Maternal and Child Nutrition最新文献

{"title":"Co-Coverage of Essential Interventions Across the Health System Continuum of Care for Improving Child Nutrition in Ethiopia.","authors":"Alemnesh Petros, Meron Girma, Tsedey Moges, Alemayehu Hussen, Tadesse Kebebe, Meseret Woldeyohannes, Teshome Asefa, Daniel Abera, Yirgalem Tadesse, Getachew Tollera, Mesay Hailu, Arnaud Laillou, Stanley Chitekwe, Kaleab Baye, Ramadhani Noor, Masresha Tessema","doi":"10.1111/mcn.70107","DOIUrl":"https://doi.org/10.1111/mcn.70107","url":null,"abstract":"<p><p>This study aimed to assess the coverage of essential nutrition interventions delivered through the health system and explored the relationship between co-coverage and child- and maternal-level factors, household-level factors, and access to healthcare facilities. We used data from the Ethiopia Food and Nutrition Strategy Baseline Survey, a population-based cross-sectional study conducted between July 2021 and October 2022. The survey was conducted in 10 regions and 2 city administrations of Ethiopia. A total of 7931 women of reproductive age (15-49 years) and children aged 0-59 months (mother-child pairs) were included. We assessed coverage for 16 essential nutrition and health interventions. Our findings show that the coverage of essential nutrition interventions is suboptimal. Notably, interventions delivered during pregnancy and in early infancy had the highest coverage compared to those provided in late childhood. We identified missed opportunities to deliver of nutrition interventions in the corresponding health platforms. Despite 41% of women reporting having four or more antenatal care visits during their last pregnancy, only 17% took 90 or more iron/folic acid tablets. We also found pro-rich and pro-urban inequalities in access for almost all interventions. Among children eligible to receive all 16 interventions (12-59 months), 8% had zero exposure to interventions. Child age, household wealth, maternal education, place of residence, and walking time to the nearest health facility were significantly associated with co-coverage. The observed low coverage, coupled with existing inequities and identified opportunity gaps in intervention delivery, emphasizes the need to better leverage the health system to reduce undernutrition.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":" ","pages":"e70107"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Haemoglobin Concentrations From Venous and From Finger-Pricked Capillary Blood in a Region With a High Prevalence of Anaemia in Ethiopia.","authors":"Desalegn Kuche, Masresha Tessema, Kaleab Baye, Zeweter Abebe, Ramadhani Noor, Teshome Assefa, Alemayehu Hussen, Meseret Woldeyohannes, Stanley Chitekwe, Barbara J Stoecker","doi":"10.1111/mcn.70109","DOIUrl":"https://doi.org/10.1111/mcn.70109","url":null,"abstract":"<p><p>This cross-sectional study was conducted in the Somali Regional State in Ethiopia. The purpose of the study was to compare haemoglobin (Hb) concentrations from venous and finger-pricked capillary blood using the HemoCue 301 as well as estimating anaemia prevalence. Participants were non-pregnant women of reproductive age (WRA), 18-49 years old (n = 884). Blood was collected by trained laboratory technologists using standard protocols. Venous blood was transferred from the EDTA-coated vacutainer to a HemoCue microcuvette. An automatic safety lancet was used to obtain capillary blood, and a microcuvette was filled with the third drop. Both venous and capillary blood were analysed immediately in the field using the same HemoCue analyser. The mean (±SD) Hb concentration was 11.6 ± 2.2 g/dL for venous blood and 11.4 ± 2.3 g/dL for capillary blood. The mean Hb difference was 0.2 ± 0.8 g/dL (p < 0.0001). After adjustment for altitude, anaemia prevalence was estimated. Both blood collection methods confirmed anaemia prevalence as a severe public health problem; the prevalence was 66.6% from venous and 70.7% from capillary blood. Using venous Hb as the standard, the sensitivity of capillary Hb was 94.9%, and its specificity was 77.5% in identifying anaemia. The differences in anaemia estimates using venous and capillary blood have the potential to impact both public health strategies and programme evaluations.