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Pye H. Nursing Considerations for Emergency Department Care of the Breastfeeding Dyad. J Emerg Nurs 2024; 50:324-329. [PMID: 38456865 DOI: 10.1016/j.jen.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 03/09/2024]
Abstract
Although postpartum dyads frequently present to the emergency department, treatment of the lactating parent and breastfeeding child is often driven by medical misconceptions. Incorrect advice about continuation or cessation of breastfeeding for medical reasons can lead to maternal and infant harm. In lactation, demand begets supply; missing a feed can be detrimental to short- and long-term breastfeeding outcomes. The purpose of this Clinical Nurses Forum article is to argue the importance of appropriate care of the breastfeeding dyad in the emergency department setting and to interpret current evidence-based information on lactation for the emergency staff nurse. High-quality care for the breastfeeding dyad requires knowledge of lactation physiology, contraindications for breastfeeding, and safe medications and diagnostic procedures. The well-informed emergency nurse must advocate for evidence-based care of the breastfeeding dyad within the emergency department.
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Mosquera PS, Lourenço BH, Matijasevich A, Castro MC, Cardoso MA. Prevalence and predictors of breastfeeding in the MINA-Brazil cohort. Rev Saude Publica 2024; 57Suppl 2:2s. [PMID: 38422331 PMCID: PMC10897961 DOI: 10.11606/s1518-8787.2023057005563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/29/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To describe the prevalence and factors associated with exclusive (EBF) and continued breastfeeding (BF) practices among Amazonian children. METHODS Data from 1,143 mother-child pairs recorded on the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) birth cohort were used. Information on EBF and BF was collected after childbirth (July 2015-June 2016) and during the follow-up visits at 1 and 6 months postpartum, 1, 2, and 5 years of age. For longitudinal analysis, the outcomes were EBF and BF duration. Probability of breastfeeding practices were estimated by Kaplan-Meier survival analysis. Associations between baseline predictors variables and outcomes among children born at term were assessed by extended Cox regression models. RESULTS EBF frequencies (95% confidence interval [95%CI]) at 3 and 6 months of age were 33% (95%CI: 30.2-36.0) and 10.8% (95%CI: 8.9-12.9), respectively. Adjusted hazard ratio for predictors of early EBF cessation were: being a first-time mother = 1.47 (95%CI: 1.19-1.80), feeding newborns with prelacteals = 1.70 (95%CI: 1.23-2.36), pacifier use in the first week of life = 1.79 (95%CI: 1.44-2.23) or diarrhea in the first two weeks of life = 1.70 (95%CI: 1.15-2.52). Continued BF frequency was 67.9% (95%CI: 64.9-70.8), 29.3% (95%CI: 26.4-32.4), and 1.7% (95%CI: 0.9-2.8) at 1, 2 and 5 years of age, respectively. Adjusted hazard ratio for predictors of early BF cessation were: male sex = 1.23 (95%CI: 1.01-1.49), pacifier use in the first week of life = 4.66 (95%CI: 2.99-7.26), and EBF less than 3 months = 2.76 (95%CI: 1.64-4.66). CONCLUSIONS EBF and continued BF duration among Amazonian children is considerably shorter than recommendations from the World Health Organization. Significant predictors of breastfeeding practices should be considered for evaluating local strategies to achieve optimal breastfeeding practices.
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Affiliation(s)
- Paola S. Mosquera
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Nutrição. São Paulo, Brasil
| | - Bárbara H. Lourenço
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Nutrição. São Paulo, Brasil
| | - Alicia Matijasevich
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina PreventivaSão PauloBrasilUniversidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Preventiva. São Paulo, Brasil
| | - Marcia C. Castro
- Harvard T.H. Chan School of Public HealthDepartment of Global Health and PopulationBostonMAEstados UnidosHarvard T.H. Chan School of Public Health. Department of Global Health and Population. Boston, MA, Estados Unidos.
| | - Marly A. Cardoso
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Nutrição. São Paulo, Brasil
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Zimmerman E, Kau M, Tovohasimbavaka RKN, Ngandu A, Kangudie DM, Van Lith L, Rajan R, Naugle D, Sherburne L. Behavioural drivers of child feeding during and after illness in the Democratic Republic of the Congo: results from a qualitative study through the lens of behavioural science. Public Health Nutr 2023; 27:e80. [PMID: 38148180 DOI: 10.1017/s136898002300294x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
OBJECTIVE For young children experiencing an illness, adequate nutrition is critical for recovery and to prevent malnutrition, yet many children do not receive the recommended quantities of food during illness and recuperation. Our research applied a behavioural science lens to identify drivers of feeding behaviours, including barriers inhibiting caregivers from following the feeding guidelines. DESIGN In 2021, we conducted qualitative research informed by the behavioural design process. Data from in-depth interviews and observations were analysed for themes. SETTING Research was conducted in South Kivu, Democratic Republic of the Congo. PARTICIPANTS Research participants included caregivers of young children, other family members, health workers and other community members. RESULTS Five key findings about behavioural drivers emerged: (1) poverty and scarcity impose practical constraints and a cognitive and emotional burden on caregivers; (2) health providers are distracted and discouraged from counselling on feeding during sick visits; (3) a focus on quality and hesitations about quantity obscure benefits of feeding greater amounts of available foods; (4) perceptions of inappropriate foods limit caregivers' choices; and (5) deference to a child's limited appetite leads to missed opportunities to encourage them to eat. CONCLUSIONS Each of these behavioural drivers is triggered by one or more addressable features in caregivers' and health workers' environment, suggesting concrete opportunities for programmes to support caregivers and health workers to improve feeding of young children during illness and recovery. In other settings where these features of the environment are similar, the insights and programming implications are likely to translate.
