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Amat Camacho N, Husain F, Bahya-Batinda D, Aung E, Chara A, Tanko M, Ogundipe OF, Barbagallo M, Aung KH, von Schreeb J, Della Corte F, Kolokotroni O, Sunyoto T. Characteristics and treatment outcomes of malnutrition among infants aged less than 6 months in North-East Nigeria (2019-2022). MATERNAL & CHILD NUTRITION 2024:e13676. [PMID: 38837325 DOI: 10.1111/mcn.13676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/04/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024]
Abstract
Recommendations for the management of malnutrition among infants aged less than 6 months (<6 m) are based on limited evidence. This study aimed to describe the characteristics, treatment outcomes and outcome-associated factors among malnourished infants <6 m admitted at Médecins Sans Frontières (MSF) inpatient and ambulatory therapeutic feeding centres (ITFC and ATFC) in North-East Nigeria, 2019-2022. We conducted a descriptive analysis of the cohorts and logistic regression to measure the association between two selected outcomes-inpatient mortality and defaulting from the ambulatory programme-and possible factors associated. In total, 940 infants <6 m were admitted at ITFC. Most of them presented severe acute malnutrition and comorbidities, with diarrhoea being the most frequent. On discharge, 13.3% (n = 125) of infants were cured, 72.9% (n = 684) stabilized (referred to ATFC), 6.5% (n = 61) left against medical advice and 4.2% (n = 39) died. The median length of hospital stay was 10 days [IQR 7-14]. A hospital stay shorter than 10 days was significantly associated with inpatient mortality (aOR = 12.51, 95% confidence interval [CI] = 3.72-42.11, p ≤ 0.01). Among 561 infants followed up at the ATFC, only 2.8% reported comorbidities. On discharge, 80.9% (n = 429) were cured, 16.2% (n = 86) defaulted and 1.1% (n = 6) died. Male sex (aOR = 1.94, 95% CI = 1.15-3.27, p = 0.01), internally displaced status (aOR = 1.70, 95% CI = 1.05-2.79, p = 0.03) and <-3 WLZ (aOR = 1.95, 95% CI = 1.05-3.63, p = 0.03) were significantly associated with programme defaulting. Stabilization and recovery rates among malnourished infants <6 m in the studied project align with acceptable standards in this humanitarian setting. Notable defaulting rates from outpatient care should be further explored.
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Affiliation(s)
- Nieves Amat Camacho
- Department of Global Public Health, Global Disaster Medicine-Health Needs and Response, Karolinska Institutet, Stockholm, Sweden
- Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Faisal Husain
- Médecins Sans Frontières, Operational Center Brussels, Abuja, Nigeria
| | - Dang Bahya-Batinda
- Médecins Sans Frontières, Operational Center Brussels, Luxembourg Operational Unit, Luxembourg, Luxembourg
| | - Eithandee Aung
- Médecins Sans Frontières, Operational Center Brussels, Abuja, Nigeria
| | - Abdullahi Chara
- Médecins Sans Frontières, Operational Center Brussels, Maiduguri, Nigeria
| | - Musa Tanko
- Médecins Sans Frontières, Operational Center Brussels, Maiduguri, Nigeria
| | | | - Mario Barbagallo
- Médecins Sans Frontières, Operational Center Brussels, Brussels, Belgium
| | - Kyi Htet Aung
- Médecins Sans Frontières, Operational Center Brussels, Abuja, Nigeria
| | - Johan von Schreeb
- Department of Global Public Health, Global Disaster Medicine-Health Needs and Response, Karolinska Institutet, Stockholm, Sweden
| | - Francesco Della Corte
- Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Ourania Kolokotroni
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Temmy Sunyoto
- Médecins Sans Frontières, Operational Center Brussels, Luxembourg Operational Unit, Luxembourg, Luxembourg
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Abdelrahmman K, Borg B, Mihrshahi S, Gribble K. Facilitators and Barriers of Wet Nursing from Antiquity to the Present: A Narrative Review with Implications for Emergencies. Breastfeed Med 2024; 19:155-165. [PMID: 38489525 DOI: 10.1089/bfm.2023.0318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Background: If maternal breastfeeding is not possible, wet nursing allows infants to receive the nutrition and protection against disease that breastfeeding provides. Such protection may be particularly valuable in emergencies. However, while wet nursing is recommended in the Operational Guidance on Infant and Young Child Feeding in Emergencies it is underutilized. This narrative review aimed to develop an understanding of wet