392 results on '"Menon, Purnima'
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2. Scale and Sustainability: The Impact of a Women’s Self-Help Group Program on Household Economic Well-Being in India
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Kalyani Raghunathan, Neha Kumar, Shivani Gupta, Giang Thai, Samuel Scott, Avijit Choudhury, Madhu Khetan, Purnima Menon, and Agnes Quisumbing
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Development - Abstract
Microfinance groups are a prominent source of small-scale rural credit in many developing countries. In India, evidence of the impact of the now ubiquitous women-only savings and credit self-help groups (SHGs) on household consumption and asset accumulation is inconclusive and based on small-scale interventions. Further, little is known about the sustainability of impacts at scale. We use panel data on close to 2500 households from five states in India to estimate the impact of SHG membership on household expenditure and asset ownership. Over four years, we find small but significant impacts of SHG membership on household expenditure and livestock ownership. Membership duration has a modest effect, suggesting that initial impacts may taper off as the program scales up, though small sample sizes limit our ability to draw inferences. Accompanying evidence on pathways is compelling; related work shows that SHG participation improves information, empowerment, and access to entitlements. While the direct impacts of SHG membership may not suffice to fill gaps in access to credit faced by the rural poor, impacts along these additional pathways could intensify the benefits of these groups.
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- 2022
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3. Changes in anemia and anthropometry during adolescence predict learning outcomes: findings from a 3-year longitudinal study in India
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Phuong H Nguyen, Monika Walia, Anjali Pant, Purnima Menon, and Samuel Scott
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Male ,Nutrition and Dietetics ,Adolescent ,Anthropometry ,India ,Nutritional Status ,Medicine (miscellaneous) ,Anemia ,Young Adult ,Cross-Sectional Studies ,Thinness ,Prevalence ,Humans ,Female ,Longitudinal Studies ,Growth Disorders - Abstract
Anemia and poor physical growth during adolescence have far-ranging consequences, but limited longitudinal evidence exists on how changes in these factors relate to changes in learning skills as adolescents mature.We examined the association between changes in anemia and physical growth during adolescence and learning outcomes.We used longitudinal data from the Understanding the Lives of Adolescents and Young Adults (UDAYA) project, which surveyed adolescents aged 10-19 y in northern India in 2015-2016 and 2018-2019 (n = 5963). We used multilevel mixed-effects logistic regression models to examine associations between changes in anemia/thinness/stunting status (4 groups: never, improved, new, and persistent) and reading (ability to read a story) and math proficiency (ability to solve division problems) at follow-up.Persistent anemia and stunting were higher among girls than among boys (46% compared with 8% and 37% compared with 14%, respectively), but persistent thinness was lower (7% compared with 16%). Improvement in anemia, thinness, and stunting was 1.4-1.7 times higher among boys than among girls. Boys who were anemic in both waves were 74% [adjusted odds ratio (AOR): 0.26; 95% CI: 0.12, 0.59] and 65% (AOR: 0.35; 95% CI: 0.16, 0.76) less likely to be able to read a story and solve division problems, respectively, than boys who were nonanemic in both waves. Persistent thinness in boys was negatively associated with both reading (AOR: 0.37; 95% CI: 0.21, 0.66) and math proficiency (AOR: 0.27; 95% CI: 0.16, 0.46). Persistent stunting contributed to lower reading and math proficiency in boys and girls (AORs: 0.29-0.46). Boys whose anemia or thinness status improved and girls whose stunting status improved had similar learning skills at follow-up as those who were never anemic/thin/stunted.Persistent anemia, thinness, and short stature during adolescence were associated with poor learning. Programs targeted at adolescents should contribute to nurturing environments that foster healthy growth and learning.
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- 2022
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4. Reducing childhood stunting in India: Insights from four subnational success cases
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Rasmi Avula, Phuong Hong Nguyen, Lan Mai Tran, Supreet Kaur, Neena Bhatia, Rakesh Sarwal, Arjan de Wagt, Deepika Nayar Chaudhery, and Purnima Menon
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Development ,Agronomy and Crop Science ,Food Science - Abstract
Global success case analyses have identified factors supporting reductions in stunting across countries; less is known about successes at the subnational levels. We studied four states in India, assessing contributors to reductions in stunting between 2006 and 2016. Using public datasets, literature review, policy analyses and stakeholder interviews, we interpreted changes in the context of policies, programs and enabling environment. Primary contributors to stunting reduction were improvements in coverage of health and nutrition interventions (ranged between 11 to 23% among different states), household conditions (22-47%), and maternal factors (15-30%). Political and bureaucratic leadership engaged civil society and development partners facilitated change. Policy and program actions to address the multidimensional determinants of stunting reduction occur in sectors addressing poverty, food security, education, health services and nutrition programs. Therefore, for stunting reduction, focus should be on implementing multisectoral actions with equity, quality, and intensity with assured convergence on the same geographies and households.The online version contains supplementary material available at 10.1007/s12571-021-01252-x.
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- 2022
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5. Specificity Matters: Unpacking Impact Pathways of Individual Interventions within Bundled Packages Helps Interpret the Limited Impacts of a Maternal Nutrition Intervention in India
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Melissa F Young, Edward A. Frongillo, Sebanti Ghosh, Thomas Forissier, Purnima Menon, Lan Mai Tran, Phuong H. Nguyen, Shivani Kachwaha, Jessica Escobar-Alegria, Rasmi Avula, and Praveen Kumar Sharma
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Counseling ,Nutrition and Dietetics ,Service delivery framework ,media_common.quotation_subject ,Supply chain ,Psychological intervention ,India ,Nutritional Status ,Medicine (miscellaneous) ,Prenatal Care ,Maternal Nutritional Physiological Phenomena ,medicine.disease ,Work (electrical) ,Acquired immunodeficiency syndrome (AIDS) ,Nursing ,Pregnancy ,Data quality ,Intervention (counseling) ,medicine ,Humans ,Female ,Quality (business) ,Psychology ,Delivery of Health Care ,media_common - Abstract
To address gaps in coverage and quality of nutrition services, AliveThrive (AT) strengthened the delivery of maternal nutrition interventions through government antenatal care (ANC) services in Uttar Pradesh, India. The impact evaluation of the AT interventions compared intensive ANC (I-ANC) with standard ANC (S-ANC) areas and found modest impacts on micronutrient supplementation, dietary diversity, and weight-gain monitoring.This study examined intervention-specific program impact pathways (PIPs) and identified reasons for limited impacts of the AT maternal nutrition intervention package.We used mixed methods: frontline worker (FLW) surveys (n = ∼500), counseling observations (n = 407), and qualitative in-depth interviews with FLWs, supervisors, and block-level staff (n = 59). We assessed 7 PIP domains: training and materials, knowledge, supportive supervision, supply chains, data use, service delivery, and counseling.Exposure to training improved in both I-ANC and S-ANC areas with more job aids used in I-ANC compared with S-ANC (90% compared with 70%), but gaps remained for training content and refresher trainings. FLWs' knowledge improvement was higher in I-ANC than S-ANC (22-36 percentage points), but knowledge of micronutrient supplement benefits and recommended foods was insufficient (50%). Most FLWs received supervision (90%), but supportive supervision was limited by staff vacancies and competing work priorities. Supplies of iron-folic acid and calcium supplements were low in both areas (30-50% stock-outs). Use of monitoring data during review meetings was higher in I-ANC than S-ANC (52% compared with 36%) but was constrained by time, understanding, and data quality. Service provision improved in both I-ANC and S-ANC areas, but counseling on supplement benefits and weight-gain monitoring was low (30-40%).Systems-strengthening efforts improved maternal nutrition interventions in ANC, but gaps remained. Taking an intervention-specific perspective to the PIP analysis in this package of services was critical to understand how common and specific barriers influenced overall program impact.