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Affiliation(s)
| | - Madeline Kau
- ideas42, 80 Broad St, Floor 30, New York, NY10004, USA
| | | | - Augustin Ngandu
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD21202, USA
| | - Didier Mbayi Kangudie
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD21202, USA
| | - Lynn Van Lith
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD21202, USA
| | - Radha Rajan
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD21202, USA
| | - Danielle Naugle
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD21202, USA
| | - Lisa Sherburne
- JSI Research and Training Institute, 44 Farnsworth Street, Boston, MA02210, USA
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Wijenayake S, Martz J, Lapp HE, Storm JA, Champagne FA, Kentner AC. The contributions of parental lactation on offspring development: It's not udder nonsense! Horm Behav 2023; 153:105375. [PMID: 37269591 PMCID: PMC10351876 DOI: 10.1016/j.yhbeh.2023.105375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 06/05/2023]
Abstract
The Developmental Origins of Health and Disease (DOHaD) hypothesis describes how maternal stress exposures experienced during critical periods of perinatal life are linked to altered developmental trajectories in offspring. Perinatal stress also induces changes in lactogenesis, milk volume, maternal care, and the nutritive and non-nutritive components of milk, affecting short and long-term developmental outcomes in offspring. For instance, selective early life stressors shape the contents of milk, including macro/micronutrients, immune components, microbiota, enzymes, hormones, milk-derived extracellular vesicles, and milk microRNAs. In this review, we highlight the contributions of parental lactation to offspring development by examining changes in the composition of breast milk in response to three well-characterized maternal stressors: nutritive stress, immune stress, and psychological stress. We discuss recent findings in human, animal, and in vitro models, their clinical relevance, study limitations, and potential therapeutic significance to improving human health and infant survival. We also discuss the benefits of enrichment methods and support tools that can be used to improve milk quality and volume as well as related developmental outcomes in offspring. Lastly, we use evidence-based primary literature to convey that even though select maternal stressors may modulate lactation biology (by influencing milk composition) depending on the severity and length of exposure, exclusive and/or prolonged milk feeding may attenuate the negative in utero effects of early life stressors and promote healthy developmental trajectories. Overall, scientific evidence supports lactation to be protective against nutritive and immune stressors, but the benefits of lactation in response to psychological stressors need further investigation.
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Affiliation(s)
- Sanoji Wijenayake
- Department of Biology, The University of Winnipeg, Winnipeg, Manitoba, Canada.
| | - Julia Martz
- School of Arts & Sciences, Health Psychology Program, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| | - Hannah E Lapp
- Deparment of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Jasmyne A Storm
- Department of Biology, The University of Winnipeg, Winnipeg, Manitoba, Canada
| | | | - Amanda C Kentner
- School of Arts & Sciences, Health Psychology Program, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA.
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Sebai I, Decelles S, Batal M. Determinants of dietary diversity among children 6-23 months: a cross-sectional study in three regions of Haiti. J Hum Nutr Diet 2022; 36:833-847. [PMID: 36514214 DOI: 10.1111/jhn.13128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The prenatal, perinatal, postnatal and nutritional (A3PN) support study was a 4-year initiative aimed to reduce maternal mortality in Haiti. A cross-sectional study was developed to collect the baseline data for evaluation purposes of the A3PN. This study aimed to determine the factors contributing to dietary diversity (DD) in Haitian children aged 6-23 months. METHODS A cross-sectional study during two seasons (the lean season and the harvest season) was carried out in Haiti to assess the DD of children and their mothers using non-quantitative 24-h recalls. Indicators of DD were minimum dietary diversity for children (MDD-C) and minimum dietary diversity for women (MDD-W). Mid-upper arm circumference was measured in women and children, and food security was assessed using the Household Hunger Scale. Focus groups were also conducted to gain a better understanding of the quantitative findings. RESULTS Only 7.3% of the children included in this study met the MDD-C. Factors associated with MDD-C were the season (odds ratio [OR]: 0.141 [0.039-0.513]), land ownership or rental (OR: 4.603 [1.233-17.188]), maternal education (OR: 0.092 [0.011-0.749]), the mother's responsibility for the main or secondary source of income for the household (OR: 2.883 [1.030-8.069]) and her DD (OR: 5.690 [1.916-16.892]). Focus groups revealed the existence of various food restrictions. CONCLUSIONS The results indicated that the low prevalence of MDD-C in three regions of study in Haiti is indicative of a serious public health concern that might be further aggravated by local food taboos. They also suggest that to fight against hunger, it is necessary to focus on women's well-being.
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Affiliation(s)
- Ines Sebai
- Canada Research Chair in Nutrition and Health Inequalities (CIENS), Ottawa, Ontario, Canada.,TRANSNUT, Département de nutrition, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada.,Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
| | - Stéphane Decelles
- Canada Research Chair in Nutrition and Health Inequalities (CIENS), Ottawa, Ontario, Canada.,TRANSNUT, Département de nutrition, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Malek Batal
- Canada Research Chair in Nutrition and Health Inequalities (CIENS), Ottawa, Ontario, Canada.,TRANSNUT, Département de nutrition, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada.,Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
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Roy SK, Jahan K, Khatoon S, Alam N, Tasnim S, Parveen S, Ferdaus A, Cubra K. Effectiveness of home-based "egg-suji" diet in management of severe acute malnutrition of Rohingya refugee children. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2022; 41:53. [PMID: 36434664 PMCID: PMC9700960 DOI: 10.1186/s41043-022-00321-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 08/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prevalence of severe acute malnutrition (SAM) among Rohingya children aged 6-59 months who took shelter in refugee camp in Cox's Bazar District, Bangladesh, was found to be 7.5%. OBJECTIVE To measure the effectiveness of homemade diet in the management of severe acute malnutrition of Rohingya refugee children. METHODS In total, 645 SAM children (MUAC < 11.5 cm) aged 6-59 months were selected and fed the homemade diet for 3 months by their caregivers and followed up for next 2 months. Nutrition counseling, demonstration of food preparation and the ingredients of food (rice powder, egg, sugar and oil) were provided to the families for 3 months to cook "egg-suji" diet to feed the children. RESULTS The study children were assessed for nutritional status. After intervention, energy intake from diet increased from 455.29 ± 120.9 kcal/day to 609.61 ± 29.5 kcal/day (P = 0.001) in 3 months. Frequency of daily food intake improved from 4.89 ± 1.02 to 5.94 ± 0.26 (P = 0.001). The body weight of children increased from 6.3 ± 1.04 kg to 9.93 ± 1.35 kg (P = 0.001), height increased from 67.93 ± 6.18 cm to 73.86 ± 0.35 (P = 0.001) cm, and MUAC improved from 11.14 ± 1.35 cm to 12.89 ± 0.37 cm (P = 0.001). HAZ improved from - 3.64 ± 1.35 to - 2.82 ± 1.40 (P = 0.001), WHZ improved from - 2.45 ± 1.23 to 1.03 ± 1.17 (P = 0.001), WAZ improved from - 3.8 ± 0.61 to - 0.69 ± 0.78, and MUACZ improved from - 3.32 ± 0.49 to 1.8 ± 0.54 (P = 0.001) from the beginning to the end of observation. Morbidity was found in 5.12% children in the first month which reduced to 0.15% at the end of follow-up. CONCLUSIONS Nutritional counseling and supply of food ingredients at refugee camps resulted in complete recovery from severe malnutrition for all children which was sustainable.
