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BackgroundThe association of early maternal birthing age with smaller children has been widely observed. However, it is unclear if this is due to confounding by factors such as socioeconomic status, or the age at which child growth restriction first occurs.ObjectiveTo examine the effect of early maternal birthing age on the first-born child's height-for-age in a sample of developing countries in Africa, Asia, and Latin America.DesignCross-sectional data from Demographic Health Surveys from 18 countries were used, to select the first-born child of mothers aged 15–24 years and a range of potential confounding factors, including maternal height. Child length/height-for-age z-scores (HAZs) was estimated in age bands of 0–11, 12–23, 24–35, 36–47, and 48–59 months; HAZ was first compared between maternal age groups of 15–17, 18–19, and 20–24 years.Results1) There were significant bivariate associations between low child HAZ and young maternal age (71 of 180 possible cases; at p<0.10), but the majority of these did not persist when controlling for confounders (41 cases, 23% of the 180). 2) For children <12 months, when controlling for confounders, three out of seven Asian countries showed a significant association between lower infant HAZ and low maternal age, as did six out of nine African countries (15–17 or 15–19 years vs. the older group). 3) The association (adjusted) continued after 24 months in 12 of the 18 countries, in Africa, Asia, and Latin America. 4) The stunting differences for children between maternal age groups were around 9 percentage points (ppts) in Asia, 14 ppts in Africa, and 10 ppts in Latin America. These data do not show whether this is due to, for example, socioeconomic factors that were not included, an emerging effect of intrauterine growth restriction, or the child feeding or caring behaviors of young mothers. The latter is considered to be the most likely.ConclusionsThe effect of low maternal age on child height restriction from 0 to 11 months occurred in half the countries studied after adjusting for confounders. Poorer growth continuing after 24 months in children of younger mothers was observed in all regions, but needs further research to determine the causes. The effects were about double (in stunting prevalence terms) in Africa, where there was an increase in 10 ppts in stunting for children of young mothers.

Objectives We conducted a process evaluation to examine the perceptions of program implementers, community leaders, and beneficiaries to assess the intervention's acceptability and to document how multisectoral agricultural livelihood interventions were implemented. Methods Interventions were implemented from March 2019 to March 2020 in 30 unions of three Bangladeshi districts. Delivered by community partners, interventions aimed to improve health and nutrition service utilization, social and behavior change regarding infant and young child feeding (IYCF), and homestead food production (through community farmers or private sector agro-input retailers) among poor mothers of under-two children. Leveraging the RE-AIM framework, we evaluated implementation through in-depth interviews with service providers (n = 13), focus group discussions with beneficiaries (8 sessions), and process documentation (12 events). Results Most service providers, community leaders, and beneficiaries expressed satisfaction with interventions and a desire to continue participation. Beneficiaries especially appreciated the health and nutrition education provided through different formats, including mothers' group meetings, voice messages, home visits, counseling at health facilities, and education on food production by community farmers or retailers. Additionally, beneficiaries described increased health knowledge and highly valued material benefits offered through vegetable seeds and poultry rearing inputs. Beneficiaries appreciated retailers' support to grow vegetables and raise chickens and awareness efforts on the importance of good nutrition and IYCF practices. However, findings suggested community farmers offered more interpersonal support than retailers. Service providers noted the importance of sustained community engagement. Conclusions Findings suggest that tested interventions combining food production with health and nutrition education are a viable, acceptable approach to promoting improved IYCF practices. Existing community-based organizations can reach vulnerable households with multisectoral nutrition approaches. Funding Sources United States Agency for International Development (USAID).

Objectives The USAID's Strengthening Multisectoral Nutrition Programming through Implementation Science Activity (MSNP) in Bangladesh gathered local knowledge to augment national data to ensure nutrition programming delivery was appropriately targeted. Such knowledge allowed MSNP's social protection conditional cash transfer (CCT) activity to reach most at-risk individuals. Methods Using structured field observation forms, six trained staff documented nutrition programming decision-making processes and MSNP project activities regarding appropriate beneficiary targeting in six districts. Numerous project documents were reviewed and site visits conducted to evaluate CCT implementation in action. Data were coded into three aspects of learning (challenges and methods to alleviate them, successes, and recommendations for future programming) and analyzed according to themes identified in research utilization literature. Results CCT, an incentive-based delivery mechanism targeting women based on locally collected data, positively influenced household decision-makers, including women, to provide effective health and nutrition care for themselves and their children. CCT, received upon completion of antenatal care visits and participation in nutrition education sessions, effectively supported the uptake of MSNP community workers’ nutrition advice led to improve water, sanitation, and hygiene practices in remote areas. Requiring CCT beneficiaries to open bKash accounts to ensure financial transparency and that funds reached the intended participants helped establish women as nutrition decision makers, improving financial inclusion for extreme-poor women. Conclusions CCT stimulates use of nutrition and health services, increasing household resources for nutrition-related behaviors and allowing women to exercise financial freedom. To improve evidence utilization in nutrition programming, national indicators must be complemented with local knowledge gathering processes, with local stakeholders and beneficiaries involved to ensure appropriate targeting and to transform knowledge into practice. Funding Sources United States Agency for International Development (USAID).

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