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":" ","pages":"e70109"},"PeriodicalIF":2.6,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Saccharomyces cerevisiae Yeast-Based Supplement and Breast Milk Supply: A Randomised Placebo-Controlled Trial.","authors":"Lili Jia, Louise Brough, Janet L Weber","doi":"10.1111/mcn.70112","DOIUrl":"https://doi.org/10.1111/mcn.70112","url":null,"abstract":"<p><p>Saccharomyces cerevisiae yeast-based supplements (SCYS) are frequently used as galactagogues with limited evidence of their efficacy. This study investigates the effect of SCYS on human milk oligosaccharide (HMO) concentration and indicators of milk supply. Sixty-eight breastfeeding women with a healthy singleton infant aged 1-7 months were randomly assigned to consume a SCYS product (5 g/day) or placebo for 4 weeks. The primary outcome was the change in the total HMO concentration. The secondary outcomes included participants' perceptions of milk supply, intervention effectiveness, postnatal distress, infant feeding patterns, infant anthropometry, and adverse effects. Intention-to-treat analysis was performed. Multivariable linear regression analysis showed no significant effect of SCYS on individual or total HMO concentrations. However, 65% of women in the SCYS group, compared to 35% in the placebo group, perceived an increase in milk production (p < 0.05). No significant differences were found for other secondary outcomes. However, mothers in the SCYS group had a small but significant improvement in perception of their milk quantity and quality (p < 0.05). SCYS use was also associated with significantly lower formula use at 6 months postpartum (4% vs. 27%, p < 0.05). While SCYS does not impact HMO concentration, it may improve women's perceptions of milk supply. A larger randomised controlled trial is needed to assess its potential effects on actual milk production and composition and address issues of perceived insufficient milk. Trial Registration: This trial was registered at the Australian New Zealand Clinical Trials Registry (trial registration number: ACTRN12619000704190).</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":" ","pages":"e70112"},"PeriodicalIF":2.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden and Correlates of Child Undernutrition Based on the Composite Index of Anthropometric Failure (CIAF) in Bangladesh: Evidence From the 2019 Multiple Indicator Cluster Survey.","authors":"Fazley Amin, Md Taj Uddin","doi":"10.1111/mcn.70105","DOIUrl":"https://doi.org/10.1111/mcn.70105","url":null,"abstract":"<p><p>Despite economic growth and poverty reduction, child undernutrition is still widespread in Bangladesh. This study aimed to evaluate both the burden and correlates of undernutrition among children under five in Bangladesh using the Composite Index of Anthropometric Failure (CIAF). Data were obtained from the 2019 Multiple Indicator Cluster Survey (MICS), comprising a weighted sample of 21,885 children collected through a nationally representative cross-sectional survey between January and June 2019. The study applied a two-stage stratified cluster sampling technique. To determine the factors influencing CIAF, a generalized linear mixed model (GLMM) was employed, accounting for clustering effects. The adjusted odds ratio (AOR) was derived, accompanied by its corresponding 95% CI, and a significance threshold of p < 0.05 was used to identify significant predictors of CIAF. The study revealed an overall CIAF prevalence of 37.2% (95% CI: 36.6%-37.9%). The prevalence of combined stunting and underweight was 11.9%, wasting and underweight 4.2%, and concurrent stunting, wasting and underweight 3.3%. Children aged 24-59 months, multiple births, birth size smaller than average, children of mothers with below primary education (AOR: 2.02; 95% CI: 1.59-2.57), received no ANC visits (AOR: 1.23; 95% CI: 1.04-1.46), children delivered at home, and children from lower socio-economic families had significantly higher odds of undernutrition compared with other counterparts (AOR: 1.70; 95% CI: 1.37-2.11). In Bangladesh, more than one-third of under-five children suffer from undernutrition, hindering the potential of millions. Urgent policy action is needed to address undernutrition, particularly among socio-economically disadvantaged children and those in the Sylhet division. Strengthening nutritional programs, maternal education, financial stability and healthcare access is crucial. The study recommends adopting CIAF as a national indicator to measure child undernutrition and guide comprehensive strategies to achieve the Sustainable Development Goals.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":" ","pages":"e70105"},"PeriodicalIF":2.