No abstract

The objective of this review was to assess the impact of lifestyle interventions (including dietary interventions, physical activity, behavioral therapy, or any combination of these interventions) to prevent and manage childhood and adolescent obesity. We conducted a comprehensive literature search across various databases and grey literature without any restrictions on publication, language, or publication status until February 2020. We included randomized controlled trials and quasi-experimental studies from both high income countries (HIC) and low-middle-income countries (LMICs). Participants were children and adolescents from 0 to 19 years of age. Studies conducted among hospitalized children and children with any pre-existing health conditions were excluded from this review. A total of 654 studies (1160 papers) that met the inclusion criteria were included in this review. A total of 359 studies targeted obesity prevention, 280 studies targeted obesity management, while 15 studies targeted both prevention and management. The majority of the studies (81%) were conducted in HICs, 10% of studies were conducted in upper middle income countries, while only 2% of the studies were conducted in LMICs. The most common setting for these interventions were communities and school settings. Evidence for the prevention of obesity among children and adolescents suggests that a combination of diet and exercise might reduce the BMI z-score (MD: −0.12; 95% CI: −0.18 to −0.06; 32 studies; 33,039 participants; I2 93%; low quality evidence), body mass index (BMI) by 0.41 kg/m2 (MD: −0.41 kg/m2; 95% CI: −0.60 to −0.21; 35 studies; 47,499 participants; I2 98%; low quality evidence), and body weight (MD: −1.59; 95% CI: −2.95 to −0.23; 17 studies; 35,023 participants; I2 100%; low quality evidence). Behavioral therapy alone (MD: −0.07; 95% CI: −0.14 to −0.00; 19 studies; 8569 participants; I2 76%; low quality evidence) and a combination of exercise and behavioral therapy (MD: −0.08; 95% CI: −0.16 to −0.00; 9 studies; 7334 participants; I2 74%; low quality evidence) and diet in combination with exercise and behavioral therapy (MD: −0.13; 95% CI: −0.25 to −0.01; 5 studies; 1806 participants; I2 62%; low quality evidence) might reduce BMI z-score when compared to the control group. Evidence for obesity management suggests that exercise only interventions probably reduce BMI z-score (MD: −0.13; 95% CI: −0.20 to −0.06; 12 studies; 1084 participants; I2 0%; moderate quality evidence), and might reduce BMI (MD: −0.88; 95% CI: −1.265 to −0.50; 34 studies; 3846 participants; I2 72%) and body weight (MD: −3.01; 95% CI: −5.56 to −0.47; 16 studies; 1701 participants; I2 78%; low quality evidence) when compared to the control group. and the exercise along with behavioral therapy interventions (MD: −0.08; 95% CI: −0.16 to −0.00; 8 studies; 466 participants; I2 49%; moderate quality evidence), diet along with behavioral therapy interventions (MD: −0.16; 95% CI: −0.26 to −0.07; 4 studies; 329 participants; I2 0%; moderate quality evidence), and combination of diet, exercise and behavioral therapy (MD: −0.09; 95% CI: −0.14 to −0.05; 13 studies; 2995 participants; I2 12%; moderate quality evidence) also probably decreases BMI z-score when compared to the control group. The existing evidence is most favorable for a combination of interventions, such as diet along with exercise and exercise along with behavioral therapy for obesity prevention and exercise alone, diet along with exercise, diet along with behavioral therapy, and a combination of diet, exercise, and behavioral therapy for obesity management. Despite the growing obesity epidemic in LMICs, there is a significant dearth of obesity prevention and management studies from these regions.

Introduction: Since decades, the health system of Afghanistan has been in disarray due to ongoing conflict. We aimed to explore the direct effects of conflict on provision of reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH&N) services and describe the contextual factors influencing these services. Method: We conducted a quantitative analysis of secondary data on RMNCAH&N indicators and undertook a supportive qualitative study to help understand processes and contextual factors. For quantitative analysis, we stratified the various provinces of Afghanistan into minimal-, moderate-and severe conflict categories based on battle-related deaths from Uppsala Conflict Data Program (UCDP) and through accessibility of health services using a Delphi methodology. The coverage of RMNCAH&N indicators across the continuum of care were extracted from the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Survey (MICS). The qualitative data was captured by conducting key informant interviews of multi-sectoral stakeholders working in government, NGOs and UN agencies. Results: Comparison of various provinces based on the severity of conflict through Delphi process showed that the mean coverage of various RMNCAH&N indicators including antenatal care (OR: 0.