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- 2022
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6. Assessing sustainment of health worker outcomes beyond program end: Evaluation results from an infant and young child feeding intervention in Bangladesh
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Corrina Moucheraud, Adrienne Epstein, Haribondhu Sarma, Sunny S. Kim, Phuong Hong Nguyen, Mahfuzur Rahman, Md. Tariquijaman, Jeffrey Glenn, Denise D. Payán, Purnima Menon, and Thomas J. Bossert
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IntroductionAlive and Thrive (A&T) implemented infant and young child feeding (IYCF) interventions in Bangladesh. We examine the sustained impacts on health workers' IYCF knowledge, service delivery, job satisfaction, and job readiness three years after the program's conclusion.MethodsWe use data from a cluster-randomized controlled trial design, including repeated cross-sectional surveys with health workers in 2010 (baseline, n = 290), 2014 (endline, n = 511) and 2017 (post-endline, n = 600). Health workers in 10 sub-districts were trained and incentivized to deliver intensified IYCF counseling, and participated in social mobilization activities, while health workers in 10 comparison sub-districts delivered standard counseling activities. Accompanying mass media and policy change activities occurred at the national level. The primary outcome is quality of IYCF service delivery (number of IYCF messages reportedly communicated during counseling); intermediate outcomes are IYCF knowledge, job satisfaction, and job readiness. We also assess the role of hypothesized modifiers of program sustainment, i.e. activities of the program: comprehensiveness of refresher trainings and receipt of financial incentives. Multivariable difference-in-difference linear regression models, including worker characteristic covariates and adjusted for clustering at the survey sampling level, are used to compare differences between groups (intervention vs. comparison areas) and over time (baseline, endline, post-endline).ResultsAt endline, health workers in intervention areas discussed significantly more IYCF topics than those in comparison areas (4.9 vs. 4.0 topics, p p = 0.067). Comprehensive refresher trainings were protective against deterioration in service delivery. Between baseline and endline, the intervention increased health workers' knowledge (3.5-point increase in knowledge scores in intervention areas, vs. 1.5-point increase in comparison areas, p DiscussionOur study showed sustained impact of IYCF interventions on health workers' knowledge, but not job satisfaction or job readiness—and, critically, no sustained program effect on service delivery. Programs of limited duration may seek to assess the status of and invest in protective factors identified in this study (e.g., refresher trainings) to encourage sustained impact of improved service delivery. Studies should also prioritize collecting post-endline data to empirically test and refine concepts of sustainment.
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- 2023
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7. Take-home rations in the Integrated Child Development Services (ICDS): Study of coverage and uptake in Tamil Nadu
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Rasmi Avula, Purnima Menon, Sattvika Ashok, and Sapna Nair
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- 2023
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8. Trends and patterns in consumption of foods among Indian adults: Insights from National Family Health Surveys, 2005-06 to 2019- 21
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Purnima Menon, Avula Laxmaiah, Alka Chauhan, Parul Puri, Sarang Pedgaonkar, L.K. Dwivedi, S.K. Singh, Sylvie Chamois, Phuong Hong Nguyen, Samuel Scott, Rati Kapoor, and Sharvari Patwardhan
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- 2023
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9. Anaemia in Indians aged 10-19 years: Prevalence, burden and associated factors at national and regional levels
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Scott, Samuel, Lahiri, Anwesha, Sethi, Vani, De Wagt, Arjan, Menon, Purnima, Yadav, Kapil, Varghese, Mini, Joe, William, Vir, Sheila C, Nguyen, Phuong Hong, Scott, Samuel [0000-0002-5564-0510], Sethi, Vani [0000-0001-9408-2956], Menon, Purnima [0000-0001-5988-2894], Nguyen, Phuong Hong [0000-0003-3418-1674], and Apollo - University of Cambridge Repository
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Male ,anaemia ,Nutrition and Dietetics ,Adolescent ,Anemia, Iron-Deficiency ,public health ,Malnutrition ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,India ,Anemia ,Iron Deficiencies ,Hemoglobinopathies ,Zinc ,Pediatrics, Perinatology and Child Health ,Ferritins ,Prevalence ,Humans ,Female ,Micronutrients ,Child ,Vitamin A - Abstract
Anaemia control programmes in India are hampered by a lack of representative evidence on anaemia prevalence, burden and associated factors for adolescents. The aim of this study was to: (1) describe the national and subnational prevalence, severity and burden of anaemia among Indian adolescents; (2) examine factors associated with anaemia at national and regional levels. Data (n = 14,673 individuals aged 10-19 years) were from India's Comprehensive National Nutrition Survey (CNNS, 2016-2018). CNNS used a multistage, stratified, probability proportion to size cluster sampling design. Prevalence was estimated using globally comparable age- and sex-specific cutoffs, using survey weights for biomarker sample collection. Burden analysis used prevalence estimates and projected population from 2011 Census data. Multivariable logistic regression models were used to analyse factors (diet, micronutrient deficiencies, haemoglobinopathies, sociodemographic factors, environment) associated with anaemia. Anaemia was present in 40% of girls and 18% of boys, equivalent to 72 million adolescents in 2018, and varied by region (girls 29%-46%; boys 11%-28%) and state (girls 7%-62%; boys 4%-32%). Iron deficiency (ferritin < 15 μg/L) was the strongest predictor of anaemia (odds ratio [OR]: 4.68, 95% confidence interval [CI]: [3.21,6.83]), followed by haemoglobinopathies (HbA2 > 3.5% or any HbS) (OR: 2.81, 95% CI: [1.66,4.74]), vitamin A deficiency (serum retinol
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- 2022
10. Unequal coverage of nutrition and health interventions for women and children in seven countries
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Phuong Hong Nguyen, Nishmeet Singh, Samuel Scott, Sumanta Neupane, Manita Jangid, Monika Walia, Zivai Murira, Zulfiqar Bhutta, Harriet Torlesse, Ellen Piwoz, Rebecca Heidkamp, and Purnima Menon
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Bangladesh ,Socioeconomic Factors ,Research ,Public Health, Environmental and Occupational Health ,Humans ,India ,Nutritional Status ,Female ,Health Facilities ,Sri Lanka - Abstract
