Carol Jean Henry

Background: Children’s eating habits are formed at an early age, making childhood a crucial period for introducing novel foods, such as pulse-based food products. Pulse Discovery Toolkit (PDTK) intervention was designed to increase familiarity with pulses and to eventually contribute to the consumption of pulse-based foods among preschool children in childcare centers (CCs). Objective: To determine PDTK’s impact on knowledge, acceptability, and consumption of pulse-based foods among preschool children attending CCs, and to assess its feasibility and acceptability by early childhood educators (ECE) and cooks. The nutrient contents and food group servings of pulse-based intervention recipes in the PDTK were also compared with regular CC recipes. Method: The PDTK intervention was delivered over a 3-month period in 2 CCs in Saskatoon (50 children, 8 staff). The intervention, which integrated taste exposure and nutrition education, consisted of 12 child-friendly weekly lessons, a food service guide for cooks, 15 recipes for pulse-based foods, 4 intervention recipes incorporated in the CC menu, and 4 parent newsletters. Mixed methods were used with pre- and postintervention knowledge tests, plate waste measurement, sensory evaluation, ECE and cook’s perspective, and nutrient content comparison of the intervention and control foods from the regular childcare menu to evaluate the intervention’s impact. Result: Improvements in correct identification of chickpeas (2/21 [10%] at preintervention to 7/21 [33%] at postintervention, P =.074), beans (8/21 [38%] to 11/21 [52%], P =.68), and peas (6/21 [27%] to 8/21 [38%], P =.61) were not statistically significant. Children consumed higher amounts of the regular recipes (293.54, SD 27.65; 178.46, SD 24.33) than the intervention recipes (211.56, SD 25.61; 108.83, SD 21.97) at both times, respectively. However, at the end of the intervention, significant differences were only observed in the amount of total food consumption ( P =.049) and the protein content ( P =.04) when consumption proportion was examined, with both being higher for the control recipes in comparison to the intervention recipes. The majority (92% and 72%) of the children rated the refried bean wrap and lentil smoothie, “yummy,” respectively. Most of the intervention recipes have lower energy, fat, and sodium content compared with the regular CC recipes. Findings from ECE semistructured interviews and the lesson plan evaluations revealed that the ECEs reacted favorably to the curriculum. The cooks from the participating CCs did not report any barriers to cooking pulses in their facility. However, the need for modification to make the recipes easier to cook in CCs was noted in our study. Conclusions: With a few modifications to make some of the lessons more age-appropriate and some of the recipes easier to cook, it is feasible to implement the PDTK in CCs in order to promote regular consumption of pulses.

Objective: We conducted a six-month nutrition education intervention focused on the consumption of pulses and other foods to assess the effect on knowledge, attitude and practice (KAP) as well as the nutritional status of children and mothers from two pulse-growing communities in Halaba, south Ethiopia. Methods: About 200 mother–child pairs in each of two purposively selected communities participated in this intervention study. A six-month nutrition education programme, involving interactive monthly community meetings and home visits, was offered to one of the two communities and the other served as a control/comparison. This study incorporated the use of Health Belief Model constructs to assess the KAP/perceptions of mothers surrounding pulse and other food consumptions, as well as nutrition-related issues before and after the intervention. Objective measures included dietary diversity scores (DDSs), one-day weighed dietary intakes and nutritional status measures based on anthropometric information. Demographics and socioeconomic information were also collected at baseline and endline. Results: Significant improvements (p < 0.05) were found in the intervention group on the KAP and perceptions of pulse nutrition benefits among mothers, DDSs and pulse and animal source food consumption indexes for mothers and children and the mean body-mass-index-for-age Z-score and wasting among children. Conclusions: Community-based nutrition education interventions involving monthly interactive community meetings and home visits in pulse-growing communities from a resource-poor country like Ethiopia can be effective in improving mothers’ knowledge of pulse nutrition and consumption frequency, leading to improvements in the DDSs of children and mothers while decreasing child underweight and wasting.

Background: Promoting pulse consumption in schools could improve students’ healthy food choices. Pulses, described as legumes, are rich in protein and micronutrients and are an important food choice for health and well-being. However, most Canadians consume very little pulse-based food. Objective: This pilot study sought to investigate outcomes of a teacher-led, school-based food literacy intervention focused on the Pulses Make Perfect Sense (PMPS) program in 2 high schools in Saskatoon, Saskatchewan. Methods: Both high schools were selected using a convenience sampling technique and have similar sociodemographic characteristics. The mean age of students was 16 years. The intervention comprised 7 key themes focused on pulses, which included defining pulses; health and nutritional benefits of pulses; incorporating pulses into meals; the role of pulses in reducing environmental stressors, food insecurity, and malnutrition; product development; taste testing and sensory analysis; and pulses around the world. A self-administered questionnaire was used to assess knowledge, attitudes, practices, and barriers regarding pulse consumption in students at baseline and study end. Teachers were interviewed at the end of the intervention. Descriptive statistics and the nonparametric Mann-Whitney U test were used for analysis. Results: In total, 41 and 32 students participated in the baseline and study-end assessments, respectively. At baseline, the median knowledge score was 9, attitude score was 6, and barrier score was 0. At study end, the median knowledge score was 10, attitude score was 7, and barrier score was 1. A lower score for barriers indicated fewer barriers to pulse consumption. There was a significant difference between baseline and study-end scores in knowledge (P<.05). Barriers to pulse consumption included parents not cooking or consuming pulses at home, participants not liking the taste of pulses, and participants often preferring other food choices over pulses. The teachers indicated that the pulse food-literacy teaching resources were informative, locally available, and easy to use. Conclusions: Despite the improvements in knowledge, attitude, and practice, pulse consumption did not change significantly at the end of the intervention. Future studies with larger samples are needed to determine the impact of PMPS on knowledge, attitude, and practice of high school students.