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Purchasing and Consumption Dynamics of Commercially Processed Complementary Foods and Caregiver Motivations and Reasons for Purchasing These Foods in Nairobi.","authors":"Antonina N Mutoro, Maureen Gitagia, Charity Zvandaziva, Veronica Sanda Ojiambo, Gershim Asiki, Elizabeth Kimani-Murage","doi":"10.1111/mcn.70102","DOIUrl":"https://doi.org/10.1111/mcn.70102","url":null,"abstract":"<p><p>Commercially processed complementary foods (CPCFs) are consumed in Kenya, but little is known about caregiver perceptions and reasons for their consumption. We explored caregiver perceptions, motivations and reasons for purchasing CPCFs. This cross-sectional mixed-methods study was conducted in Nairobi among caregivers of children aged 6-23 months. A four-stage sampling strategy was used to select study sites non-slum (Westlands) and slum (Mathare) areas, retail outlets and study participants. Eighty-one caregivers (40 in Mathare, 41 in Westlands) were recruited for the quantitative survey, from this sample 16 participants were recruited for qualitative in-depth interviews. Questions about the place of purchase, types of foods purchased, reasons for purchase, sources of information on infant and young child feeding and CPCFs, and perceptions on health and nutrition claims were asked. Nearly all caregivers (96.3%) reported giving their children CPCFs. Close to half of caregivers offered CPCFs as a snack (46.9%) while 21% offered them as a main meal. CPCFs were perceived to be healthy (73.1%), nutritious (71.8%) and easy to prepare (70.7%) and child preference (55.6%), price (54.3%), taste (51.9%), nutritional quality (55.6%) and food safety (62.9%) were considered important factors when purchasing them. Nutrition and health claims on product packaging were documented, and these appeared to influence caregiver perceptions about CPCFs. Participants perceived CPCFs as good and healthy for children and rich in nutrients essential for growth and development. This is in line with nutrition claims on these products. CPCFs are highly regarded by caregivers and are consumed in slum and non-slum settings in Nairobi. Given that misleading health and nutrition claims are used to market them, CPCFs may negatively impact child health if their marketing and consumption are not regulated.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":" ","pages":"e70102"},"PeriodicalIF":2.6,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Engaging Fathers in Child Nutrition: Exploring Intra-household Gender Dynamics in Nutrition Interventions in Ethiopia.","authors":"Yaeeun Han, David Pelletier, Jieun Kim, John Hoddinott","doi":"10.1111/mcn.70088","DOIUrl":"https://doi.org/10.1111/mcn.70088","url":null,"abstract":"<p><p>This study aims to examine intra-household gender dynamics in response to a nutrition intervention (maternal Behaviour Change Communication (BCC), paternal BCC, and food vouchers) aimed at improving IYCF practices using qualitative methods. Participants were drawn from a subset of households enrolled in a larger cluster - randomized controlled trial (RCT) conducted in rural Ethiopia. A total of 40 participants (20 mother-father pairs) from intervention and control households were interviewed separately to explore intra-dyadic beliefs and household decision-making. Furthermore, this study explores plausible mechanisms behind the main RCT finding that greater father involvement, while increasing knowledge, did not consistently improve infant and young child feeding (IYCF) outcomes. We find that BCC mothers had the tendency to adopt more gender-equal beliefs, particularly regarding men's roles in childcare and household chores, whereas fathers were slower to shift their views. This may have led to increased discordance in gender norms within BCC households. By contrast, control couples often retained traditional views, but showed more intra-couple alignment. Unexpectedly, control fathers were sometimes more progressive than control mothers, potentially due to higher education levels. We also find increased paternal engagement occasionally introduced conflicting priorities, as fathers asserted authority over household spending - sometimes at the expense of child-focused nutrition. These findings underscore the complexity of engaging fathers in nutrition interventions and point to the need for strategies that address underlying gender norms and decision-making dynamics within households.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":" ","pages":"e70088"},"PeriodicalIF":2.