Valerie L Flax
Biographic Data
| ID | 156629 |
|---|---|
| NAME | Valerie L Flax |
| GIVEN NAMES | Valerie L |
| FAMILY NAME | Flax |
| SIGNATURE | FLAX V L |
| AFFILIATIONS | RTI International |
| ORCID | 0000-0003-0200-3355 |
| VERIFIED | Yes |
| TOTAL WORKS | 34 |
| TOTAL CITATIONS | 10 |
| AUTHOR COUNT | 34 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2007 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 2 |
Factors that influence acute malnutrition detection and treatment by community health promoters in Samburu and Turkana counties, Kenya
Global acute malnutrition (GAM) among children
Prevalence and risk factors of diarrhea among young children in Kenya’s drylands
Diarrhea is the third leading cause of malnutrition and mortality among children under five globally. Environmental and socioeconomic conditions in the drylands of sub-Saharan Africa may increase the risk of diarrhea, yet few studies have examined the factors in these settings. We therefore aimed to estimate the prevalence of diarrhea and identify potential risk factors among young children in Kenya drylands. Data are from a longitudinal populati…
Process evaluation of enhanced community health system activities to improve detection and management of acute malnutrition in Samburu County, Kenya
Acute malnutrition remains a persistent public health concern in Kenya’s arid and semi-arid lands, including Samburu County, where the prevalence of global acute malnutrition (GAM) frequently exceeds the emergency threshold of 15%. Since 2023, a program collaborating with the county government has been implementing a range of enhanced community health systems activities focused on improving early detection and management of acute malnutrition. Th…
Implementing a multilevel, multicomponent intervention to engage fathers in complementary feeding in Northern Nigeria
The Alive & Thrive multilevel, multicomponent intervention to engage fathers in complementary feeding in Kaduna State, Nigeria previously showed significant increases in complementary feeding practices for children. This analysis explores the perceptions of intervention deliverers and recipients to inform future spread. The intervention components included counseling cards, home visits, feeding bowls, texts/prerecorded messages, posters, leaflets…
Factors associated with infant and young child feeding practices in Kaduna and Lagos States, Nigeria
Early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), and minimum dietary diversity (MDD) are recommended infant and young child feeding (IYCF) practices. Subnational analyses of predictors of these practices are rare but can contribute to programmatic and policy decisions. The aim of this study was to assess predictors of EIBF, EBF, and MDD in Kaduna and Lagos States, Nigeria. This analysis of the population-based data from th…
Why Animal‐Source Foods Are not Consumed by Women and Children in the Amhara Region
This study aimed to understand the barriers and facilitators of animal source food (ASF) consumption among women and children in Wag Himra, South Gondar, and Central Gondar zones of Amhara Region, Ethiopia. Women and men with children under 2 years, grandmothers, community and religious leaders, and midwives and health workers were included. Thirty separate focus group discussions and 35 key informant interviews were conducted from July to August…
Factors Influencing Wasting in Children Under 5 in Arid Regions of Kenya
Child wasting is a major public health problem in low- and middle-income countries. Our study aimed to identify immediate, underlying and basic factors influencing wasting among children in Turkana and Samburu, two arid and semi-arid regions in Kenya. Data are from a longitudinal study of children under 3 years of age at baseline, with follow-up every 4 months for 2 years. Generalized estimating equations were used to assess risk factors of wasti…
Examining the complex dynamics influencing acute malnutrition in Turkana and Samburu counties
Acute malnutrition in children under 5 years is persistent in Eastern Africa's arid and semiarid lands. This study aimed to identify the drivers of acute malnutrition in Turkana and Samburu counties, Kenya. This was a population-based longitudinal mixed-methods observational study. Qualitative and quantitative data were collected at Wave 1, but only quantitative data were collected during follow-up. Participants were a representative sample of ch…
Changing maternal, infant and young child nutrition practices through social and behaviour change interventions implemented at scale
Alive & Thrive (A&T) is an initiative designed to advance the implementation of maternal, infant and young child nutrition (MIYCN) social and behaviour change (SBC) at a large scale. The aims of this research were to: (1) describe A&T's SBC implementation processes and their impact based on a review of programme documents and peer-reviewed publications and (2) gather lessons learned from key informant interviews (N = 23) with A&T staff and stakeh…