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Affiliation(s)
- S. K. Roy
- Bangladesh Breastfeeding Foundation (BBF), Institute of Public Health (IPH), Room #195-201, Mohakhali, Dhaka, 1212 Bangladesh
| | - Khurshid Jahan
- Bangladesh Breastfeeding Foundation (BBF), Institute of Public Health (IPH), Room #195-201, Mohakhali, Dhaka, 1212 Bangladesh
| | - Soofia Khatoon
- Bangladesh Breastfeeding Foundation (BBF), Institute of Public Health (IPH), Room #195-201, Mohakhali, Dhaka, 1212 Bangladesh
| | - Nurul Alam
- grid.414142.60000 0004 0600 7174The International Centre for Diarrheal Disease Research, Bangladesh (icddr’b), Mohakhali, Dhaka, Bangladesh
| | - Saria Tasnim
- Bangladesh Breastfeeding Foundation (BBF), Institute of Public Health (IPH), Room #195-201, Mohakhali, Dhaka, 1212 Bangladesh
| | | | - Ambrina Ferdaus
- Bangladesh Breastfeeding Foundation (BBF), Institute of Public Health (IPH), Room #195-201, Mohakhali, Dhaka, 1212 Bangladesh
| | - Khadijatul Cubra
- Bangladesh Breastfeeding Foundation (BBF), Institute of Public Health (IPH), Room #195-201, Mohakhali, Dhaka, 1212 Bangladesh
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Simultaneous analysis of feeding practice indicators during childhood diarrhea in Malawi. SCIENTIFIC AFRICAN 2022. [DOI: 10.1016/j.sciaf.2022.e01391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nguyen NT, Do HT, Pham NTV. Barriers to exclusive breastfeeding: A cross-sectional study among mothers in Ho Chi Minh City, Vietnam. BELITUNG NURSING JOURNAL 2021; 7:171-178. [PMID: 37469344 PMCID: PMC10353628 DOI: 10.33546/bnj.1382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/23/2021] [Accepted: 05/03/2021] [Indexed: 07/21/2023] Open
Abstract
Background Exclusive breastfeeding provides numerous benefits to the health of infants, mothers, economics, and the environment. However, during the exclusive breastfeeding period, the mothers face many barriers. Objective This study aimed to describe the perceived barrier of breastfeeding and compare its differences among mothers in Vietnam according to demographic and individual characteristics. Methods A cross-sectional study was conducted among 246 women in Ho Chi Minh City, Vietnam. Data were derived from the original survey using a self-administered questionnaire asking about the barriers of breastfeeding in three aspects: maternal, infant, and socio-environment. Descriptive statistics, Independent t-test, and ANOVA were used to describe the mothers' characteristics and the breastfeeding barriers. Results The barrier from the infants was the most noticeable, followed by socio-environment and maternal barriers, respectively. Breastfeeding in public places (M = 2.93, SD = 0.92), baby's illness (M = 2.74, SD = 0.99), and insufficient milk supply (M = 2.70, SD =0.99) were considered as major barriers to six-month exclusive breastfeeding among mothers in Ho Chi Minh City, Vietnam. Among the age groups, mothers who were more than 35 years old perceived had lower breastfeeding barriers than the younger mothers (F = 3.67, p = 0.03). Conclusion The investigation of the barriers against exclusive breastfeeding practice can help nurses and midwives develop breastfeeding promotion programs to promote exclusive breastfeeding rate for women in Vietnam.
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Affiliation(s)
- Nhan Thi Nguyen
- Faculty of Nursing and Medical Technology, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Huong Thi Do
- Faculty of Nursing and Medical Technology, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Nhu Thi Van Pham
- Faculty of Nursing and Medical Technology, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
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Woldetensay YK, Belachew T, Ghosh S, Kantelhardt EJ, Biesalski HK, Scherbaum V. The effect of maternal depressive symptoms on infant feeding practices in rural Ethiopia: community based birth cohort study. Int Breastfeed J 2021; 16:27. [PMID: 33743775 PMCID: PMC7980325 DOI: 10.1186/s13006-021-00375-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/12/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Maternal depression and other psychosocial factors have been shown to have adverse consequences on infant feeding practices. This study explored the longitudinal relationship of maternal depressive symptoms and other selected psychosocial factors with infant feeding practices (IFPs) in rural Ethiopia using summary IFP index. METHODS This study uses existing data from the ENGINE birth cohort study, conducted from March 2014 to March 2016 in three districts in the southwest of Ethiopia. A total of 4680 pregnant women were recruited and data were collected once during pregnancy (twice for those in the first trimester), at birth, and then every 3 months until the child was 12 months old. A standardized questionnaire was used to collect data on IFPs, maternal depressive symptoms, household food insecurity, intimate partner violence (IPV), maternal social support, active social participation, and other sociodemographic variables. A composite measure of IFP index was computed using 14 WHO recommended infant and young child feeding (IYCF) practice indicators. High IFP index indicated best practice. Prenatal and postnatal maternal depressive symptoms were assessed using the patient health questionnaire (PHQ-9). Linear multilevel mixed effects model was fitted to assess longitudinal relationship of IFPs with maternal depression and other psychosocial factors. RESULTS Reports of higher postnatal depressive symptoms (ß = - 1.03, P = 0.001) and IPV (ß = - 0.21, P = 0.001) were associated with lower scores on the IFP index. Whereas, reports of better maternal social support (ß = 0.11, P = 0.002) and active social participation (ß = 0.55, P < 0.001) were associated with higher scores on the IFP index. Contrary to expectations, moderate household food insecurity (ß = 0.84, P = 0.003), severe household food insecurity (ß = 1.03, P = 0.01) and infant morbidity episodes (ß = 0.63, P = 0.013) were associated with higher scores on the IFP index. CONCLUSIONS Overall, a multitude of factors are related to IFPs and hence coordinated, multi-sectoral and multi-stakeholder interventions including maternal depressive symptoms screening and management are needed to improve infant feeding practices.