To examine inequalities and opportunity gaps in co-coverage of health and nutrition interventions in seven countries.We used data from the most recent (2015-2018) demographic and health surveys of mothers with children younger than 5 years in Afghanistan (Only 15% of 231 113 mother-child pairs received all eight health interventions (weighted percentage). The percentage of mother-child pairs who received no nutrition interventions was highest in Pakistan (25%). Wealth gaps (richest versus poorest) for co-coverage of health interventions were largest for Pakistan (slope index of inequality: 62 percentage points) and Afghanistan (38 percentage points). Wealth gaps for co-coverage of nutrition interventions were highest in India (32 percentage points) and Bangladesh (20 percentage points). Coverage of nutrition interventions was lower than for associated health interventions, with opportunity gaps ranging from 4 to 54 percentage points.Co-coverage of health and nutrition interventions is far from optimal and disproportionately affects poor households in south Asia. Policy and programming efforts should pay attention to closing coverage, equity and opportunity gaps, and improving nutrition delivery through health-care and other delivery platforms.Examen des inégalités et des écarts de perspectives dans la couverture commune des interventions en matière de santé et de nutrition dans sept pays.Nous avons utilisé les données des enquêtes démographiques et sanitaires les plus récentes (2015-2018) auprès de mères ayant des enfants de moins de 5 ans en Afghanistan (Seuls 15 % des 231 113 couples mère-enfant ont bénéficié des huit interventions sanitaires (pourcentage pondéré). Le taux de couples mère-enfant n’ayant bénéficié d’aucune intervention en matière de nutrition était le plus élevé au Pakistan (25 %). Les écarts de richesse (les plus riches par rapport aux plus pauvres) pour la couverture commune des interventions sanitaires étaient les plus importants au Pakistan (indice de pente des inégalités : 62 points de pourcentage) et en Afghanistan (38 points de pourcentage). Les écarts de richesse pour la couverture commune des interventions en nutrition étaient les plus élevés en Inde (32 points de pourcentage) et au Bangladesh (20 points de pourcentage). La couverture des interventions en matière de nutrition était plus faible que celle des interventions sanitaires associées, avec des écarts de perspectives s’étalant de 4 à 54 points de pourcentage.La couverture commune des interventions en matière de santé et de nutrition est loin d’être optimale et affecte de manière disproportionnée les ménages pauvres d’Asie du Sud. Les efforts en matière de politique et de programmation devraient viser à combler les écarts en matière de couverture, d’équité et de perspective et à améliorer la fourniture d’interventions de nutrition au travers de soins de santé et d’autres plateformes de prestation.Analizar las desigualdades y la falta de oportunidades en la cobertura conjunta de las intervenciones sanitarias y de nutrición en siete países.Se utilizaron los datos de las encuestas demográficas y sanitarias más recientes (entre 2015 y 2018) de madres con hijos menores de 5 años en Afganistán (Solo el 15 % de 231 113 parejas madre e hijo recibieron las ocho intervenciones sanitarias (porcentaje ponderado). El porcentaje de parejas madre e hijo que no recibieron ninguna intervención de nutrición fue mayor en Pakistán (25 %). Las diferencias de riqueza (los más ricos frente a los más pobres) para la cobertura conjunta de las intervenciones sanitarias fueron mayores en Pakistán (índice de desigualdad de la pendiente: 62 puntos porcentuales) y en Afganistán (38 puntos porcentuales). Las diferencias de riqueza para la cobertura conjunta de las intervenciones de nutrición fueron mayores en India (32 puntos porcentuales) y en Bangladesh (20 puntos porcentuales). La cobertura de las intervenciones de nutrición fue menor que la de las intervenciones sanitarias asociadas, con diferencias de oportunidad que iban de 4 a 54 puntos porcentuales.La cobertura conjunta de las intervenciones sanitarias y de nutrición está lejos de ser óptima y afecta de manera desproporcionada a los hogares pobres de Asia Meridional. Los esfuerzos en materia de política y programación deben prestar atención a la reducción de las diferencias de cobertura, equidad y oportunidad, y a la mejora de la prestación de servicios de nutrición a través de la atención sanitaria y demás plataformas de prestación.الغرض فحص التفاوتات وفجوات الفرص في التغطية المشتركة للتدخلات الصحية والغذائية في سبع دول . الطريقة قمنا باستخدام بيانات من أحدث المسوحات السكانية والصحية (الفترة من 2015 إلى 2018) للأمهات ممن لديهم أطفال أصغر من 5 سنوات في أفغانستان (العدد = 19632)، وبنغلاديش (العدد = 5051)، والهند (العدد = 184641)، وملديف (العدد = 2368)، ونيبال (العدد = 3998)، وباكستان (العدد = 8285)، وسري لانكا (العدد = 7138). قمنا بتقدير التغطية المشتركة لمجموعة من ثمانية تدخلات صحية وثمانية تدخلات غذائية، وقمنا بتقييم تفاوتات التغطية المشتركة داخل كل دولة حسب الثروة والجغرافيا. وقمنا بفحص فجوات الفرص عن طريق مقارنة تغطية التدخلات الغذائية، في مقابل تغطية المنصات الخاصة بها لتقديم التدخلات الصحة. النتائج 15% فقط من 231113 من ثنائيات الأمهات والأطفال تلقوا كل التدخلات الصحية الثمانية (النسبة المئوية المرجحة). أما النسبة المئوية لثنائيات الأمهات والأطفال الذين لم يتلقوا أي من التدخلات الغذائية، فقد كانت الأعلى في باكستان (25%). كانت فجوات الثروة (الأغنى مقابل الأفقر) للتغطية المشتركة للتدخلات الصحية هي الأكبر في باكستان (مؤشر الانحدار للتفاوت: 62 نقطة مئوية) وأفغانستان (38 نقطة مئوية). كانت فجوات الثروة في التغطية المشتركة للتدخلات الغذائية هي الأعلى في الهند (32 نقطة مئوية)، وبنغلاديش (20 نقطة مئوية). كانت تغطية التدخلات الغذائية أقل من تغطية التدخلات الصحية المناظرة لها، حيث تراوحت فجوات الفرص من 4 إلى 54 نقطة مئوية. الاستنتاج التغطية المشتركة للتدخلات الصحية والغذائية بعيدة كل البعد عن المثالية، وتؤثر بشكل غير متناسب على الأسر الفقيرة في سبع دول. يجب أن تولي جهود السياسات والبرمجة اهتمامًا لسد فجوات التغطية، والإنصاف، والفرص، وتحسين تقديم خدمات التغذية من خلال منصات تقديم الرعاية الصحية وغيرها من الخدمات.旨在研究七个国家在健康和营养干预全民覆盖方面的不均衡性和机会差距。.我们采用来自阿富汗 (在 231,113 对母子中,只有 15% 的人接受了全部八项健康干预(权重比例)。巴基斯坦未接受营养干预的母子比例最高 (25%)。健康干预全民覆盖体现的财富差距(最富与最穷)最大的国家是巴基斯坦(不平等斜率指数:62 个百分点)和阿富汗(38 个百分点)。营养干预全民覆盖体现的财富差距最大的国家是印度(32 个百分点)和孟加拉国(20 个百分点)。营养干预覆盖范围低于相关的健康干预覆盖范围,机会差距从 4 到 54 个百分点不等。.健康和营养干预的全民覆盖率远未达到最佳值,且对南亚穷困家庭的影响尤为严重。政策和规划工作应注意缩小覆盖范围、平等和机会差距,并通过医疗保健和其他服务平台改善营养供给。.Изучить неравенство и различия в возможностях совместного охвата мероприятиями в области здравоохранения и питания в семи странах.Авторы применили данные последних (2015–2018 гг.) демографических обследований и обследований состояния здоровья матерей с детьми младше 5 лет в Афганистане (Только 15% из 231 113 пар «мать-ребенок» участвовали во всех восьми мероприятиях в области здравоохранения (взвешенный процент). Процент пар «мать-ребенок», которые не участвовали ни в одном мероприятии в области питания, был самым высоким в Пакистане (25%). Разрыв в уровне благосостояния (самые богатые и самые бедные) для совместного охвата мероприятиями в области здравоохранения был самым большим в Пакистане (показатель крутизны неравенства: 62 процентных пункта) и Афганистане (38 процентных пунктов). Разрыв в уровне благосостояния для совместного охвата мероприятиями в области питания был самым высоким в Индии (32 процентных пункта) и Бангладеше (20 процентных пунктов). Охват мероприятиями в области питания был ниже, чем сопутствующими мероприятиями в области здравоохранения, с различиями в возможностях от 4 до 54 процентных пунктов.Совместный охват мероприятиями в области здравоохранения и питания отнюдь не является оптимальным и непропорционально затрагивает неимущие домашние хозяйства в Южной Азии. При разработке политики и программ следует уделять внимание устранению пробелов в охвате, равенстве и возможностях, а также улучшению системы поставки продовольствия с помощью медицинских и других платформ.
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- 2021
11. A multinational Delphi consensus to end the COVID-19 public health threat