BACKGROUND Promoting pulse consumption in schools could improve students’ healthy food choices. Pulses, described as legumes, are rich in protein and micronutrients and are an important food choice for health and well-being. However, most Canadians consume very little pulse-based food. OBJECTIVE This pilot study sought to investigate outcomes of a teacher-led, school-based food literacy intervention focused on the Pulses Make Perfect Sense (PMPS) program in 2 high schools in Saskatoon, Saskatchewan. METHODS Both high schools were selected using a convenience sampling technique and have similar sociodemographic characteristics. The mean age of students was 16 years. The intervention comprised 7 key themes focused on pulses, which included defining pulses; health and nutritional benefits of pulses; incorporating pulses into meals; the role of pulses in reducing environmental stressors, food insecurity, and malnutrition; product development; taste testing and sensory analysis; and pulses around the world. A self-administered questionnaire was used to assess knowledge, attitudes, practices, and barriers regarding pulse consumption in students at baseline and study end. Teachers were interviewed at the end of the intervention. Descriptive statistics and the nonparametric Mann-Whitney U test were used for analysis. RESULTS In total, 41 and 32 students participated in the baseline and study-end assessments, respectively. At baseline, the median knowledge score was 9, attitude score was 6, and barrier score was 0. At study end, the median knowledge score was 10, attitude score was 7, and barrier score was 1. A lower score for barriers indicated fewer barriers to pulse consumption. There was a significant difference between baseline and study-end scores in knowledge (P<.05). Barriers to pulse consumption included parents not cooking or consuming pulses at home, participants not liking the taste of pulses, and participants often preferring other food choices over pulses. The teachers indicated that the pulse food-literacy teaching resources were informative, locally available, and easy to use. CONCLUSIONS Despite the improvements in knowledge, attitude, and practice, pulse consumption did not change significantly at the end of the intervention. Future studies with larger samples are needed to determine the impact of PMPS on knowledge, attitude, and practice of high school students.

Background: Limited studies in Ethiopia showed that infants and young children are at high risk of inadequate intake of energy and nutrients. However, inclusive assessment of both nutrient intakes and their food sources are lacking. We aimed at assessing energy and nutrient intakes and their food sources during religious fasting and non-fasting periods among 6–23 months old children in Northern Ethiopia.Methods: Data for this longitudinal study were collected following repeated multiple-pass 24-h dietary recall technique through face-to-face interviews with primary caregivers. Using a two-stage systematic random sampling method, a total of 570 and 551 children participated respectively in the lent fasting and non-fasting periods. Energy and nutrient intakes were estimated and compared with WHO daily requirements. All foods that a child consumed on the day preceding the date of data collection were recorded and processed with database software. Chi-square and t- tests were used to analyze the data. Non-normally distributed data were analyzed using Wilcoxon signed-rank test and statistical significance was set atp < 0.05.Results: The overall prevalence of child stunting was 41.4%. Almost all of children (99.6%) consumed grains, roots, and tubers. The inadequacy prevalence of energy, protein and eight selected micronutrients (calcium, iron, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin C) intake were 96.2, 44.9, and 95.5%, respectively. Calcium and zinc were the highest (100%) deficits observed across all age groups. Although consumption of animal source foods (ASFs) was very low (dairy 10.1%, meat 2.3% and eggs 23.6%), there was significantly higher consumption of meat and eggs during the non-fasting compared to fasting period (p < 0.001).Conclusions: Inadequate intake of energy and nutrients was common among 6–23 months old children. Cereals were found to be the main sources of many of the nutrients. The consumption of ASFs among 6–23-month-old children was low which was also affected by the religious fasting period. Hence, strengthening social and behavior change communication, supporting rural households to raise poultry and small ruminants is recommended.

