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Jiregna B, Amare M, Dinku M, Nigatu D, Desalegn D. Women Health Literacy and Associated Factors on Women and Child Health Care in Ilu Ababor Public Health Facilities, Ethiopia. Int J Womens Health 2024; 16:143-152. [PMID: 38292301 PMCID: PMC10826516 DOI: 10.2147/ijwh.s443198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/22/2024] [Indexed: 02/01/2024] Open
Abstract
Background Maternal health literacy (MHL) is the ability of mothers to obtain, interpret, appraise, and apply women and child health information that contributes to a reduction in mortality among mothers and children. This is an important concern since a woman's health during pregnancy may be her first interaction with the healthcare system, and a woman's comprehension of health information has a direct impact on her unborn child's growth throughout the process of conception. Aim Assess the degree of maternal health literacy and related factors in women's and children's health care among mothers whose children have received basic immunizations at the public healthcare facilities in Ilu Abba Boor. Methods and Materials A cross-sectional study was carried out in the facility between December 2021 and January 2022. Investigators trained supervisors and data collectors for five days before data collection. Through basic random sampling, 411 mothers whose children had received the minimum set of vaccinations from health facilities in the Ilu Ababor zone of Oromia, Ethiopia, were chosen. Face-to-face interviews were used to gather the data, which were then imported into Epidata 4.1 and exported to SPSS. The factors associated with maternal health literacy in maternal and child healthcare were identified through the application of descriptive statistics, bivariate analysis, and multivariable logistic regression analyses. The findings are displayed in the form of graphs, tables, and figures. Results This study had a 100% response rate when 411 participants were invited to participate. The mean maternal health literacy score was 28.5±10.3. Most of the women (293 [71.3%]) had inadequate health literacy levels while 118 (28.7%) had adequate. The multivariate analysis's findings indicated that the rate of adequate maternal health literacy was 12.2 times higher among urban women than among rural ones (AOR=12.2 [5.34, 24.48]). Women who gave birth vaginally were 0.24 times less likely to have adequate maternal health literacy than women who had a caesarean section (AOR=0.24 [0.112, 0.503]). Mothers who had four or more prenatal care follow-ups were found to have sufficient maternal health literacy higher than those who had just one (AOR=0.23[0.095, 0.556]), two (AOR=0.26[0.138, 0.307]), and three times (0.14{0.108, 0.167]) antenatal care contacts. Discussion and Recommendation This study shows that inadequate maternal health literacy affects the healthcare of mothers and children. Given the significance of health literacy for women's health, national health authorities ought to develop more educational initiatives aimed at raising health literacy rates and empowering women who are of reproductive age.
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Affiliation(s)
- Bikila Jiregna
- Department of Midwifery, Mattu University, Mattu town, Oromia, Ethiopia
| | - Mesganew Amare
- Department of Midwifery, Jimma University, Jimma Town, Oromia, Ethiopia
| | - Megersa Dinku
- Department of Nursing, Mattu University, Mattu town, Oromia, Ethiopia
| | - Desalegn Nigatu
- Department of Nursing, Mattu University, Mattu town, Oromia, Ethiopia
| | - Defaru Desalegn
- Department of Psychiatry, Mattu University, Mattu town, Oromia, Ethiopia
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Sato Y, Khamphithoun S, Saiyachak K, Ando H, Ishizuka T, Saeki S, Miyoshi M. Enhancing child dietary diversity through cooking demonstration and nutritional education in rural Lao PDR. Trop Med Health 2024; 52:8. [PMID: 38191472 PMCID: PMC10773088 DOI: 10.1186/s41182-023-00571-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/24/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Efforts to prevent malnutrition in children under five are crucial for both short-term and long-term impact, especially in resource-constrained low- and middle-income countries, where ensuring minimal food diversity remains an urgent challenge. Our organization implemented initiatives to improve dietary diversity among children under five in rural areas of Lao People's Democratic Republic (Lao PDR). METHODS We carried out educational and awareness programs directed at caregivers of children aged 6-59 months. These programs were delivered by healthcare professionals and trained community volunteers in specific areas of Xaybouathong District, Khammouane Province. To evaluate the impact of our interventions, we conducted surveys both at the beginning and end of the project. We designated the Individual Dietary Diversity Score IDDS as the objective variable, serving as an indicator of child dietary diversity. Using sociodemographic and economic indicators as explanatory variables, we assessed the impact of the intervention through multivariate analysis with a generalized linear model as well as a bivariate analysis. RESULTS The comparison between 210 children at baseline and 205 children at endline revealed a significant increase in IDDS among children aged 6-23 months (from 3.36 to 4.22) and children aged 24-59 months (from 3.29 to 3.83). Multivariate analysis indicated a significant association between the intervention effect (baseline vs. endline) and the village of residence. Furthermore, significant improvements were observed in each food group that constitute IDDS, including vegetables and fruits, eggs, and legumes and nuts. CONCLUSIONS Even in resource-limited settings, such as rural areas of Lao PDR, it is possible to improve child dietary diversity through educational approaches that encourage the utilization of locally available foods.