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Lazarus, Jeffrey V., Romero, Diana, Kopka, Christopher J., Karim, Salim Abdool, Abu-Raddad, Laith J., Almeida, Gisele, Baptista-Leite, Ricardo, Barocas, Joshua A., Barreto, Mauricio L., Bar-Yam, Yaneer, Bassat, Quique, Batista, Carolina, Bazilian, Morgan, Chiou, Shu-Ti, del Rio, Carlos, Dore, Gregory J., Gao, George F., Gostin, Lawrence O., Hellard, Margaret, Jimenez, Jose L., Kang, Gagandeep, Lee, Nancy, Matičič, Mojca, McKee, Martin, Nsanzimana, Sabin, Oliu-Barton, Miquel, Pradelski, Bary, Pyzik, Oksana, Rabin, Kenneth, Raina, Sunil, Rashid, Sabina Faiz, Rathe, Magdalena, Saenz, Rocio, Singh, Sudhvir, Trock-Hempler, Malene, Villapol, Sonia, Yap, Peiling, Binagwaho, Agnes, Kamarulzaman, Adeeba, El-Mohandes, Ayman, Barreto, Mauricio, Abdulla, Salim, Addleman, Sarah, Aghayeva, Gulnara, Agius, Raymond, Ahmed, Mohammed, Ramy, Mohamed Ahmed, Aide, Pedro, Aleman, Soo, Alfred, Jean-Patrick, Ali, Shamim, Aliaga, Jorge, Aloudat, Tammam, Alqahtani, Saleh A., Al-Salman, Jameela, Amuasi, John H., Agrawal, Anurag, Anwar, Wagida, Araujo-Jorge, Tania, Artaza, Osvaldo, Asadi, Leyla, Awuku, Yaw, Baker, Michael, Barberia, Lorena, Bascolo, Ernesto, Belcher, Paul, Bell, Lizett, Benzaken, Adele, Bergholtz, Emil, Bhadelia, Nahid, Bhan, Anant, Bilodeau, Stephane, Bitrán, Ricardo, Bluyssen, Philomena, Bosman, Arnold, Bozza, Fernando A., Brinkmann, Melanie M., Brown, Andrew, Mellado, Bruce, Bukusi, Elizabeth, Bullen, Chris, Buonanno, Giorgio, Burgess, Rochelle, Butler, Matthew, Byakika-Kibwika, Pauline, Cabieses, Baltica, Carlsson, Gunilla, Cascini, Fidelia, Chabala, Chishala, Chakroun, Mohamed, Cheng, null, Chetty, Agnes, Chumachenko, Dmytro, Consalves, Gregg, Conway Morris, Andrew, Cordie, Ahmed, Corrah, Tumani, Crabtree-Ramírez, Brenda, Dashdorj, Naranjargal, Davidovitch, Nadav, de Souza, Luis Eugenio, Dhariwal, Akshay Chand, Druică, Elena, Ergonul, Onder, Erondu, Ngozi A., Essar, Mohammad Yasir, Ewing, Andrew, Fanjul, Gonzalo, Feierstein, Daniel, Feigl-Ding, Eric, Figueroa, Ramon, Figueroa, John Peter, Fisher, Dale, Flores, Walter, Forero-Peña, David A., Frumkin, Howard, Gamkrelidze, Amiran, Gandhi, Monica, Garcia, Patricia, Garcia-Basteiro, Alberto L., García-Sastre, Adolfo, Garg, Suneela, Gbeasor-Komlanvi, null, Gershenson, Carlos, Gilada, Ishwar, Giovanella, Ligia, González, Marino, Green, Manfred S., Greenhalgh, Trisha, Griffin, Paul, Griffin, Stephen, Grinsztejn, Beatriz, Anand, Tanu, Guerra, Germán, Guinto, Renzo, Gujski, Mariusz, Guner, Rahmet, Hamdy, Adam, Hâncean, Marian-Gabriel, Haniffa, Abusayeed, Hartigan-Go, Kenneth Y., Hassan, Hoda K., Hay, Simon I., Heino, Matti T. J., Hel, Zdenek, Hotez, Peter, Hu, Jia, Hukić, Mirsada, IJsselmuiden, Carel, Iroko, Davidson, Iskarous, Maged, Izugbara, Chimaraoke, Jacobs, Choolwe, Jadad, Alejandro R., Jehan, Fyezah, Jordan, Ayana, Jroundi, Imane, Kain, Kevin, Kamberi, Fatjona, Karamov, Eduard, Karan, Abraar, Katz, Rebecca, Katzourakis, Aris, Kazembe, Abigail, Khamis, Faryal, Khamzayev, Komiljon, Khanyola, Judy, Khunti, Kamlesh, Kiguli-Malwadde, Elsie, Kim, Woo Joo, Kirenga, Bruce J., Klimovský, Daniel, Kmush, Brittany L., Knaul, Felicia, Kogevinas, Manolis, Kristensen, Frederik, Kumar, Dinesh, Kumar, Raman, Kvalsvig, Amanda, Lacerda, Marcus V., Lal, Arush, Lawton, Tom, Lemery, Jay, Leonardi, Anthony J., Li, Yuguo, Löttvall, Jan, Lounis, Mohamed, Maceira, Daniel, MacIntyre, C. Raina, Madani, Azzeddine, Magiorkinis, Gkikas, Malekzadeh, Reza, Choisy, Marc, Marcelin, Jasmine R., Marks, Guy B., Marr, Linsey, Marrazzo, Jeanne, Martina, Antonieta, Martín-Moreno, José M., Mateos, Carlos, Mayxay, Mayfong, Mazarati, Jean Bapiste, Mboup, Souleymane, McDonald, Jennifer, McMillan, Faye, Mechili, Enkeleint, Medici, Andre, Davis, Sarah L. M., Meier, Petra, Memish, Ziad A., Menon, Jaideep, Menon, Purnima, Mesiano-Crookston, Jonathan, Michie, Susan, Mikolasevic, Ivana, Milicevic, Ognjen, Mishra, Asit Kumar, Mohamed, Rahma, Mokdad, Ali H., Monroy-Valle, Michele, Morawska, Lidia, Moschos, Sterghios A., Motawea, Karam, Mousavi, Sayed Hamid, Mumtaz, Ghina, Munene, Peter K., Muñoz Almagro, Carmen, Muriuki, Janet, Muyingo, Sylvia, Naniche, Denise, Naylor, C. David, Ndembi, Nicaise, Nemec, Juraj, Nesteruk, Igor, Ngaruiya, Christine, Nguyen, Hung, Nikolova, Dafina, Nitzan, Dorit, Norheim, Ole, Noushad, Mohammed, Ntoumi, Francine, Nyborg, Gunhild Alvik, Ochodo, Eleanor, Odabasi, Zekaver, Okwen, Mbah Patrick, Olivia, Keiser, Ong, David S. Y., Opara, Ijeoma, Orozco, Miguel, Oshitani, Hitoshi, Pagel, Christina, Pai, Madhukar, Pálsdóttir, Björg, Papatheodoridis, Georgios, Paraskevis, Dimitrios, Leigh, Jeanna Parsons, Pécoul, Bernard, Peichl, Andreas, Perez-Then, Eddy, Duc, Phuc Pham, Philippe, Cécile, Pineda Rojas, Andrea, Pladsen, Courtney, Pozniak, Anton, Quiroga, Rodrigo, Qureshi, Huma, Rampal, Sanjay, Ranney, Megan, Rathe, Laura, Ratzan, Scott, Raventos, Henriette, Rees, Helen, Reis, Renata, Ricciardi, Walter, Rizk, Nesrine, Robalo, Magda, Robertson, Eleanor, Robinson, Leanne, Rokx, Casper, Ros, Tamsin, Røttingen, John-Arne, Rubin, Meir, Ruxrungtam, Kiat, Sadirova, Shakhlo, Saha, Senjuti, Salgado, Nelly, Sanchez, Lizet, Sangaramoorthy, Thurka, Santamaria-Ulloa, Carolina, Santos, Renata, Sawaf, Bisher, Schneider, Matthias F., Schooley, Robert T., Sener, Alper, Sepulveda, Jaime, Shah, Jaffer, Shibani, Mosa, Shoib, Sheikh, Sikazwe, Izukanji, Šimaitis, Aistis, Gill, Amandeep Singh, Skhvitaridze, Natia, Sokolović, Milka, Solomon, Roma, Solórzano, Xavier, Springer, Sandra A., Šrol, Jakub, Staines, Anthony, Stelfox, Henry T., Strathdee, Steffanie, Sulaiman, Lokman Hakim, Sutton, Brett, Svanæs, Dag, Swed, Sarya, Sypsa, Vana, Sørensen, Kristine, Tajudeen, Raji, Tan, Amy, Tang, Julian, Tanner, Marcel, Sethi, Tavpritesh, Temmerman, Marleen, Than, Kyu Kyu, Tinto, Halidou, Tomètissi, Sênoudé Pacôme, Torres, Irene, Tshering, null, Tsiodras, Sotirios, Tsofa, Benjamin, Vahlne, Anders, Vargas, Juan Rafael, Bernal, Ivan Dario Velez, Ventura, Deisy, Vilasanjuan, Rafael, Vipond, Joe, Wamala-Andersson, Sarah, Wargocki, Pawel, West, Robert, Weyand, Angela, White, Trenton M., Wolff, Guntram, Yao, Maosheng, Yates, Christian A., Yeboah, Georgina, Yee-Sin, Leo, Yi, Siyan, Teo, Yik-Ying, Yong, Poovorawan, Zamora-Mesía, Victor, Øvrehus, Anne, 0000-0001-9618-2299, 0000-0002-4832-9564, 0000-0002-4986-2133, 0000-0003-0790-0506, 0000-0003-0875-7596, 0000-0002-6994-1891, 0000-0002-3869-615X, 0000-0001-5286-4044, 0000-0001-6203-1847, 0000-0002-0121-9683, 0000-0003-1793-6350, 0000-0003-2418-0037, 0000-0002-5095-748X, 0000-0003-4492-3256, 0000-0002-5964-8210, 0000-0002-6779-3151, 0000-0002-8074-4450, Lazarus, Jeffrey V [0000-0001-9618-2299], Romero, Diana [0000-0002-4832-9564], Karim, Salim Abdool [0000-0002-4986-2133], Abu-Raddad, Laith J [0000-0003-0790-0506], Bassat, Quique [0000-0003-0875-7596], Chiou, Shu-Ti [0000-0002-6994-1891], Gao, George F [0000-0002-3869-615X], Gostin, Lawrence O [0000-0001-5286-4044], Jimenez, Jose L [0000-0001-6203-1847], McKee, Martin [0000-0002-0121-9683], Oliu-Barton, Miquel [0000-0003-1793-6350], Pradelski, Bary [0000-0003-2418-0037], Rathe, Magdalena [0000-0002-5095-748X], Trock-Hempler, Malene [0000-0003-4492-3256], Yap, Peiling [0000-0002-5964-8210], Binagwaho, Agnes [0000-0002-6779-3151], Kamarulzaman, Adeeba [0000-0002-8074-4450], Apollo - University of Cambridge Repository, Helsinki Collegium for Advanced Studies, Research Group of Nelli Hankonen, Doctoral Programme in Social Sciences, Academic Disciplines of the Faculty of Social Sciences, RS: CAPHRI - R2 - Creating Value-Based Health Care, International Health, Performance analysis and optimization of LARge Infrastructures and Systems (POLARIS), Inria Grenoble - Rhône-Alpes, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Laboratoire d'Informatique de Grenoble (LIG), Université Pierre Mendès France - Grenoble 2 (UPMF)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut National Polytechnique de Grenoble (INPG)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre Mendès France - Grenoble 2 (UPMF)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut National Polytechnique de Grenoble (INPG)-Centre National de la Recherche Scientifique (CNRS), Internal Medicine, Medical Microbiology & Infectious Diseases, Veritati - Repositório Institucional da Universidade Católica Portuguesa, and Lazarus J. V., Romero D., Kopka C. J., Karim S. A., Abu-Raddad L. J., Almeida G., Baptista-Leite R., Barocas J. A., Barreto M. L., Bar-Yam Y., et al.
