The study findings suggest that although WV nutrition interventions have shown impact, there is also a nonnutritional pathway of child stunting in rural Armenia. Thus, antistunting interventions should include sanitation and hygienic measures along with adequate perinatal care and maternal and child nutrition to further reduce childhood stunting, ensuring long-term health benefits for children not only in rural Armenia but also in rural communities in other low/middle-income countries.

Objective: Despite the trend of increasing prevalence of childhood anaemia in Armenia, no studies exploring its risk factors have been conducted in the country. The present study aimed to investigate the prevalence and determinants of childhood anaemia in rural Armenia. Design: Blood Hb level was measured among a representative sample of children using the HemoCue Hb201 + analyser. The revealed cases with anaemia were compared with randomly selected non-anaemic controls. Mothers of cases and controls were interviewed. Logistic and linear regression models were fitted to identify the risk factors of anaemia and low Hb level, respectively. Setting: Talin communities, Aragatsotn Province, Armenia. Subjects: Children under 5 years of age in Talin region. Results: Of the 729 studied children, 32·4 % were anaemic with 14·7 % having moderate/severe anaemia. Infants were the most affected group with 51·1 % being anaemic before 6 months and 67·9 % at 6-12 months of age. Fitted regression models identified the following predictors of anaemia: younger age, male gender, shorter birth length, anaemia during pregnancy, lower meal frequency per day, lack of meat in the diet, using dung cakes for heating and living in a community that received an incomplete set of nutrition interventions. Conclusions: The study identified several modifiable risk factors that could be targeted to reduce childhood anaemia in rural Armenia and, possibly, in rural areas in other low-/middle-income countries. The suggested interventions include prevention and treatment of anaemia during pregnancy, provision of adequate complementary feeding to children with inclusion of meat in their daily diet and reduction of their exposure to biomass fuel smoke.

The latest evidence demonstrates the importance of nurturing care from conception to lay a strong foundation for children's cognitive, socio-emotional and physical well-being. The interventions enhancing parental practices in children's health and growth, protection from neglect, abuse, and injury have lifelong impact on health, learning, economic productiveness outcomes. Existing maternal and child health delivery platforms might potentially be utilized to integrate Early Childhood Development interventions. However, there is a dearth of studies demonstrating the feasibility and effectiveness of an integrated MCH and ECD model. ECD component was integrated into MCH program activities, implemented and tested in Armenia. For 14 months, all mothers of children aged 0 to 23 months (1300) living in 43 communities in Gegharkunik province (Armenia) participated in the study. Twenty-three intervention communities (680 children) received added ECD package to MCH intervention, and 20 control communities (630 children) received only MCH intervention. We used a quasi-experimental intervention-control design, with pre-and post-data collected. Variables measured and compared were related to child development, nutrition status, parental child care (stimulation, discipline) and nutrition practices. Intervention sites showed 83% higher odd of total ECD composite score (cognitive, language, motor) compared to children in the control sites. Child caregivers had better child care, nutrition practices and early learning support than controls. No change was found in discipline practices and stunting rates. MCH-ECD integrated model is an effective delivery platform for improving parenting behavior, child growth, and development.

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Background The objective of the study to determine if a nurturing care parenting programme delivered in a humanitarian setting in Rwanda to determine would benefit early development, learning and care outcomes for young children under 5 years and their caregivers compared to standard care. Methodology The parenting programme was implemented in Rwanda’s Mugombwa, Kansi and Kigeme refugee camp and host communities. Via a quasi-experimental research design, the study assessed the effects of intervention delivered as high dose (HD: 12 group sessions and 4 home visits) or low dose (LD: 6 group sessions and 2 home visits) on child and caregiver outcomes compared to the control group from similar settings receiving standard care. Child development outcomes were assessed using the Ages and Stages Questionnaires (ASQ). Parenting practices with respect to early learning and stimulation were assessed using standard questionnaires. Findings A total of 733 children and families were assessed: HD = 314, LD = 240, control = 179. No significant difference on child development scores between intervention and control groups was found. Caregivers exposed to HD and LD packages had significantly higher scores on early learning and stimulation practices compared to the control group respectively with 211(67.2%), 148 (61.7%) vs. 66 (36.9%), p < .001 caregivers engaged in 4 or more activities in the past 3 days. Similarly on responsive feeding items, a higher percentage of HD and LD group caregivers were engaged in positive behaviours compared to control group: 164 (52.2%), 108 (45%) vs 62 (34.6%), p = 0.001. No differences were found in the study arms in regard to caregiver mental health. Conclusion Parenting programmes in humanitarian settings can positively impact on nurturing care practices, even with a low dose, which are essential to strengthening children’s resilience living in at-risk conditions such as refugee settings. Further studies in such context are essential to strengthen the proof of concept from the study findings.