Background: Despite progress made to improve access to child health services, mothers’ consistent utilization of these services has been constrained by several factors. This study is aimed at assessing the inequalities in key child health service utilization and assess the role of antenatal care (ANC) on subsequent service use. Method: The analysis of the present study was based on the Ethiopian Demographic and Health Surveys, a nationally representative sample of 10,641 children. A health service utilization score was constructed from the affirmative responses of six key child health interventions associated with the most recent birth: ANC service, delivery of the last child at health facilities, postnatal care services, vitamin A intake, iron supplementation and intake of deworming pills by the index child. A mixed effect Poisson regression model was used to examine the predictors of health service utilization and three separate mixed effect logistic regression models for assessing the role of ANC for continued use of delivery and postnatal care services. Results: The results of mixed effect Poisson regression indicate that the expected mean score of health service utilization was lower among non-first birth order children, older and high parity women, those living in polygamous families and women living in households with no access to radio. The score was higher for respondents with better education, women who had previous experience of terminated pregnancy, residing in more affluent households, and women with experiences of mild to high intimate partner violence. Further analysis of the three key health services (ANC, delivery, and postnatal care), using three models of mixed effect logistic regression, indicates consistent positive impacts of ANC on the continuum of utilizing delivery and postnatal care services. ANC had the strongest effects on both institutional delivery and postnatal care service utilization. Conclusion: The findings implicated that maternal and child health services appear as continuum actions/behavior where utilization of one affects the likelihood of the next service types. The study indicated that promoting proper ANC services is very beneficial in increasing the likelihood of mothers utilizing subsequent services such as delivery and postnatal care services.

Background: The beginning of the COVID-19 pandemic presented many sudden challenges regarding food, including grocery shopping changes (eg, reduced store hours, capacity restrictions, and empty store shelves due to food hoarding), restaurant closures, the need to cook more at home, and closures of food access programs. Eat Well Saskatchewan (EWS) implemented a 16-week social media campaign, #eatwellcovid19, led by a dietitian and nutrition student that focused on sharing stories submitted by the Saskatchewan public about how they were eating healthy during the COVID-19 pandemic. Objective: The goal of this study was to describe the implementation of the #eatwellcovid19 social media campaign and the results from the evaluation of the campaign, which included campaign performance using social media metrics and experiences and perspectives of campaign followers. Methods: Residents of Saskatchewan, Canada, were invited to submit personal stories and experiences to EWS about how they were eating healthy during the COVID-19 pandemic from April to August 2020. Each week, one to three stories were featured on EWS social media platforms—Facebook, Instagram, and Twitter—along with evidence-based nutrition information to help residents become more resilient to challenges related to food and nutrition experienced during the COVID-19 pandemic. Individuals who submitted stories were entered into a weekly draw for a Can $100 grocery gift card. Social media metrics and semistructured qualitative interviews of campaign followers were used to evaluate the #eatwellcovid19 campaign. Results: In total, 75 stories were submitted by 74 individuals on a variety of topics (eg, grocery shopping, traditional skills, and gardening), and 42 stories were featured on social media. EWS shared 194 #eatwellcovid19 posts across social media platforms (Facebook: n=100; Instagram: n=55; and Twitter: n=39). On Facebook, #eatawellcovid19 reached 100,571 followers and left 128,818 impressions, resulting in 9575 engagements. On Instagram, the campaign reached 11,310 followers, made 14,145 impressions, and received 823 likes and 15 comments. On Twitter, #eatwellcovid19 made 15,199 impressions and received 424 engagements. Featured story submission posts had the best engagement on Facebook and the most likes and comments on Instagram. The EWS social media pages reported increases in their following during the campaign (Instagram: +30%; Facebook: +14%; and Twitter: +12%). Results from the interviews revealed that there were two types of campaign followers: those who appreciated hearing the stories submitted by followers, as it helped them to feel connected to the community during social isolation, and those who appreciated the evidence-based information. Conclusions: Numerous stories were submitted to the #eatwellcovid19 social media campaign on various topics. On Instagram and Facebook, posts that featured these stories had the highest engagement. During this campaign, EWS’s social media following increased by more than 10% on each platform. The approach used for the #eatwellcovid19 campaign could be considered by others looking to develop health promotion campaigns.

Background: Childhood morbidities such as diarrhea and pneumonia are the leading causes of death in Ethiopia. Appropriate healthcare-seeking behavior of mothers for common childhood illnesses could prevent a significant number of these early deaths; however, little nation-wide research has been conducted in Ethiopia to assess mothers’ healthcare-seeking behavior for their under five children. Methods: The study used the Ethiopian Demographic and Health Surveys (EDHS) data. The EDHS is a cross sectional survey conducted in 2016 on a nationally representative sample of 10,641 respondents. The main determinants of care-seeking during diarrhea and acute respiratory infection (ARI) episodes were assessed using multiple logistic regression analyses while adjusting for complex survey design. Results: Only 43% and 35% of households sought medical attention for their children in episodes of diarrhea and ARI, respectively, during a reference period of 2 weeks before the survey. The odds of seeking care for diarrhea are lower for non-working mothers versus working mothers. The likelihood of seeking care for diarrhea or ARI is higher for literate fathers compared to those with no education. The place of delivery for the child, receiving postnatal checkup and getting at least one immunization in the past determined the likelihood of seeking care for ARI, but not for diarrhea. The odds of seeking care are higher for both diarrhea and ARI among households that are headed by females and where mothers experienced Intimate Partner Violence (IPV) violence. Religion and types of family structure are also significant factors of seeking care for diarrhea episodes, but not for ARI. Conclusions: The findings call for more coordinated efforts to ensure equitable access to health care services focusing on mothers living in deprived household environment. Strengthening partnerships with public facilities, private health care practitioners, and community-based organizations in rural areas would help further improve access to the services.