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Pandemics/economics ,BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences ,COVID-19 Vaccines ,Delphi Technique ,General Science & Technology ,International Cooperation ,Temel Bilimler (SCI) ,ÇOK DİSİPLİNLİ BİLİMLER ,Public Health/economics ,[SHS]Humanities and Social Sciences ,SDG 3 - Good Health and Well-being ,RA0421 Public health. Hygiene. Preventive Medicine ,Medicine and Health Sciences ,Humans ,prevention and control ,human ,Settore MED/42 - IGIENE GENERALE E APPLICATA ,Health Education ,Pandemics ,Multidisipliner ,Organizations ,Multidisciplinary ,MULTIDISCIPLINARY SCIENCES ,COVID-19/economics ,Temel Bilimler ,pandemic ,Communication ,Health Policy ,BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti ,Doğa Bilimleri Genel ,COVID-19 ,3142 Public health care science, environmental and occupational health ,Delphi study ,NATURAL SCIENCES, GENERAL ,N/A ,Public Opinion ,Government ,Natural Sciences (SCI) ,Public Health ,Natural Sciences - Abstract
Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic . Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches , while maintaining proven prevention measures using a vaccines-plus approach that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.
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- 2022
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12. Multiple modifiable maternal, household and health service factors are associated with maternal nutrition and early breastfeeding practices in Burkina Faso
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Sunny S. Kim, Césaire T. Ouédraogo, Rock R. Zagré, Rasmané Ganaba, Maurice G. Zafimanjaka, Manisha Tharaney, and Purnima Menon
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Counseling ,Nutrition and Dietetics ,Iron ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Prenatal Care ,Maternal Nutritional Physiological Phenomena ,Breast Feeding ,Folic Acid ,Pregnancy ,Pediatrics, Perinatology and Child Health ,Burkina Faso ,Humans ,Female - Abstract
Low coverage of effective nutrition interventions in many high-burden countries, due to service provision and demand factors, result in poor uptake of recommended practices and nutrition outcomes. We examined the factors that influence maternal nutrition and early breastfeeding practices and determined the extent that the key factors could improve these practices in two regions in Burkina Faso. We used household survey data among pregnant (n = 920) and recently delivered women (n = 1840). Multivariable regression analyses were conducted to identify the determinants of a diverse diet and iron-folic acid (IFA) supplement consumption, weight monitoring during pregnancy and early initiation of breastfeeding (EIBF). Population attributable risk analysis was used to estimate how much the outcomes can be improved under optimal conditions of interventions that address the modifiable determinants. During pregnancy, 21% of women achieved minimum diet diversity (MDD-W), 70% consumed 90+ IFA tablets and 65% were weighed 4+ times; EIBF was 40%. Nutrition knowledge was associated with MDD-W (odds ratio [OR]: 3.2), 90+ IFA (OR: 1.5) and EIBF (OR: 1.9). Positive social norms and family support were associated with 90+ IFA (OR: 1.5). Early and 4+ ANC visits were associated with 90+ IFA (OR: 1.5 and 10) and 4+ weight monitoring (OR: 6.2). Nutrition counselling was associated with 90+ IFA (OR: 2.5) and EIBF (OR: 1.5). Under optimal programme conditions, 41% of women would achieve MDD-W, 93% would consume 90+ IFA, 93% would be weighed 4+ times and 57% would practice EIBF. Strengthening the delivery and uptake of interventions targeted at these modifiable factors has the potential to improve maternal nutrition practices.
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- 2022
13. Learning together: Experimental evidence on the impact of group-based nutrition interventions in rural Bihar
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Kalyani Raghunathan, Neha Kumar, Shivani Gupta, Tarana Chauhan, Ashi Kohli Kathuria, and Purnima Menon
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Economics and Econometrics ,Sociology and Political Science ,Geography, Planning and Development ,Building and Construction ,Development - Published
- 2023
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14. Strengthening Nutrition Interventions in Antenatal Care Services Affects Dietary Intake, Micronutrient Intake, Gestational Weight Gain, and Breastfeeding in Uttar Pradesh, India: Results of a Cluster-Randomized Program Evaluation
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Rasmi Avula, Praveen Kumar Sharma, Jessica Escobar-Alegria, Shivani Kachwaha, Edward A. Frongillo, Phuong H. Nguyen, Sumeet Patil, Thomas Forissier, Lan M. Tran, Sebanti Ghosh, Melissa F Young, and Purnima Menon
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breastfeeding ,030309 nutrition & dietetics ,Breastfeeding ,India ,Medicine (miscellaneous) ,micronutrient intake ,Prenatal care ,Food group ,Eating ,AcademicSubjects/MED00060 ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,hemic and lymphatic diseases ,Environmental health ,medicine ,Humans ,Longitudinal Studies ,030212 general & internal medicine ,reproductive and urinary physiology ,interpersonal counseling ,0303 health sciences ,Nutrition and Dietetics ,Prenatal nutrition ,business.industry ,Behavior change ,Prenatal Care ,diet quality ,medicine.disease ,Micronutrient ,female genital diseases and pregnancy complications ,Gestational Weight Gain ,Community and International Nutrition ,Breast Feeding ,Cross-Sectional Studies ,AcademicSubjects/SCI00960 ,Female ,business ,Breast feeding ,Program Evaluation ,maternal nutrition - Abstract
Background Maternal nutrition interventions are inadequately integrated into antenatal care (ANC). Alive & Thrive aimed to strengthen delivery of micronutrient supplements and intensify interpersonal counseling and community mobilization through government ANC services. Objectives We compared nutrition-intensified ANC (I-ANC) with standard ANC (S-ANC) on coverage of nutrition interventions and maternal nutrition practices. Methods We used a cluster-randomized design with cross-sectional baseline (2017) and endline (2019) surveys (n ∼660 pregnant and 1800 recently delivered women per survey) and a repeated-measures longitudinal study in 2018–2019 (n = 400). We derived difference-in-difference effect estimates (DIDs) for diet diversity, consumption of micronutrient supplements, weight monitoring, and early breastfeeding practices. Results Despite substantial secular improvements in service coverage from India's national nutrition program, women in the I-ANC arm received more home visits [DID: 7–14 percentage points (pp)] and counseling on core nutrition messages (DID: 10–23 pp) than in the S-ANC arm. One-third of women got ≥3 home visits and one-fourth received ≥4 ANC check-ups in the I-ANC arm. Improvements were greater in the I-ANC arm than in the S-ANC arm for any receipt and consumption of iron–folic acid (DID: 7.5 pp and 9.5 pp, respectively) and calcium supplements (DID: 14.1 pp and 11.5 pp, respectively). Exclusive breastfeeding improved (DID: 7.5 pp) but early initiation of breastfeeding did not. Maternal food group consumption (∼4 food groups) and probability of adequacy of micronutrients (∼20%) remained low in both arms. Repeated-measures longitudinal analyses showed similar results, with additional impact on consumption of vitamin A–rich foods (10 pp, 11 g/d), other vegetables and fruits (22–29 g/d), and gestational weight gain (0.4 kg). Conclusions Intensifying nutrition in government ANC services improved maternal nutrition practices even with strong secular trends in service coverage. Dietary diversity, supplement consumption, and breastfeeding practices remained suboptimal. Achieving greater behavior changes will require strengthening the delivery and use of maternal nutrition services integrated into ANC services in the health system. This trial was registered at clinicaltrials.gov as NCT03378141.