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Affiliation(s)
- Yu Sato
- Our Lady of the Snow St. Mary's Hospital, Tsubuku Honmachi 422, Kurume, Fukuoka, Japan.
- Non-Profit Organization ISAPH Tokyo Office, OWK Bld. 3F, Shimbashi 3-5-2, Minato-Ku, Tokyo, Japan.
- Aomori University of Health and Welfare, Oaza-Hamatate Mase 58-1, Aomori, Aomori, Japan.
| | | | | | - Hisao Ando
- Our Lady of the Snow St. Mary's Hospital, Tsubuku Honmachi 422, Kurume, Fukuoka, Japan
- Non-Profit Organization ISAPH Tokyo Office, OWK Bld. 3F, Shimbashi 3-5-2, Minato-Ku, Tokyo, Japan
| | - Takaaki Ishizuka
- Our Lady of the Snow St. Mary's Hospital, Tsubuku Honmachi 422, Kurume, Fukuoka, Japan
- Non-Profit Organization ISAPH Tokyo Office, OWK Bld. 3F, Shimbashi 3-5-2, Minato-Ku, Tokyo, Japan
| | | | - Miki Miyoshi
- Aomori University of Health and Welfare, Oaza-Hamatate Mase 58-1, Aomori, Aomori, Japan
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Yang X, Qiu M, Yang Y, Yan J, Tang K. Maternal postnatal confinement practices and postpartum depression in Chinese populations: A systematic review. PLoS One 2023; 18:e0293667. [PMID: 37903136 PMCID: PMC10615300 DOI: 10.1371/journal.pone.0293667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/14/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The postpartum period is critical for maternal health status after childbirth. The traditional Chinese postpartum confinement practice, "doing-the-month", is considered especially effective in helping mothers recover during the postpartum period. However, research has not provided evidence to confirm its benefits. Postpartum depression is a common postpartum disease that seriously threatens maternal health. The systematic review aims to explore the association between "doing-the-month" and postpartum depression in the Chinese female population and to provide a scientific foundation for evidence-based postpartum maternal care. METHODS Five databases (PubMed, Embase, Web of Science, Scopus, Cochrane, PsycINFO, and Web of Science) were searched according to the protocol (INPALSY202320102). The JBI assessment tool was used to assess the quality of the included studies. RESULTS Sixteen quantitative studies from China and Chinese female immigrants in other countries, including 15 cross-sectional studies and 1 randomized controlled study, were identified. Four studies indicated that "doing-the-month" rituals reduced postpartum depression risk while 2 studies showed opposite results; 10 studies did not show a significant association between "doing-the-month" practices and postpartum depression. CONCLUSION There is conflicting evidence regarding the association between "doing-the-month" and the likelihood of developing postpartum depression. Some studies have explored the impact of family ties, particular rituals, and specific stressors during the postpartum period on the occurrence of postpartum depression in Chinese women. According to current research, "doing-the-month" practice failed to show a significant protective effect on postpartum depression in the Chinese maternal population. Evidence-based medical health education for the Chinese postpartum female community is urgently needed.
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Affiliation(s)
- Xiao Yang
- Health Policy and Management Department, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mujie Qiu
- The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yichun Yang
- Department of Obstetrics, Longgang District Central Hospital of Shenzhen, Shenzhen, China
| | - Junlin Yan
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Nutrition and health-seeking practices during pregnancy and lactation and potential strategies to increase micronutrient intakes among women in northern Lao PDR. J Nutr Sci 2022; 11:e95. [PMID: 36405099 PMCID: PMC9641509 DOI: 10.1017/jns.2022.94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
Access to and utilisation of antenatal care (ANC) is important for optimising health and nutrition during pregnancy. This study aimed to assess adherence to and factors associated with ANC and antenatal supplement use among Laotian women, and consider culturally appropriate strategies to increase micronutrient intakes. Mother-child (aged 21 d to <18 months) dyads (n 699) enrolled in a hospital-based prospective cohort study with the community comparison group in Luang Prabang province were interviewed about their antenatal history, supplement use, household sociodemographic and dietary practices, including postpartum food avoidances. Ninety percent of women (mean age 24⋅7 ± 6⋅3 years) reported receiving ANC during their pregnancy, with the majority reporting four to seven contacts, while 84⋅6 and 17⋅3 % reported supplement use during pregnancy and lactation, respectively. Adequate ANC contacts (≥8) and supplement use was more likely among women with complete primary education and from higher socioeconomic status households, and less likely among women belonging to ethnic minority populations and those who delivered their child at home. All women continued to consume salt while adhering to postpartum food avoidances; however, 58⋅5 and 38⋅7 % of habitual consumers restricted fish and soy sauces, respectively. Eighty-six percent of women reported they would be willing to take supplements when adhering to postpartum dietary restrictions. Overall, women's reported ANC attendance and antenatal supplement use was suboptimal. Understanding predictors of and barriers to ANC and supplement use may help implement effective public health strategies to improve adherence. Alongside targeted supplementation, salt fortification with micronutrients may be a viable population-wide intervention that needs further evaluation.
