BackgroundStunting affects child survival and is a key indicator of child well-being. Therefore, reducing stunting is a global goal. Improving infant and young child feeding (IYCF) practices is a recommended approach to reduce the risk of mortality and ameliorate nutritional status. Behavioural change interventions have the potential to improve IYCF practices.MethodsWe evaluated the effectiveness of an innovative behavioural change strategy on caregiver’s knowledge, IYCF practices and nutritional status of children from low-income households in El Alto, Bolivia. Home visits used culturally adapted participatory play strategies to promote recommended IYCF practices. A total of 2014 households with children younger than 12 months at baseline were randomly assigned to treatment and control groups.FindingsCaregiver knowledge and IYCF practices improved by 0.2 SD, as did food expenditures on recommended foods and dietary diversity. No significant effects were detected on anthropometric indicators or anaemia. Treatment compliance was 88% of households at enrolment and 66% at completion.InterpretationParticipatory play-based behavioural change strategies are a promising delivery model to improve recommended IYCF practices. After 30 months of intervention, we found sustained positive effects on caregiver’s knowledge and IYCF practices but no effect on nutritional status. Despite the lack of effect on linear growth and anaemia, our results highlight the relevance of implementing interventions that improve IYCF practices due to their importance for early development and prevention of obesity. Other contextual variables, apart from diet, that could be limiting children’s growth potential in this population need to be identified to design holistic approaches that improve child well-being and human capital.
Background Body image concerns are prevalent among Brazilian adolescents and can lead to poor psychological and physical health. Yet, there is a scarcity of culturally-appropriate, evidence-based interventions that have been evaluated and made widely available. Chatbot technology (i.e., software that mimics written or spoken human speech) offers an innovative method to increase the scalability of mental health interventions for adolescents. The present protocol outlines the co-creation and evaluation of a body image chatbot for Brazilian adolescents via a partnership between academics, industry organisations and the United Nations Children’s Fund (UNICEF). Methods A two-armed fully remote randomised controlled trial will evaluate the chatbot’s effectiveness at improving body image and well-being. Adolescent girls and boys (N = 2800) aged 13–18 years recruited online will be randomly allocated (1:1) into either: 1) a body image chatbot or 2) an assessment-only control condition. Adolescents will engage with the chatbot over a 72-hour period on Facebook Messenger. Primary outcomes will assess the immediate and short-term impact of the chatbot on state- and trait-based body image, respectively. Secondary outcomes will include state- and trait-based affect, trait self-efficacy and treatment adherence. Discussion This research is the first to develop an evidence-informed body image chatbot for Brazilian adolescents, with the proposed efficacy trial aiming to provide support for accessible, scalable and cost-effective interventions that address disparities in body image prevalence and readily available resources. Trial registration number NCT04825184, registered 30th March 2021.
Características de la vivienda Vivienda.-Mayoritariamente sobresalen las casas como tipo de vivienda en el 24% de los casos, con una marcada incidencia de declaración de cuartos o habitaciones sueltas del 73%. La incidencia de piso de material firme es del 93% entre los hogares. Un 85% de los hogares utiliza gas licuado a través de garrafa para cocinar. Agua, saneamiento y condiciones del ambiente Acceso a agua.-El 81% de los hogares cuenta con acceso para consumo y uso en el hogar a través de agua de red provista por EPSAS en el Alto. Consultados sobre las acciones de tratamiento del agua para beber, los hogares respondieron en un 56% de los casos que utilizan el agua tal como la obtienen. El 44% respondió utilizar filtros antes de consumir el agua. Saneamiento.-La posesión de baño o letrina alcanza el 85% de los hogares en la zona del Distrito 8. Para el desagüe de los desechos, prevalecen la utilización de pozos ciegos (88%) y cámaras sépticas (11%). Una amplia mayoría de hogares declara que vierte los desechos de las aguas originadas en la cocina directamente a la calle (85%). Conocimiento de las madres en cuidados de nutrición y salud Nutrición.-En lactancia, al ser consultadas sobre el tiempo después del parto en que se debe iniciar la lactancia en los niños, el 79% respondió "inmediatamente". Sobre la duración de la lactancia, en promedio, para las madres encuestadas, se extiende hasta los 7.55 meses de edad. Se identificó la edad de inicio de la alimentación complementaria a los 6.19 meses de edad. Prácticas de alimentación en el hogar Lactancia.-En términos de lactancia materna al momento del nacimiento, se observa un inicio temprano de la lactancia materna dentro de la primera hora de vida en un 76.77% de los casos. Según la medición de práctica de lactancia exclusiva en niños hasta los 6 meses de edad, encontramos que, ante la condición rigurosa de exclusividad, la proporción de niños con lactancia exclusiva es casi 0 en esta población. Alimentación complementaria.-En términos de introducción de alimentos sólidos, semisólidos y suaves, un 78% de los niños entre 6 y 8 meses ya comienzan a ingerir estos tipos de alimentos en su alimentación. El 80.23% de los niños entre 6 y 23 meses mantiene una dieta alimentaria mínimamente diversa, que incluye 4 o más grupos alimentarios. Antropometría Desnutrición crónica.-La encuesta detectó una prevalencia de desnutrición crónica de 21% entre menores de 36 meses. Riesgo de obesidad.-La prevalencia de sobrepeso es de 3% de la población, mientras que la prevalencia de obesidad es 1% de la población. Los datos de antropometría fueron recolectados sobre una muestra de niños menores a 36 meses de edad. Salud en niños Prevalencia de diarrea.-La encuesta mide la prevalencia autorreportada de diarrea en niños menores a 36 meses. La proporción de niños que reportan haber sufrido un episodio de diarrea en las últimas 2 semanas es del 18%. Y en estos casos, el número de días que le duró la diarrea asciende a 4.45 en promedio.
Interventions that offer growth monitoring and nutrition counseling services to families with young children are one of the cornerstones of nutrition policy in developing countries. By raising caregivers’ awareness and encouraging recommended feeding, health, and hygiene practices, these programs seek to improve children’s growth, measured in terms of height and weight. We explore the effects of one such intervention that conducted home visits and community meetings with mothers of children under two years old in El Alto, a city of high poverty concentration in Bolivia. Project eligibility was limited to just over 400 households residing within a strictly defined geographical area. We exploit the resulting geographical discontinuity to identify impacts. Three years after the project started, we find that caregivers in the intervention area show substantial gains in health- and nutrition-related knowledge (0.327s) and practices (0.273s) relative to their peers just outside the project boundary. We find no detectable impacts on children’s height, but observe a significant increase in the prevalence of overweight children. For contexts such as El Alto, with high prevalence of stunting and increasing risk of overweight in the same population, these results suggest that nutrition promotion interventions should reassess both content and behavioral change strategies to reduce stunting while concurrently preventing excess weight gain in children. JEL codes: I15, J13, C93
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