Maternal and Child Nutrition最新文献

{"title":"How Does Household Food Insecurity Impact Complementary Feeding, in High Income Countries, in a Cost-of-Living Crisis? A Systematic Scoping Review.","authors":"Grace Hollinrake, Lowri Stevenson, Laura L Wilkinson, Sophia Komninou, Amy Brown","doi":"10.1111/mcn.70082","DOIUrl":"https://doi.org/10.1111/mcn.70082","url":null,"abstract":"<p><p>Complementary feeding, when infants are introduced to solid foods, is an important stage of learning new tastes, textures and eating behaviours. Austerity, post-BREXIT (in the UK) and the COVID-19 pandemic have created a cost-of-living crisis, exacerbating prevalence of food insecurity in high-income countries. Understanding how this may impact upon parents' experience of complementary feeding is important. This systematic scoping review therefore examined how food insecurity impacts diet and feeding practices during the complementary feeding period for infants aged 6-18 months. Four electronic databases were searched, identifying 5822 articles. 3293 titles and abstracts, from which 30 full texts were screened by two independent reviewers. The final review included five articles (two qualitative and three quantitative). Three articles were conducted in Australia, one in America, one in New Zealand with 1044 parent/child dyads in total. Strategies such as encouraging children to finish their food, avoiding foods that might not be accepted and reducing food variety were common. These strategies may ensure children are fed but may reduce elements of complementary feeding that we know are important such as exposing infants to wide varieties of tastes, textures and nutrients and adopting a responsive feeding style. The sparsity of evidence in this review, particularly for research based in the UK, highlights the need for further research in high-income countries to explore the impact of household food insecurity on complementary feeding. This will help to identify priorities for those working in policy and practice to support families with complementary feeding during the cost-of-living crisis and beyond.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":" ","pages":"e70082"},"PeriodicalIF":2.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977920","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":"Precision and Sample Sizes Achieved for Infant and Young Child Feeding Indicators Evaluated in Anthropometry Assessments: A Secondary Analysis of Population-Representative Surveys in Refugee Settings.","authors":"Eva Leidman, Behzad Kianian, Oleg Bilukha","doi":"10.1111/mcn.70078","DOIUrl":"https://doi.org/10.1111/mcn.70078","url":null,"abstract":"<p><p>This study characterizes the sample size and precision for infant and young child feeding (IYCF) indicators evaluated in surveys conducted in refugee settings, characterized by sample sizes enabling timely information to inform humanitarian response. We analyzed surveys provided by the United Nations High Commissioner for Refugees conducted from 2013 to 2019. For eight IYCF indicators recommended in the current global guidance, we assessed achieved sample sizes and precision by evaluating the half-width of 95% confidence intervals (HWCIs) by survey design. Among cluster surveys, we characterized the intraclass correlation coefficients (ICCs) and design effects. Final analysis included 203 surveys from refugee settings in 15 countries. Ever breastfed and bottle feeding indicators were the most precise (median HWCI: 3.1% and 3.6%) due to inclusion of all children 0-23 months resulting in relatively large sample sizes and estimates of prevalence close to 100% and 0%, respectively. Exclusive breastfeeding under 6 months and the introduction of solid foods (6-8 months) had the lowest precision (median HWCI estimates: 12.6% and 18.2%). In cluster surveys, early initiation of breastfeeding and flesh food consumption stood out with markedly higher design effects (median estimates: 2.63 and 2.17) driven by relatively larger sample sizes and high ICCs (median estimates: 0.31 and 0.27); all other indicators had median design effects < 1.3. Evidence on expected variation in precision and heterogeneity by indicator can help design surveys with samples that allow for the rapid collection of data sufficient to inform emergency responses. High caution is needed when interpreting estimates of exclusive breastfeeding and introduction of solid foods in past surveys given lower precision.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":" ","pages":"e70078"},"PeriodicalIF":2.