Digital technologies are increasingly used to promote and support breastfeeding, particularly where access to skilled lactation counseling is limited. This Perspective argues that such tools should complement, not replace, in-person care and should be integrated into maternal and child health systems in low- and middle-income countries. Drawing on lessons from large-scale digital health initiatives, it highlights the importance of equity, government ownership, and sustainability. The paper also emphasizes the need for pandemic and emergency preparedness in digital strategies to ensure continuity of breastfeeding support when face-to-face services are disrupted. It concludes with key priorities for policymakers and implementers to design, evaluate, and scale digital breastfeeding interventions responsibly and equitably.

Micronutrient deficiencies affect two-thirds of reproductive-age women globally, with pregnant women in low- and middle-income countries at higher risk due to greater nutritional needs and limited diets. Multiple micronutrient supplements (MMS) have shown greater benefits than iron-folic acid (IFA) during pregnancy, but WHO currently limits recommendations to humanitarian or research settings. This study synthesises experiences of implementation research designed to support and document the transition from IFA to MMS for pregnant women in Bangladesh, Burkina Faso, Madagascar and Tanzania, providing insights for scaling up MMS programming globally. This qualitative study used key informant interviews and reviews of key policies, proposals, and project materials. Purposive sampling identified 16 key informants involved in the project design, implementation, or funding at country, regional, or global levels. Semi-structured questionnaires guided discussions on themes including project planning, policy environment, community engagement, logistics, and monitoring. Qualitative descriptive analysis of interview transcripts and documents identified key themes and insights. Findings revealed context-specific successes and challenges in transitioning to MMS, highlighting the unique opportunity to strengthen antenatal care (ANC) systems. Key informants emphasised the importance of context specific situational analysis and tailored interventions, strong policy support, community engagement, robust supply chains, sustainable financing, effective monitoring systems, and collaboration among stakeholders. The experiences from this project contribute to the evidence base on MMS implementation. They demonstrate that the transition from IFA to MMS should be leveraged to enhance services and advocate for a health systems-wide approach, moving beyond isolated interventions, to foster more impactful and integrated improvements within ANC.

The 2025 call of the World Alliance for Breastfeeding Action (WABA) is to prioritise breastfeeding through creating sustainable support systems. This is based on the strong foundations of breastfeeding and the unique properties of human milk to nourish, protect and provide optimal physical, emotional and cognitive growth for the infant. Empowering women to establish and maintain lactation is critical for the short- and long-term health of mothers and infants; reducing infant and maternal morbidity; reducing healthcare costs; and building healthy societies. Studies have demonstrated this can be done effectively and sustainably using peer educators to provide support, knowledge and self-efficacy to establish and maintain breastfeeding. However, rates of breastfeeding remain far below global targets. Safe and sustainable support options are needed for mothers who struggle with an insufficient milk supply, despite lactation support. These options include wet nursing and safe human milk sharing. When these are not possible/feasible, donor milk from human milk banks should be considered. Creating support systems requires investing in financial and human resources to protect, promote and support breastfeeding through revisiting these sustainable approaches.

Poor diet quality may contribute to the multiple forms of malnutrition among children in Ghana. This cross-sectional study (1) described the prevalence and frequency of consumption of fruits, vegetables, sugar-sweetened beverages (SSB), salty snacks and sweet snacks among children 2-5 years in northern Ghana; (2) identified factors associated with consumption; and (3) examined relationships between consumption and nutritional status. Households were recruited from urban and rural clusters in Tolon and Kumbungu districts. Children's (2-5 years; n = 243) dietary data were collected using a questionnaire modelled after the WHO STEPS tool. We assessed children's height, weight, haemoglobin and micronutrient biomarker (n = 125) concentrations. We used multi-variable logistic and linear regression to identify individual, maternal and household factors predicting consumption of the food groups and relationships between consumption and nutritional status. In a typical week, most children consumed vegetables (98%), sweet snacks (81%) and fruits (76%); 50% consumed salty snacks and 46% consumed SSB. Average number of servings consumed weekly, mean (SD), was: 7.9 (7.3) vegetables, 2.9 (2.5) sweet snacks, 2.6 (3.9) SSB, 1.8 (1.7) fruits and 1.2 (1.7) salty snacks. Children in households with higher food insecurity were more likely to report consumption of all food groups (> 0 servings fruits, SSB, salty snacks and sweet snacks; ≥ 7 servings vegetables weekly), but other characteristics did not consistently predict consumption. Few associations were found between consumption and nutritional status. Interventions to increase fruit and vegetable intake to align with guidelines, while avoiding SSB and snack foods, are needed.

