Portion-size estimation training in second- and third-grade American Indian children.
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Training in portion-size estimation is known to improve the accuracy of dietary self-reporting in adults, but there is no comparable evidence for children. To obtain this information, we studied 110 second- and third-grade American Indian schoolchildren (34 control subjects were not trained), testing the hypotheses that a 45-min portion-size estimation training session would reduce children's food quantity estimation error, and that the improvement would be dependent on food type, measurement type, or both. Training was a hands-on, 4-step estimation and measurement skill-building process. Mixed linear models (using logarithmic-transformed data) were used to evaluate within- and between-group differences from pre- to posttest. Test scores were calculated as percentage estimation errors by difference and absolute value methods. Mean within-group estimation error decreased significantly (P<0.05) from pre- to posttest for 7 of 12 foods (trained group) by both calculation methods, plus 3 additional foods by the difference method and one additional food by the absolute value method. Significant (P<0.05) between-group differences occurred for 3 foods, reflecting a greater decrease in estimation error for the trained group. Improvement was greatest for solid foods estimated by dimensions (P>0.05) or in cups (P<0.05), for liquids estimated by volume or by label reading (P<0.001), and for one amorphous food estimated in cups (P<0.01). Despite these significant improvements in estimation ability, the error for several foods remained >100% of the true quantity, indicating that more than one training session would be necessary to further increase dietary reporting accuracy. (+info)
Culturally appropriate nutrition education improves infant feeding and growth in rural Sichuan, China.
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Chinese studies indicate that the growth of rural infants and children lags behind that of their urban counterparts after 4 mo of age and that the gap is widening. However, the rural areas are home to >85% of China's 300 million children. Clearly, culturally appropriate rural complementary feeding interventions are needed to close the growth and health gaps. After a 1990 survey of infants in rural Sichuan confirmed that poor infant feeding practices rather than inadequate household food resources were responsible for the growth faltering, a year-long community-based pilot nutrition education intervention (n congruent with 250 infants each in Education and Control groups) was undertaken in four townships. The goal was to improve infant growth by improving infant feeding practices. Features of the intervention included the training and mobilizing of village nutrition educators who made monthly growth monitoring and complementary feeding counseling visits to all pregnant women and families with infants born during the intervention in the study villages. After 1 y, the Education group mothers showed significantly higher nutrition knowledge and better reported infant feeding practices than their Control group counterparts. Also, the Education group infants were significantly heavier and longer, but only at 12 mo (weight-for-age -1.17 vs. -1.93; P = 0.004; height-for-age -1.32 vs. -1.96; P = 0.022), had higher breast-feeding rates overall (83% vs. 75%; P = 0.034) and lower anemia rates (22% vs. 32%; P = 0.008) than the Control group infants. We conclude that these methods have potential for adaptation and development to other rural areas in the county, province and nation. (+info)
Nutrition knowledge and food intake of seven-year-old children in an atherosclerosis prevention project with onset in infancy: the impact of child-targeted nutrition counselling given to the parents.
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OBJECTIVE: To compare nutrition knowledge and food intake in 7-y-old intervention and control children in an atherosclerosis risk factor intervention trial after 6.5 y of nutrition counselling given to the parents. DESIGN, SUBJECTS AND METHODS: Intervention families in the Special Turku Coronary Risk Factor Intervention Project received child-oriented nutritional counselling one to three times a year since child's age of 7 months, aimed at reduced saturated fat and cholesterol intake. Children's nutrition knowledge was analysed in a time-restricted cohort of 70 seven-y-old (34 boys) intervention children and 70 control children (40 boys) with a picture identification test. For comparison, children's food intake was evaluated using scores developed for the project that reflected quality and quantity of fat and quantity of salt in children's two or three 4-day food diaries recorded between 5.5 and 7 y of age. RESULTS: Child-targeted nutrition counselling of the intervention families only slightly increased intervention children's knowledge of heart-healthy foods (42.6% vs 34.9% correct answers by the intervention and control children, P = 0.057). Only < or = 20% of the children were able to adequately justify their answers in the test. The food diaries of the intervention children comprised more foods low in saturated fat and high in unsaturated fat than those of the control children (57.1% vs 41.7% of the maximum score for low fat foods, P = 0.0001; 48.9% vs 37.7% for high unsaturated fat foods, P = 0.0009, respectively), but the intervention and control children consumed similar amounts of low-salt foods (P = 0.23). Nutrition knowledge and food use scores correlated poorly (r = -0.20-0.35). CONCLUSIONS: Child-targeted nutrition counselling repeatedly given to the parents during and after child's infancy strongly influenced food choice scores of the 5.5-7-y-old children but failed to influence children's salt intake or scores in a nutrition knowledge picture test. (+info)
Evaluation of implementation and effect of primary school based intervention to reduce risk factors for obesity.
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OBJECTIVES: To implement a school based health promotion programme aimed at reducing risk factors for obesity and to evaluate the implementation process and its effect on the school. DESIGN: Data from 10 schools participating in a group randomised controlled crossover trial were pooled and analysed. SETTING: 10 primary schools in Leeds. PARTICIPANTS: 634 children (350 boys and 284 girls) aged 7-11 years. MAIN OUTCOME MEASURES: Response rates to questionnaires, teachers' evaluation of training and input, success of school action plans, content of school meals, and children's knowledge of healthy living and self reported behaviour. RESULTS: All 10 schools participated throughout the study. 76 (89%) of the action points determined by schools in their school action plans were achieved, along with positive changes in school meals. A high level of support for nutrition education and promotion of physical activity was expressed by both teachers and parents. 410 (64%) parents responded to the questionnaire concerning changes they would like to see implemented in school. 19 out of 20 teachers attended the training, and all reported satisfaction with the training, resources, and support. Intervention children showed a higher score for knowledge, attitudes, and self reported behaviour for healthy eating and physical activity. CONCLUSION: This programme was successfully implemented and produced changes at school level that tackled risk factors for obesity. (+info)
Randomised controlled trial of primary school based intervention to reduce risk factors for obesity.