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849569","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":"Socioeconomic Risk Factors Associated With Acute Malnutrition Severity Among Under-Five Children Based on a Machine Learning Approach: The Case of Rural Emergency Contexts in Niger and Mali","authors":"Luis Javier Sánchez-Martínez,&nbsp;Pilar Charle-Cuéllar,&nbsp;Abdias Ogobara Dougnon,&nbsp;Fanta Toure,&nbsp;Antonio Vargas,&nbsp;Candela Lucía Hernández,&nbsp;Noemí López-Ejeda","doi":"10.1111/mcn.70039","DOIUrl":"10.1111/mcn.70039","url":null,"abstract":"<p>Currently, child acute malnutrition continues to be a serious public health problem, and although its most fatal consequences are well known, its associated factors still need to be studied in more depth in different contexts. The objective of the present study is to determine the association between socioeconomic variables and acute malnutrition severity in rural emergency contexts of Niger and Mali. The present study consists of a secondary analysis of controlled trials. Data related to a total of 1447 treated children (6–59 months of age) were considered, for whom the Variable Selection Using Random Forests (VSURF) algorithm was applied to create interpretation and prediction random forest models (considering 86 variables). In Mali and Niger, the prediction models agree in pointing out aspects related to the water source and the work activity of caregivers as some of the main risk factors for developing severe acute malnutrition. However, the interpretation models highlight important heterogeneity, with the distance to the health center being the greatest exponent of this situation, being the most important factor in Niger while disappearing in Mali. The prediction accuracy in the interpretation model was 68.0% in Niger and 79.80% in Mali, while the prediction model reached similar rates of 63.17% and 75.63%, respectively. Machine learning techniques have proven to be a valid tool to interpret and predict the degree of severity of acute malnutrition based on socioeconomic characteristics, including complex interrelationships. The results obtained point out different aspects to be addressed to prevent and minimize the effects of acute malnutrition.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":"21 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/mcn.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiometabolic Markers Associated With Altered Fetal Growth in Mediterranean Cohort","authors":"Ehsan Motevalizadeh,&nbsp;Andrés Díaz-López,&nbsp;Cristina Jardí,&nbsp;Cristina Rey-Reñones,&nbsp;Francisco Martín-Luján,&nbsp;Victoria Arija","doi":"10.1111/mcn.70086","DOIUrl":"10.1111/mcn.70086","url":null,"abstract":"<p>Cardiometabolic disturbances in pregnancy appear to be associated with inappropriate fetal growth, but evidence from uncomplicated pregnancies is still scarce and, due to varied findings, inconclusive. Moreover, most studies focus on specific markers, often measured at a single gestational time-point. We aimed to assess the associations between maternal cardiometabolic markers, measured in early and late pregnancy, and neonatal size in a Mediterranean cohort of healthy women. Longitudinally, we analyzed 264 mother-neonate pairs. Maternal metabolic markers (glucose, insulin resistance, triglycerides, total cholesterol, HDL-c, LDL-c, and blood pressure (BP)) were assessed in the first (T1) and third (T3) trimesters. Birthweight (g) and head circumference (HC, cm) were assessed in the newborns. Small (SGA, &lt; 10th percentile) and large (LGA, &gt; 90th percentile) for-gestational-age were the primary outcomes. Multivariable-adjusted linear and logistic regressions were performed. Overall, based on weight and HC at birth, there were 10.5% and 6.4% SGA infants, while 8.1% and 16.7% were LGA, respectively. After adjustments for confounders, maternal T1 triglycerides were positively associated with birthweight (β:74.81 g per 1-SD increment, <i>p</i> = 0.006), and higher T1 LDL-c levels increased the risk of LGA newborns (OR:1.64 g per 1-SD increment, <i>p</i> = 0.046). T3 diastolic-BP was inversely associated with birthweight (β:-86.19 g per 1-SD increment; <i>p</i> = 0.010) and HC (β:-0.30 g per 1-SD increment; <i>p</i> = 0.008). High diastolic-BP (≥ 75th percentile, 77 mmHg) was also linked to a higher risk of SGA newborns for both weight (OR:3.54, <i>p</i> = 0.022) and HC (OR:2.56 g per 1-SD increment, <i>p</i> = 0.025). In conclusions, elevated maternal lipids in early pregnancy and diastolic BP in late pregnancy adversely impact offspring birth size, highlighting the importance of incorporating metabolic monitoring into routine prenatal care.