Kodish Stephen R, Matean Maryam, Grey Kelsey, Palaniappan Uma, Northrup-Lyons Martina, Yalvigi Akshata, Gwavuya Stanley, Mclean Judy, Erasmus Wendy
Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, United States of America.
Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, United States of America.
PLOS Glob Public Health. 2022 Dec 19;2(12):e0001343. doi: 10.1371/journal.pgph.0001343. eCollection 2022.
The East and Pacific region includes 14 Pacific Island Countries where, between 2000 and 2016, indicators of stunting, wasting, and micronutrient deficiencies have plateaued or worsened, while rates of overweight, obesity, and associated disease have risen. The Republic of Marshall Islands (RMI) is no exception: maternal and child nutrition indicators have not improved in decades. A study of the contemporary factors shaping the RMI nutrition situation was needed for informing policy and tailoring interventions. This formative study had an iterative design utilizing qualitative methods. An exploratory Phase 1 included 59 semi-structured interviews with community members, 86 free lists with caregivers, 8 participatory workshops, and 20 meal observations (round 1). Findings were synthesized to inform a confirmatory Phase 2 where 13 focus groups, 81 pile sorts, 15 meal observations (round 2), and 2 seasonal food availability workshops were conducted. Textual data were analyzed thematically using NVivo while cultural domain analysis was conducted in Anthropac. RMI faces interrelated challenges that contribute to a lack of nutritious and local food availability, which is compounded by high food costs relative to household incomes. A decades-long cultural transition from local to processed diets has resulted in infant and young child diets now characterized by morning meals of doughnuts, bread, and ramen with tea, coffee, or Kool-Aid and afternoon meals that include rice with canned meats (e.g., store-bought chicken, hot dogs). Individual preferences for processed food imports have increased their supply. Low maternal risk perception toward nutrition-related illnesses may further explain sub-optimal diets. Improving the RMI food environment will require approaches that align with the multi-level determinants of sub-optimal diets found in this study. As the ten-year 2013 RMI Food Security Policy soon ends, study findings may be used to inform new policy development and investments for improving the nutrition situation.
东太平洋地区包括14个太平洋岛国，在2000年至2016年期间，发育迟缓、消瘦和微量营养素缺乏指标停滞不前或恶化，而超重、肥胖及相关疾病的发病率则有所上升。马绍尔群岛共和国（RMI）也不例外：母婴营养指标几十年来一直没有改善。需要对影响马绍尔群岛共和国营养状况的当代因素进行研究，以为政策提供信息并量身定制干预措施。这项形成性研究采用定性方法进行了迭代设计。探索性的第一阶段包括对社区成员进行59次半结构化访谈、与照顾者进行86次自由列举、举办8次参与式研讨会以及进行20次膳食观察（第一轮）。研究结果被综合起来，为验证性的第二阶段提供信息，在该阶段进行了13次焦点小组讨论、81次分类排序、15次膳食观察（第二轮）以及举办了2次季节性食物供应研讨会。文本数据使用NVivo进行了主题分析，而文化领域分析则在Anthropac中进行。马绍尔群岛共和国面临着相互关联的挑战，这些挑战导致缺乏营养丰富的本地食物供应，而相对于家庭收入而言的高食品成本又使情况更加复杂。从本地饮食到加工饮食的长达数十年的文化转变，导致婴幼儿饮食现在的特点是早餐为甜甜圈、面包和拉面配茶、咖啡或酷爱饮料，午餐则是米饭配罐装肉类（如商店购买的鸡肉、热狗）。个人对加工食品进口的偏好增加了其供应量。母亲对营养相关疾病的低风险认知可能进一步解释了不理想的饮食。改善马绍尔群岛共和国的食物环境将需要与本研究中发现的不理想饮食的多层次决定因素相一致的方法。由于2013年马绍尔群岛共和国为期十年的粮食安全政策即将结束，研究结果可用于为改善营养状况的新政策制定和投资提供信息。