The World Health Organization's 2023 recommendations for managing moderate wasting provide criteria for prioritizing children to receive specially formulated foods (SFF) rather than counseling alone. However, the practical programmatic impact of such prioritization is unclear. This secondary analysis aimed to describe the caseload and treatment outcomes among moderately wasted 6- to 59-month-old Malian children, categorized into higher-priority (HP) and lower-priority (LP) groups. All children admitted with a MUAC ≥ 115 to < 125 mm without nutritional edema received SFF (500 kcal/day) until they achieved a MUAC ≥ 125 mm for 2 consecutive visits. HP criteria were < 2 years old, WAZ < -3 SD, or MUAC 115-119 mm; LP criteria were ≥ 2 years, WAZ ≥ -3 SD, or MUAC ≥ 120 mm. We reported the caseload per priority criterion and compared treatment outcomes, including recovery and anthropometric changes, between LP and HP children. Of the 35 685 children included in the analysis, 95% met at least one priority criterion. The proportion of children recovered was similar between LP and HP children, regardless of the criterion used. MUAC-for-age z-score and WAZ weekly changes showed similar trajectories. Furthermore, although classified as LP, children > 2 years exhibited lower WAZ throughout treatment compared to children < 2 years. Most moderately wasted children (MUAC < 125 mm) met at least one priority criterion, raising concerns about the feasibility and rationale of the prioritization approach. The similar recovery rates in higher- and lower-priority groups after both received SFF highlight the need for research to assess the impact of different interventions.

Severe acute malnutrition (SAM) affects 12.2 million children globally. Integrating a water, sanitation and hygiene (WASH) kit in outpatient SAM treatment can improve recovery rates by preventing WASH-related diseases and complications, but its cost at scale remains unknown. This study estimates the cost of integrating a WASH kit, composed of chlorine-based water treatment, safe water storage with a lid, soap, and a hygiene promotion component into Senegal's national protocol for treating uncomplicated SAM. This costing study was nested within the TISA randomised controlled trial, which evaluated the addition of a WASH component to standard SAM treatment for children aged 6-59 months. Cost data were collected from 660 participants enroled between December 2020 and December 2021. We took a societal perspective and used a micro-costing approach to estimate direct medical, non-medical and indirect costs. The WASH component led to a 2021 international $105.32 additional cost per child treated, with the WASH kit, transportation and management representing $33.03. Sensitisation to hygiene and water treatment cost $13.46 at health posts and $29.63 for two at-home visits. No additional out-of-pocket expenses were incurred by households, but $1.58 in opportunity costs (income loss) was observed. Human resources were the main cost driver for the WASH component, exceeding the human resources for standard SAM treatment. The total societal cost per child treated was $338.77, ranging from $238.09 to $517.29 in sensitivity analysis, with the SAM treatment representing 69% ($233.40) of this total cost. The main expense for this component was Ready-to-Use-Therapeutic Food (RUTF) ($154.39). The absence of additional costs for households induced by the WASH component is encouraging, as it suggests that it would not represent an obstacle to integration into the national protocol. We produced a robust and comprehensive cost estimate for integrating a WASH kit and hygiene promotion into Senegal's SAM treatment protocol. This increased the treatment cost by 45% which was lower than estimates from a previous study. Results inform budget planning and support future cost-effectiveness analyses of integrating WASH interventions into SAM protocols.