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":"21 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/mcn.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling Disparities and Missed Opportunities in Vitamin A Supplementation Among Children Under Five in Ethiopia.","authors":"Tsedey Moges, Meron Girma, Alemnesh Petros, Nardos Birru, Alemayehu Hussen, Meseret Woldeyohannes, Abiy Tefera, Tadesse Kebebe, Berhanu Wodajo, Getachew Tollera, Mesay Hailu, Stanley Chitekwe, Hiwot Darsene, Kidist Woldesenbet, Kaleab Baye, Masresha Tessema, Ramadhani Noor","doi":"10.1111/mcn.70067","DOIUrl":"https://doi.org/10.1111/mcn.70067","url":null,"abstract":"<p><p>Vitamin A supplementation (VAS) is an effective and low-cost strategy for improving vitamin A status and reducing childhood morbidity and mortality. Ethiopia started nationwide biannual VAS in 2006, but routine VAS coverage consistently remained low, necessitating the use of multiple delivery approaches. This study aimed to determine coverage, existing disparities, and missed opportunities for VAS among children under 5 years of age in Ethiopia. We used the data from Ethiopia's Food and Nutrition Strategy baseline survey, a cross-sectional study conducted between 2021 and 2023. This analysis included a subsample of 8580 children aged 6-59 months. Nationally, routine VAS coverage was 21%, with significant inequalities reflected by the slope inequality index (SII) and concentration index (CIX). A significantly higher VAS coverage was observed among the wealthiest households (SII; CIX: 30.2, 23.0), urban residents (32.3, 13.7), and agrarians (23.7, 6.1) than their counterparts (p < 0.001). VAS coverage was also higher among children from households where the head had attained above secondary education compared to those with no formal education (36% vs. 14%). About 39% of 9-15-month-old children received measles but not VAS, illustrating a missed opportunity as the two interventions are delivered in integration. Such missed opportunities disproportionately affected rural residents, revealing multiple deprivations. The VAS program has faced recent challenges, marked by inequitable coverage and weak service integration. To enhance coverage, equity, and program resilience, it is essential to expand access, tailor delivery approaches, and leverage diverse service contact points.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":" ","pages":"e70067"},"PeriodicalIF":2.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790664","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":"Profits Before Health? New Zealand Government Rejection of Stricter Infant Formula Marketing Standards and the Lobbying Behind It","authors":"Naomi Hull,&nbsp;Anusha Bradley,&nbsp;Monique Boatwright,&nbsp;Libby Salmon,&nbsp;Julie P. Smith,&nbsp;Phillip Baker","doi":"10.1111/mcn.70087","DOIUrl":"10.1111/mcn.70087","url":null,"abstract":"<p>In 2024, the New Zealand (NZ) government made a rare departure from the joint food standards programme with Australia, administered by Food Standards Australia New Zealand (FSANZ). This paper presents a timely case study of how transnational dairy and baby food corporations lobbied the NZ government to reject updated infant formula standards, despite strong evidence and support across Australia for reform. Globally, transnational corporations dominate commercial milk formula industry, and industry and utilise lobbying strategies to delay and limit regulation. Drawing on original data from official information act requests, we examine the political dynamics surrounding infant formula regulation and the implications for breastfeeding protection and health governance in the region. Despite FSANZ's evidence-based decisions to improve labelling, restrict health claims, and enhance consumer protection, NZ bowed to the lobbying pressure of key companies who had cited risks to exports, jobs and future product development. Lobbying by these companies targeted the Prime Minister and key ministers, demonstrating a remarkable level of access and influence. This case exposes the weaknesses in NZ's political transparency laws, where no mandatory lobbying registers and reporting requirements exist. We conclude that it is crucial for governments to make policy decisions without the influence of the baby food industry and provide a strong argument for better regulation of corporate lobbying. Infant and young child health must be prioritised over profit.