Attitudes, beliefs and social norms regarding infant and young child feeding among Nigerian mothers, fathers and grandmothers across time
Infant and young child feeding (IYCF) interventions in low-resource countries mainly target pregnant women and mothers of young children; however, fathers and grandmothers also influence IYCF practices. We conducted focus group discussions with mothers, fathers and grandmothers of young children across three time points in areas where an IYCF social and behaviour change intervention was implemented in Nigeria to explore differences by participant…
Gender roles and masculinities in leveraging milk for household nutrition
Malnutrition in children remains a significant public health and development challenge in Rwanda. Animal Source Foods (ASFs) provide an important mechanism for supplying children with energy, proteins, and micro-nutrients. Using evidence from a study on the Girinka dairy program in Rwanda, this article adds a masculinities lens to nutrition strategies. It suggests potential ways to engage men in nutrition interventions whilst promoting gender-equ…
Maternal and paternal involvement in complementary feeding in Kaduna State, Nigeria
Household gender roles influence infant and young child feeding behaviours and may contribute to suboptimal complementary feeding practices through inequitable household decision-making, intra-household food allocation and limited paternal support for resources and caregiving. In Igabi local government area of Kaduna State, Nigeria, the Alive & Thrive (A&T) initiative implemented an intervention to improve complementary feeding practices through …
Cross-country comparison of dietary patterns and overweight and obesity among adult women in urban Sub-Saharan Africa
Objective: To derive dietary patterns (DP) among women of reproductive age (WRA) and older women in urban Sub-Saharan Africa (SSA), and to examine their association with body mass index (BMI), overweight and obesity. Design: We used principal component analysis to derive DP. Their association with BMI, overweight and obesity was assessed using linear and multinomial logistic regression models controlling for age, marital status, education and wea…
Food purchasing decisions of Malawian mothers with young children in households experiencing the nutrition transition
As overweight/obesity prevalence increases in sub-Saharan Africa, information is needed about factors influencing food purchases in households with overweight members. This study assessed food purchasing decisions of Malawian mothers with young children (N = 54 dry season, N = 55 rainy season) among whom the mother, child, or both were overweight. Research assistants completed structured observations of mothers shopping for food during the dry se…
After their wives have delivered, a lot of men like going out
Female-initiated HIV prevention methods, such as oral pre-exposure prophylaxis (PrEP) and the vaginal ring, may be important risk reduction strategies for breastfeeding women. Given their novelty, information about the sociocultural context and how it influences perceptions of and support for their use during breastfeeding is lacking. To address this gap, we conducted 23 focus group discussions separately with pregnant and breastfeeding women, ma…
Body size preferences and food choice among mothers and children in Malawi
Overweight in mothers and children in sub-Saharan Africa is rapidly increasing and may be related to body size perceptions and preferences. We enrolled 268 mother-child (6-59 months) pairs in central Malawi; 71% of mothers and 56% of children were overweight/obese, and the remainder were normal weight. Interviewers used seven body silhouette drawings and a questionnaire with open- and closed-ended questions to measure mothers' perceptions of curr…
Optimizing portion-size estimation aids
Objective: To investigate preferences for and ease-of-use perceptions of different aspects of printed and digitally displayed photographic portion-size estimation aids (PSEA) in a low-resource setting and to document accuracy of portion-size selections using PSEA with different visual characteristics. Design: A convergent mixed-methods design and stepwise approach were used to assess characteristics of interest in isolation. Participants served t…
Using Trials of Improved Practices to identify practices to address the double burden of malnutrition among Rwandan children
Objective: Low- and middle-income countries (LMIC) are increasingly experiencing the double burden of malnutrition. Studies to identify ‘double-duty’ actions that address both undernutrition and overweight in sub-Saharan Africa are needed. We aimed to identify acceptable behaviours to achieve more optimal feeding and physical activity practices among both under- and overweight children in Rwanda, a sub-Saharan LMIC with one of the largest recent …