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- 2021
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15. Nourishing our future: the Lancet Series on adolescent nutrition
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Purnima Menon, Lynnette M. Neufeld, Edward A. Frongillo, Shanshan He, Shane A. Norris, Mariam Naguib, Surabhi Dogra, Emily Mates, Dougal S Hargreaves, and George C Patton
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medicine.medical_specialty ,Series (mathematics) ,Family medicine ,medicine ,General Medicine ,Psychology - Published
- 2022
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16. Adolescent birth and child undernutrition: an analysis of demographic and health surveys in Bangladesh, 1996–2017
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Sabina Faiz Rashid, Kaosar Afsana, Priyanjana Pramanik, Phuong H. Nguyen, Purnima Menon, Akhter Ahmed, Samuel Scott, and Long Quynh Khuong
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Male ,early marriage ,Adolescent ,Sanitation ,Nyasnutr1013 ,Child Nutrition Disorders ,History, 21st Century ,General Biochemistry, Genetics and Molecular Biology ,Young adolescents ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,underweight ,History and Philosophy of Science ,Pregnancy ,Humans ,Medicine ,Public Health Surveillance ,030212 general & internal medicine ,Geography, Medical ,Child growth ,Child ,Adverse effect ,Demography ,Bangladesh ,Adolescent Mothers ,030219 obstetrics & reproductive medicine ,Poverty ,business.industry ,Maternal and child health ,General Neuroscience ,Malnutrition ,stunting ,Original Articles ,History, 20th Century ,Nutrition Surveys ,medicine.disease ,Socioeconomic Factors ,Nyaspubl8657 ,Nyassoci9990 ,Female ,Original Article ,Underweight ,medicine.symptom ,business ,Nyasdeve3255 ,adolescent birth - Abstract
Adolescent birth is a major global concern owing to its adverse effects on maternal and child health. We assessed trends in adolescent birth and examined its associations with child undernutrition in Bangladesh using data from seven rounds of Demographic and Health Surveys (1996–2017, n = 12,006 primiparous women with living children, Adolescent birth is a major global concern owing to its adverse effects on maternal and child health. We assessed trends in adolescent birth and examined its associations with child undernutrition in Bangladesh using data from seven rounds of Demographic and Health Surveys. Our analysis demonstrates that birth during adolescence, a common occurrence in Bangladesh, is associated with child undernutrition.
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- 2021
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17. Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda
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Purnima Menon, Cesar G. Victora, Giovanna Gatica-Domínguez, Parul Christian, Robert E. Black, and Luis Paulo Vidaletti
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Adult ,medicine.medical_specialty ,Social Determinants of Health ,Mothers ,Developing country ,030204 cardiovascular system & hematology ,Child Nutrition Disorders ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,Global health ,Humans ,Medicine ,030212 general & internal medicine ,Social determinants of health ,Child ,Developing Countries ,Poverty ,Wasting ,business.industry ,Public health ,Malnutrition ,General Medicine ,medicine.disease ,Breast Feeding ,Educational Status ,Female ,medicine.symptom ,business ,Breast feeding - Abstract
13 years after the first Lancet Series on maternal and child undernutrition, we reviewed the progress achieved on the basis of global estimates and new analyses of 50 low-income and middle-income countries with national surveys from around 2000 and 2015. The prevalence of childhood stunting has fallen, and linear growth faltering in early life has become less pronounced over time, markedly in middle-income countries but less so in low-income countries. Stunting and wasting remain public health problems in low-income countries, where 4·7% of children are simultaneously affected by both, a condition associated with a 4·8-times increase in mortality. New evidence shows that stunting and wasting might already be present at birth, and that the incidence of both conditions peaks in the first 6 months of life. Global low birthweight prevalence declined slowly at about 1·0% a year. Knowledge has accumulated on the short-term and long-term consequences of child undernutrition and on its adverse effect on adult human capital. Existing data on vitamin A deficiency among children suggest persisting high prevalence in Africa and south Asia. Zinc deficiency affects close to half of all children in the few countries with data. New evidence on the causes of poor growth points towards subclinical inflammation and environmental enteric dysfunction. Among women of reproductive age, the prevalence of low body-mass index has been reduced by half in middle-income countries, but trends in short stature prevalence are less evident. Both conditions are associated with poor outcomes for mothers and their children, whereas data on gestational weight gain are scarce. Data on the micronutrient status of women are conspicuously scarce, which constitutes an unacceptable data gap. Prevalence of anaemia in women remains high and unabated in many countries. Social inequalities are evident for many forms of undernutrition in women and children, suggesting a key role for poverty and low education, and reinforcing the need for multisectoral actions to accelerate progress. Despite little progress in some areas, maternal and child undernutrition remains a major global health concern, particularly as improvements since 2000 might be offset by the COVID-19 pandemic.
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- 2021
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18. Mobilising evidence, data, and resources to achieve global maternal and child undernutrition targets and the Sustainable Development Goals: an agenda for action
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Jai K Das, Stuart Gillespie, Stephen A. Vosti, Ellen Piwoz, Rebecca Heidkamp, Jonathan Kweku Akuoku, Purnima Menon, Marie T. Ruel, Mary Rose D’Alimonte, Emily C Keats, Zulfiqar A Bhutta, Jack W Clift, and Augustin Flory
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Sustainable development ,Economic growth ,Sanitation ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Call to action ,03 medical and health sciences ,Malnutrition ,0302 clinical medicine ,Social protection ,Political science ,medicine ,Food systems ,030212 general & internal medicine ,Social determinants of health ,Health policy - Abstract
As the world counts down to the 2025 World Health Assembly nutrition targets and the 2030 Sustainable Development Goals, millions of women, children, and adolescents worldwide remain undernourished (underweight, stunted, and deficient in micronutrients), despite evidence on effective interventions and increasing political commitment to, and financial investment in, nutrition. The COVID-19 pandemic has crippled health systems, exacerbated household food insecurity, and reversed economic growth, which together could set back improvements in undernutrition across low-income and middle-income countries. This paper highlights how the evidence base for nutrition, health, food systems, social protection, and water, sanitation, and hygiene interventions has evolved since the 2013 Lancet Series on maternal and child nutrition and identifies the priority actions needed to regain and accelerate progress within the next decade. Policies and interventions targeting the first 1000 days of life, including some newly identified since 2013, require renewed commitment, implementation research, and increased funding from both domestic and global actors. A new body of evidence from national and state-level success stories in stunting reduction reinforces the crucial importance of multisectoral actions to address the underlying determinants of undernutrition and identifies key features of enabling political environments. To support these actions, well-resourced nutrition data and information systems are essential. The paper concludes with a call to action for the 2021 Nutrition for Growth Summit to unite global and national nutrition stakeholders around common priorities to tackle a large, unfinished undernutrition agenda-now amplified by the COVID-19 crisis.
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- 2021
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19. Storytelling for persuasion: Insights from community health workers on how they engage family members to improve adoption of recommended maternal nutrition and breastfeeding behaviours in rural Bangladesh
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Gargi Wable Grandner, Kathleen M. Rasmussen, Katherine L. Dickin, Purnima Menon, Tiffany Yeh, and John Hoddinott
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Community Health Workers ,Bangladesh ,Nutrition and Dietetics ,Communication ,Persuasive Communication ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Mothers ,Breast Feeding ,Pregnancy ,Pediatrics, Perinatology and Child Health ,Humans ,Female ,Child - Abstract
Community health workers (CHWs) increasingly provide interpersonal counselling to childbearing women and their families to improve adoption of recommended maternal and child nutrition behaviours. Little is known about CHWs' first-hand experiences garnering family support for improving maternal nutrition and breastfeeding practices in low-resource settings. Using focused ethnography, we drew insights from the strategies that CHWs used to persuade influential family members to support recommendations on maternal diet, rest and breastfeeding in a behaviour change communication trial in rural Bangladesh. We interviewed 35 CHWs providing at-home interpersonal counselling to pregnant women and their families in seven 'AliveThrive' intervention sites. In-depth probing focused on how CHWs addressed lack of family support. Thematic coding based on Fisher's narrative paradigm revealed strategic use of three rhetorical principles by CHWs: ethos (credibility), pathos (emotion) and logos (logic). CHWs reported selectively targeting pregnant women, husbands and mothers-in-law based on their influence on behavioural adoption. Key motivators to support recommended behaviours were improved foetal growth and child intelligence. Improved maternal health was the least motivating outcome, even among mothers. Logically coherent messaging resonated well with husbands, while empathetic counselling was additionally required for mothers. Mothers-in-law were most intransigent, but were persuaded via emotional appeals. Persuasion on maternal rest was most effort-intensive, resulting in contextually appealing but scientifically inaccurate messaging. Our study demonstrates that CHWs can offer important insights on context-relevant, feasible strategies to improve family support and uptake of nutrition recommendations. It also identifies the need for focused CHW training and monitoring to address scientifically flawed counselling narratives.