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":"21 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/mcn.70087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulated Impact of Vitamin A-Fortified Sugar on Dietary Adequacy and Association of Usual Sugar Intake With Plasma and Breast Milk Retinol Among Lactating Zambian Women","authors":"Demewoz Haile,&nbsp;Reina Engle-Stone,&nbsp;Bess Caswell,&nbsp;Hanqi Luo,&nbsp;Kevin W. Dodd,&nbsp;Charles D. Arnold,&nbsp;Modou Jobarteh,&nbsp;Matthew Greene,&nbsp;Mackford Chipili,&nbsp;Marjorie J. Haskell,&nbsp;Amanda C. Palmer","doi":"10.1111/mcn.70077","DOIUrl":"10.1111/mcn.70077","url":null,"abstract":"<p>In Zambia, mandatory sugar fortification with vitamin A (VA) has been implemented, but its impact on VA inadequacy and status has yet to be assessed. This study evaluated the contribution of VA-fortified sugar to dietary VA adequacy and the relationship between dietary intakes and VA status in 243 lactating women, based on 24-h dietary recalls in Mkushi, Zambia. We estimated usual intake distributions and the prevalence of VA adequacy using the National Cancer Institute (NCI) method across five scenarios: without sugar fortification; with fortification at 3.1 or 8.8 mg/kg (median levels previously measured in Mkushi); at 10 mg/kg (the minimum legal requirement at the household level), and at 15 mg/kg (the minimum legal requirement at the factory level). We applied the regression calibration method to examine associations of usual intake of sugar and dietary VA with plasma and breast milk retinol concentrations. Without fortified sugar, the estimated prevalence of dietary VA inadequacy was 83% (standard error [SE]: 6). Projected reductions in VA inadequacy were 7 (SE: 6), 24 (SE: 14), 30 (SE: 15) and 47 (SE: 18) percentage points for sugar fortification at 3.1, 8.8, 10 and 15 mg/kg, respectively. Usual sugar intake was not significantly associated with plasma or breast milk retinol concentrations. The potential impacts of sugar fortification on VA intakes are limited if the programme is not implemented as planned. Even if the target fortification levels are achieved (10 mg/kg), sugar fortification alone is unlikely to eliminate dietary VA inadequacy among lactating women in Zambia.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":"21 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/mcn.70077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heavy on Plans, Light on Delivery: The Structural Failures of Ethiopia's Nutrition Policies","authors":"Taddese Zerfu","doi":"10.1111/mcn.70073","DOIUrl":"10.1111/mcn.70073","url":null,"abstract":"<p>Ethiopia's development ambitions rest on the foundation of a healthy population, yet its nutrition sector remains stalled despite decades of planning and investment. Nearly 38% of children under five are stunted, and food insecurity continues to affect millions. Landmark initiatives like the National Food and Nutrition Policy and the Seqota Declaration demonstrate strong political will—but implementation and scale-up falters due to entrenched structural failures. At the core of this breakdown is an overstretched and under-resourced frontline workforce. Health Extension Workers, while committed, are burdened with wide-ranging responsibilities, and lack the specialized training needed for effective nutrition service delivery. As a result, national strategies often collapse at the community level, where change is most urgently needed. This is further compounded by fragmented coordination. Despite the multisectoral nature of malnutrition—spanning health, agriculture, education, and social protection—ministries and partners frequently work in silos, sending conflicting messages to the same households. Meanwhile, valuable research and data remain disconnected from policy and program implementation, limiting the system's responsiveness and accountability. The path forward requires more than incremental fixes. Ethiopia needs specialized community nutrition workers to bridge the last-mile gap, a high-level coordination mechanism to align sectoral actions, and agile policies grounded in real-time evidence. Without these structural reforms, the burden of malnutrition will continue to erode the country's human capital and economic potential. This is not just a health crisis—it is a critical bottleneck to national progress. The time for structural transformation is now.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":"21 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/mcn.