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Affiliation(s)
- Yitbarek Kidane Woldetensay
- Institute of Nutrition Science (140a), University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Tefera Belachew
- Department of Population and Family Health, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Shibani Ghosh
- Tufts University, Friedman School of Nutrition Science and Policy, Boston, USA
| | - Eva Johanna Kantelhardt
- Department of Gynecology, Faculty of Medicine, Martin-Luther University, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther University, Halle, Germany
| | - Hans Konrad Biesalski
- Institute of Nutrition Science (140a), University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutrition Science (140a), University of Hohenheim, Stuttgart, Germany
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Ngwira A, Chamera F, Soko MM. Estimating the national and regional prevalence of drinking or eating more than usual during childhood diarrhea in Malawi using the bivariate sample selection copula regression. PeerJ 2021; 9:e10917. [PMID: 33717686 PMCID: PMC7931711 DOI: 10.7717/peerj.10917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background Estimation of prevalence of feeding practices during diarrhea using conventional imputation methods may be biased as these methods apply to observed factors and in this study, feeding practice status was unobserved for those without diarrhea. The study aimed at re-estimating the prevalence of feeding practices using the bivariate sample selection model. Methods The study used 2015–2016 Malawi demographic health survey (MDHS) data which had 16,246 children records who had diarrhea or not. A bivariate Joe copula regression model with 90 degrees rotation was fitted to either drinking or eating more, with diarrhea as a sample selection outcome in the bivariate models. The prevalence of drinking more than usual and prevalence of eating more than usual were then estimated based on the fitted bivariate model. These prevalences were then compared to the prevalences estimated using the conventional imputation method. Results There was a substantial increase in the re-estimated national prevalence of drinking more fluids (40.0%, 95% CI [31.7–50.5]) or prevalence of eating more food (20.46%, 95% CI [9.87–38.55]) using the bivariate model as compared to the prevalences estimated by the conventional imputation method, that is, (28.9%, 95% CI [27.0–30.7]) and (13.1%, 95% CI [12.0–15.0]) respectively. The maps of the regional prevalences showed similar results where the prevalences estimated by the bivariate model were relatively higher than those estimated by the standard imputation method. The presence of diarrhea was somehow weakly negatively correlated with either drinking more fluids or eating more food. Conclusion The estimation of prevalence of drinking more fluids or eating more food during diarrhea should use bivariate modelling to model sample selection variable so as to minimize bias. The observed negative correlation between diarrhea presence and feeding practices implies that mothers should be encouraged to let their children drink more fluids or eat more food during diarrhea episode to avoid dehydration and malnutrition.
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Affiliation(s)
- Alfred Ngwira
- Basic Sciences Department, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
| | - Francisco Chamera
- Basic Sciences Department, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
| | - Matrina Mpeketula Soko
- Basic Sciences Department, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
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Lutter CK, Grummer-Strawn L, Rogers L. Complementary feeding of infants and young children 6 to 23 months of age. Nutr Rev 2021; 79:825-846. [PMID: 33684940 DOI: 10.1093/nutrit/nuaa143] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Complementary feeding, when foods are introduced to complement a milk-based diet, generally occurs between 6 and 23 months of age. It is a critical period for both physical and cognitive development. During this period, the growth rate of the brain is one of the fastest during the life span and, consequently, the timing, dose, and duration of exposure to specific nutrients can result in both positive and negative effects. Complementary feeding is more than ensuring an adequate intake of nutrients; it also is about avoiding excess intakes of calories, salt, sugars, and unhealthy fats. Meals are cultural and social events where young children observe, imitate, learn about foods to like or dislike, and form lifelong eating habits and practices. Meals are also when a child learns to touch foods and connect food tastes to how foods look and feel. Ideally, complementary feeding is responsive and promotes child autonomy, but it can also be used to manage behavior problems or overly indulge a child, resulting in long-term consequences for nutrition and health. Therefore, in addition to what a child is fed, attention to how a child is fed is also important. In this review, 12 topics relevant for updating global guidance on complementary feeding were identified: age of introduction of complementary foods; continued breastfeeding; responsive feeding; safe preparation and storage of complementary foods; food textures, flavors, and acceptance; energy and meal and snack frequency; fats, protein, and carbohydrates; dietary diversity; milks other than breast milk; fluid needs; unhealthy foods and beverages; and use of vitamin and mineral supplements or supplementary foods.
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Affiliation(s)
- Chessa K Lutter
- Division of Food Security and Agriculture, RTI International, Washington, DC, USA
| | | | - Lisa Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
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12
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Tsehay CT, Aschalew AY, Dellie E, Gebremedhin T. Feeding Practices and Associated Factors During Diarrheal Disease Among Children Aged Less Than Five Years: Evidence from the Ethiopian Demographic and Health Survey 2016. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:69-78. [PMID: 33633479 PMCID: PMC7901551 DOI: 10.2147/phmt.s289442] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/09/2021] [Indexed: 11/23/2022]
Abstract
Purpose Diarrhea is a common childhood illness and one of the leading causes of death in young children globally. In Ethiopia, a significant number of deaths and hospitalizations in under-five children are related to diarrheal diseases. Inappropriate feeding during diarrhea leads to a double burden of diarrhea recurrence and malnutrition among children. However, empirical evidence is limited in Ethiopia. Thus, this study was aimed to assess feeding practices and associated factors during diarrheal disease among children aged less than five years in Ethiopia. Patients and Methods The study used the Ethiopian Demographic and Health Survey (EDHS) 2016 data. A two-stage stratified sampling technique was applied to identify 917 under five years children. Generalized linear mixed model analyses were computed, and a P value of less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) were used to identify statistically significant factors with feeding practices. Results The majority (92.5%) of mothers were married. Out of the participants, (54.1%) of children were male; 55.6% of them were in the age group of 6–23 months. The appropriate feeding practices for children aged less than five years who had diarrhea was 15.4% (95% CI: 13.7%-18.2%). Mothers aged 25–34 years (AOR: 0.6, 95% CI: 0.4–0.9), agricultural occupation of mothers (AOR: 2.2, 95% CI: 1.3–3.6), mothers attended four and more antenatal visit (AOR: 2.3, 95% CI: 1.3–4.32) and mothers who had a postnatal checkup within two months of birth (AOR: 1.9, 95% CI: 1.1–3.2) were factors statistically associated with child feeding practices during diarrhea. Conclusion Less than one-fifth of under-five children practiced appropriate feeding during diarrheal disease. Working in agriculture and attending antenatal care and postnatal checkup within two months were positively influencing feeding practice. Therefore, the government of Ethiopia needs to strengthen the existing maternal and child health services.
