Integrated management of GAM in children is an acceptable alternative to standard management and provides greater community coverage. This trial was registered at clinicaltrials.gov as NCT01785680.

Objective: There is a recognised need to strengthen capacity in the nutrition in emergencies sector and for greater clarity on the role of emergency nutritionists and the skills they require. Competency frameworks are an important tool for human resource development and have been developed for several other humanitarian sectors. We therefore developed a technical competency framework for practitioners in nutrition in emergencies. Design: Existing competency frameworks were reviewed and interviews conducted to explore methods used in developing competency frameworks for other sectors. Competencies were identified through interviews with field experts, feedback from course trainees, academic course content and job specifications. Competencies were then categorised and behavioural indicators developed for each. The draft framework was then reviewed by members of the Global Nutrition Cluster and modified in an iterative process. Setting: Global. Subjects: Not applicable. Results: A wide range of competencies were identified as essential for nutritionists working in emergencies, covering technical skills and general core competencies. The proposed framework contains twenty competency areas with 161 behavioural indicators categorised into three levels, corresponding to the requirements of progressively more senior roles. Many of the competencies are common across development and emergency nutrition. Conclusions:The proposed technical competency framework should prove to be a valuable tool in creating standards within the sector and promoting effective capacity strengthening and professionalisation. Continued research is needed to validate the framework, optimise methods for assessment, develop approaches to integrate it within the sector and measure its impact on performance.

Objectives: Less than a quarter of Omani infants < 6 months are exclusively breastfed. Therefore, this study aimed to examine individual barriers and supports to exclusive breastfeeding and identify potential policy and programmatic interventions in Oman. Methods: A cross-sectional Barrier Analysis was carried out among a purposive sample of Omani women - 45 “Doers” (who exclusively breastfed their infants) and 52 “Non-Doers” (who do not) – who were selected and interviewed by trained enumerators in health clinics in various parts of the country. A barrier analysis tool, adapted for the Omani context, covered 12 common determinants of behavior adoption using open-ended questions regarding participants’ perceptions about exclusive breastfeeding including positive and negative consequences, self-efficacy and social norms. Qualitative analysis involved coding and tabulating as well as thematic analysis. Results: Mothers report that motivation for exclusive breastfeeding include the perception that it leads to healthier children, is easy, readily available and therefore convenient and that mothers report an elevated level of family support for breastfeeding. Barriers included perceived milk insufficiency and mother’s employment. Conclusion: To achieve the 2025 exclusive breastfeeding target of 50%, public health action should focus on emphasizing the benefits and convenience of exclusive breastfeeding and building women’s confidence in their ability to produce sufficient milk. These efforts will require increasing the knowledge and skills of community and health care workers and establishing monitoring mechanisms. Expanding paid maternity leave and supportive workplace policies are necessary to encourage working women to exclusively breastfeed. Keywords: Breastfeeding, Breastfeeding barriers, Breastfeeding support, Exclusive breastfeeding, Nutrition policy, Oman, Health Promotion.