Addressing child undernutrition in Tanzania with the ASTUTE program

BACKGROUND

Optimal infant and young child feeding practices (IYCFP) reduce childhood stunting and are associated with additional health benefits. In Tanzania, IYCFP are far from optimal where 32% of children under the age of 5 years are stunted. The purpose of this study was to examine whether behavior change communication focused on reducing child undernutrition was associated with improved IYCFP in Tanzania.

METHODS

A cross-sectional survey was administered to approximately 10,000 households with children under the age of 2 at baseline and endline. Bivariate analyses and logistic regression was used to examine the relationship between exposure to behavior change communication and timely initiation of breastfeeding, exclusive breastfeeding, continued breastfeeding at one year, timely complementary feeding (CF), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD).

RESULTS

Mothers who heard a radio spot about IYCFP were more likely than mothers who had not heard a radio spot about IYCFP to begin complementary foods at six months. Their children were also more likely to achieve MMF, MDD, and MAD with odds ratios of 2.227 (p = 0.0061), 1.222 (p = 0.0454), 1.618 (p =  < .0001), and 1.511 (p = 0.0002), respectively. Mothers who saw a TV spot about IYCFP were more likely to have greater odds of knowing when to begin complementary feeding, feeding their child a minimally diverse diet (4 food groups or more), and serving a minimum acceptable diet with odds ratios of 1.335 (p = 0.0081), 1.360 (p = 0.0003), and 1.268 (p = 0.0156), respectively.

CONCLUSION

Exposure to behavior change communication in Tanzania was generally associated with some increased knowledge of optimal IYCFP as well as practicing IYCF behaviors. Behavior change communication planners and implementers may want to consider conducting similar campaigns as an important component of behavior change to reduce undernutrition and poor health outcomes in developing settings.

Evaluating the validity of responsiveness to inhaled nitric oxide in pediatric patients with ARDS: an analytic tool

OBJECTIVES

To determine whether improved oxygenation indicates a valid response to inhaled nitric oxide (iNO) therapy in patients with pediatric ARDS, and to establish an analytic tool to differentiate the iNO effects from those of other interactive factors in pediatric patients with ARDS.

DESIGN

Consecutive case series evaluated by post hoc analysis tool.

PATIENTS AND METHODS

Nineteen patients treated with iNO for ARDS or pulmonary hypertension were enrolled in our study. We evaluated the PaO(2)/fraction of inspired oxygen ratio (PF ratio), oxygenation index (OI), patient position (prone vs supine), PaCO(2), pH, and vasoactive drug support, and classified patients' responsiveness to iNO into three categories: (1) possible response, an increase in PF ratio, with no alteration of the aforementioned variables in a direction known to improve oxygenation; (2) nonspecific response, an increase in PF ratio with no increase in OI, and alteration of one or more of the other four criteria in a direction known to improve oxygenation; and (3) undetermined response, an increase in both the PF ratio and OI, indicating a deliberate augmentation in ventilator support.

RESULTS

A total of 119 data points were evaluated. Fifty data points (42%) exhibited no response to iNO. Thirty-two data points (27%) were classified as having possible responses, 35 data points (29%) as nonspecific, and 2 data points (2%) as undetermined responses to the iNO treatment.

CONCLUSIONS

In ARDS, improved oxygenation amid iNO treatment is multifactorial. In only 27% of our evaluated data points could the increase in PF ratio be attributed to iNO. We suggest that when clinically utilizing iNO, the interactive factors described by us should be taken into account for data analysis.