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Affiliation(s)
- Chalie Tadie Tsehay
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Andualem Yalew Aschalew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Endalkachew Dellie
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsegaye Gebremedhin
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Faerber EC, Stein AD, Webb Girard A. Portion size and consistency as indicators of complementary food energy intake. MATERNAL AND CHILD NUTRITION 2021; 17:e13121. [PMID: 33533154 PMCID: PMC7988842 DOI: 10.1111/mcn.13121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/14/2020] [Accepted: 11/19/2020] [Indexed: 01/03/2023]
Abstract
We evaluated whether novel portion size and consistency indicators can identify children with low complementary food energy intake in southern Ethiopia. We conducted 24-h dietary recalls with caregivers of 548 children aged 6-13 months; additionally, caregivers estimated their child's usual portion size using uncooked rice and selected which of five photographs of porridges of varying consistencies most closely matched the food their child usually ate. Complementary food energy and density from the 24-h recall were used as reference values. We computed correlation coefficients and areas under receiver operating characteristic curves (AUC) and conducted sensitivity and specificity analyses to classify children with low complementary food energy intake. The median complementary food energy intakes for children 6-8, 9-11 and 12-13 months were 312, 322 and 375 kcal; median estimated portion sizes were 50, 58 and 64 ml, respectively. Estimated portion size correlated with total complementary food energy intake and with average energy and quantity consumed per feeding (r = 0.42, 0.46 and 0.45, respectively, all p < 0.001). Reported food consistency was weakly correlated with total complementary food energy intake (r = 0.18) and density (r = 0.10), and energy density of porridge only (r = 0.24, all p < 0.05). Predicted energy intake combining feeding frequency and portion size predicted inadequate energy intake better than did feeding frequency alone in infants 6-8 months [∆AUC = 0.16, 95% confidence interval (CI) 0.04, 0.28] and 9-11 months (∆AUC = 0.09, 95% CI 0.04, 0.14). Caregiver estimates of portion size can improve identification of infants with low complementary food energy intake when more robust dietary assessment is not feasible.
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Affiliation(s)
- Emily C Faerber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Amy Webb Girard
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Roth MC, Humphreys KL, King LS, Gotlib IH, Robakis TK. Breastfeeding Difficulties Predict Mothers’ Bonding with Their Infants from Birth to Age Six Months. Matern Child Health J 2021; 25:777-785. [DOI: 10.1007/s10995-020-03036-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
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15
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Ngwalangwa F, Chirambo CM, Lindsjö C, Dube Q, Langton J, Baker T, Hildenwall H. Feeding practices and association of fasting and low or hypo glycaemia in severe paediatric illnesses in Malawi - a mixed method study. BMC Pediatr 2020; 20:423. [PMID: 32887575 PMCID: PMC7472578 DOI: 10.1186/s12887-020-02305-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The presence of low or hypo glycaemia in children upon admission to hospital in low income countries is a marker for poor outcome. Fasting during illness may contribute to low blood glucose and caretakers' feeding practices during childhood illnesses may thus play a role in the development of low or hypo glycaemia. This study aims to describe the caretaker's feeding practices and association of fasting with low or hypo glycaemia in sick children in Malawi. METHODS A mixed method approach was used combining quantitative cross-sectional data for children aged 0-17 years admitted to Queen Elizabeth Central Hospital (QECH), a tertiary hospital in Malawi, with qualitative focus group discussions conducted with caretakers of young children who were previously referred to QECH from the five health centres around QECH. Logistic regression was used to analyse the quantitative data and thematic content analysis was conducted for qualitative data analysis. RESULTS Data for 5131 children who were admitted through the hospital's Paediatric Accident and Emergency Department (A&E) were analysed whereof 2.1% presented with hypoglycaemia (< 2.5 mmol/l) and 6.6% with low glycaemia (≥2.5mmoll/l - < 5 mmol/l). Fasting for more than eight hours was associated with low glycaemia as well as hypoglycaemia with Adjusted Odds Ratios (AOR) of 2.9 (95% Confidence Interval (CI) of 2.3-3.7) and 4.6, (95% CI 3.0-7.0), respectively. Caretakers demonstrated awareness of the importance of feeding during childhood illness and reported intensified feeding attention to sick children but face feeding challenges when illness becomes severe causing them to seek care at a health facility. CONCLUSION Results suggests that caretakers understand the importance of feeding during illness and make efforts to intensify feeding a sick child but challenges occur when illness is severe leading to fasting. Fasting among children admitted to hospitals may serve as a marker of severe illness and determine those at risk of low and hypoglycaemia.
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Affiliation(s)
- Fatsani Ngwalangwa
- Department of Paediatrics, College of Medicine, University of Malawi, P/Bag 360, Blantyre, Malawi.
| | | | - Cecilia Lindsjö
- Department of Care Science, Malmö University, 205 06, Malmö, Sweden
| | - Queen Dube
- Department of Paediatrics, Queen Elizabeth Central Hospital, P.O Box 95, Blantyre, Malawi
| | - Josephine Langton
- Department of Paediatrics, College of Medicine, University of Malawi, P/Bag 360, Blantyre, Malawi
| | - Tim Baker
- Department of Paediatrics, College of Medicine, University of Malawi, P/Bag 360, Blantyre, Malawi.,Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Helena Hildenwall
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 52, Huddinge, Sweden
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16
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Ngwalangwa F, Phiri CHA, Dube Q, Langton J, Hildenwall H, Baker T. Risk Factors for Mortality in Severely Ill Children Admitted to a Tertiary Referral Hospital in Malawi. Am J Trop Med Hyg 2020; 101:670-675. [PMID: 31287044 PMCID: PMC6726928 DOI: 10.4269/ajtmh.19-0127] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In low-resource settings, many children are severely ill at arrival to hospital. The risk factors for mortality among such ill children are not well-known. Understanding which of these patients are at the highest risk could assist in the allocation of limited resources to where they are most needed. A cohort study of severely ill children treated in the resuscitation room of the pediatric emergency department at Queen Elizabeth Central Hospital in Malawi was conducted over a 6-month period in 2017. Data on signs and symptoms, vital signs, blood glucose levels, and nutritional status were collected and linked with in-hospital mortality data. The factors associated with in-hospital mortality were analyzed using multivariable logistic regression. Data for 1,359 patients were analyzed and 118 (8.7%) patients died. The following factors were associated with mortality: presence of any severely deranged vital sign, unadjusted odds ratio (UOR) 2.6 (95% CI 1.7–4.0) and adjusted odds ratio (AOR) 3.2 (95% CI 2.0–5.0); severe dehydration, UOR 2.6 (1.4–5.1) and AOR 2.8 (1.3–6.0); hypoglycemia glycemia (< 5 mmol/L), UOR 3.6 (2.2–5.8) and AOR 2.7 (1.6–4.7); and severe acute malnutrition, UOR 5.8 (3.5–9.6) and AOR 5.7 (3.3–10.0). This study suggests that among severely sick children, increased attention should be given to those with hypo/low glycemia, deranged vital signs, malnutrition, and severe dehydration to avert mortality among these high-risk patients.