Validation of a digitally displayed photographic food portion-size estimation aid among women in urban and rural Malawi
Objective: To validate digitally displayed photographic portion-size estimation aids (PSEA) against a weighed meal record and compare findings with an atlas of printed photographic PSEA and actual prepared-food PSEA in a low-income country. Design: Participants served themselves water and five prepared foods, which were weighed separately before the meal and again after the meal to measure any leftovers. Participants returned the following day an…
Infant and young child feeding learning sessions during savings groups are feasible and acceptable for HIV‐positive and HIV‐negative women in Malawi
Based on formative research, HIV-positive women in Lilongwe District, Malawi receive little infant and young child feeding (IYCF) counselling postpartum and want more support for IYCF from their husbands. To address these gaps, we implemented a behaviour change communication intervention promoting IYCF in village savings and loan associations (VSLAs) that included HIV-positive and HIV-negative women. The intervention consisted of 15 IYCF learning…
The effects of a lipid‐based nutrient supplement and antiretroviral therapy in a randomized controlled trial on iron, copper, and zinc in milk from HIV ‐infected M alawian mothers and associations wit…
We evaluated effects of antiretroviral (ARV) therapy and lipid-based nutrient supplements (LNSs) on iron, copper, and zinc in milk of exclusively breastfeeding HIV-infected Malawian mothers and their correlations with maternal and infant biomarkers. Human milk and blood at 2, 6, and 24 weeks post-partum and blood during pregnancy (≤30 weeks gestation) were collected from 535 mothers/infant-pairs in the Breastfeeding, Antiretrovirals, and Nutritio…
HIV‐positive Malawian women with young children prefer overweight body sizes and link underweight body size with inability to exclusively breastfeed
Before the prevention of mother-to-child transmission (PMTCT) program was widely implemented in Malawi, HIV-positive women associated exclusive breastfeeding with accelerated disease progression and felt that an HIV-positive woman could more successfully breastfeed if she had a larger body size. The relationship between breastfeeding practices and body image perceptions has not been explored in the context of the Option B+ PMTCT program, which of…
Evaluating the effect of integrated microfinance and health interventions
BACKGROUND: Solutions delivered within firm sectoral boundaries are inadequate in achieving income security and better health for poor populations. Integrated microfinance and health interventions leverage networks of women to promote financial inclusion, build livelihoods, and safeguard against high cost illnesses. Our understanding of the effect of integrated interventions has been limited by variability in intervention, outcome, design, and me…
Reflux Incidence among Exclusively Breast Milk Fed Infants
The practice of feeding infants expressed breast milk is increasing in the United States, but the impacts on infant and maternal health are still understudied. This study examines the monthly incidence of regurgitation (gastro-esophageal reflux) in exclusively breast milk fed infants from ages two to six months. Among infants whose mothers participated in the Infant Feeding Practices II Study (IFPS II; 2005-2007), data on reflux and feeding mode …
Group cell phones are feasible and acceptable for promoting optimal breastfeeding practices in a women's microcredit program in Nigeria
As part of a breastfeeding promotion intervention trial in Nigeria, we provided one cell phone per group of 5-7 microcredit clients and instructed the group's cell phone recipient to share weekly breastfeeding voice and text messages with group members. We measured the feasibility and acceptability of using group cell phones by conducting semi-structured exit interviews with 195 microcredit clients whose babies were born during the intervention (…
Feeding patterns and behaviors during home supplementation of underweight Malawian children with lipid-based nutrient supplements or corn-soy blend
The way caregivers use supplementary food for undernourished children and integrate it into feeding patterns may influence the benefits achieved by supplementation. We studied feeding patterns and behaviors in 170 underweight 6-17-month-olds who received either lipid-based nutrient supplements (LNS) (n=85) or corn-soy blend (CSB) (n=85) during a 12-week intervention trial in southern Malawi. Observational data were collected during one 11h home v…
Malawian mothers’ attitudes towards the use of two supplementary foods for moderately malnourished children