Suaahara was a USAID-funded multi-sectoral integrated nutrition program that aimed to improve the nutritional status of children under the age of five and their mothers in Nepal. The program included multiple interventions targeted to mothers and children, as well as other caregivers. Caregiver knowledge of optimal nutrition and health practices among household members is an important driver of healthy child and maternal nutrition behaviors. This study investigates the associations between exposure to Suaahara interventions and knowledge of maternal and child nutrition and health practices among mothers (n = , grandmothers (n = , and male household heads (n = . Linear and logistic regression models were conducted using data from the endline survey of Suaahara's impact evaluation conducted in 2022. Exposure to Suaahara was associated with mothers' and grandmothers' knowledge of ideal child and maternal health and nutrition practices. Compared to those unexposed to Suuahara, mothers and grandmothers who were exposed to Suaahara interventions had 2.09 and 2.23 times higher odds respectively (p = 0.001; p = < 0.001), respectively, of having correct knowledge of exclusive breastfeeding, and 1.48 and 1.47 times higher odds respectively, of having correct knowledge of age of introduction of all types of complementary foods (p = 0.005; p = 0.070). Furthermore, exposed mothers had 1.49 times higher odds (p = 0.021) and exposed grandmothers had 1.42 times higher odds (p = 0.09) of knowing that young children should be fed more during illness. Male household heads who were exposed had 1.71 times higher odds of knowing that colostrum should be given to children immediately after birth (p = 0.027). Exposure to Suaahara was also associated with mothers' and grandmothers' knowledge of ideal maternal health and nutrition practices. Exposed mothers had 1.64 times higher odds (p = 0.011) and grandmothers had 2.92 times higher odds (p < 0.001) of knowing that mothers should take iron and folic acid supplementation for 180 days during pregnancy (p = 0.011; p = < 0.001). Exposed grandmothers had 1.87 times higher odds of having correct knowledge that mothers should have at least 4 antenatal care visits (p = 0.012). Exposed mothers and grandmothers had 1.88 and 1.90 times higher odds of having correct knowledge that mothers need at least 3 postnatal care visits (p = 0.002; p = 0.051). This study highlights multiple positive associations between exposure to Suaahara and knowledge of mothers and grandmothers around maternal and child health and nutrition practices. This effect was less pronounced in male household heads suggesting that tailored interventions are necessary to improve knowledge of appropriate child and maternal nutrition and health practices in this group. Future research should consider collecting data from multiple household members to better understand the paths between their knowledge and impact on maternal and child health and nutrition practices.

Food provision in early years settings (EYS) presents an opportunity to support healthy eating amongst young children. This study aimed to record and nutritionally analyse setting lunches provided for, consumed and wasted by 3- to 4-year-old children attending EYS in Sheffield, England, including a comparison to packed lunches. Lunch choices were recorded for participating children, along with weights of foods served and any leftovers. A total of 142 setting lunches were recorded, eaten by 46 children attending four of eight recruited EYS. Lunches included vegetables (83.8%) more often than fruit (59.2%), and on average provided sufficient energy, carbohydrate, fibre, protein, vitamins A and C, calcium, iodine and zinc, but insufficient iron. Free sugars and saturated fat, but not sodium, were higher than recommended. Children left 22% of food served on their plate, and consumption of energy, carbohydrate, fibre, vitamin A, iron, iodine and zinc was lower than recommended. Food and nutrient contents were also compared to 185 packed lunches eaten by 67 children from eight settings. Setting lunches contained less food (median 288 g) than packed lunches (median 321 g, p < 0.001) and were more likely to meet guidelines for free sugars (p < 0.001), saturated fat (p < 0.001), vitamin A (p = 0.034), vitamin C (p < 0.001) and sodium (p < 0.001) but less frequently provided sufficient fibre (p = 0.025), calcium (p < 0.001), iron (p < 0.001) and zinc (p < 0.001). Setting lunches were more nutritionally balanced than packed lunches. However, to maximise EYS potential contribution to children's diets, settings must have access to support to both provide sufficiently nutrient-dense meals and encourage children to eat them.

