A Year in Publications: Alive & Thrive's annual research summary

Feb 06 2023

In 2022, Alive & Thrive's research generated evidence and insights on maternal, infant, young child and adolescent nutrition topics across diverse contexts. Published in leading peer-reviewed journals, our research is the foundation of all our work, informing the technical assistance we provide to governments, serving as the basis for our knowledge products, and informing advocacy for stronger nutrition policies.

In addition to the summary below, you can find Alive & Thrive's complete collection of research in our evidence map and explore our ongoing implementation research, which seeks to answer “how” to implement the most effective policies and interventions. All of Alive & Thrive's data can be found on Dataverse.

We hope you will find this body of work helpful in your ongoing efforts to improve nutrition outcomes for women and children.

Infant and Young Child Nutrition

Nigeria complementary feedingMaternal and paternal involvement in complementary feeding in Kaduna State, Nigeria: The continuum of gender roles in urban and rural settings. (January 2022). Maternal & Child Nutrition.
Focus group discussions with mothers and fathers explored household gender roles within the context of a father-focused complementary feeding Alive & Thrive intervention. While traditional normative roles of fathers can limit their involvement in child feeding and support, mothers and fathers in urban wards communicated less traditional approaches to their roles and described shared decision-making on complementary feeding practices. Full text.

Countries' experiences scaling up national breastfeeding, protection, promotion and support programmes: Comparative case studies analysis. (April 2022). Maternal & Child Nutrition.
This four-country comparison study found that evidence-based advocacy, political will, financing, research and evaluation, and coordination are key to fostering an enabling environment for breastfeeding in Burkina Faso, the Philippines, Mexico, and the United States of America. Lack of adequate maternity protection and aggressive marketing of breastmilk substitutes undermine investments to protect, promote, and support breastfeeding in these diverse contexts. Full text.

Complementary feeding social and behavior change communication for fathers and mothers improves children's consumption of fish and eggs and minimum meal frequency in Kaduna State, Nigeria. (April 2022). Current Developments In Nutrition.
An Alive & Thrive SBCC intervention that engaged mothers and fathers in Kaduna State, Nigeria, improved children’s consumption of fish and eggs and minimal meal frequency, fathers’ and mothers’ knowledge of complementary feeding, and fathers’ support for complementary feeding, despite low levels of reported exposure. Full text.

Breastfeeding interpersonal communication, mobile phone support, and mass media messaging increase exclusive breastfeeding at 6 and 24 weeks among clients of private health facilities in Lagos, Nigeria. (May 2022). Journal of Nutrition.
An Alive & Thrive intervention in private health care facilities in Nigeria – including training for health-care providers on the Baby-Friendly Hospital Initiative and breastfeeding counseling skills, provision of interpersonal communication and support to women at facilities and on WhatsApp, distribution of behavior change communication materials, and mobile phone and mass media messaging – significantly increased the percentage of infants who were exclusively breastfed at 6 weeks and 24 weeks, but had no impact on early initiation of breastfeeding. Full text

Fathers’ complementary feeding support moderates the association between mothers’ autonomous household decision-making and optimal complementary feeding. (June 2022). Current Developments in Nutrition.
This paper examined data from an Alive & Thrive implementation research study in Kaduna State, Nigeria, finding that high levels of fathers’ complementary feeding support strengthened the association of maternal decision-making autonomy with children’s minimum meal frequency and minimum acceptable diet, but not with minimum dietary diversity. Full text.

Factors influencing the practice of exclusive breastfeeding in West and Central Africa. (June 2022). Current Developments in Nutrition.
This literature review provides insights on facilitators as well as the many factors preventing exclusive breastfeeding in West and Central Africa, providing evidence for "Stronger With Breastmilk Only," a regional initiative launched in 2019 by UNICEF, WHO, and Alive & Thrive. Full text.