Food purchasing decisions of Malawian mothers with young children in households experiencing the nutrition transition
As overweight/obesity prevalence increases in sub-Saharan Africa, information is needed about factors influencing food purchases in households with overweight members. This study assessed food purchasing decisions of Malawian mothers with young children (N = 54 dry season, N = 55 rainy season) among whom the mother, child, or both were overweight. Research assistants completed structured observations of mothers shopping for food during the dry se…
Perceptions of Child Body Size and Health Care Seeking for Undernourished Children in Southern Malawi
Child undernutrition affects millions of children globally, but little is known about the ability of adults to detect different types of child undernutrition in low-income countries. We used focused ethnographic methods to understand how Malawian parents and grandparents describe the characteristics they use to identify good and poor child growth, their actual or preferred patterns of health seeking for undernourished children, and the perceived …
Feeding patterns of underweight children in rural Malawi given supplementary fortified spread at home
Fortified spread (FS), containing dry food particles embedded in edible fat, offers a convenient means for nutrition rehabilitation. To describe how caregivers feed FS to their undernourished children at home, and how FS use affects other feeding patterns, we conducted a longitudinal observational study in rural Malawi. Sixteen 6- to 17-month-old underweight children (weight-for-age z-score < -2.0; -3.0 < weight-for-height z-score < 0) received F…
Malawian mothers’ attitudes towards the use of two supplementary foods for moderately malnourished children
Feeding patterns and behaviors during home supplementation of underweight Malawian children with lipid-based nutrient supplements or corn-soy blend
The way caregivers use supplementary food for undernourished children and integrate it into feeding patterns may influence the benefits achieved by supplementation. We studied feeding patterns and behaviors in 170 underweight 6-17-month-olds who received either lipid-based nutrient supplements (LNS) (n=85) or corn-soy blend (CSB) (n=85) during a 12-week intervention trial in southern Malawi. Observational data were collected during one 11h home v…
Responsive feeding and child interest in food vary when rural Malawian children are fed lipid‐based nutrient supplements or local complementary food
Caregiver and child behaviours during feeding have been used to measure responsiveness, which has been recognised as important for child growth and development. The aims of this study were to understand how caregiver and child behaviours differ when feeding lipid-based nutrient supplements (LNS) vs. local complementary food and to detect associations between behaviours and child interest in food. Sixteen moderately underweight 6-17-month-old Mala…
It was caused by the carelessness of the parents’
Parents' conceptions of child growth, health and malnutrition are culturally bound, making information about local understandings of malnutrition and its causes necessary for designing effective nutrition programmes. This study used ethnographic methods to elucidate cultural models of child care and malnutrition among the Yao of southern Malawi. Data were collected in six rural villages from 28 key informant interviews with village chiefs and tra…
Provision of lipid‐based nutrient supplements to H onduran children increases their dietary macro‐ and micronutrient intake without displacing other foods
Inadequate energy intake and poor diet quality are important causes of chronic child undernutrition. Strategies for improving diet quality using lipid-based nutrient supplements (LNS) are currently being tested in several countries. To date, information on children's dietary intakes during LNS use is available only from Africa. In this study, we collected 24-h dietary recalls at baseline, 3, 6, 9 and 12 months on Honduran children (n = 298) parti…
Factors associated with early growth in E gyptian infants
Optimal nutrition is critical to the attainment of healthy growth, human capital and sustainable development. In Egypt, infants and young children face overlapping forms of malnutrition, including micronutrient deficiencies, stunting and overweight. Yet, in this setting, little is known about the factors associated with growth during the first year of life. A rise in stunting in Lower Egypt from 2005 to 2008 prompted this implementation research …
Reflux Incidence among Exclusively Breast Milk Fed Infants