Children's early years food environment can influence dietary habits. We evaluated Yes to Veg! a 4-week nursery-based programme on pre-school children's vegetable exposure, consumption and agency. A quasi-experimental study in 11 nurseries (6 intervention/5 controls) located in socio-economically deprived areas of Glasgow, Scotland. Yes to Veg! delivered locally grown fresh vegetables once-per-week for children's daily nursery activities. Control nurseries received standard healthy eating recommendations. Parental pre- and post-questionnaires measured child vegetable exposure (vegetables tried from a 27-item list), consumption frequency (1 = once-per-week to 5 = everyday) and variety consumed (0 = none/1 = 1-4/2 = 5-9/3 = 10+ kinds). Qualitative comments reported by parents, nursery staff and from researcher observations were extracted for qualitative themes. From 257 parent-child dyads recruited, 57 (n = 34 intervention/n = 23 control, child mean age 51 months) completed both questionnaires. Vegetables tried [Mean(SD)] did not change between intervention [total score pre 16.7(4.5) vs 16.8(5.6) post, difference 0.19(0.6), p = 0.765] and control group [total score pre 16.4(5.3) vs 16.0(5.6) post, difference -0.39(0.57), p = 0.503]. Median pre- and post-consumption frequency in both groups was 4 (most days); the variety of vegetables consumed was higher in intervention (5-9 items) vs control (1-4 items) and these measurements didn't change between pre- and post. Vegetable agency increased in the intervention; parents said children talked more about vegetables at home (91% vs 65% control) and were willing to try vegetables at home (41% vs 34% control); emerging qualitative themes included children's engagement with vegetables, sensory interaction and programme acceptance. Yes to Veg! facilitated exposure, engagement and familiarisation to vegetables, was well implemented and received, but did not change consumption.

Polyunsaturated fatty acids (PUFAs) are critical for fetal development during pregnancy. This study evaluates the association between maternal serum n-3 and n-6 PUFAs in early pregnancy and the risk of large-for-gestational-age (LGA) infants. A nested case-control study was conducted with 45 LGA-appropriate for gestational age (AGA) matched pairs from a cohort of 2839 pregnant women. Maternal serum samples collected during early pregnancy were analyzed for lipid profiles using gas chromatography-mass spectrometry (GC-MS). Associations between fatty acid levels and LGA risk were assessed using Spearman correlation, chi-square tests, and logistic regression. The results indicated that higher arachidonic acid (ARA, p = 0.024) and docosahexaenoic acid (DHA, p = 0.039) levels were positively correlated with LGA risk. Linoleic acid (LA, p = 0.009), alpha-linolenic acid (ALA, p = 0.040), and the n-6/n-3 PUFA ratio (p = 0.034) were negatively correlated with LGA. Adjusted odds ratios indicated that higher quartiles of ARA (OR = 2.293, p = 0.078) and DHA (OR = 2.593, p = 0.038) increased LGA risk, while higher n-6 PUFA levels reduced the risk (OR = 0.340, p = 0.019). In conclusion, early pregnancy serum n-3 and n-6 PUFA levels are associated with LGA risk. Elevated ARA and DHA levels may increase LGA risk, while higher n-6 PUFA levels may be protective. These findings suggest that PUFA levels could serve as early indicators for targeted nutritional interventions.

The Ghana School Feeding Programme (GFSP) operates a decentralised procurement model, in which school caterers are responsible for: selecting, purchasing, transporting, preparing, delivering and distributing school meals. However, caterers' views and experiences are rarely taken into account. This study aimed to better understand GSFP caterers' lived professional experience to identify context-specific challenges and solutions around their food procurement and provisioning practices. A photovoice study was conducted in March-April 2024 in three regional districts of Greater Accra: Ashaiman, La Nkwantanang and Ningo-Prampram. Schools (n = 60) were randomly selected and school caterers (n = 34) were invited to attend training on the photovoice method and cocreate research questions. The training was attended by 27 caterers and individual follow-up interviews were conducted with 19 or the original participants. Data analysis included emergent themes and a priori codes, based on a school food system framework. A photo exhibition was held to advocate for change among GSFP stakeholders. Key themes discussed included: infrastructure support, food preparation, caterer wellbeing and wholesale and trading. Challenges such as low allocation of funds per student and delayed payments were referenced by all caterers and cut across most food system steps, shifting or interrupting caterers' ability to provide meals. Caterers recommended solutions included: timely payments, increased funding, bulk food purchasing, access to electricity and water and on-site school kitchens to improve GSFP delivery. The GSFP's procurement models merits careful review as current overhead costs placed on small-scale food system actors are unsustainable and jeopardise programme objectives. Acknowledging caterers' daily challenges and addressing concerns can promote caterer wellbeing alongside meal quality for programme beneficiaries.

