'The bigger the better'--mothers' social networks and child nutrition in Andhra Pradesh

OBJECTIVE: It is hypothesised that mothers' social networks can positively affect child nutrition through the sharing of health knowledge and other resources. The present study describes the composition of mothers' networks, examines their association with child nutrition, and assesses whether health knowledge is shared within networks. DESIGN AND SETTING: Cross-sectional data for mothers of young children from Andhra Pradesh (south India) were combined with existing data from the Young Lives study, in which the mothers were participating (n = 282). RESULTS: The composition of social networks varied between urban and rural areas, with urban networks being larger, more female, more literate and with a greater proportion of members living outside the household and being non-family. There was a positive association between child's height-for-age Z-score and mother's network size and network literacy rate. The association with network literacy was stronger among the poorest households. Women commonly reported seeking or receiving health advice from network members.CONCLUSION: Big and literate social networks are associated with better child nutrition, especially among the poor. The dissemination of health knowledge between network members is a plausible way in which social networks benefit child nutrition in India. Further research into the underlying mechanisms is necessary to inform the development of interventions that channel health information through word of mouth to the most excluded and vulnerable families.     

The Public Health Nutrition workforce and its future challenges: the US experience

OBJECTIVES: To describe the US public health nutrition workforce and its future social, biological and fiscal challenges. DESIGN: Literature review primarily for the four workforce surveys conducted since 1985 by the Association of State and Territorial Public Health Nutrition Directors. SETTING: The United States. SUBJECTS: Nutrition personnel working in governmental health agencies. The 1985 and 1987 subjects were personnel in full-time budgeted positions employed in governmental health agencies providing predominantly population-based services. In 1994 and 1999 subjects were both full-time and part-time, employed in or funded by governmental health agencies, and provided both direct-care and population-based services. RESULTS: The workforce primarily focuses on direct-care services for pregnant and breast-feeding women, infants and children. The US Department of Agriculture funds 81.7 % of full-time equivalent positions, primarily through the WIC Program (Special Supplemental Nutrition Program for Women, Infants, and Children). Of those personnel working in WIC, 45 % have at least 10 years of experience compared to over 65 % of the non-WIC workforce. Continuing education needs of the WIC and non-WIC workforces differ. The workforce is increasingly more racially/ethnically diverse and with 18.2 % speaking Spanish as a second language. CONCLUSIONS: The future workforce will need to focus on increasing its diversity and cultural competence, and likely will need to address retirement within leadership positions. Little is known about the workforce's capacity to address the needs of the elderly, emergency preparedness and behavioural interventions. Fiscal challenges will require evidence-based practice demonstrating both costs and impact. Little is known about the broader public health nutrition workforce beyond governmental health agencies.     

Public health nutrition practice in Canada: a situational assessment

OBJECTIVE: Renewed focus on public health has brought about considerable interest in workforce development among public health nutrition professionals in Canada. The present article describes a situational assessment of public health nutrition practice in Canada that will be used to guide future workforce development efforts. METHODS: A situational assessment is a planning approach that considers strengths and opportunities as well as needs and challenges, and emphasizes stakeholder participation. This situational assessment consisted of four components: a systematic review of literature on public health nutrition workforce issues; key informant interviews; a PEEST (political, economic, environmental, social, technological) factor analysis; and a consensus meeting. FINDINGS:Information gathered from these sources identified key nutrition and health concerns of the population; the need to define public health nutrition practice, roles and functions; demand for increased training, education and leadership opportunities; inconsistent qualification requirements across the country; and the desire for a common vision among practitioners. CONCLUSIONS: Findings of the situational assessment were used to create a three-year public health nutrition workforce development strategy. Specific objectives of the strategy are to define public health nutrition practice in Canada, develop competencies, collaborate with other disciplines, and begin to establish a new professional group or leadership structure to promote and enhance public health nutrition practice. The process of conducting the situational assessment not only provided valuable information for planning purposes, but also served as an effective mechanism for engaging stakeholders and building consensus.     

