Complementary Feeding in Western Cape, South Africa: Identifying Suboptimal Practices and Potential Targets for Intervention

Introduction Appropriate complementary feeding is important for the normal growth and development of children. This study aimed to describe the complementary feeding practices and identify suboptimal practices that would be possible targets for intervention to improve practices among mothers of infants aged six weeks to one year in Western Cape Province, South Africa. Methods This hospital-based cross-sectional study was conducted at the emergency unit of the Department of Paediatrics and Child Health of Tygerberg Academic Hospital, Cape Town, South Africa, between May 2017 and June 2017 among 110 mothers and their infants. Infants with minor ailments were included in the study. Patients requiring hospital admissions or severely ill infants requiring oxygen or ventilation, premature babies, and children with congenital anomalies were excluded from the study. The relationship between sociodemographic variables and the time of commencement of complementary food was described. Results The mean age of infants was 6.4±3.2 months, while the mean age of mothers was 27.6±5.5 years. On average, the age at introduction of complementary food to infants was 2.17±1.50 months. Among the complementary foods given to infants less than six months of age, cereals were the most commonly introduced (76.5%), while the least were sweet beverages (5.9%). Maternal age ≤ 34 years and first-born infant were significantly associated with early commencement of complementary food before six months of age (p=0.042 and p=0.032, respectively). Conclusion This study indicated that commencement of complementary food as early as two months of age with the use of non-nutritious and inappropriate food remains a significant problem in the region. There is a need for further education of mothers on appropriate complementary feeding practices given the importance of complementary feeding practices to the optimum growth and development of children.

Predictors of In-Patient Mortality of Severe Acute Malnutrition of Hospitalised Children in a Tertiary Facility in Southern Nigeria

Introduction

Severe acute malnutrition (SAM) remains a public health concern in developing countries. Children with SAM are nine times more likely to die compared with those that are well-nourished. Most studies on SAM in Nigeria focus on disease burden without evaluating risk factors that may be useful as interventions in reducing mortality. This study evaluated predictors of mortality and outcome among hospitalised children with SAM in Southern Nigeria.

Methods

Children with SAM admitted into the paediatric medical ward of the University of Calabar Teaching Hospital between September 2017 and November 2019 were studied prospectively. A multivariable logistic regression was used to identify factors that independently predicted mortality with a p-value <0.05 considered significant.

Results

One hundred children were studied. The mean age was 14.28 ± 14.04 months, of which 89% were less than two years of age. Oedematous and non-oedematous SAM were found in 18.5% and 81.5%, respectively. Co-morbidities included tuberculosis (TB) (13.0%), HIV (12.0%), and HIV/TB co-infection (3.0%). Clinical presentation included fever (21.7%), anaemia (19.9%), diarrhoea (19.1%), skin changes (8.7%), and shock (1.8%). The mean duration of hospital stay was 11.48 ± 6.87 days. Nine of the children were discharged against medical advice and were excluded from further analysis. About 92.3% were discharged for follow-up and 7.7% died. After multivariable regression, the predictors of mortality were shock (p=0.037, adjusted odds ratio (aOR): 17.51, 95% confidence interval (95% CI): 1.19-258.77) and skin changes (p=0.035, aOR: 9.81, 95% CI: 1.18-81.46).

Conclusion

The presence of shock and skin changes are independently associated with mortality in hospitalised children with SAM. Prompt referral of children with SAM and more so with complications of shock and skin changes is hereby advocated to reduce mortality.

Current Knowledge of Breastfeeding Among Health Workers in a Developing Country Setting: A Survey in Calabar, Nigeria

Background

Health workers are in a strategic position to provide correct information to mothers on breastfeeding practice. This study assessed knowledge of breastfeeding among health workers in health facilities in Calabar.

Methods

This was a cross-sectional descriptive study. A 45-item self-administered questionnaire was used to obtain data. Ethical clearance for the study was obtained from the Cross River State Research and Ethics Committee. Data were analyzed using SPSS version 21.0 (SPSS, Inc., Chicago, USA). A knowledge score of at least 90% was considered satisfactory. Factors associated with the level of knowledge were determined using chi-square. The p-value was set at 0.05.

Result

Two hundred and twenty-five healthcare professionals were surveyed, with a mean age of 37.5 ± 9.4 years, ranging from 20 to 65 years. The commonest age group was 41 to 50 years (43.1%). Females (80.9%) formed a larger proportion of participants with a female-male ratio of 4:1. The mean percentage of knowledge score was 85.1 ± 9.0%. A satisfactory level of knowledge was found in 27.1% of respondents. About one-third (33.7%) and one-fifth (21.8%) of health workers were not aware of the weight control benefit and protection against osteoporosis of breastmilk, respectively. Approximately one-fifth (22.2%) of respondents had misconceptions concerning the effects of colostrum on the prevention of neonatal jaundice. Nurses with diploma level of training had a satisfactory level of knowledge, compared with other professions (p < 0.05).

Conclusion

Health workers’ knowledge of breastfeeding was generally good though suboptimal. Health-related professions should provide current information on the best breastfeeding practices.

Inflammatory Bowel Disease in Children: Experience and Constraints in a Resource-limited Setting

Introduction: Inflammatory bowel disease (IBD), though well described in the Caucasian population, is rarely encountered in the black African children. The aim of this study was to increase the awareness of this emerging condition in African children and highlight the constraints of management in a resource-limited setting like Nigeria.

Methods: This study included an audit of children with IBD who were seen between January 2015 and February 2020 at the Lagos University Teaching Hospital (LUTH). The clinical records of children aged one to 16 years who presented with recurrent abdominal pain, weight loss, and gastrointestinal (GI) bleeding with clinical suspicion of IBD were reviewed. Clinical features, endoscopic findings, histopathologic findings, and treatment were documented.

Results: Eight children with IBD were seen during the study period. The median age was 12.0 years (range: five to 15 years). The most common reported concerns in the children were chronic abdominal pain [seen in four patients (50%)] and bloody diarrhea [seen in three patients (42.30%)]. Weight loss and arthritis were seen in three (37.5%) and one (12.5%) children, respectively. Endoscopy confirmed two cases of Crohn’s disease (CD), three cases of ulcerative colitis (UC), and three cases of indeterminate colitis (IC). The children with CD were treated with steroids and exclusive enteral nutrition, with one patient receiving methotrexate, while the UC and IC patients received 5-aminosalicylate therapy.

Conclusion: Although IBD is uncommon in Nigeria, a high index of suspicion is vital to enable early diagnosis and appropriate treatment. Management in the African setting is severely constrained by limited access to endoscopy facilities and nonavailability of other effective treatment options such as biologic agents.