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Affiliation(s)
- Fatsani Ngwalangwa
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Queen Dube
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Josephine Langton
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Helena Hildenwall
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Global Health-Health System and Policy Research Group, Stockholm, Sweden
| | - Tim Baker
- Department of Public Health Sciences, Karolinska Institutet, Global Health-Health System and Policy Research Group, Stockholm, Sweden.,Queen Elizabeth Central Hospital, Blantyre, Malawi.,Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
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17
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Torlesse H, Aguayo VM. Aiming higher for maternal and child nutrition in South Asia. MATERNAL AND CHILD NUTRITION 2019; 14 Suppl 4:e12739. [PMID: 30499249 PMCID: PMC6588023 DOI: 10.1111/mcn.12739] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 12/31/2022]
Abstract
The sustainable development of nations relies on children developing to their full potential and leading healthy, productive, and prosperous lives. Poor nutrition in early life threatens the growth and development of children, especially so in South Asia, which has the highest burdens of stunting, wasting, and anaemia in the world. Targeted actions to reduce stunting and other forms of child malnutrition in South Asia should be informed by an understanding of what drives poor nutrition in children, who is most affected, and effective programme approaches. To this end, the UNICEF Regional Office for South Asia commissioned a series of papers in 2016–2017 to fill knowledge gaps in the current body of evidence on maternal and child nutrition in South Asia, including analyses of: (a) the links between anthropometric failure in children and child development; (b) the time trends, current distribution, disparities and inequities of child stunting, wasting and anaemia, and their direct and underlying causes, including maternal anaemia, low birth weight, breastfeeding, and complementary feeding; (c) policy and programme actions to increase the coverage of nutrition interventions during pregnancy, improve breastfeeding practices, and care for severely wasted children. This overview paper summarizes the evidence from these analyses and examines the implications for the direction of future advocacy, policy, and programme actions to improve maternal and child nutrition in South Asia.
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Affiliation(s)
- Harriet Torlesse
- Nutrition Section, UNICEF Regional Office for South Asia, Kathmandu, Nepal
| | - Víctor M Aguayo
- Nutrition Section, Programme Division, UNICEF, New York, New York
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18
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Krasevec J, An X, Kumapley R, Bégin F, Frongillo EA. Diet quality and risk of stunting among infants and young children in low- and middle-income countries. MATERNAL AND CHILD NUTRITION 2018; 13 Suppl 2. [PMID: 29032628 DOI: 10.1111/mcn.12430] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 11/28/2016] [Accepted: 12/05/2016] [Indexed: 01/23/2023]
Abstract
Age-appropriate complementary feeding practices are far from optimal among low- and middle-income countries with available data. The evidence on the association between feeding practices and linear growth is mixed. We sought to systematically examine the association between two indictors of dietary quality-dietary diversity and animal source food (ASF) consumption (WHO, 2008)-and stunting (length-for-age z-score) employing existing data from 39 Demographic and Health Surveys. Data on 74,548 children aged 6-23 months were pooled and multiple logistic regression models, adjusting for child, maternal, and household characteristics, employed to assess the association between dietary quality and stunting. Stratified models by child age and by World Bank country-income classifications (World Bank, 2015) were also applied. Children aged 6-23 months consuming zero food groups in the previous day had a 1.345 higher odds of being stunted when compared to the reference group (≥5 food groups); those who did not consume any ASF in the previous day had a 1.436 higher odds of being stunted compared to children consuming all three types of ASF (egg, meat, and dairy). We estimated that 2,629 cases of stunting would have been averted (12.6% of those stunted) among the population studied if all children had consumed five or more food groups. Outcomes by country-income groupings showed larger associations of diet diversity and ASF consumption for upper- and lower-middle income countries compared to low-income countries. In summary, dietary diversity and ASF consumption were associated with stunting, with associations varying by stratified groups.
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Affiliation(s)
- Julia Krasevec
- Data and Analytics Section, Division of Data, Research and Policy, UNICEF, New York, New York, USA
| | - Xiaoyi An
- Data and Analytics Section, Division of Data, Research and Policy, UNICEF, New York, New York, USA
| | - Richard Kumapley
- Data and Analytics Section, Division of Data, Research and Policy, UNICEF, New York, New York, USA
| | - France Bégin
- Nutrition Section, Programme Division, UNICEF, New York, New York, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
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19
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Lin YT, Kalhan AC, Lin YTJ, Kalhan TA, Chou CC, Gao XL, Hsu CYS. Risk assessment models to predict caries recurrence after oral rehabilitation under general anaesthesia: a pilot study. Int Dent J 2018; 68:378-385. [PMID: 29740814 DOI: 10.1111/idj.12396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Oral rehabilitation under general anaesthesia (GA), commonly employed to treat high caries-risk children, has been associated with high economic and individual/family burden, besides high post-GA caries recurrence rates. As there is no caries prediction model available for paediatric GA patients, this study was performed to build caries risk assessment/prediction models using pre-GA data and to explore mid-term prognostic factors for early identification of high-risk children prone to caries relapse post-GA oral rehabilitation. METHODS Ninety-two children were identified and recruited with parental consent before oral rehabilitation under GA. Biopsychosocial data collection at baseline and the 6-month follow-up were conducted using questionnaire (Q), microbiological assessment (M) and clinical examination (C). RESULTS The prediction models constructed using data collected from Q, Q + M and Q + M + C demonstrated an accuracy of 72%, 78% and 82%, respectively. Furthermore, of the 83 (90.2%) patients recalled 6 months after GA intervention, recurrent caries was identified in 54.2%, together with reduced bacterial counts, lower plaque index and increased percentage of children toothbrushing for themselves (all P < 0.05). Additionally, meal-time and toothbrushing duration were shown, through bivariate analyses, to be significant prognostic determinants for caries recurrence (both P < 0.05). CONCLUSIONS Risk assessment/prediction models built using pre-GA data may be promising in identifying high-risk children prone to post-GA caries recurrence, although future internal and external validation of predictive models is warranted.
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Affiliation(s)
- Yai-Tin Lin
- Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | | | | | - Tosha Ashish Kalhan
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | | | - Xiao Li Gao
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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20
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Campisi SC, Cherian AM, Bhutta ZA. World Perspective on the Epidemiology of Stunting between 1990 and 2015
. Horm Res Paediatr 2018; 88:70-78. [PMID: 28285312 DOI: 10.1159/000462972] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/09/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Stunting is the most prevalent form of child undernutrition with current worldwide estimates at 156 million. The majority of these children reside in low- and middle-income countries. When stunting prevails to adulthood, optimal growth potential and economic productivity are minimized. RESULTS In 2015 there were 98.5 million fewer stunted children under 5 years of age than in 1990. In East Asia and Pacific and South Asia, the stunting prevalence decreased by 24.8 and 25%, respectively. Minimal declines were observed in Latin America and the Caribbean at 12.6%, in the Middle East and North Africa at 12.9%, and in sub-Saharan Africa at 13.4%. But because large populations of children under 5 years of age are distributed disproportionately, decreases in prevalence do not translate to fewer numbers of stunted children globally. In sub-Saharan Africa, the number of stunted children increased by 12.4 million between 1990 and 2015. CONCLUSIONS Adult height is dependent on nutrition-specific or nutrition-sensitive factors. Nutrition-specific factors can be targeted according to their impact at critical points of development and therefore offer multiple windows of opportunity for interventions. To date, many interventions focus on the first 1,000 days, but opportunities may extend into later childhood and adolescence.
