undernourished prior to or during pregnancy face this nutritionally-demanding life stage with disadvantages such as small stature and poor micronutrient status. These factors increase the risk of complications during pregnancy and delivery, with serious implications for the health and survival of mothers and babies. Children of undernourished mothers may be born underweight, putting them at higher risk of acute infectious diseases, chronic diseases, and physical and cognitive impairments. Maternal mortality due to postpartum hemorrhage and preeclampsia can be prevented with micronutrient supplementation.

To help ensure healthy pregnancies and good birth outcomes, our group studies key behaviors related to both provision and utilization of antenatal care (ANC). We assess the quality of ANC in limited resource settings and the potential benefits of strengthening health systems to deliver quality care. We also investigate women’s perceptions of ANC and factors that influence access to and utilization of ANC and adherence to prenatal nutritional supplements. Other preventive strategies developed and studied by the group include community-based delivery of health and nutrition education in pregnancy, and behavior change communication and social support strategies for promoting nutritional care in pregnancy.

Projects

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

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

Katherine L. DickinRebecca Stoltzfus, Gina ChapleauStephanie MartinLaura Smith, Erica Philips

Resources

Resources for Health Workers

A Trainer’s Guide for Healthcare Providers and Community Health Workers: Training materials on calcium and iron-folic acid supplementation for pregnant women.

Community Health Worker Job Aids from Kenya: Calcium and Iron-Folic Acid Supplementation Behavior Change Materials.

Frequently Asked Questions (FAQs)

Prevention of pre-eclampsia FAQ: Calcium supplementation in pregnancy for prevention of pre-eclampsia

Experiences with prenatal IFA supplementation FAQGuidance for prenatal calcium supplementation programming based on experiences with iron and folic acid (IFA) supplementation

Use of Mentoring Relationships to Build Capacity for Multisectoral Nutrition Systems

What is the Issue?

Fifty-four countries are taking part in the Scaling Up Nutrition (SUN) movement, and are putting plans and strategies in place to use a multisectoral approach to reduce chronic malnutrition. Much attention in SUN has been dedicated to raising awareness, obtaining commitments, and coordinating stakeholders at the global and national levels. Although multisectoral nutrition policies continue to roll out, there is little information to date on how it is functioning below the regional level and how it is impacting communities.

SUN countriesTanzania has become one of the leading nations within the SUN MOVEMENT with a strong, progressive National Nutrition Strategy and growing commitment to nutrition across nine key ministries. In order to continue to raise the profile of nutrition and improve nutrition outcomes, it is paramount to support the newly created position of the District Nutrition Officer (DNuO) and ensure that the current scopes of practice, supervisory and reporting structures, technical capacities, and relationships among district officers and diverse cadres are aligned in strong and efficient ways to meet nutrition goals.

What do we aim to achieve?

Cornell researchers have partnered with representatives from five leading Tanzanian institutions and have jointly developed a strong action plan during a 2-week Collaborative Nutrition Workshop held at Cornell in Oct 2015.

Overall this project aims to increase knowledge at the district level in optimal approaches for:

 (1) Involving multiple sectors in addressing nutrition priorities; (2) Coordinating nutrition programming among the various sectors; and (3) Increasing the capacity to deliver effective nutrition interventions at the district and community levels.

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(From left) Haikael Martin, Mary Mosha, Sia Msuya and Clara Mollay discuss how to build capacity for District Nutrition Officers in Tanzania

This team will build and support the Tanzanian nutrition system in two rural districts, advocating for multisectoral action by establishing and supporting beneficial relationships between academic institutions, district officers, and natural community leaders.  To do this, we will:

  • Strengthen the capacity of the District Nutrition Officer (DNuO) to teach, support and advocate for nutrition activities within the district.
  • Collaboratively identify key areas to strengthen to increase nutrition capacity including the promotion of community-driven and community-led interventions.
  • Mentor the DNuO to identify key strengths and weaknesses and come up with tailored plans to capitalize on the strengths and minimize the weaknesses.

Experts from Kilimanjaro Christian Medical University College (KCMUCo), Nelson Mandela African Institution of Science and Technology (NM-AIST), Sokoine University of Agriculture (SUA), Muhimbili University of Health and Allied Sciences (MUHAS), and the Tanzanian Food and Nutrition Centre (TFNC) are structuring mentorship teams to be embedded in these 2 rural districts, and are systematically documenting their actions and outcomes, as a basis for recommending larger scale support to the local nutrition system throughout Tanzania.