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OBJECTIVE: To assess if a school based intervention was effective in reducing risk factors for obesity. DESIGN: Group randomised controlled trial. SETTING: 10 primary schools in Leeds. PARTICIPANTS: 634 children aged 7-11 years. INTERVENTION: Teacher training, modification of school meals, and the development of school action plans targeting the curriculum, physical education, tuck shops, and playground activities. MAIN OUTCOME MEASURES: Body mass index, diet, physical activity, and psychological state. RESULTS: Vegetable consumption by 24 hour recall was higher in children in the intervention group than the control group (weighted mean difference 0.3 portions/day, 95% confidence interval 0.2 to 0.4), representing a difference equivalent to 50% of baseline consumption. Fruit consumption was lower in obese children in the intervention group (-1.0, -1.8 to -0.2) than those in the control group. The three day diary showed higher consumption of high sugar foods (0.8, 0.1 to 1.6)) among overweight children in the intervention group than the control group. Sedentary behaviour was higher in overweight children in the intervention group (0.3, 0.0 to 0.7). Global self worth was higher in obese children in the intervention group (0.3, 0.3 to 0.6). There was no difference in body mass index, other psychological measures, or dieting behaviour between the groups. Focus groups indicated higher levels of self reported behaviour change, understanding, and knowledge among children who had received the intervention. CONCLUSION: Although it was successful in producing changes at school level, the programme had little effect on children's behaviour other than a modest increase in consumption of vegetables. (+info)
Knowledge, attitude and practice of health workers in Keffi local government hospitals regarding Baby-Friendly Hospital Initiative (BFHI) practices.
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OBJECTIVE: To assess the knowledge, attitude and practice of health workers towards Baby Friendly Hospital Initiative (BFHI) practices and thereafter plan an advocacy on BFHI training of the workers. DESIGN: A randomised cross-sectional study. SETING: Ten out of 16 health facilities reflecting all the levels of healthcare provision in Keffi Local Government Area in Nassarawa State, Nigeria, were selected. Staff of these health facilities had not received BFHI training, although breastfeeding is the norm in this population, exclusive breastfeeding is almost zero. SUBJECTS: A total of 250 health workers (six doctors, 160 nurses and 84 auxiliary staff) met in the health facilities at the time of interview. INTERVENTION: A structured questionnaire based on 10 steps to successful breastfeeding was administered by one of the authors and a Lactad nurse between July and October 1995. RESULTS: Fifty-two (20.8%) were aware of the need for initiating breastfeeding within 30 min of birth and 92 (36.8%) were aware of breastfeeding support groups. However, there were significant differences in the level of awareness among the doctors compared to the other categories of health staff (P<0.05). Also, 48 (19.2%) of the health workers believed that babies less than 6 months of age should not be given water (statistical difference (P<0.05) between doctors' attitude and that of the other health workers). Thirteen (5.22%) health workers could demonstrate correct positioning and attachment. CONCLUSION: There was general lack of awareness of some major recommended practices in the hospitals that will promote and sustain breastfeeding. There is therefore the need for policy changes and BFHI training for the staff of these health facilities to respond to the concern and growing need for proper infant/young child feeding. (+info)
An implementation framework for household and community integrated management of childhood illness.
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This paper describes the development and recent history of the third component of the Integrated Management of Childhood Illness (IMCI) strategy, improving household and community practices (HH/C IMCI). An implementation framework for this third component, developed through review of experiences of non-governmental organizations (NGOs) working in community-based child health and nutrition programmes, is then presented. This Framework responds to demand from NGOs and their partners for a description of the different categories of community-level activities necessary for the implementation of a comprehensive child health and nutrition programme. These categories of activities facilitate the systematic cataloguing, synthesis and coordination of organizational activities and experience. It also serves as a reference tool for improving communication of related community child health activities, and a guide for designing appropriate behaviour change strategies. The Framework was endorsed by participants in an international workshop held in Baltimore, Maryland in January 2001, and specified three linked elements that are integral to HH/C IMCI, supported by a multi-sectoral platform that addresses constraints communities face in adopting practices that promote health and nutrition. The three programmatic Elements critical to HH/C IMCI programmes are (1). improving partnerships between health facilities or services and the communities they serve; (2). increasing appropriate and accessible care and information from community-based providers; and (3). integrating promotion of key family practices critical for child health and nutrition. The Framework presented in this paper is an ideal tool for describing, sharing and coordinating efforts in the field, and is purposely descriptive rather than prescriptive. (+info)
Child participation in WIC: Medicaid costs and use of health care services.
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OBJECTIVES: We used data from birth certificates, Medicaid, and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to examine the relationship of child participation in WIC to Medicaid costs and use of health care services in North Carolina. METHODS: We linked Medicaid enrollment, Medicaid paid claims, and WIC participation files to birth certificates for children born in North Carolina in 1992. We used multiple regression analysis to estimate the effects of WIC participation on the use of health care services and Medicaid costs. RESULTS: Medicaid-enrolled children participating in the WIC program showed greater use of all types of health care services compared with Medicaid-enrolled children who were not WIC participants. CONCLUSIONS: The health care needs of low-income children who participate in WIC may be better met than those of low-income children not participating in WIC. (+info)