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Affiliation(s)
- Susan C Campisi
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Arlin Mary Cherian
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,School of Dietetics and Human Nutrition, McGill University, Montreal, Québec, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
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21
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Nabwera HM, Moore SE, Mwangome MK, Molyneux SC, Darboe MK, Camara-Trawally N, Sonko B, Darboe A, Singhateh S, Fulford AJ, Prentice AM. The influence of maternal psychosocial circumstances and physical environment on the risk of severe wasting in rural Gambian infants: a mixed methods approach. BMC Public Health 2018; 18:109. [PMID: 29304780 PMCID: PMC5756408 DOI: 10.1186/s12889-017-4984-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 12/07/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Severe wasting affects 16 million under 5's and carries an immediate risk of death. Prevalence remains unacceptably high in sub-Saharan Africa and early infancy is a high-risk period. We aimed to explore risk factors for severe wasting in rural Gambian infants. METHODS We undertook a case-control study from November 2014 to June 2015, in rural Gambia. Cases had WHO standard weight-for-length z-scores (WLZ) < -3 on at least 1 occasion in infancy. Controls with a WLZ > -3 in the same interval, matched on age, gender, village size and distance from the clinic were selected. Standard questionnaires were used to assess maternal socioeconomic status, water sanitation and hygiene and maternal mental health. Conditional logistic regression using a multivariable model was used to determine the risk factors for severe wasting. Qualitative in depth interviews were conducted with mothers and fathers who were purposively sampled. A thematic framework was used to analyse the in-depth interviews. RESULTS Two hundred and eighty (77 cases and 203 controls) children were recruited. In-depth interviews were conducted with 16 mothers, 3 fathers and 4 research staff members. The mean age of introduction of complementary feeds was similar between cases and controls (5.2 [SD 1.2] vs 5.1 [SD 1.3] months). Increased odds of severe wasting were associated with increased frequency of complementary feeds (range 1-8) [adjusted OR 2.06 (95%: 1.17-3.62), p = 0.01]. Maternal adherence to the recommended infant care practices was influenced by her social support networks, most importantly her husband, by infant feeding difficulties and maternal psychosocial stressors that include death of a child or spouse, recurrent ill health of child and lack of autonomy in child spacing. CONCLUSION In rural Gambia, inappropriate infant feeding practices were associated with severe wasting in infants. Additionally, adverse psychosocial circumstances and infant feeding difficulties constrain mothers from practising the recommended child care practices. Interventions that promote maternal resilience through gender empowerment, prioritising maternal psychosocial support and encouraging the involvement of fathers in infant and child care promotion strategies, would help prevent severe wasting in these infants.
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Affiliation(s)
- Helen M Nabwera
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia. .,Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel street, London, WC1E 7HT, UK.
| | - Sophie E Moore
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia.,Division of Women's Health, King's College London, 10th floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Martha K Mwangome
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O.Box 230-80108, Kilifi, Kenya
| | - Sassy C Molyneux
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O.Box 230-80108, Kilifi, Kenya.,University of Oxford, Nuffield Department of Medicine, Henry Wellcome Building for Molecular Physiology, Old Road Campus, Headington, Oxford, OX3 7BN, UK
| | - Momodou K Darboe
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia
| | | | - Bakary Sonko
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia
| | - Alhagie Darboe
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia
| | - Seedy Singhateh
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia
| | - Anthony J Fulford
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia.,Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel street, London, WC1E 7HT, UK
| | - Andrew M Prentice
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia.,Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel street, London, WC1E 7HT, UK
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Aguayo VM, Menon P. Stop stunting: improving child feeding, women's nutrition and household sanitation in South Asia. MATERNAL AND CHILD NUTRITION 2017; 12 Suppl 1:3-11. [PMID: 27187906 PMCID: PMC5084809 DOI: 10.1111/mcn.12283] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The latest available data indicate that 38% of South Asia's children aged 0–59 months are stunted. Such high prevalence combined with the region's large child population explain why South Asia bears about 40% of the global burden of stunting. Recent analyses indicate that the poor diets of children in the first years of life, the poor nutrition of women before and during pregnancy and the prevailing poor sanitation practices in households and communities are important drivers of stunting, most likely because of underlying conditions of women's status, food insecurity, poverty, and social inequalities. With this evidence in mind, UNICEF Regional Office for South Asia convened the Regional Conference: Stop Stunting: Improving Child Feeding, Women's Nutrition, and Household Sanitation in South Asia (New Delhi, November 10–12, 2014). The Conference provided a knowledge‐for‐action platform with three objectives: (1) share state‐of‐the‐art research findings on the causes of child stunting and its consequences for child growth and development and the sustainable growth and development of nations; (2) discuss better practices and the cost and benefits of scaling up programmes to improve child feeding, women's nutrition, and household sanitation in South Asia; and (3) identify implications for sectoral and cross‐sectoral policy, programme, advocacy and research to accelerate progress in reducing child stunting in South Asia. This overview paper summarizes the rationale for the focus on improving child feeding, women's nutrition, and household sanitation as priority areas for investment to prevent child stunting in South Asia. It builds on the invited papers presented at or developed as a follow on to the Stop Stunting Conference.
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Affiliation(s)
- Víctor M Aguayo
- Regional Nutrition Advisor for South Asia, United Nations Children's Fund (UNICEF), Regional Office for South Asia, Kathmandu, Nepal
| | - Purnima Menon
- Senior Research Fellow, International Food Policy Research Institute (IFPRI), New Delhi, India
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Naila N, Nahar B, Lazarus M, Ritter G, Hossain M, Mahfuz M, Ahmed T, Denno D, Walson J, Ickes S. "Those who care much, understand much." Maternal perceptions of children's appetite: Perspectives from urban and rural caregivers of diverse parenting experience in Bangladesh. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28730705 DOI: 10.1111/mcn.12473] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/31/2017] [Accepted: 05/05/2017] [Indexed: 01/22/2023]
Abstract
Appetite in children is an important determinant of nutritional intake and growth. The information used by caregivers to understand children's appetite can help inform infant and young child feeding promotion and appetite assessment. We conducted a qualitative study to (a) explore maternal perceptions and responses to children's appetite and (b) to identify how these factors differ by type of caregiver, level of maternal experience, and urban versus rural context. We used purposive sampling to recruit mothers and alternate caregivers into 14 total focus group discussions (six to eight participants in each group; N = 95) in both urban and rural settings in Bangladesh. To understand children's appetite, caregivers monitor children's dietary patterns, emotional signs, and physical and verbal cues. Healthy appetite was observed by willingness to eat diverse foods, finish offered portions, and by acceptance of foods without excessive prompting. Child illness was cited for a cause of low appetite, which was manifested through fussiness, and avoiding commonly consumed foods. Mothers described a limited set of feeding practices (offering diverse foods, playing, and cheering children with videos) to encourage consumption when children lacked appetite. Mothers' stress related to work was noted as a barrier to identifying appetite cues. Urban mothers described a lower access to instrumental social support for child feeding but informational support than mothers in the rural setting. Understanding caregivers' perceptions of children's appetite may inform strategies to improve responsive feeding and tool development to assess changes in appetite as early indicators of change in health or nutrition status among high-risk children.