Maternal diet quality and perinatal depression significantly impact maternal and child health, yet their relationship remains underexplored in low-resource settings. This cross-sectional study examined the association between overall diet quality and risk of depression during the third trimester among 296 pregnant women receiving antenatal care at Dhulikhel Hospital, Nepal (August 2023-January 2024). Depression risk was assessed using the Edinburgh Postnatal Depression Scale (EPDS), with scores ≥ 12 indicating elevated symptoms. Diet quality was measured using an adapted Nepali version of the 23-item PrimeScreen questionnaire, generating a Prime Diet Quality Score (PDQS) ranging from 0 to 46. Multivariable logistic regression models were used to estimate the association between PDQS and depression risk, adjusting for age, education, ethnicity, occupation, parity, gestational week, physical activity, and pre-pregnancy BMI. The mean PDQS was 24.7 (SD = 3.1), and 22.3% of participants screened positive for depression. Each 1-point increase in PDQS was associated with 16% lower odds of depression (adjusted OR: 0.84; 95% CI: 0.70-0.90; p = 0.002). These findings suggest that higher overall diet quality is associated with a reduced likelihood of third trimester depression. Further longitudinal studies are warranted to assess causality and inform targeted nutritional interventions. If supported by further studies, incorporating brief dietary assessments like PrimeScreen into antenatal care may potentially offer a feasible strategy to identify women with suboptimal diet quality and co-occurring depressive symptoms in low- and middle-income countries.

Experiencing food insecurity in early childhood is associated with adverse health and nutrition outcomes. About 66% of Brazilian households with children are food insecure; however, interventions targeting early childhood have fallen short in addressing food insecurity due to a lack of funding and multisectoral coordination combined with the COVID-19 pandemic. Therefore, protecting children from food insecurity is a complex task in Brazil and requires innovative approaches. We hypothesize that applying a Nurturing Care Framework (NCF) lens and systems thinking tools can indicate pragmatic pathways to reduce early childhood food insecurity. To examine this hypothesis, we used a participatory group model-building approach to integrate the knowledge of twelve Brazilian experts working in different sectors into a qualitative causal loop diagram (CLD) underlying the dynamics of food insecurity in early childhood. By analyzing the CLD, we aimed (1) to assess whether the Brazilian food insecurity system includes the NCF components and identify how these systems affect young children, and (2) to qualitatively explore feedback loops, pivotal variables (i.e., variables with the most immediate causes and/or immediate causal consequences), and leverage points (i.e., specific variables to intervene to produce a change in the overall system) to reduce food insecurity in early childhood. The integrated CLD outlines a structure with 28 variables assigned across the NCF components. A deeper qualitative analysis of the direct and indirect links identified how food insecurity is experienced by young children. This included a description of two feedback loops reinforcing childhood food insecurity, such as Financial Hardships and Emotional Distress Spiral. Food quality emerged as the pivotal variable with the most proximate causes and/or consequences related to early childhood food insecurity. Positive parenting practices and participation in daycare emerged as direct links to address early childhood food insecurity. Expanding access to nurturing care through national and local policies can enhance the resilience of the systems underlying early childhood food insecurity to disruptions such as the COVID-19 pandemic.

Psycho-social stimulation interventions, recommended in the WHO guidelines for severe acute malnutrition (SAM), have been demonstrated to improve neurodevelopment and growth. However, interventions which have proven effective in clinical trials are resource-intensive and may be challenging in many contexts. This study aimed to explore facilitators, barriers and the existing provision of psycho-social stimulation interventions. We undertook a survey targeting practitioners across the globe who are involved in SAM care and/or programme management. We then undertook 12 semi-structured key informant interviews with practitioners from diverse professional contexts. We transcribed and coded interviews using a deductive approach based on the Consolidated Framework for Implementation Science Research (CFIR). We gained 42 responses from 18 countries for our survey with 29 respondents including psycho-social stimulation interventions in their SAM programmes. Our 12 key informant interviews described several barriers (financial, physical, and human resource limitations, prioritisation of life-saving care, and staff beliefs) as well as some potential facilitators (inclusion in guidelines, enjoyment for staff and parents, and emerging evidence of benefits in terms of short and long-term outcomes). This multi-country mixed methods study revealed that there are very heterogeneous patterns around the implementation of psycho-social interventions in children with SAM. Our study has demonstrated the perceived challenges by professionals involved in SAM care of the feasibility of implementing interventions from research trials. Pragmatic studies are needed which also include an assessment of implementation to enhance an understanding of what might drive uptake. Limitations of our study include a potential respondent bias and small sample size.