Effectiveness of a community-based intervention to improve nutrition in young children in Senegal: a difference in difference analysis

There are few studies of community growth promotion as a means of addressing malnutrition that are based on longitudinal analysis of large-scale programmes with adequate controls to construct a counterfactual. The current study uses a difference in difference comparison of cohorts to assess the impact on the proportion of underweight children who lived in villages receiving services provided by the Senegal Nutrition Enhancement Project between 2004 and 2006. The project, designed to extend nutrition and growth promotion intervention into rural areas through non-governmental organisation service providers, significantly lowered the risk of a child having a weight more than 2 sd below international norms. The odds ratio of being underweight for children in programme villages after introduction of the intervention was 0.83 (95% CI 0.686, 1.000), after controlling for regional trends and village and household characteristics. Most measured aspects of health care and health seeking behaviour improved in the treatment relative to the control.     

Role of India's Anganwadi Center in Securing Food and Nutrition for Mothers and Children

India's 2013 National Food Security Act identifies Anganwadi centers (the courtyard shelter) as responsible for ensuring the food and nutrition for mothers and children. This article proposes four essential reforms that must take place to revitalize the languishing Anganwadi system: (a) strengthen implementation of the Integrated Child and Development Services (ICDS) through greater outreach and education; (b) boost incentives for Anganwadi workers and Anganwadi health workers; (c) bring together different government stakeholders to provide the integrative framework needed; and (d) improve monitoring and evaluation of Anganwadis so as to better gauge not just performance of workers, but also health and nutrition outcomes among women and children.     

Responding to the crisis in sub-Saharan Africa: the role of nutrition

In the chapter dealing with education and health, the report of the influential Commission for Africa prioritises basic health systems, HIV/AIDS, malaria and tuberculosis. In contrast, nutrition is given less than half a page and is reduced to parasite control and micronutrient support. Such neglect of nutrition is hard to understand in the context of increasing hunger and malnutrition across the continent. Sub-Saharan Africa is the only region in the world where the proportion of underweight children has stagnated and the absolute numbers have actually increased in the last decade. It has been pointed out that if current trends continue sub-Saharan Africa will achieve the Millennium Development Goal for child mortality around 2115 - one century after the target date. Quite clearly those concerned with nutrition need to more powerfully advocate the role of nutrition in lifting Africa out of the spiral of poverty. The present paper argues that to achieve this requires an understanding not just of the critical role of nutrition for health and development (both individual and national), but also of how recent global changes are interacting with changes in food production and supply, other determinants of maternal and child health, and the role and capacity of the state to tackle malnutrition in Africa. It concludes by suggesting some responses that nutritionists could now be making.     

土壤健康与农业绿色发展：机遇与对策

农业绿色发展是农业现代化的必由之路,土壤健康是农业绿色发展的基石。本文系统总结了国内外有关土壤健康的内涵、研究进展和发展趋势,探讨了提升土壤健康的途径和对策,并对我国未来健康土壤培育工程提出了建议和展望。健康土壤培育的核心是消除土壤障碍因子,深入挖掘土壤生物学潜力,增碳提高资源效率,强化生物学过程,协同地上和地下生物互作。通过优化土壤内部调节过程,最小化外部的投入,以实现土壤生产功能和其他生态服务的同步提升。健康土壤的培育是一个系统工程,需要对投入品-生产过程-产品品质-产品加工-废弃物循环等全产业链进行系统综合考虑,多学科交叉创新,政产学研用一体化联合攻关,同时还需要政策保障和激励措施,需要全社会行动起来。     

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.     

