Global Nutrition

Brief description
The Maternal and Infant Nutrition Interventions trial in Matlab, (ISRRCTN16581394), in short the MINIMat trial, combined a number of early life nutrition interventions (prenatal food and micronutrient supplementations, exclusive breastfeeding promotion) which in line with the Developmental Origins of Health and Disease aims to evaluate both short and long-term health and nutrition related outcomes in the offspring. In addition, efforts were taken to include assessments of environmental exposures such as toxic metals but also exposure to social factors such as domestic violence. The cohort of MINIMat children has repeatedly (1-24m, 4.5y, 10y, 15y) been followed-up on various nutrition, health, growth and cognitive developmental outcomes. We are now working on follow-up of the MINIMat grandchildren who start to be born to the MINIMat girls. The MINIMat project has so far, resulted in more than 100 publications and 18 PhD students have defended their theses based on data from the MINIMat project. A bibliography can be found under publications at the research group's page.

Collaborators (main)
International Centre for Diarrhoeal Disease Research (icddr,b),Bangladesh research groups at Karolinska Institutet, London School of Hygiene and Tropical Medicine, Institute of Child Health, London, UK, University of California at Davis and Cornell University and Ithaca College in Ithaca, USA, Faculty of medicine, University of Tsukuba, Japan, National Institute for Health and Welfare, Helsinki, Finland

Funding (main)
Swedish Research council, icddr,b, UNICEF, Swedish International Development Cooperative Agency (Sida), Uppsala University, Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (FORMAS), UK Medical research, Department International Development (DFID), Japan Society for the promotion of Science, Child Health and Nutrition research

Responsible researcher/contact person
Eva-Charlotte Ekström, lotta.ekstrom@uu.se

Brief description
Betel chewing is prevalent in Asia including among women in pregnancy. Betel is known as carcinogenic but little is known about health risks for mother and foetus. Studies suggest that health risks are similar to that of undernourishment in early life; adverse pregnancy outcome, poor foetal and infant growth and increased risk for metabolic syndrome in adulthood. Thus, if poor nutrition and betel chewing are combined synergetic affects are plausible. Set in rural Bangladesh our is aim of this project is to evaluate the health consequences for mother and offspring of betel chewing in pregnancy.

Collaborators
International Centre for Diarrhoeal Disease Research (icddr,b), Bangladesh, and BRAC, Dhaka, Bangladesh

Funding
Swedish Research Council

Responsible researcher/contact person
Eva-Charlotte Ekström, lotta.ekstrom@se

Brief summary

This project focuses on children's consumption of healthy and unhealthy foods in Addis Ababa, Ethiopia. The main aim of the project is to understand what drives parents' – mainly mothers' – food choices for their children under the age of five. Several factors influence these choices, but many studies in urban areas in low-income countries have focused on factors related to the availability or price of different foods. The Swedish-Ethiopian research group's own recently completed studies in Addis Ababa (EAT Addis) clearly indicate that factors other than availability and affordability drive food choices and that these factors vary for different food and social groups. The project includes identifying these other driving factors and developing instruments to measure them. At a later stage, these instruments will be used to evaluate the main driving factors for children's consumption of healthy and unhealthy foods.

Collaborators
Addis Continental Institute of Public Health, Addis Ababa, Ethiopia, Lunds universitet

Funding
Swedish Research Council (VR)

Responsible researcher/contact person
Eva-Charlotte Ekström, lotta.ekstrom@uu.se

Brief description
Food and nutrition security is a cornerstone for achieving global sustainable development. In Africa’s rapidly growing cities, unemployment and widespread poverty currently leads to high levels of food and nutrition insecurity for a large share of the population. Undernutrition as well as overnutrition cause health related problems affecting individuals and society at large. In spite of these pressing challenges, the factors influencing the access to and consumption of food among urban people in low-income countries, remain insufficiently studied and understood. In the research project EAT Addis we aim to evaluate the social, economic and gender stratification of household food and nutrition security and their accessibility to safe and nutritious foods with a particular focus on young children. The influence of the urban food environment and its seasonal dynamic will be evaluated as well as the role of women empowerment in their role as gatekeeper between the food environment and the family.

Collaborators
Addis Continental Institute of Public Health, Addis Ababa, Ethiopia, Lund University, Swedish University of Agricultural Sciences, Lund

Funding
Swedish Research Council FORMAS

Responsible researcher/contact person
Eva-Charlotte Ekström, lotta.ekstrom@uu.se

Brief description
Effective nutrition interventions exist to prevent and manage mother and child malnutrition. Scaling up of such interventions is less successful and influenced by the context where it is implemented. This study was done within Ethiopia’s community-based program for management of severe acute malnourished children which is scaled up nationwide. The project analyses the influence of women’s empowerment on the outcome of rehabilitation of their severely malnourished children as well as the importance of the quality of the program.

Collaborators
Addis Continental Institute of Public Health, Addis Ababa, Ethiopia

Funding
Swedish Agency for Research Cooperation and Uppsala University

Responsible researcher/contact person
Eva-Charlotte Ekström, lotta.ekstrom@uu.se

Brief description
Recent calls to tackle child malnutrition include interventions to improve quality of infants and young children’s diet. Our project was set in a community undergoing the nutrition transition in which traditional diets and ways of feeding young children are influenced by the increased availability of commercial infant foods as well as high-energy dense (but nutrient poor) snack foods and sugar-sweetened beverages. Our aims were to evaluate the diet of young children both in terms of recommended feeding practices but also to understand feeding of food items with limited nutritional benefits. This included analysing the role of household socio-economic situation and food security and empowerment of women (such as education, autonomy and social support).

Collaborators
Aphrodese (non-governmental organisation), and The National Autonomous University of Nicaragua, Leon, Nicaragua

Funding
Swedish Agency for Research Cooperation (SAREC) and Uppsala University

Responsible researcher/contact person
Eva-Charlotte Ekström, lotta.ekstrom@uu.se

Brief description
At the time of this project postnatal transmission of HIV through breastfeeding remained a challenge in settings with high HIV prevalence where refraining from breastfeeding neither was feasible nor safe. Breastfeeding, especially exclusive breastfeeding (EBF) plays a significant role in improving child survival and is further associated with reduced risks of postnatal HIV-infection compared to mixed-feeding. However, despite knowledge about the benefits of EBF, infant feeding counselling and support from health systems remained inadequate and thus women continue to lack important information about ways to make breastfeeding safer. To support frail health systems lay peer counsellors have been suggested as a way forward. Our cluster randomised trial PROMISE-EBF aimed at evaluating the effectiveness of community-based peer counsellors in a high HIV setting in terms of infant feeding and health outcomes in South Africa, Zambia, Uganda and Burkina Faso.

Collaborators
Bergen University, Norway; University Western Cape and Medical Research Council South Africa; Ministry of Health Bobo-Dioulasso, Burkina Faso; University of Zambia, Zambia; Makarere University, Uganda; INSERM and Université de Montpellier, France; UNICEF, NY, USA

Funding
EU, Swedish Agency for Research Cooperation (SAREC) and Uppsala University

Responsible researcher/contact person
Eva-Charlotte Ekström, lotta.ekstrom@uu.se