The practice of feeding infants expressed breast milk is increasing in the United States, but the impacts on infant and maternal health are still understudied. This study examines the monthly incidence of regurgitation (gastro-esophageal reflux) in exclusively breast milk fed infants from ages two to six months. Among infants whose mothers participated in the Infant Feeding Practices II Study (IFPS II; 2005-2007), data on reflux and feeding mode …
Group cell phones are feasible and acceptable for promoting optimal breastfeeding practices in a women's microcredit program in Nigeria
As part of a breastfeeding promotion intervention trial in Nigeria, we provided one cell phone per group of 5-7 microcredit clients and instructed the group's cell phone recipient to share weekly breastfeeding voice and text messages with group members. We measured the feasibility and acceptability of using group cell phones by conducting semi-structured exit interviews with 195 microcredit clients whose babies were born during the intervention (…
Infant and Young Child Feeding Counseling, Decision-Making, and Practices Among HIV-Infected Women in Malawi’s Option B+ Prevention of Mother-to-Child Transmission Program
Perceptions of Child Body Size and Health Care Seeking for Undernourished Children in Southern Malawi
Child undernutrition affects millions of children globally, but little is known about the ability of adults to detect different types of child undernutrition in low-income countries. We used focused ethnographic methods to understand how Malawian parents and grandparents describe the characteristics they use to identify good and poor child growth, their actual or preferred patterns of health seeking for undernourished children, and the perceived …
The effects of a lipid‐based nutrient supplement and antiretroviral therapy in a randomized controlled trial on iron, copper, and zinc in milk from HIV ‐infected M alawian mothers and associations wit…
We evaluated effects of antiretroviral (ARV) therapy and lipid-based nutrient supplements (LNSs) on iron, copper, and zinc in milk of exclusively breastfeeding HIV-infected Malawian mothers and their correlations with maternal and infant biomarkers. Human milk and blood at 2, 6, and 24 weeks post-partum and blood during pregnancy (≤30 weeks gestation) were collected from 535 mothers/infant-pairs in the Breastfeeding, Antiretrovirals, and Nutritio…
HIV‐positive Malawian women with young children prefer overweight body sizes and link underweight body size with inability to exclusively breastfeed
Before the prevention of mother-to-child transmission (PMTCT) program was widely implemented in Malawi, HIV-positive women associated exclusive breastfeeding with accelerated disease progression and felt that an HIV-positive woman could more successfully breastfeed if she had a larger body size. The relationship between breastfeeding practices and body image perceptions has not been explored in the context of the Option B+ PMTCT program, which of…
Evaluating the effect of integrated microfinance and health interventions
BACKGROUND: Solutions delivered within firm sectoral boundaries are inadequate in achieving income security and better health for poor populations. Integrated microfinance and health interventions leverage networks of women to promote financial inclusion, build livelihoods, and safeguard against high cost illnesses. Our understanding of the effect of integrated interventions has been limited by variability in intervention, outcome, design, and me…
Infant and young child feeding learning sessions during savings groups are feasible and acceptable for HIV‐positive and HIV‐negative women in Malawi
Based on formative research, HIV-positive women in Lilongwe District, Malawi receive little infant and young child feeding (IYCF) counselling postpartum and want more support for IYCF from their husbands. To address these gaps, we implemented a behaviour change communication intervention promoting IYCF in village savings and loan associations (VSLAs) that included HIV-positive and HIV-negative women. The intervention consisted of 15 IYCF learning…
Optimizing portion-size estimation aids
Objective: To investigate preferences for and ease-of-use perceptions of different aspects of printed and digitally displayed photographic portion-size estimation aids (PSEA) in a low-resource setting and to document accuracy of portion-size selections using PSEA with different visual characteristics. Design: A convergent mixed-methods design and stepwise approach were used to assess characteristics of interest in isolation. Participants served t…
Using Trials of Improved Practices to identify practices to address the double burden of malnutrition among Rwandan children
Objective: Low- and middle-income countries (LMIC) are increasingly experiencing the double burden of malnutrition. Studies to identify ‘double-duty’ actions that address both undernutrition and overweight in sub-Saharan Africa are needed. We aimed to identify acceptable behaviours to achieve more optimal feeding and physical activity practices among both under- and overweight children in Rwanda, a sub-Saharan LMIC with one of the largest recent …