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Affiliation(s)
- Nurun Naila
- Nutrition and Clinical Services Division, International Center for Diarrheal Diseases Research, Dhaka, Bangladesh
| | - Baitun Nahar
- Nutrition and Clinical Services Division, International Center for Diarrheal Diseases Research, Dhaka, Bangladesh
| | - Monica Lazarus
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA.,Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA, USA
| | - Gaelen Ritter
- Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA, USA
| | - Muttaquina Hossain
- Nutrition and Clinical Services Division, International Center for Diarrheal Diseases Research, Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Center for Diarrheal Diseases Research, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Center for Diarrheal Diseases Research, Dhaka, Bangladesh.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Donna Denno
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Judd Walson
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, WA, USA.,Departments of Medicine and Epidemiology, University of Washington, Seattle, WA, USA
| | - Scott Ickes
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA, USA
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24
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Ending Preventable Child Deaths from Pneumonia and Diarrhoea in Afghanistan: An Analysis of Intervention Coverage Scenarios Using the Lives Saved Tool. J Trop Med 2017; 2017:3120854. [PMID: 28298932 PMCID: PMC5337376 DOI: 10.1155/2017/3120854] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/11/2016] [Accepted: 12/19/2016] [Indexed: 11/18/2022] Open
Abstract
Background. Despite improvements in child health, Afghanistan still has a heavy burden of deaths due to preventable causes: 17% of under-5 deaths are due to pneumonia and 12% are due to diarrhoea. Objective. This article describes the situation of childhood pneumonia and diarrhoea in Afghanistan, including efforts to prevent, protect, and treat the two diseases. It estimates lives saved by scaling up interventions. Methods. A secondary analysis of data was conducted and future scenarios were modelled to estimate lives saved by scaling up a package of interventions. Results. The analysis reveals that 10,795 additional child deaths could be averted with a moderate scale-up of interventions, decreasing the under-five mortality rate in Afghanistan from 55 per 1,000 live births in 2015 to 40 per 1,000 in 2020. In an ambitious scale-up scenario, an additional 15,096 lives could be saved. There would be a 71% reduction in child deaths due to these two causes between 2016 and 2020 in the ambitious scenario compared to 47% reduction in the moderate scenario. Conclusion. Significant reductions in child mortality can be achieved through scale-up of essential interventions to prevent and treat pneumonia and diarrhoea. Strengthened primary health care functions and multisector collaboration on child health are suggested.
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25
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Gautam KP, Adhikari M, Khatri RB, Devkota MD. Determinants of infant and young child feeding practices in Rupandehi, Nepal. BMC Res Notes 2016; 9:135. [PMID: 26936368 PMCID: PMC4776375 DOI: 10.1186/s13104-016-1956-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/24/2016] [Indexed: 11/25/2022] Open
Abstract
Background Undernutrition is a major problem in Nepal and meeting the minimum dietary standard is essential for growth and development of young children. Continuous monitoring of such practices is important to inform policy and program formulation. This study aimed to assess complementary feeding practices, and associated factors in Western Nepal. Methods This was a cross-sectional study conducted in Rupandehi district of Western Nepal. Face-to-face interviews were conducted among 178 mothers of young children aged 6–23 months using a structured questionnaire and data on complementary feeding practices. These practices were reported as frequency distribution and the factors associated were ascertained using multiple logistic regression. Results Only 57 % of mothers initiated complementary feeding at the age of 6 months. While the proportion of young children receiving minimum meal frequency was reasonably high (84 %), meal diversity (35 %) and minimum acceptable diet (33 %) remained low. Maternal education and having had their children’s growth monitored were independently associated with receiving minimum acceptable diet. Conclusion Few infants and young children received the recommended infant and young children feeding practices. Implementing health promotion programs that educate and enhance the skills of mothers should be a priority for future nutrition interventions.
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Affiliation(s)
| | | | | | - Madhu Dixit Devkota
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
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26
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Paintal K, Aguayo VM. Feeding practices for infants and young children during and after common illness. Evidence from South Asia. MATERNAL AND CHILD NUTRITION 2016; 12 Suppl 1:39-71. [PMID: 26840205 PMCID: PMC5067777 DOI: 10.1111/mcn.12222] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/20/2015] [Accepted: 08/20/2015] [Indexed: 01/21/2023]
Abstract
Global evidence shows that children's growth deteriorates rapidly during/after illness if foods and feeding practices do not meet the additional nutrient requirements associated with illness/convalescence. To inform policies and programmes, we conducted a review of the literature published from 1990 to 2014 to document how children 0–23 months old are fed during/after common childhood illnesses. The review indicates that infant and young child feeding (IYCF) during common childhood illnesses is far from optimal. When sick, most children continue to be breastfed, but few are breastfed more frequently, as recommended. Restriction/withdrawal of complementary foods during illness is frequent because of children's anorexia (perceived/real), poor awareness of caregivers' about the feeding needs of sick children, traditional beliefs/behaviours and/or suboptimal counselling and support by health workers. As a result, many children are fed lower quantities of complementary foods and/or are fed less frequently when they are sick. Mothers/caregivers often turn to family/community elders and traditional/non‐qualified practitioners to seek advice on how to feed their sick children. Thus, traditional beliefs and behaviours guide the use of ‘special’ feeding practices, foods and diets for sick children. A significant proportion of mothers/caregivers turn to the primary health care system for support but receive little or no advice. Building the knowledge, skills and capacity of community health workers and primary health care practitioners to provide mothers/caregivers with accurate and timely information, counselling and support on IYCF during and after common childhood illnesses, combined with large‐scale communication programmes to address traditional beliefs and norms that may be harmful, is an urgent priority to reduce the high burden of child stunting in South Asia.
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Affiliation(s)
- Kajali Paintal
- Regional Office for South Asia, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Víctor M Aguayo
- Regional Office for South Asia, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
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