Behavior Change Communication Implemented at Scale in Nigeria Increases the Prevalence of Key Infant and Young Child Feeding Practices. (June 2022). Current Developments in Nutrition.
This evaluation found minimal impacts of the Alive & Thrive intervention on IYCF practices in the difference-in-differences analysis because of intervention spillover to the comparison area. Increases in IYCF practices from baseline to endline were substantial and are likely attributable to the intervention, which was the major IYCF promotion activity in both states. Full text.

“Stronger With Breastmilk Only” initiative: Evaluation in four countries in West and Central Africa and at regional level. (September 2022). Society for Implementation Science in Nutrition.
The Stronger With Breastmilk Only regional initiative was launched jointly by UNICEF, WHO and Alive & Thrive in 2019 to promote exclusive breastfeeding and discourage the practice of giving water to babies under six months in West and Central Africa. An assessment of how the regional initiative has contributed to strengthening policy and programmatic environment in four countries found that the initiative has set or reset the agenda of governments and partners on the work on breastfeeding. Maintaining this momentum and continuing to catalyze these efforts in the region are critical considering the aggressiveness of the BMS industry’s marketing. Full text.

Birth and newborn care policies and practices limit breastfeeding at maternity facilities in Vietnam. (October 2022). Frontiers in Nutrition.
This population-based, cross-sectional survey of mothers of infants living in diverse settings in Vietnam found that sub-optimal breastfeeding practices are associated with unsupportive provider behaviors and medical procedures such as cesarean birth, episiotomy, lack of immediate and uninterrupted skin-to-skin contact, and limited effectiveness of breastfeeding counseling and support during pregnancy and at the time of birth, as well as unethical marketing of commercial milk formula in health facilities. Full text.

Impacts of a social and behavior change communication program implemented at scale on infant and young feeding practices in Nigeria: Results of a cluster-randomized evaluation. (December 2022). PLoS One.
This impact evaluation of the Alive & Thrive IYCF intervention model in Kaduna and Lagos states found IYCF practices substantially improved in both intervention and comparison groups from baseline to endline, with weak impacts in the difference-in-differences analysis likely due to intervention spillover to the comparison group. Full text.

The financial costs of mass media interventions used for improving breastfeeding practices in Bangladesh, Burkina Faso, Nigeria, and Vietnam. (December 2022). International Journal of Environmental Research and Public Health.
This analysis documents the financial costs and budgetary needs for implementing mass media components of large-scale breastfeeding programs, providing annual costs, cost structures, and coverage achieved through mass media interventions in four low- and middle-income countries. National breastfeeding strategies need to provide realistic budgets based on actual program experience as shown here for mass media interventions. The results illustrate how weak enforcement of BMS Marketing Codes necessitates additional costs to counter misinformation and inform mothers and their influencers about the best way to feed infants. Full text.

Maternal Nutrition

maternal nutritionSpecificity matters: Unpacking impact pathways of individual interventions within bundled packages helps interpret the limited impacts of a maternal nutrition intervention in India. (February 2022). Journal of Nutrition.
This study found that systems-strengthening efforts improved maternal nutrition interventions in antenatal care, but gaps remained. Taking an intervention-specific perspective to the program impact pathway analysis in this package of services was critical to understand how common and specific barriers influenced overall program impact. Full text.

Process of developing models of maternal nutrition interventions integrated into antenatal care services in Bangladesh, Burkina Faso, Ethiopia and India. (June 2022). Maternal Child Nutrition.
A Theory of Change and steps for strengthening nutrition interventions developed by Alive & Thrive based on four country experiences in Africa and Asia provide practical guidance on addressing missed opportunities for a package of maternal nutrition interventions in ANC. Results were achieved by combining locally tailored health systems strengthening and social behavior change approaches. Full text.