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How do the determinants of exclusive breast-feeding change over time? A multi-survey quasi-longitudinal study in Lao People's Democratic Republic. Public Health Nutr 2022; 25:2380-2394. [PMID: 35657684 PMCID: PMC9991563 DOI: 10.1017/s1368980022001380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The current study aimed to assess trends, associated factors and the changes in these factors for exclusive breast-feeding (EBF) over the past two decades in Lao People's Democratic Republic (Lao PDR). DESIGN The current study used a quasi-longitudinal design. Descriptive analyses were done with correction for complex survey design. Inferential analyses were done for survey years separately using multiple logistic regression. Finally, pooled logistic regression analysis was done using interaction terms to quantify the difference in association per year. SETTING The current study used data from all provinces of Lao PDR collected in the years 2000, 2006, 2011/2012 and 2017. PARTICIPANTS Children aged six months or younger from Lao PDR. RESULTS EBF practice was estimated at 19·03 %, 26·87 %, 40·67 % and 44·89 % in the four survey years, respectively. Factors significantly associated with EBF included: region of residence, ethnicity, wealth index and age of child. Region and ethnicity saw significant changes in association, and the South developing positively over time as well as in the Lao-Thai ethnic group. Having had any antenatal visits was not associated with EBF practice, nor did this change over time. CONCLUSIONS Our study shows how EBF trends, and factors associated with EBF, changed over time. We applied an easily replicable methodology to assess similar public health phenomena. We argue that such analysis is particularly relevant for transitioning countries. In such rapidly evolving settings, it is crucial to take into account changing underlying factors when assessing and developing public health policy.
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de Quadros VP, Balcerzak A, Allemand P, de Sousa RF, Bevere T, Arsenault J, Deitchler M, Holmes BA. Global Trends in the Availability of Dietary Data in Low and Middle-Income Countries. Nutrients 2022; 14:nu14142987. [PMID: 35889943 PMCID: PMC9324857 DOI: 10.3390/nu14142987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 02/05/2023] Open
Abstract
Individual-level quantitative dietary data can provide suitably disaggregated information to identify the needs of all population sub-groups, which can in turn inform agricultural, nutrition, food safety, and environmental policies and programs. The purpose of this discussion paper is to provide an overview of dietary surveys conducted in low- and middle-income countries (LMICs) from 1980 to 2019, analyzing their key characteristics to understand the trends in dietary data collection across time. The present study analyzes the information gathered by the Food and Agriculture Organization of the United Nations/World Health Organization Global Individual Food consumption data Tool (FAO/WHO GIFT). FAO/WHO GIFT is a growing repository of individual-level dietary data and contains information about dietary surveys from around the world, collected through published survey results, literature reviews, and direct contact with data owners. The analysis indicates an important increase in the number of dietary surveys conducted in LMICs in the past four decades and a notable increase in the number of national dietary surveys. It is hoped that this trend continues, together with associated efforts to validate and standardize the dietary methods used. The regular implementation of dietary surveys in LMICs is key to support evidence-based policies for improved nutrition.
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Affiliation(s)
- Victoria Padula de Quadros
- Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy; (A.B.); (P.A.); (R.F.d.S.); (T.B.); (B.A.H.)
- Correspondence:
| | - Agnieszka Balcerzak
- Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy; (A.B.); (P.A.); (R.F.d.S.); (T.B.); (B.A.H.)
| | - Pauline Allemand
- Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy; (A.B.); (P.A.); (R.F.d.S.); (T.B.); (B.A.H.)
| | - Rita Ferreira de Sousa
- Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy; (A.B.); (P.A.); (R.F.d.S.); (T.B.); (B.A.H.)
| | - Teresa Bevere
- Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy; (A.B.); (P.A.); (R.F.d.S.); (T.B.); (B.A.H.)
| | - Joanne Arsenault
- Intake—Center for Dietary Assessment, FHI Solutions, Washington, DC 20009, USA; (J.A.); (M.D.)
| | - Megan Deitchler
- Intake—Center for Dietary Assessment, FHI Solutions, Washington, DC 20009, USA; (J.A.); (M.D.)
| | - Bridget Anna Holmes
- Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy; (A.B.); (P.A.); (R.F.d.S.); (T.B.); (B.A.H.)