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- 2022
20. The effect of electronic job aid assisted one‐to‐one counselling to support exclusive breastfeeding among 0–5‐month‐old infants in rural Bangladesh
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Sk Masum Billah, Tarana E. Ferdous, Abu Bakkar Siddique, Camille Raynes‐Greenow, Patrick Kelly, Nuzhat Choudhury, Tahmeed Ahmed, Stuart Gillespie, John Hoddinott, Rukhsana Haider, Purnima Menon, Shams El Arifeen, and Michael J. Dibley
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Counseling ,Rural Population ,Bangladesh ,Nutrition and Dietetics ,Infant, Newborn ,Public Health, Environmental and Occupational Health ,Infant ,Obstetrics and Gynecology ,Breast Feeding ,Pregnancy ,Pediatrics, Perinatology and Child Health ,Humans ,Female ,Electronics ,Child - Abstract
Exclusive breastfeeding (EBF) for the first 6 months has established benefits, yet had slow improvements globally. Little is known about electronic job aid-assisted counselling to support EBF. As a secondary outcome of a cluster randomized controlled trial in Bangladesh, we assessed the effect of electronic job aid-supported nutrition counselling and practical demonstration on EBF. We randomized pregnant women to one of five study arms in the trial and followed mother-child dyads until 2 years of age. Community health workers (CHWs) provided breastfeeding counselling with or without prenatal and complementary nutrient supplements in all four intervention arms. The comparison arm continued with the usual practice where mothers could receive nutrition counselling at routine antenatal and postnatal care, and during careseeking for childhood illnesses. We assessed breastfeeding indicators at birth and monthly until the child was 6 months old, in both intervention and comparison arms. To evaluate the effect of nutrition counselling on breastfeeding, we combined all four intervention arms and compared them with the comparison arm. Intervention newborns had half the risk (relative risk [RR]: 0.54, 95% confidence interval [CI]: 0.39, 0.76) of receiving prelacteal feeds than those in the comparison arm. EBF declined steeply in the comparison arm after 3 months of age. EBF was 16% higher in the intervention than the comparison arm at 4 months (RR: 1.16, 95% CI: 1.08, 1.23) and 22% higher at 5 months of age (RR: 1.22, 95% CI: 1.12, 1.33). Maternal background and household characteristics did not modify the intervention effect, and we observed no difference in EBF among caesarean versus vaginal births. Breastfeeding counselling and practical demonstration using an electronic job aid by CHWs are promising interventions to improve EBF and are scalable into existing community-based programmes.
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- 2022
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21. Using scenario‐based assessments to examine the feasibility of integrating preventive nutrition services through the primary health care system in Bangladesh
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Phuong H. Nguyen, Priyanjana Pramanik, Sk. Masum Billah, Rasmi Avula, Tarana Ferdous, Bidhan K. Sarker, Musfikur Rahman, Santhia Ireen, Zeba Mahmud, Purnima Menon, and Deborah Ash
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Bangladesh ,Nutrition and Dietetics ,Pregnancy ,Preventive Health Services ,Pediatrics, Perinatology and Child Health ,Public Health, Environmental and Occupational Health ,Feasibility Studies ,Humans ,Nutritional Status ,Obstetrics and Gynecology ,Female ,Delivery of Health Care - Abstract
The National Nutrition Services of Bangladesh aims to deliver nutrition services through the primary health care system. Little is known about the feasibility of reshaping service delivery to close gaps in nutrition intervention coverage and utilization. We used a scenario-based feasibility testing approach to assess potential implementation improvements to strengthen service delivery. We conducted in-depth interviews with 31 service providers and 12 policymakers, and 5 focus group discussions with potential beneficiaries. We asked about the feasibility of four hypothetical scenarios for preventive and promotive nutrition service delivery: community-based events (CBE) for pregnant women, well-child services integrated into immunization contacts; CBE for well-children, and well-child visits at facilities. Opinions on service delivery platforms were mixed; some recommended new platforms, but others suggested strengthening existing delivery points. CBE for pregnant women was perceived as feasible, but workforce shortages emerged as a key barrier. Challenges such as equipment portability, upset children and a fast-moving service environment suggested low feasibility of integrating nutrition into outreach immunization contacts. In contrast, CBE and facility-based well-child visits emerged as feasible options, conditional on having the necessary workforce, structural readiness and budget support. On the demand side, enabling factors include using interpersonal communication and involving community leaders to increase awareness, organizing events at a convenient time and place for both providers and beneficiaries, and incentives for beneficiaries to encourage participation. In conclusion, integrating preventive and promotive nutrition services require addressing current challenges in the health system, including human resource and logistic gaps, and investing in creating demand for preventive services.
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- 2022
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22. Intimate partner violence is associated with poorer maternal mental health and breastfeeding practices in Bangladesh
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Purnima Menon, Phuong H. Nguyen, Ruchira Tabassum Naved, and Lan Mai Tran
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Male ,breastfeeding ,media_common.quotation_subject ,education ,Breastfeeding ,Intimate Partner Violence ,Mothers ,Supplement Articles ,Logistic regression ,behavioral disciplines and activities ,Structural equation modeling ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Environmental health ,medicine ,Humans ,AcademicSubjects/MED00860 ,030212 general & internal medicine ,Child ,media_common ,Bangladesh ,030219 obstetrics & reproductive medicine ,business.industry ,Health Policy ,determinants ,social sciences ,medicine.disease ,Mental health ,Breast Feeding ,Cross-Sectional Studies ,Mental Health ,Spouse Abuse ,Domestic violence ,Female ,business ,Breast feeding ,Autonomy - Abstract
Exposure to intimate partner violence (IPV) can have profound adverse consequences on maternal and child health. This study aimed to: (1) identify factors associated with IPV during pregnancy and postpartum in Bangladesh; and (2) assess the associations between IPV and maternal mental health and breastfeeding practices. We used data from a cross-sectional survey of 2000 mothers with children
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- 2020
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23. Growth faltering in early infancy: highlights from a two-day scientific consultation
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Akanksha Srivastava, Purnima Menon, Abner Daniel, Tarun Shankar Choudhary, Maharaj K. Bhan, Rajiv Bahl, Sunita Taneja, Ranadip Chowdhury, Satinder Aneja, Praveen Kumar, Nita Bhandari, and Harish Chellani
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medicine.medical_specialty ,Severe Acute Malnutrition ,lcsh:Medicine ,Growth faltering ,Meeting Report ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Medicine ,030212 general & internal medicine ,lcsh:Science ,Biotechnology industry ,Early infancy ,business.industry ,Public health ,lcsh:R ,General Medicine ,Severe wasting ,Early life ,Severe acute malnutrition ,Family medicine ,lcsh:Q ,business - Abstract
Background Faltering of growth in early life has been recognized as a public health challenge among Indian babies. A two-day consultation on growth faltering in early infancy was organized to examine the data and evidence on identification and management of early growth failure and to identify knowledge gaps and future areas of research. The consultation was supported by the Biotechnology Industry Research Assistance Council (BIRAC), the Indian Academy of Pediatrics (Nutrition Chapter), Vardhman Mahavir Medical College and Safdarjung Hospital, and the Society for Applied Studies. It brought together researchers, clinicians, policy makers and program managers.
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- 2020
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24. What works to protect, promote and support breastfeeding on a large scale: A review of reviews
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Cecília Tomori, Sonia Hernández‐Cordero, Natalie Busath, Purnima Menon, and Rafael Pérez‐Escamilla
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Kangaroo-Mother Care Method ,Nutrition and Dietetics ,Breast Feeding ,Pediatrics, Perinatology and Child Health ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Humans ,Female ,Child - Abstract
Globally women continue to face substantial barriers to breastfeeding. The 2016 Lancet Breastfeeding Series identified key barriers and reviewed effective interventions that address them. The present study updates the evidence base since 2016 using a review of reviews approach. Searches were implemented using the Epistomenikos database. One hundred and fifteen reviews of interventions were identified and assessed for quality and risk of bias. Over half of reviews (53%) were high- or moderate quality, with the remaining low or critically low quality due to weaknesses in assessment of bias. A large portion of studies addressed high-income and upper-middle income settings, (41%), and a majority (63%) addressed health systems, followed by community and family settings (39%). Findings from reviews continue to strengthen the evidence base for effective interventions that improve breastfeeding outcomes across all levels of the social-ecological model, including supportive workplace policies; implementation of the Baby-Friendly Hospital Initiative, skin to skin care, kangaroo mother care, and cup feeding in health settings; and the importance of continuity of care and support in community and family settings, via home visits delivered by CHWs, supported by fathers', grandmothers' and community involvement. Studies disproportionately focus on health systems in high income and upper-middle income settings. There is insufficient attention to policy and structural interventions, the workplace and there is a need for rigorous assessment of multilevel interventions. Evidence from the past 5 years demonstrates the need to build on well-established knowledge to scale up breastfeeding protection, promotion and support programmes.