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to Indonesia's Dietary Guidelines Among Lactating Women: Insights for Policy and Practice","authors":"Sofa Rahmannia,&nbsp;Kevin Murray,&nbsp;Gina Arena,&nbsp;Aly Diana,&nbsp;Rosalind Gibson,&nbsp;Siobhan Hickling","doi":"10.1111/mcn.70075","DOIUrl":"10.1111/mcn.70075","url":null,"abstract":"<p>This study investigated adherence to Indonesia's Dietary Guidelines (IDG) among lactating women, examining related factors and association with nutrient intake adequacy, maternal and infant biomarkers, body mass index, and growth. Participants were lactating women (<i>n</i> = 220) from urban and rural West Java, Indonesia. Dietary intake (via 3-day weighed food records), anthropometry and blood samples were assessed. Adherence was evaluated using a scoring system tailored for IDG and adapted from the Healthy Eating Index to assess intake of food groups, sugar, salt, fat, water, coffee, and breakfast habits. Starchy staples intake exceeded recommendations by nearly double (median 7.1 vs. recommended 3–4 servings/day), while vegetable (0.5 servings/day), fruit (1.0), and water (1300 mL/day) intake fell notably short. Protein-rich food intake (3.5 servings/day) was closer to target. Only 1% of participants met three out of four food group targets. Adherence to the meal-based <i>MyPlate</i> framework showed similar imbalances, with 68% of the plate occupied by starchy staples versus the recommended 33%. Sociodemographic factors, including education, wealth, and family size, were associated with adherence to IDG components. For instance, women in the highest wealth quintile had higher adherence scores for starchy staple moderation (mean 4.3) than those in the lowest (mean 2.9). Adherence to IDG components correlated positively with nutrient intake adequacy (e.g. protein-rich food and overall adequacy: <i>r</i> = 0.19, 95% CI: 0.06–0.32) but not consistently with maternal or infant biomarkers. These findings highlight the need to refine dietary guidelines with clearer portion guidance and consideration of factors beyond intake adequacy during lactation.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":"21 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/mcn.70075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144745897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Drivers of Sustained Engagement in SMS-Based Nutrition Programmes: A Realist Evaluation With an Equity Lens in Tanzania","authors":"Inka Barnett,&nbsp;Jessica Gordon,&nbsp;Deogardius Medardi,&nbsp;Mieke Snijder","doi":"10.1111/mcn.70069","DOIUrl":"10.1111/mcn.70069","url":null,"abstract":"<p>Child undernutrition remains a global challenge, intricately linked to systemic inequities in access to maternal and child health and nutrition (MCHN) services. While SMS-based behaviour change communication (BCC) offers a scalable strategy to address this challenge, its effectiveness is often undermined by low and inconsistent user engagement. This study extends the impact evaluation of the mNutrition programme in Tanzania—a nationwide SMS-based BCC programme aimed at improving maternal and child nutrition (MCN)—to investigate what drives sustained, long-term engagement—an important but underexplored gap. The objective is to explore the mechanisms driving sustained engagement among mothers in rural Tanzania and how these are triggered by specific contextual factors and inequities. A realist approach was used, combining realist interviews with 40 sustained engagers (conducted across three sites between February and April 2019) and quantitative endline survey data. Retroductive analysis iteratively tested initial programme theories (IPTs) and derived Context-Mechanism-Outcome (CMO) configurations explaining sustained engagement. Findings showed sustained engagement resulted from the interplay between programme elements—such as content, SMS delivery (regularity, convenience, privacy), message tone (non-judgmental, supportive), and perceptions of the sender—and inequity-laden contextual realities, including time poverty, social isolation, undervaluation of women, gendered power dynamics within households and healthcare settings. The study concludes that digital BCC programmes must be context-sensitive and equity-oriented to achieve sustained engagement. Designing messages and delivery systems that reflect users' lived experiences and address structural vulnerabilities can enhance engagement and support more equitable nutrition outcomes.</p>","PeriodicalId":51112,"journal":{"name":"Maternal and Child Nutrition","volume":"21 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/mcn.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}