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Childhood Undernutrition in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.","authors":"Hannah Ricci, Daniela Schmid, Salome Kruger, Stefano Terzoni, Cristian Ricci","doi":"10.1111/mcn.70083","DOIUrl":"https://doi.org/10.1111/mcn.70083","url":null,"abstract":"<p><p>Undernutrition increases the risk of morbidity and mortality, making it essential to identify and address its key determinants. This systematic review and meta-analysis examines the impact of selected child-related, household and hygiene, and sanitation factors on the nutritional status of infants and young children aged 0-59 months in Sub-Saharan Africa. We conducted a comprehensive search of online databases using defined Medical Subject Headings and keyword search terms. Nutritional status was assessed using the WHO child growth Standards Z-scores for stunting, underweight and wasting. A meta-analysis was performed to estimate pooled associations, and heterogeneity was assessed using the Cochrane Q and I² statistic. Sensitivity analyses were conducted, and publication bias was evaluated. Out of 1, 992 articles identified, 49 studies met the inclusion criteria. Our findings indicated that diarrhoea was associated with 77% increased risk of overall undernutrition (odds ratio (OR) = 1.77; confidence interval [Cl] = 1.52, 2.06), and 92% increased risk of wasting (OR = 1.92; 95% Cl = 1.48, 2.48). Low birthweight was linked to a two-fold increased risk of stunting (OR = 2.35; 95% Cl = 1.84, 3.00), while low maternal education was associated with a higher risk of underweight (OR = 1.55; 95% Cl = 1.17, 2.04). These findings highlight the need for targeted interventions to reduce childhood undernutrition in the region.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":" ","pages":"e70083"},"PeriodicalIF":2.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuning Into Affect and Appetite in Caregivers, and Its Association With Recognising and Responding to Infant Appetite Cues.","authors":"Shihui Yu, Alison Fildes, Pam Birtill, Tang Tang, Marion M Hetherington","doi":"10.1111/mcn.70099","DOIUrl":"https://doi.org/10.1111/mcn.70099","url":null,"abstract":"<p><p>Positive mealtime interactions shape infant eating patterns potentially promoting appetite regulation. This study investigated whether caregivers who \"tune-in\" to their own internal affect and appetite cues, can also recognise and respond to their infant's appetite cues via responsive feeding (RF). Caregivers (N = 445; mean age: 33.5 ± 4.7 years) with children aged 5-28 m participated in an online survey in August 2023. Caregivers' RF practices, mealtime emotions, eating traits, alexithymia (impaired capacity to identify and express emotions) and their infant's eating traits were administered using validated questionnaires. Recent mealtime experiences were described through an open-ended question. Caregivers who relied on interoceptive cues in eating scored high on recognising infant appetite cues (R² = 0.11, F(1, 396) = 5.40, p < 0.001). Whereas caregivers with alexithymia reported poorer ability to recognise infant appetite cues (R² = 0.12, F(7, 399) = 7.53, p < 0.001) and less positive mealtime emotions (R² = 0.12, F(7, 399) = 7.49, p < 0.001) compared to those without alexithymia. Caregivers' capacity to \"tune-in\" to their own internal satiation cues inversely mediated the relationship between caregivers' alexithymia and their recognition of infant mealtime appetite cues. Infant eating traits (Food Responsiveness and Satiety Responsiveness) were associated with parental use of food to calm. Overall, RF was associated with mealtime emotions, parental ability to \"tune-in\" to their own affect (alexithymia) and appetite, and child's appetitive traits. Developing caregiver's awareness and responsiveness to their own and their child's affect and appetite cues may promote RF practices.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":" ","pages":"e70099"},"PeriodicalIF":2.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Mixed Methods Analysis of Factors That Influence the Diet Quality and Decision-Making of Adolescent Girls in an Urban Informal Settlement in Kenya.","authors":"Emily R Seiger, Mercy Owuor, Kipkoech N Ruto, Peter D Otieno, Rosebel Ouda, Mark Muasa, Kaburia F Mwenda, Erick S Nandoya, Jeffrey O Okoro, Hillary Omala, Linda Adair, Penny Gordon-Larsen, Venkata Saroja Voruganti, Alice S Ammerman, Amanda L Thompson, Katie Meyer, Stephanie L Martin","doi":"10.1111/mcn.70092","DOIUrl":"https://doi.org/10.1111/mcn.70092","url":null,"abstract":"<p><p>Due to the nutrition transition, adolescent diets globally appear to be shifting to increased consumption of fast foods and snacks high in sodium, added sugar, and saturated fat. In urban informal settlements in Kenya, limited evidence suggests adolescents consume 1-2 meals per day, have low dietary diversity, and consume foods from roadside stalls. We characterized the diets of adolescent