Assessment of Turkish women's knowledge concerning folic acid and prevention of birth defects

OBJECTIVES: In Turkey, the incidence of neural tube defects (NTDs) is 30.1 per 10,000 births. For this reason it seems an important problem for women of childbearing age. Adequate periconceptional consumption of folic acid could prevent NTDs. Most women are unaware of this recommendation. The objectives of this study were to evaluate women' knowledge and beliefs with regard to folic acid, and to estimate the consumption frequency of vitamin supplements periconceptionally and during the first trimester of pregnancy. DESIGN: Eight hundred and eighteen married women who had delivered a live-born infant within the previous 12 months completed the questionnaire. Each subject participated in a 20-minute interview, with the questionnaire comprising multiple-choice statements. A random sample of 10 public health centres was drawn from 27 in three districts in Konya where about 50% of the population lives. RESULTS: Only 22% of subjects had heard or read about folic acid. Thirteen per cent of women indicated knowledge of the direct link between folic acid supplementation and NTD prevention. The knowledge was greatest among 26- to 35-year-olds. Women with a university degree were more likely to have heard about folic acid than were less-educated women. CONCLUSION: The results indicate that further government efforts are needed to inform the population and promote the optimal use of folic acid supplements and folate-enriched foods. It is the responsibility of national authorities to increase health education concerning folic acid and the prevention of NTDs in their countries.     

Vitamin A deficiency and child mortality in Mozambique

BACKGROUND: In areas where vitamin A deficiency (VAD) is prevalent, vitamin A repletion reduces child mortality by 23% on average. OBJECTIVES: To estimate the potential child survival benefits of policies and programmes aimed at controlling VAD in Mozambique, and to make policy and programme recommendations. METHODS: The potential contribution of VAD to child mortality in Mozambique was estimated by combining the observed VAD prevalence in the under-5s (71.2%), the measured child mortality effects of VAD (risk of death in children with VAD=1.75 times higher than in children without VAD) and the observed under-5 mortality rate in the country (210 per 1000 live births). RESULTS: In Mozambique, an estimated 2.3 million children below the age of 5 years are vitamin-A-deficient. In the absence of appropriate policy and programme action, VAD will be the attributable cause of over 30,000 deaths annually in the under-5s. This represents 34.8% of all-cause mortality in this age group. DISCUSSION: Vitamin A supplementation (VAS) has been adopted as a short- to medium-term strategy to control VAD in children, and is integrated into routine child health services. However, the last VAS coverage survey showed that only 46% of children received a vitamin A supplement in the 6 months preceding the survey. If VAS coverage is to increase significantly in the foreseeable future, four areas appear to be of paramount importance: (1) reduce missed opportunities for VAS such as visits of sick children to child health services and community outreach activities; (2) take advantage of all potential opportunities for accelerating VAS coverage, such as additional vaccination campaigns and emergency response activities; (3) strengthen health workers' training, supervision and monitoring skills; and (4) increase community demand for VAS of children. Biannual VAS, as the primary component of an integrated strategy for VAD control in children, has the promise to be among the most cost-effective/high-impact child survival interventions in Mozambique.     

Television advertising and children: lessons from policy development

AIM: To conduct a policy review of the regulations related to food advertising on television aimed at children. DESIGN: The study consisted of documentary analysis of relevant legislation and policy documents related to children's advertising from both industry and non-governmental organisations at a global level and in 20 countries. This was supported with semi-structured telephone interviews with individuals from 11 countries. RESULTS: The initial findings resulted in a listing of regulatory impacts from which we developed a taxonomy of regulatory schemes. There was a tension between the development of legislation to cover this area and the use of voluntary agreements and codes. This tension represents a food industry/civic society split. The food and advertising industries are still engaged in a process of denying the impact of advertising on food choice and children as well as commissioning their own research. Outright bans are unusual, with most countries addressing the situation through voluntary agreements and self-regulation. We found a deep division over the way forward and the role and place of legislation. Policy-makers expressed concerns that national legislation was increasingly less relevant in dealing with broadcast media transmitted from outside national boundaries and therefore not subject to the receiving countries' laws but to the laws of the country from which they were transmitted. CONCLUSIONS: The options for the regulation of advertising targeted at children range from (1) a complete ban on advertising as in the case of Sweden, through (2) partial restrictions on advertising by type of food, target group or limits on the amount of advertisements or times shown, to (3) continuation of self-regulation by the advertising and food industries. There is a global dimension to regulation that needs to be built in, as national frontiers are no barriers to broadcast media and public health nutrition needs to ensure that its concerns are heard and addressed.     

