Objective To estimate how many child deaths might be prevented if user fees were removed in 20 African countries Design Simulation model combining evidence on key health interventions' impacts on reducing child mortality with analysis of the effect of fee abolition on access to healthcare services. Results Elimination of user fees could prevent approximately 233 000 (estimate range 153 000-305 000) deaths annually in children aged under 5 in 20 African countries. Conclusion Given the relatively low cost of abolition, replacing user fees with alternative financing mechanisms should be seen as an effective first step towards improving households' access to health care and achieving the millennium development goals for health.

Introduction: The aim of the research was to gain a greater understanding of infant and young child feeding perceptions and practices in the London Borough of Tower Hamlets and the role of early years’ providers in supporting healthy feeding practices. The research was used to feed into ongoing commissioning and resource allocation priorities, taking into consideration continuing budget restrictions, to achieve nutrition outcomes through effective early years’ public health interventions. Methodology: A qualitative methodology was applied. The target groups were mothers with children under five years old, early years ‘service providers and carers. The participants were selected using purposeful, convenience and snowball sampling methods. In total 18 focus group discussions, 36 interviews and 3 direct observation sessions were carried out with 144 participants across the borough. Findings:  There was generally widespread knowledge that breastfeeding is best for infants, however, there was less clarity on the best time for introducing complementary food and drinks to infants. Mothers trust health providers for information, but most used the internet, family and friends for information as it was  easier to access. Some mothers reported mixed messages, pain, and pressure from the media, families and friends as the main reasons for changing from exclusive breastfeeding to mixed feeding. Some mothers reported lack of support postnatally and inconsistent advice such as service providers giving mixed messages, especially regarding feeding in public, mixed feeding and when to introduce other fluids and foods. The borough’s infant and young child feeding support workers were valued, but not all mothers knew about the service. Certain groups, such as those with English as a second language, teenage mothers and mothers without childcare reported not using services routinely.   Conclusions: Following presentation of the key findings, and a discussion with early years’ service providers, the Tower Hamlets Public Health Division suggested practice changes which were adopted by the LBTH council. The council committed to continue supporting the Infant Feeding & Wellbeing Service (known as the Baby Feeding Service) to continue to improve infant and young child feeding practices. Health visitors are encouraged to use their new 3-4 month contact with post-natal mothers, in addition to the five mandated universal contacts, as an opportunity to offer nutrition support to mothers. The council also approved increased nutrition capacity within the Health Visiting and Public Health team. More information is now available on the Tower Hamlets website to support mothers with clear nutrition and infant feeding information with details of the many services mothers can access in the borough.

Introduction: The aim of this study was to explore the relationship between food and mood against the backdrop of increased mental health and nutrition cognizance within public health and scientific discourses. Mood was defined as encompassing positive or negative affect. Methodology: A constructionist qualitative approach underpinned this study. Convenience sampling in two faith-based settings was utilised for recruiting participants, who were aged 19-80 (median,48) years. In total 22 Christian women were included in the research, eighteen were in focus groups and four were in individual semi structured interviews. All were church-attending women in inner London. A thematic analysis was carried out, resulting in four central themes relating to food choice and food-induced mood states. Findings: Women identified a number of internal and external factors as influencing their food choices and the effect of food intake on their moods. Food choice was influenced by mood; mood was influenced by food choice. Low mood was associated with unhealthy food consumption, apparent addiction to certain foods and overeating. Improved mood was associated with more healthy eating and eating in social and familial settings. Discussion: Findings indicate food and mood are interconnected through a complex web of factors, as women respond to individual, environmental, cultural and social cues. Targeting socio-cultural and environmental influences and developing supportive public health services, via faith-based or community-based institutions could help to support more women in their struggle to manage the food and mood continuum. Successful implementation of health policies that recognise the psychological and social determinants of food choice and the effect of food consumption on mood, is essential, as is as more research into life-cycle causal factors linking food choice to mood.

While an estimated 45% of pregnant women in Malawi are anaemic, only 33% take iron tablets for a minimum of 90 days during pregnancy. The study explored the capacity of health facilities and communities to strengthen antenatal iron folate supplementation in Ntchisi, to support the achievement of Malawi’s nutrition target on halving anaemia in women of reproductive age by 2025. This qualitative study employed systematic random and purposeful sampling. Eight Focus Group Discussions with mothers of children 0-23 months, eight with Care Group volunteers and eight in-depth interviews with Village Health Workers (Health Surveillance Assistants) were conducted in each village falling within the catchment area of each of 8 health facilities. Health facilities had been sampled each from the 7 Traditional Authorities with the district hospital and direct observations had been conducted at each for antenatal care service delivery. 10 key informants from the health facilities and the District Health Office were interviewed. Thus a total of 16 FGDs, 8 HSA interviews, and 10 key informant interviews provided the data analysed in this paper.  Data were analysed manually using thematic framework analysis. Poor access to and follow up of antenatal care at the health facility has limited access to iron folate supplements, as the health facility is the main source of Iron folates. Recurrent depletion of stock of iron folate were reported by mothers at most health facilities. Consumer demand for the tablets was low due to side effects, poor acceptability, associated myths, forgetfulness and frustration from having to take a daily medication. There was limited training and education materials at the health facility and community with inadequate support given to women. The absence of clear policies and guidelines on iron folate supplementation resulted in inconsistencies in messaging. Uptake and adherence were not routinely monitored. There is a need to improve the main building blocks of the iron folate programme, including the: delivery system, tablet supply, patient education, consumer demand, monitoring and evaluation and policy.

Methodology: An exploratory methodology was adopted to examine experiences relating to capability and capacity among formal and informal helpers within the PHN domain. An online survey, mainly open-ended questions, was used to capture experiences over the period 2010 - 2020. A mixed sampling strategy, including snowball and convenience sampling, via social media and social network contact-sharing approaches, was adopted. Data was analysed using an inductive thematic approach. Results: A total of 89 participants representing the PHN system in England were recruited over two months. Three main themes and eight sub-themes were identified. The first reflected unequivocal accounts of the impact of austerity and the inability of PHN services to meet demand for food security. The second articulated capacity and capability issues within the system, with geographical variations in service delivery, and a lack of connectivity between central, local government, and third sector providers. These were attributed to widening nutrition and health inequalities. Participants felt that the government needed to invest more technical and financial resources to support public health nutrition. They also felt that schools could play a larger role at local level, but there was a need for a clear national recovery plan, setting out a comprehensive and fully supported national strategy to eradicate food insecurity in England Conclusions: Further in-depth research is needed to continue to track the impact of recovery strategies on food insecure people and the capacity of the PHN system. Urgent investment in the capacity and coordination of PHN services is needed to support food insecure people in England. The UK could include the ratification of the right to food in national laws, in line with global commitments already agreed to by the UK State Party.