girls in an urban informal settlement in Kenya and assessed the factors associated with diet quality and decision-making. We used a convergent mixed methods design to simultaneously analyze survey, dietary intake, structured interview, and focus group discussion data. Participants were recruited via a community-based participatory-development organization. We assessed diet quality from 24-h recall using the Global Diet Quality Project's Global Dietary Recommendations score-combining dietary risk factors for non-communicable disease (NCD-risk) with dietary factors protective of non-communicable disease (NCD-protect). We tested associations between diet quality, household hunger, sociodemographic variables, and food behaviors. Focus group discussion (FGD) and interview data were transcribed, translated, and analyzed thematically according to the factors that influenced diet. Adolescent girls predominately consumed food from grains, dark leafy greens, sweet tea or coffee, and deep-fried foods (predominately samosas, mandazi [doughnuts], and fries). Adolescent girls with moderate or severe household hunger had higher diet quality scores-driven by a lower consumption of dietary risk factors for non-communicable disease (NCD risk)-compared to girls with little to no household hunger. This relationship was driven by the consumption of red meat, by girls with less household hunger. In qualitative data, finances were the main decision-making factor with skipping meals as a common coping strategy. Adolescent girls were aware of what foods constitute a healthy diet, but their diet quality and decision-making were driven by household hunger, finances, and food safety.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":" ","pages":"e70092"},"PeriodicalIF":2.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enablers and Barriers to Implementing Early Childhood Development Assessment and Nutrition Interventions in Community Settings: Qualitative Case Study From Sidama Regional State, Ethiopia.","authors":"Hailu Hailemariam, Barbara J Stoecker, Zelalem Tafese Wondimagegne","doi":"10.1111/mcn.70094","DOIUrl":"https://doi.org/10.1111/mcn.70094","url":null,"abstract":"<p><p>Despite improvements in children's nutritional status and a commitment to early childhood development (ECD) policy developments in Ethiopia, the risk of poor ECD outcomes remains alarming. This study aimed to identify enablers and barriers to the implementation of ECD assessment and provision of nutrition-focused interventions in community settings. A qualitative case study was employed in Hawassa city and Dore Bafano district of Sidama region from November 2023 to February 2024. Fifteen key informant interviews (KIIs) and five focus group discussions (FGDs) were conducted with purposively selected key informants from the healthcare system and mothers of children under two years old, respectively. Pre-tested interview and discussion guides were used for data collection and a narrative thematic analysis was applied at different levels of the socio-ecological model (SEM). The existing ECD policy and strategy landscape, healthcare system, communication and trust built between the health Extension workers (HEWs) and the community, existence of different mothers groups and the HEWs positive attitudes were identified as enablers; however, gaps in ECD practical knowledge and community awareness, low commitment of HEWs and political leaders at multiple levels, as well as absence of training, facilities and standardized indicators of ECD were identified as barriers for the implementation of ECD assessment and provision of nutrition-interventions in the community settings. ECD assessments and nutrition-focused interventions can be integrated into the existing health extension program, with HEWs playing key roles. This requires raising awareness of ECD policies across all healthcare levels and providing targeted training for HEWs on ECD assessment and its targeted interventions. Building the capacity of all persons associated with health posts, and incorporating ECD indicators into HEWs' services and their supervision checklists will enhance the effectiveness and sustainability of ECD integration in the community, leading to improved child health and development outcomes. Additional research is required to develop a tailored, user-friendly and time-saving ECD assessment tool for use in the community by the HEWs to assess, classify and identify children at risk of developmental delay.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":" ","pages":"e70094"},"PeriodicalIF":2.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}