Optimal nutrition plays a crucial role in pregnancy. Maternal malnutrition is a risk factor for maternal, fetal, and neonatal complications and is more prevalent in low and middle-income countries (LMICs). This review aims to study the effectiveness of antenatal macronutrient nutritional interventions on maternal, neonatal, and child outcomes. We searched the CENTRAL, PubMed, Embase, and other databases for randomized controlled trials and quasi-experimental designs on healthy pregnant women in LMICs. We also searched grey literature and reports from Google Scholar, Web of Science, and websites of different organizations. Title/abstract screening, full-text screening, and data extraction filtered 15 studies for inclusion. Balanced energy protein (BEP) supplementation (n = 8) studies showed a reduced incidence of perinatal mortality, stillbirths, low birth weight (LBW) infants, small for gestational age (SGA) babies and increased birth weight. Food distribution programs (FDPs) (n =5) witnessed reduced rates of SGA, stunting, wasting, and increased birth weight and birth length. Studies on intervention for obesity prevention (n = 2) showed reductions in birth weight. Other findings were statistically insignificant. Subgroup analyses were conducted to study the effectiveness of supplementation between regions, location, the timing of supplementation and nutritional status; however, there were a limited number of studies in each subgroup. Data from our review supports the antenatal supplementation of BEP and FDP for the prevention of adverse maternal, neonatal, and child outcomes that can be utilized for future policymaking. However, more research is required before recommending obesity prevention programs.Nutrients 2020, 12, 531 2 of 16 malnutrition in LMICs, with one study quoting rates from 20% in sub-Saharan Africa and south/central America to approximately 40% in India [3].Life course theory demonstrates the childhood experiences affecting health conditions at adulthood (e.g., diabetes, depression) [6]. Likewise, antenatal malnutrition forces a fetus to adapt to an environment of scarcity and, consequently, the adverse effects extend beyond the perinatal period and end up with the child having long-term chronic diseases such as cognitive dysfunction, obesity, diabetes mellitus, and hypertension. Conversely, evidence also suggests the harmful effects of overnutrition [7] in all phases of pregnancy. Nutrition transition has engulfed developing countries, which has caused reduced mortality leading to increased populations, followed by a decrease in fertility. The increase in intake of sugar and fats has also reduced physical activity, contributing to obesity in pregnant women that lead to complicated pregnancies, which also affects the neonate at birth and in future life [8]. It was found that obesity increases the risk of fetal macrosomia, stillbirth, congenital obesity [9][10][11], and infant mortality [12].Current guidelines have reported on the use and effectiveness of iron and other multi-nutrient formulations...

No abstract

Introduction: In conflict affected countries, healthcare delivery remains a huge concern. Pakistan is one country engulfed with conflict spanning various areas and time spans. We aimed to explore the effect of conflict on provision of reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH&N) services and describe the contextual factors influencing the prioritization and implementation in conflict affected areas of Pakistan (Balochistan and FATA). Method: We conducted a secondary quantitative and a primary qualitative analysis. For the quantitative analysis, we stratified the various districts/agencies of Balochistan and FATA into the conflict categories of minimal-, moderate-and severe based on accessibility to health services through a Delphi methodology with local stakeholders and implementing agencies and also based on battle-related deaths (BRD) information from Uppsala Conflict Data Program (UCDP). The coverage of RMNCAH&N indicators across the continuum of care were extracted from the demographic and health surveys (DHS) and district health information system (DHIS). We conducted a stratified descriptive analysis and multivariate analysis using STATA version 15. The qualitative data was captured by conducting key informant interviews of stakeholders working in government, NGOs, UN agencies and academia. All the interviews were audiotaped which were transcribed, translated, coded and analyzed on Nvivo software version 10.

Jai Das and colleagues present an innovative and evolutionary model of multistakeholder and multisectoral collaboration in scaling up coverage of health services in Afghanistan

Background: Optimal nutrition plays a crucial role in pregnancy. Poor maternal nutrition and maternal obesity has risk factors for serious fetal complications and neonatal outcomes, including intrauterine growth restriction, congenital abnormalities, stillbirth, low birth weight (LBW), preterm birth, fetal macrosomia, increased risk of neonatal infections, neonatal hypothermia, and neonatal death. The prevalence of maternal malnutrition is higher in low-and middle-income countries (LMICs) (10-19%) when compared with highincome countries, with variation by region and by country. Several behavioral interventions, including dietary control and exercise, have been found to reduce the risk of these adverse outcomes. However, none has reviewed dietary interventions to prevent maternal obesity in pregnant women.Objectives: The review aims to assess the effectiveness of balanced energy protein (BEP) supplementation, food distribution programs (FDPs), and dietary interventions to prevent maternal obesity during pregnancy on birth, child health, and developmental outcomes.Search Methods: We searched Cochrane Controlled Trials Register (CENTRAL), MEDLINE, Embase, CINAHL, and 12 other databases, and trials registers for ongoing studies up until April 2019. We also searched for gray literature from different sources and for citations on Google Scholar and Web of Sciences. We also checked the reference lists of included studies and relevant reviews and contacted the authors of studies for any ongoing and unpublished studies. The search was followed by title/abstract screening, full-text screening and data extraction. Selection Criteria: We included randomized control trials, and quasi experimental trials to evaluate the impact of nutritional interventions (BEP, FDP, and dietary interventions to prevent maternal obesity) compared to control or standard of care, among healthy pregnant women of any age living in LMICs.