Strengthening nutrition interventions in antenatal care services improved consumption of Iron-Folic Acid supplements and early breastfeeding practices in Burkina Faso. (June 2022). Current Developments in Nutrition.
Strengthening maternal nutrition interventions delivered through government ANC services was feasible and effective in improving maternal nutrition practices, despite implementation during the COVID-19 pandemic in Burkina Faso. Continued efforts to support the health system with the delivery of nutrition services during ANC and increasing demand for use of maternal nutrition services may be required for greater behavior changes. It is also important to address family support, social norms, and other factors to improve maternal diet. Full text

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. (July 2022). Maternal & Child Nutrition.
Analysis of narratives of nutrition-promoting, rural Bangladeshi community health workers suggest that behavior change communication strategies to persuade husbands require logical and credible information (logos and ethos) to establish their support, while childbearing women may additionally require emotional appeals (pathos) to adopt promoted behaviors. Mothers-in-law, who traditionally influence multiple nutrition behaviors, can be persuaded via strategic use of ethos and pathos. Full text.

Multiple modifiable maternal, household and health service factors are associated with maternal nutrition and early breastfeeding practices in Burkina Faso. (November 2022). Maternal & Child Nutrition.
This study identified factors that can be modified by interventions at the individual, household and health service levels to improve maternal nutrition and breastfeeding practices in Burkina Faso: High maternal knowledge was an important factor for maternal dietary diversity, breastfeeding and IFA consumption; family support and positive social norms were influential on the consumption of 90+ IFA tablets; and health service factors, such as timing of first ANC visit, 4+ ANC visits, receipt of home visits and counseling, were important factors for IFA consumption, weight monitoring and breastfeeding. Full text.

Adolescent Nutrition

Ethiopia adolescent nutritionDeterminants of adolescent nutrition status and practices in Burkina Faso using a pooled secondary analysis. (June 2022). Current Developments in Nutrition.
This study found that dietary diversity was sub-optimal among adolescent girls. However, the findings showed a strong association between high dietary diversity and unhealthy food intake, namely added sugar consumption, among adolescents in Burkina Faso. This is an important consideration for policy makers as they design adolescent nutrition programs to reduce malnutrition. Full text.

School-based nutrition interventions had impacts on dietary diversity and meal frequency of adolescent girls in Ethiopia. (June 2022). Current Developments in Nutrition.
Integrating nutrition education into classroom and extra-curricular activities in primary schools in Ethiopia was feasible and achieved a significant impact on girls’ dietary diversity and meal frequency. Hands-on activities, engaging parents, and providing reinforcing messages through multiple contact points about eating a variety of locally available nutrient rich foods and adequate meal frequency resulted in significant improvements in dietary diversity and meal frequency. Telling adolescents not to eat junk foods that they crave or enjoy may have been more successful if the food environments (e.g., food vendors near schools) were engaged in curbing consumption. Full text.

Maternity Protections

maternity protectionsViolations of the International Code of Breast-milk Substitutes (BMS) in commercial settings and media in Bangladesh. (March 2022). Maternal & Child Nutrition.
This, the first known study documenting violations of the International Code of Marketing of Breast-milk Substitutes using the standard NetCode protocol in Bangladesh, showed that Code violations were high in retail stores and were more prevalent in the capital city; further, violations were significantly higher on the internet compared to radio, television, and newspapers, highlighting the need for strengthening the monitoring of internet-based promotions. Full text.

Global evidence of persistent violations of the International Code of Marketing of Breast-milk Substitutes: A systematic scoping review. (March 2022). Maternal & Child Nutrition.
A scoping review of 153 studies from over 95 countries from 1981 to August 2021 found that violations of the International Code of Marketing of Breast-milk Substitutes are persistent and widespread, with studies reporting a broad range of marketing tactics targeting mothers and families, health workers, and the general public. Marketing via digital platforms and brand extension has become more frequent. Full text.

Awareness, perceptions, gaps, and uptake of maternity protection among formally employed women in Vietnam. (April 2022). International Journal of Environmental Research and Public Health.
Although Vietnam’s maternity protection policy helps protect the rights of women and children, interviews of formally employed women revealed implementation gaps that limit its effectiveness. Full text.

Babies before business: Protecting the integrity of health professionals from institutional conflict of interest. (August 2022). BMJ Global Health.
Manufacturers of commercial milk formulas use marketing tactics, including financial or material support, sponsorship of training or research and advertising in journals or at events, that contribute to conflicts of interest within the health system. Governments, health professional associations, and accreditation bodies have a duty of care to protect health systems from predatory marketing and to facilitate individual health workers to practice in an ethical manner. Full text.