nursing practice across time and location, and why wet nursing is currently so little supported to inform interventions to support wet nursing in emergencies. Method: Medline and Embase were searched for "wet nursing," "cross-nursing," "shared breastfeeding," and "non-maternal nursing". Included articles were inductively analyzed to identify positive and negative factors associated with previous wet nursing practice. Results: This review included 74 records. Our analysis of the wet nursing literature includes historical and contemporary themes with milk kinship and wet nursing as risky being shared themes across time periods. Our analysis revealed that it is how wet nursing is undertaken that influences whether it benefits women, children, and societies or not. Facilitators and barriers to wet nursing in emergencies related to infant mortality rates, cultural and individual support for wet nursing, availability of wet nurses, and resources to support wet nursing. Conclusion: Understanding the conditions under which wet nursing has positive outcomes and what can be done to facilitate beneficial wet nursing practices will assist in enabling wet nursing to be more commonly implemented in emergencies.
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Affiliation(s)
- Khadija Abdelrahmman
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Bindi Borg
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Karleen Gribble
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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Amat Camacho N, von Schreeb J, Della Corte F, Kolokotroni O. Interventions to support the re-establishment of breastfeeding and their application in humanitarian settings: A systematic review. MATERNAL & CHILD NUTRITION 2022; 19:e13440. [PMID: 36222214 PMCID: PMC9749597 DOI: 10.1111/mcn.13440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022]
Abstract
In 1998, the World Health Organisation (WHO) published general guidelines proposing essential measures to achieve relactation. Yet, increased knowledge about the practical set-up of relactation support interventions in different contexts is needed, especially in humanitarian settings, where nonbreastfed infants are particularly at risk. This study aimed to compile and assess the characteristics, outcomes and factors influencing the implementation of relactation support interventions reported since the latest WHO recommendations. We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, undertaking a search from Medline, Embase, PubMed Central, Web of Science, Global Health and CINAHL electronic databases. Studies published in English and Spanish, reporting characteristics and outcomes of relactation support provided to non-(breastfeeding) BF mothers with infants aged less than 6 months were included. Data were analysed by narrative synthesis and the Johanna Briggs Institute Critical Appraisal Tools were used for quality assessment. Overall, 16 studies met the inclusion criteria. Most were observational and conducted in middle-income countries, only one focused on humanitarian settings. Studies reported inpatient and community-based interventions, which generally followed WHO recommendations for relactation. In 13 out of 16 studies, over 80% of mothers restarted BF after receiving relactation support. Enabling factors included younger infant age, shorter lactation gap, mother's strong motivation, family support, and continuous skilled support. Although current literature suggests that intensive relactation support can contribute to re-establish BF, its application and effectiveness in humanitarian settings remain uncertain. Further research is needed to explore the effectiveness, feasibility and acceptability of different approaches to relactation support, especially in humanitarian settings.
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Affiliation(s)
- Nieves Amat Camacho
- Department of Global Public Health, Center for Research on Health Care in DisastersKarolinska InstituteStockholmSweden,Centre for Research and Training in Disaster Medicine,Humanitarian Aid, and Global HealthUniversità del Piemonte OrientaleNovaraItaly
| | - Johan von Schreeb
- Department of Global Public Health, Center for Research on Health Care in DisastersKarolinska InstituteStockholmSweden
| | - Francesco Della Corte
- Centre for Research and Training in Disaster Medicine,Humanitarian Aid, and Global HealthUniversità del Piemonte OrientaleNovaraItaly
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