Tillage and the environment in sub-tropical Australia—Tradeoffs and challenges

Tillage is defined here in a broad sense, including disturbance of the soil and crop residues, wheel traffic and sowing opportunities. In sub-tropical, semi-arid cropping areas in Australia, tillage systems have evolved from intensively tilled bare fallow systems, with high soil losses, to reduced and no tillage systems. In recent years, the use of controlled traffic has also increased. These conservation tillage systems are successful in reducing water erosion of soil and sediment-bound chemicals. Control of runoff of dissolved nutrients and weakly sorbed chemicals is less certain. Adoption of new practices appears to have been related to practical and economic considerations, and proved to be more profitable after a considerable period of research and development. However there are still challenges. One challenge is to ensure that systems that reduce soil erosion, which may involve greater use of chemicals, do not degrade water quality in streams. Another challenge is to ensure that systems that improve water entry do not increase drainage below the crop root zone, which would increase the risk of salinity. Better understanding of how tillage practices influence soil hydrology, runoff and erosion processes should lead to better tillage systems and enable better management of risks to water quality and soil health. Finally, the need to determine the effectiveness of in-field management practices in achieving stream water quality targets in large, multi-land use catchments will challenge our current knowledge base and the tools available.     

Soil degradation and mitigation in agricultural lands in the Indian Anthropocene

Current widespread and intensive soil degradation in India has been driven by unprecedented levels of population growth, large-scale industrialization, high-yield agriculture, urban sprawl and the spread of human infrastructure. The damage caused to managed and natural systems by soil degradation threatens livelihoods and local services and leads to national socio-economic disruption. Human-induced soil degradation results from land clearing and deforestation, inappropriate agricultural practices, improper management of industrial effluents and wastes, careless management of forests, surface mining, urban sprawl, and ill-planned commercial and industrial development. Of these, inappropriate agricultural practices, including excessive tillage and use of heavy machinery, over-grazing, excessive and unbalanced use of inorganic fertilizers, poor irrigation and water management techniques, pesticide overuse, inadequate crop residue and/or organic carbon inputs, and poor crop cycle planning, account for nearly 40% (121 Mha) of land degradation across India. Globally, human activities related to agriculture contribute to the transgression of four of the nine Planetary Boundaries proposed by Rockström et al. (2009): Climate Change, Biodiversity Integrity, Land-system Change, and altered Phosphorus and Nitrogen Biogeochemical Flows. This review focuses on how knowledge of soil processes in agriculture has developed in India over the past 10 years, and the potential of soil science to meet the objectives of the United Nations' Sustainable Development Goal 2: Zero Hunger (End hunger, achieve food security, improved nutrition and promote sustainable agriculture), using the context of the four most relevant Planetary Boundaries as a framework. Solutions to mitigate soil degradation and improve soil health in different regions using conservation agricultural approaches have been proposed. Thus, in this review we (1) summarize the outputs of recent innovative research in India that has explored the impacts of soil degradation on four Planetary Boundaries (Climate Change, Biodiversity Loss, Land-system Change, and altered Biogeochemical Flows of Phosphorus and Nitrogen) and vice-versa; and (2) identify the knowledge gaps that require urgent attention to inform developing soil science research agendas in India, to advise policy makers, and to support those whose livelihoods rely on the land.     

Increasing activity and improving nutrition through a schools-based programme: Project Energize. 1. Design, programme, randomisation and evaluation methodology

Project Energize is a through-school nutrition and activity programme that is being evaluated in a 2-year, cluster-randomised, longitudinal study. The present paper describes the background of the programme and study, the programme development and delivery, the study methodology including randomisation, measurement and analysis tools and techniques, and the mix of the study population. The programme is being delivered to sixty-two primary schools with sixty-two control schools, each limb containing about 11 000 students. The children in the evaluation cohort are 5 or 10 years old at enrolment; the randomisation protocol has achieved post-consent enrolment of 3000 evaluation participants, who are comparable by age, sex and school decile. End-point measures include body composition and associated physical characteristics, fitness, home and school environment and practice.     