Implementation and effectiveness of policies adopted to enable breastfeeding in the Philippines are limited by structural and individual barriers. (September 2022). International Journal of Environmental Research and Public Health.
This mixed methods study, which included in-depth interviews with 100 parents and key stakeholders in the Greater Manila Area, identified structural and individual barriers that limit the effectiveness of the Philippines' comprehensive breastfeeding policy framework and proposed actions to address these barriers. Full text.

Babies before bottom lines: A call for Australia to end exploitative marketing of commercial milk formula at home and abroad. (November 2022). Lancet Regional Health – Western Pacific.
The Australian Government has declined opportunities to correct historical inaction on the issue of unethical marketing of commercial milk formula products and has supported predatory marketing strategies at home and abroad. The forthcoming review of Australia’s voluntary system of industry self-regulation presents an important opportunity to implement a stronger regulatory approach that aligns with the Code of Marketing of Breast-milk Substitutes. Full text.

Systems Strengthening

Systems strengthening EAPUsing scenario-based assessments to examine the feasibility of integrating preventive nutrition services through the primary health care system in Bangladesh. (May 2022). Maternal & Child Nutrition.
This study uses a scenario-based feasibility testing approach to explore potential interventions to strengthen preventive and promotive nutrition service delivery through the primary health care system. The findings highlight three highly feasible potential platforms (community-based events [CBE] for pregnant women, CBE for well-children and well-child visits at facilities) to expand preventive services. Integrating preventive and promotive nutrition services requires addressing current challenges in the health system, including human resource and logistic gaps, and investing in creating demand for preventive services in Bangladesh. Full text.

Disruptions, restorations and adaptations to health and nutrition service delivery in multiple states across India over the course of the COVID-19 pandemic in 2020: An observational study. (July 2022). PLoS One.
Stringent COVID-19-related lockdown measures disrupted health and nutrition services to mothers and children in India. Rapid policy guidance and adaptations by frontline health workers enabled restoration but little remains known about uptake by client populations. Full text.

Expanding integrated competency-focused health worker curricula for maternal, infant and young child nutrition. (August 2022). Education Sciences.
This paper presents a multistage process used to map pre-service curricula for health workers, analyze expected competencies, and recognize broader factors that must be considered to develop a competency-focused curriculum that includes MIYCN. Supplementary material includes tools that can be used to review curricula and integrate skills such as communication and counselling. Full text.

Quality of nutrition services in primary health care facilities of Dhaka city: State of nutrition mainstreaming in urban Bangladesh. (December 2022). PLoS ONE.
This study identified gaps in facility readiness, and implementation of nutrition services, at public primary health care facilities in urban Dhaka, Bangladesh. There was high client satisfaction with services at private facilities compared to public. Full text.


IFA BurkinaMaternal resources for care are associated with child growth and early childhood development in Bangladesh and Vietnam. (January 2022). Child Care Health Dev.
Maternal height, well-nourishment, mental well-being, decision-making, support in chores, and perceived social support were associated with child outcomes. Full text.

A review of front-of-pack nutrition labelling in Southeast Asia: Industry interference, lessons learned, and future directions. (June 2022). The Lancet Regional Health – Southeast Asia.
Extensive industry interference has limited implementation of recommended front of pack labeling of food items across Southeast Asia. This interference can be anticipated and managed to optimize governments’ ability to develop and implement effective food labelling policies. Full text.

The association between Iron and Folic Acid supplementation and malaria prophylaxis and linear growth among children and neonatal mortality in Sub-Saharan Africa – A pooled analysis. (October 2022). Nutrients.
Antenatal malaria prophylaxis is important as a potential intervention to improve nutrition outcomes (linear growth) and reduces neonatal mortality in malaria-endemic countries of sub-Saharan Africa. Coordinating efforts between malaria and the health and nutrition sectors should be considered to improve these outcomes in sub-Saharan Africa countries. Full text.

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