Validation of a digitally displayed photographic food portion-size estimation aid among women in urban and rural Malawi
Objective: To validate digitally displayed photographic portion-size estimation aids (PSEA) against a weighed meal record and compare findings with an atlas of printed photographic PSEA and actual prepared-food PSEA in a low-income country. Design: Participants served themselves water and five prepared foods, which were weighed separately before the meal and again after the meal to measure any leftovers. Participants returned the following day an…
After their wives have delivered, a lot of men like going out
Female-initiated HIV prevention methods, such as oral pre-exposure prophylaxis (PrEP) and the vaginal ring, may be important risk reduction strategies for breastfeeding women. Given their novelty, information about the sociocultural context and how it influences perceptions of and support for their use during breastfeeding is lacking. To address this gap, we conducted 23 focus group discussions separately with pregnant and breastfeeding women, ma…
Body size preferences and food choice among mothers and children in Malawi
Overweight in mothers and children in sub-Saharan Africa is rapidly increasing and may be related to body size perceptions and preferences. We enrolled 268 mother-child (6-59 months) pairs in central Malawi; 71% of mothers and 56% of children were overweight/obese, and the remainder were normal weight. Interviewers used seven body silhouette drawings and a questionnaire with open- and closed-ended questions to measure mothers' perceptions of curr…
Cross-country comparison of dietary patterns and overweight and obesity among adult women in urban Sub-Saharan Africa
Objective: To derive dietary patterns (DP) among women of reproductive age (WRA) and older women in urban Sub-Saharan Africa (SSA), and to examine their association with body mass index (BMI), overweight and obesity. Design: We used principal component analysis to derive DP. Their association with BMI, overweight and obesity was assessed using linear and multinomial logistic regression models controlling for age, marital status, education and wea…
Food purchasing decisions of Malawian mothers with young children in households experiencing the nutrition transition
As overweight/obesity prevalence increases in sub-Saharan Africa, information is needed about factors influencing food purchases in households with overweight members. This study assessed food purchasing decisions of Malawian mothers with young children (N = 54 dry season, N = 55 rainy season) among whom the mother, child, or both were overweight. Research assistants completed structured observations of mothers shopping for food during the dry se…
Maternal and paternal involvement in complementary feeding in Kaduna State, Nigeria
Household gender roles influence infant and young child feeding behaviours and may contribute to suboptimal complementary feeding practices through inequitable household decision-making, intra-household food allocation and limited paternal support for resources and caregiving. In Igabi local government area of Kaduna State, Nigeria, the Alive & Thrive (A&T) initiative implemented an intervention to improve complementary feeding practices through …
Changing maternal, infant and young child nutrition practices through social and behaviour change interventions implemented at scale
Alive & Thrive (A&T) is an initiative designed to advance the implementation of maternal, infant and young child nutrition (MIYCN) social and behaviour change (SBC) at a large scale. The aims of this research were to: (1) describe A&T's SBC implementation processes and their impact based on a review of programme documents and peer-reviewed publications and (2) gather lessons learned from key informant interviews (N = 23) with A&T staff and stakeh…
Attitudes, beliefs and social norms regarding infant and young child feeding among Nigerian mothers, fathers and grandmothers across time
Infant and young child feeding (IYCF) interventions in low-resource countries mainly target pregnant women and mothers of young children; however, fathers and grandmothers also influence IYCF practices. We conducted focus group discussions with mothers, fathers and grandmothers of young children across three time points in areas where an IYCF social and behaviour change intervention was implemented in Nigeria to explore differences by participant…
Medicine (28 works) · Child Nutrition and Water Access (26 works) · Environmental health (21 works) · Pediatrics (15 works) · Child Nutrition and Feeding Issues (12 works) · Nursing (11 works) · Psychology (11 works) · Focus group (9 works) · Malnutrition (9 works) · Obesity, Physical Activity, Diet (9 works)