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- 2022
25. Is respectful care provided by community health workers associated with infant feeding practices? A cross sectional analysis from India
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Lia C. H. Fernald, Sumeet Patil, Dilys Walker, Purnima Menon, Nadia Diamond-Smith, and Lakshmi Gopalakrishnan
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Infant health ,Cross-sectional study ,Anganwadi workers ,Mothers ,India ,8.1 Organisation and delivery of services ,Reproductive health and childbirth ,Nursing ,Respect ,Quality interactions ,Library and Information Studies ,Pregnancy ,Clinical Research ,Environmental health ,Behavioral and Social Science ,Community health workers ,Humans ,Sociology ,Infant Nutritional Physiological Phenomena ,Health behaviors ,Infant feeding ,Nutrition ,Community Health Workers ,Pediatric ,Research ,Prevention ,Health Policy ,Quality of care ,Infant ,Feeding Behavior ,Health Services ,Cross-Sectional Studies ,Breast Feeding ,Good Health and Well Being ,Public Health and Health Services ,Health Policy & Services ,Female ,Generic health relevance ,Public aspects of medicine ,RA1-1270 ,Health and social care services research - Abstract
Objectives Breastfeeding and complementary feeding practices in India do not meet recommendations. Community health care workers (CHWs) are often the primary source of information for pregnant and postpartum women about Infant and Young Child Feeding (IYCF) practices. While existing research has evaluated the effectiveness of content and delivery of information through CHWs, little is known about the quality of the interpersonal communication (respectful care). We analyzed the effect of respectful interactions on recommended IYCF practices. Methods We use data from evaluation of an at-scale mHealth intervention in India that serves as a job aid to the CHWs (n = 3266 mothers of children Results About half of women reported positive, respectful interactions with CHWs. Interactions that are more respectful were associated with better recall of appropriate health messages. Interactions that are more respectful were associated with a greater likelihood of adopting all child-feeding behaviors except timely initiation of breastfeeding. After including recall in the model, the effect of respectful interactions alone reduced. Conclusions Respectful care from CHWs appears to be significantly associated with some behaviors around infant feeding, with the primary pathway being through better recall of messages. Focusing on improving social and soft skills of CHWs that can translate into better CHW-beneficiary interactions can pay rich dividends. Funding This study is funded by Grant No. OPP1158231 from Bill and Melinda Gates Foundation. Trial registration number: https://doi.org/10.1186/ISRCTN83902145
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- 2022
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26. Smarter policies for enhanced food security and food system outcomes
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Michael Wang, Purnima Menon, Rasmi Avula, Shivani Kachwaha, and Phuong Hong Nguyen
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- 2022
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27. State nutrition profile: Rajasthan
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Purnima Menon, Esha Sarswat, William Joe, Robert Johnston, Neena Bhatia, Rakesh Sarwal, Sudhir.K. Singh, Phuong Hong Nguyen, and Anita Christopher
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- 2022
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28. State nutrition profile: Chhattisgarh
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Phuong Hong Nguyen, Purnima Menon, Esha Sarswat, William Joe, Robert Johnston, Neena Bhatia, Rakesh Sarwal, S.K. Singh, Soyra Gune, and Aditya Madhusudan
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- 2022
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29. Advancing global health and the sustainable development goals through transdisciplinary research and equitable publication practices
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Craig R. Cohen, Andres G. Lescano, Fernando O. Mardones, Purnima Menon, Harsha Thirumurthy, and Sarah Ssali
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- 2022
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30. Coverage of nutrition and health Interventions in INDIA: Insights from the National Family Health Surveys
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Alka Chauhan, Parul Puri, Sarang Pedgaonkar, L.K. Dwivedi, S.K. Singh, Purnima Menon, Phuong Hong Nguyen, Rasmi Avula, Soyra Gune, and Anita Christopher
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- 2022
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31. State nutrition profile: Goa
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Phuong Hong Nguyen, Purnima Menon, William Joe, Robert Johnston, Neena Bhatia, Rakesh Sarwal, Sudhir.K. Singh, Rasmi Avula, and Vishakha Wadhwani
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- 2022
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32. State nutrition profile: Tamil Nadu
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Phuong Hong Nguyen, Purnima Menon, Esha Sarswat, William Joe, Robert Johnston, Neena Bhatia, Rakesh Sarwal, S.K. Singh, and Anita Christopher
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- 2022
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33. Availability of data on diets in South Asia: A data availability assessment for Bangladesh, India, Nepal, and Pakistan
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Timothy Krupnik, Avinash Kishore, Purnima Menon, Sumanta Neupane, and Samuel Scott
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- 2022
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34. State nutrition profile: Chandigarh
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Phuong Hong Nguyen, Purnima Menon, Esha Sarswat, William Joe, Robert Johnston, Neena Bhatia, Rakesh Sarwal, Sudhir.K. Singh, and Soumyajit Ray
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- 2022
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35. State nutrition profile: Meghalaya
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Phuong Hong Nguyen, Purnima Menon, Esha Sarswat, William Joe, Robert Johnston, Neena Bhatia, Rakesh Sarwal, Sudhir.K. Singh, Samuel Scott, and Anita Christopher
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- 2022
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36. State nutrition profile: Nagaland
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Phuong Hong Nguyen, Robert Johnston, Nishmeet Singh, Rakesh Sarwal, William Joe, Neena Bhatia, Purnima Menon, and S. K. Singh
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Political science ,State (functional analysis) ,Agricultural economics - Published
- 2022
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37. State nutrition profile: Andaman and Nicobar Islands
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Phuong Hong Nguyen, Purnima Menon, William Joe, Robert Johnston, Neena Bhatia, Rakesh Sarwal, Sudhir.K. Singh, Samuel Scott, Vishakha Wadhwani, and Anita Christopher
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- 2022
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38. State nutrition profile: Himachal Pradesh
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Robert Johnston, Rasmi Avula, William Joe, Anita Christopher, Rakesh Sarwal, Neena Bhatia, Esha Sarswat, Purnima Menon, S. K. Singh, and Phuong Hong Nguyen
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Geography ,State (functional analysis) ,Socioeconomics - Published
- 2022
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39. State nutrition profile: Telangana
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Phuong Hong Nguyen, Purnima Menon, Esha Sarswat, William Joe, Robert Johnston, Neena Bhatia, Rakesh Sarwal, Sudhir.K. Singh, Samuel Scott, and Anita Christopher
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- 2022
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40. State nutrition profile: Uttarakhand
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Phuong Hong Nguyen, Purnima Menon, Esha Sarswat, William Joe, Robert Johnston, Neena Bhatia, Rakesh Sarwal, Sudhir.K. Singh, and Anjali Pant
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- 2022
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41. State nutrition profile: Uttar Pradesh
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Purnima Menon, Esha Sarswat, William Joe, Robert Johnston, Neena Bhatia, Rakesh Sarwal, S.K. Singh, Phuong Hong Nguyen, and Soyra Gune
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- 2022
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42. State nutrition profile: Sikkim
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Robert Johnston, Rasmi Avula, Sattvika Ashok, Rakesh Sarwal, Neena Bhatia, William Joe, Purnima Menon, Shambhavi Singh, and Phuong Hong Nguyen
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Geography ,State (functional analysis) ,Socioeconomics - Published
- 2022
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43. State nutrition profile: Madhya Pradesh
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Phuong Hong Nguyen, Purnima Menon, Esha Sarswat, William Joe, Robert Johnston, Neena Bhatia, Rakesh Sarwal, Sudhir.K. Singh, and Soumyajit Ray
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- 2022
- Full Text
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44. State nutrition profile: Puducherry
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Phuong Hong Nguyen, Purnima Menon, Esha Sarswat, William Joe, Robert Johnston, Neena Bhatia, Rakesh Sarwal, Sudhir.K. Singh, and Aditya Madhusudan
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- 2022
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45. State nutrition profile: Mizoram
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Purnima Menon, S. K. Singh, Rakesh Sarwal, Neena Bhatia, Robert Johnston, Sattvika Ashok, Phuong Hong Nguyen, and William Joe
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State (functional analysis) ,Socioeconomics ,Mathematics - Published
- 2022
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46. Connecting the dots to transform food systems in South Asia: TAFSSA’s engagement strategy
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Timothy Krupnik, Nur-A-Mahajabin Khan, Purnima Menon, and Esha Sarswat
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- 2022
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47. State nutrition profile: Chandigarh
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Phuong Hong Nguyen, Purnima Menon, Esha Sarswat, William Joe, Robert Johnston, Neena Bhatia, Rakesh Sarwal, Sudhir.K. Singh, Rasmi Avula, and Aditya Madhusudan
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- 2022
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48. State nutrition profile: Karnataka
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Phuong Hong Nguyen, Purnima Menon, Esha Sarswat, William Joe, Robert Johnston, Neena Bhatia, Rakesh Sarwal, Sudhir.K. Singh, Rasmi Avula, and Soyra Gune
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- 2022
- Full Text
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49. State nutrition profile: Manipur
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Purnima Menon, Esha Sarswat, William Joe, Robert Johnston, Neena Bhatia, Rakesh Sarwal, Sudhir.K. Singh, Phuong Hong Nguyen, and Soyra Gune
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- 2022
- Full Text
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50. State nutrition profile: Kerala
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Phuong Hong Nguyen, Purnima Menon, Esha Sarswat, William Joe, Robert Johnston, Neena Bhatia, Rakesh Sarwal, Sudhir.K. Singh, Rasmi Avula, and Soyra Gune
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- 2022
- Full Text
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