Future Testing Opportunities to Ensure Sustainability of the Biofuels Industry

For the soil and plant analysis community, development and expansion of biofuels will create many opportunities to provide a wide variety of analytical services. Our objective is to explore potential areas where those services could be marketed to support sustainable development of biofuels. One of the first is to provide soil fertility and plant nutrition information for sustainable feedstock production. Chemical, physical, and biological indicators of soil quality should also be monitored and interpreted using tools such as the soil management assessment framework (SMAF) to ensure soil resources can continue to meet global food, feed, and fiber demands as well as the new demands for biofuels. Feedstock sugar profile information will be needed to help manage conversion processes, calculate economic drivers such as the minimum ethanol selling price (MESP), and determine suitability for other bioproducts. There will also be an increasing need to evaluate a variety of coproducts created by corn (Zea mays) milling, soybean (Glycine max Merr.) processing, and the fledgling lignocellulosic conversion processes. For coproducts produced from wet or dry corn milling and dry grind ethanol production, accurate and efficient analysis and digestibility of fiber components [neutral detergent fiber (NDF), acid detergent fiber (ADF), and total dietary fiber (TDF)], amino acids (lysine, trypotophan, and methionine), fatty acids, and minerals (phosphorus and sulfur) will be needed. In addition, a capacity to accurately and rapidly detect contamination by mycotoxins such as aflatoxin, zearalenone, and fumonisisn or the presence of antibiotics such as penicillin or virginiamycin could potentially be important. For the biodiesel industry, methanol concentrations in crude glycerin must be reduced to meet Food and Drug Administration guidelines and quantified to ensure this coproduct is safe for use in livestock feeds. Finally, monitoring for several processes and coproducts associated with pyrolysis, a thermochemical platform for biomass conversion to bio-oils, biochar, and other products will be needed. We conclude that sustainable development of biofuel industries will have many positive benefits for soils, plant, and animal production systems and the analysts who will provide analytical services for monitoring all aspects of the biofuels industry.     

Balanced and integrated nutrient management for enhancedand economic food production: case study from rainfed semi-arid tropics in India

Soil degradation in the semi-arid tropics (SAT) is mainly responsible for low crop and water productivity. In Madhya Pradesh and Rajasthan states in India, the soil analyses of farmers’ fields revealed widespread deficiencies of S (9–96%), B (17–100%) and Zn (22–97%) along with that of P (25–92%). Soil organic C was deficient in 7–84% fields indicating specifically N deficiencies and poor soil health in general. During on-farm evaluations in rainy seasons 2010 and 2011, the soil test based addition of deficient nutrient fertilizers as balanced nutrition (BN) increased crop yields by 6–40% (benefit to cost ratios of 0.81–4.28) through enhanced rainwater use efficiency. The integrated nutrient management (INM), however, decreased the use of chemical fertilizers in BN by up to 50% through on-farm produced vermicompost and recorded yields at par or more than BN with far better benefit to cost ratios (2.26–10.2). Soybean grain S and Zn contents improved with INM. Applied S, B, Zn and vermicompost showed residual benefits as increased crop yields for succeeding three seasons. Hence, results showed INM/BN was economically beneficial for producing more food, while leading to resilience building of SAT production systems.     

The role of mentoring in public health nutrition workforce development. Perspectives of advanced-level practitioners

OBJECTIVE: To explore the nature, role and utility of mentoring in the development of competence in advanced-level Australian public health nutritionists. DESIGN: Qualitative study using in-depth interviews. SUBJECTS AND SETTING: Eighteen advanced-level public health nutritionists working in academic and practice settings in Australia. RESULTS: The attributes and career pathways of the subjects were consistent with previous findings. Dissatisfaction with clinical practice was a key reason for choosing a career in public health. Experiential learning, postgraduate education and mentoring from both peers and senior colleagues were the most significant contributors to competency development. The subjects supported mentoring as an important strategy for public health nutrition workforce development and articulated the characteristics and models important for mentoring relationships in public health nutrition. CONCLUSIONS: The present study suggests mentoring was an important part of competency development for advanced-level public health and community nutritionists in Australia. Mentoring programmes based on experiential learning may assist in developing public health nutrition workforce competence.