Child stunting affects 38.3% of children under five in Ethiopia as of 2016. Women's empowerment, defined through both fundamental capabilities and household decision-making authority, has emerged as a critical determinant of child nutritional outcomes. Drawing on Sen's capability approach and Kabeer's empowerment framework, we examined the associations between two distinct dimensions of women's empowerment and child stunting across Ethiopia's diverse regions. We analyzed 18,466 mother-child pairs from the 2011 and 2016 Ethiopia Demographic and Health Surveys. Validated empowerment indices were constructed using factor analysis. We employed hierarchical multilevel models as our primary specification to examine the associations between women's empowerment and child stunting across Ethiopia's 11 administrative regions. Between 2011 and 2016, stunting declined from 42.3% to 36.4%. Women's decision-making authority increased (mean score: 0.70-0.78), while capabilities remained stable (0.17- 0.16). Higher capabilities were significantly associated with lower odds of stunting (β = -0.141, aOR = 0.87, 95% CI: 0.83, 0.91), whereas decision-making showed no association (β = 0.013, aOR = 1.01, 95% CI: 0.98, 1.05). A significant interaction between capabilities and decision-making was observed (β = 0.050, aOR = 1.05, 95% CI: 1.01, 1.09). Regional heterogeneity was substantial: Amhara maintained high stunting rates despite empowerment gains, while Somali saw improvements with low capabilities but increased decision-making. The study findings suggest that interventions should prioritize capability development through region-specific strategies reflecting diverse pastoral, agrarian, and urban contexts; promote multi-sectoral programs linking education and nutrition services; and develop monitoring frameworks to track both dimensions of empowerment at the regional level.

Tajikistan faces significant food insecurity and multiple forms of malnutrition in its population, with women particularly at risk. Social norms related to gender and intrahousehold hierarchy are pervasive. Yet, how gender impacts dietary intake in Tajikistan remains to be studied. Understanding this mechanism is critical to develop adequate strategies for effective, equitable progress in mitigating malnutrition and food insecurity. An explanatory sequential mixed-methods study was conducted to assess the extent and identify the drivers of gender-based and intrahousehold differences in dietary diversity in Khatlon Province, Tajikistan. Predictors of dietary diversity were statistically assessed using quantitative survey data from 1704 adults who participated in the 2023 USAID/IFPRI Population-Based Survey. Qualitative data from 12 focus group discussions, 19 individual interviews, and 21 Photovoice interviews were analyzed using reflexive thematic analysis to further ascertain and understand these drivers. Gender was identified as a predictor of dietary diversity in both quantitative and qualitative findings. Women reported lower dietary diversity than men, even within in the same household. Gender norms contribute to unequal food distribution and opportunities to consume food away from the household. Expressing social values such as respect during mealtimes and perceptions of dietary needs prioritize men and children over women in consuming foods deemed more nutritious (e.g., meat). This study highlights the importance of considering household dynamics and gender roles in equitably addressing food and nutrition insecurity and malnutrition. Mitigating malnutrition in Tajikistan will necessitate gender equity-focused social behavior change interventions targeting women and men across different generations.

Human milk provides essential nutrition for infants, particularly vulnerable preterm and low-birth-weight neonates. This qualitative study explored Iranian mothers' perspectives on human milk bank (HMB) services through semi-structured interviews with 16 participants (9 donors, 7 recipients) across four HMBs. Using inductive content analysis, we identified five key themes: (1) Expanding opportunities for HMB utilization requires integrating milk donation education into prenatal programs and addressing awareness gaps; (2) Familiarizing parents with HMB services through healthcare providers and social media is crucial for engagement; (3) Infrastructure limitations including equipment shortages and insufficient HMB locations hinder service delivery; (4) Donated human milk (DHM) represents both hope for recipients and fulfillment for donors; and (5) Religious beliefs about milk kinship and family support significantly influence participation. Findings reveal that while Iran has developed the Middle East's most extensive HMB network, cultural and religious considerations around milk kinship require sensitive approaches. Donors reported altruistic motivations and emotional rewards, whereas recipients described DHM as critical for infant survival. Key barriers included limited public awareness, equipment deficiencies, and concerns about milk safety. The study highlights the need for culturally adapted education campaigns, standardized equipment, and policy support to expand services. These results provide valuable insights for improving HMB implementation in Muslim-majority contexts while addressing unique regional challenges in neonatal nutrition. The research underscores DHM's potential to reduce infant mortality when combined with appropriate infrastructure and community engagement strategies.

In Brazil, the Kangaroo Care Method (KCM) is a public policy that proposes systematic and humanized care for preterm low birth weight infants (LBWI), and one of its pillars is breastfeeding promotion. Therefore, this study aims to compare complementary feeding of LBWI in terms of age of introduction and the type of food offered according to the type of care received-KCM or Conventional Care (CC). A prospective cohort study was conducted from September 2019 to August 2021 at a Brazilian university hospital. A total of 65 LBWI born at the institution weighing 1800 g or less were included. Data were collected during the first week of hospitalization and at 4 and 6 months of corrected age. The median age at food introduction was estimated by survival analysis using the Kaplan-Meier method. The log-rank test was used to compare the median age at the time of food introduction according to the type of care. Longer exclusive breastfeeding (KCM = 30 days; CC = 0.001, p = 0.002) and continued breastfeeding were observed in KCM preterm infants (KCM = 172 days; CC = 0.001, p = 0.002). The median age at introduction of infant formula (KCM = 38 days; CC = 35 days), water (KCM = 65 days; CC = 46 days), salted porridge (KCM = 139 days; CC = 136 days) and fruits (KCM = 134 days; CC = 136 days) was similar between both types of care received. No ultra-processed foods were consumed. In conclusion, despite encouraging exclusive and continuous breastfeeding, there was no significant difference in the time of introduction of foods according to the type of care received.

Poor dietary quality, particularly inadequate fruit and vegetable (F&V) intake, remains a significant public health challenge globally. This article synthesizes findings from scoping reviews examining diet and F&V intake, and interventions to increase F&V consumption among population groups in five countries: Benin, Fiji, the Philippines, Sri Lanka and Tanzania. Our analysis confirms previous findings of inadequate F&V intake across all five countries, with most adults consuming well below the WHO recommendations of 400 g per day. Across the five countries, the identified scientific evidence is limited due to heterogeneous dietary assessment methods, limited coverage of population groups in national surveys and smaller studies, and limited data from rigorous evaluations of interventions aiming to increase F&V intake. Although all five countries have developed food-based dietary guidelines promoting F&V intake, research on their implementation and effectiveness remains limited. To build evidence for effective programmes and policies to improve both quantity and diversity of F&V intake, we identify three priority areas for future research: standardizing dietary assessment methods for use in surveys and evaluations, understanding context-specific drivers and determinants of F&V intake and strengthening intervention research in low-resource settings.

There is growing attention to the influence of commercial milk formula (CMF) marketing on health professionals and their professional associations, with ongoing controversies about the conflicts of interest created by the CMF industry and how health professionals and their associations can avoid them. Australian guidelines state that health workers should implement the International Code of Marketing of Breast-milk Substitutes (the Code), and a recent regulatory review considered whether health professional association (HPA) ethical codes and standards require compliance with the Code. However, evidence was lacking. This study aimed to assess the extent to which Australian HPAs' codes and standards require compliance with the Code. Sampled were national associations of regulated health professionals likely to provide health care to mothers and infants. Online searches of websites of these Australian HPAs were conducted in 2021 and repeated in 2024, to identify documents on professional ethics on the Code and breastfeeding. To assess the documents, we developed a simple scoring system and tool using the eight critical elements of the Code and World Health Organisation guidance for health workers. Searches identified 19 within-scope associations. Most (15/19) had no provisions relating to the Code or Guidance in their ethics or standards documents in 2024. Only one comprehensively covered the Code components and just five scored above 50 per cent. Professional association codes of ethics and standards in Australia do not prevent health professionals being influenced by CMF company marketing or ensure breastfeeding is protected, promoted and supported in line with health worker responsibilities under Australian guidelines and the Code. Future research could apply this scoring system in other country settings, and for other HPAs.