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Nisar S, Tanvir M, Ganai MA, Kareem O, Muzaffer U, Wani IH. Clinical profile of subjects presenting as thiamine responsive upper GI upset: a pointer towards gastric beriberi. Nutrition 2022; 102:111730. [DOI: 10.1016/j.nut.2022.111730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
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Smith TJ, Tan X, Arnold CD, Sitthideth D, Kounnavong S, Hess SY. Traditional prenatal and postpartum food restrictions among women in northern Lao PDR. MATERNAL AND CHILD NUTRITION 2021; 18:e13273. [PMID: 34595830 PMCID: PMC8710103 DOI: 10.1111/mcn.13273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/28/2021] [Accepted: 09/01/2021] [Indexed: 11/04/2022]
Abstract
Culturally determined food restrictions are common among pregnant and postpartum women in Asia. This study aimed to describe perinatal dietary restrictions, factors associated with food avoidances and attainment of minimum dietary diversity (MDD‐W) among women in Lao PDR. Mother–child (aged 21 days to <18 months) dyads (n = 682) were enrolled into a cohort study in northern Lao PDR and interviewed at one time point postpartum. During pregnancy and postpartum, 1.6% and 97% of women reported following dietary restrictions, respectively. Cluster analysis identified four distinct postpartum dietary patterns: most restrictive (throughout first 2 months postpartum); least restrictive; 2 weeks highly restrictive and 1 month highly restrictive, followed by 19%, 15%, 5% and 62% of women, respectively. Greater maternal age, gravidity and higher household socioeconomic status were associated with allowing more diverse foods, while women from food insecure households followed more restrictive diets for longer. Women belonging to the Hmong ethnic group followed a highly restrictive diet of white rice and chicken for the first month postpartum. MDD‐W was achieved by 10% of women restricting their diet at the time of the interview compared with 17% of women who were consuming their normal diet (p = 0.04). Postpartum dietary restrictions are widespread among women in northern Lao PDR. These highly restrictive diets, low dietary diversity and food insecurity likely contribute to micronutrient deficiencies in women that may have important consequences for their breastfed infants through reduced breastmilk micronutrient content, which requires further exploration. Culturally appropriate strategies to increase micronutrient intakes among women should be considered.
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Affiliation(s)
- Taryn J Smith
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
| | - Xiuping Tan
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
| | - Charles D Arnold
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
| | - Dalaphone Sitthideth
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Sonja Y Hess
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
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Whitfield KC, Smith TJ, Rohner F, Wieringa FT, Green TJ. Thiamine fortification strategies in low- and middle-income settings: a review. Ann N Y Acad Sci 2021; 1498:29-45. [PMID: 33496051 PMCID: PMC8451796 DOI: 10.1111/nyas.14565] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/30/2020] [Accepted: 01/09/2021] [Indexed: 12/13/2022]
Abstract
Thiamine (vitamin B1 ) is an essential micronutrient in energy metabolism and cognitive and neurological health. Thiamine deficiency disorders (TDDs) have a range of clinical presentations that result in various morbidities and can be fatal if not promptly recognized and treated, especially in infants. To intervene, thiamine intakes by breastfeeding mothers and others at risk of thiamine deficiency should be increased to ensure adequate thiamine intake. Although thiamine fortification programs have a long history in high-income countries, there are few mandatory fortification programs to address TDDs in low- and middle-income countries (LMICs), particularly in the regions of greatest concern, South and Southeast Asia. This review highlights essential aspects for consideration in the development of a mandatory fortification program in LMICs, including an overview of the data required to model fortification dosing schemes, available thiamine fortificants, and potential fortification vehicles, as well as identifies current knowledge gaps.
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Affiliation(s)
- Kyly C. Whitfield
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Taryn J. Smith
- Institute for Global NutritionUniversity of California DavisDavisCalifornia
| | | | - Frank T. Wieringa
- UMR‐95 QualiSud, French National Research Institute for Sustainable Development (IRD)CIRAD/IRD/University of Montpellier/SupAgro/University of Avignon/University of RéunionAvignonFrance
| | - Tim J. Green
- SAHMRI Women and KidsSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
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Jeong Y, Yi K, Hansana V, Kim JM, Kim Y. Comparison of Nutrient Intake in Lao PDR by the Korean CAN-Pro and Thailand INMUCAL Analysis Programs. Prev Nutr Food Sci 2021; 26:40-50. [PMID: 33859958 PMCID: PMC8027042 DOI: 10.3746/pnf.2021.26.1.40] [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: 08/28/2020] [Revised: 12/12/2020] [Accepted: 12/25/2020] [Indexed: 11/13/2022] Open
Abstract
A computer-based nutritional analysis program can help to identify the nutritional status of people and provide information for nutritional counseling, nutrition education, diet planning, and menu development. Although computer-based nutritional analysis has been conducted since the 1960s in developed countries, in developing countries nutritional analysis programs either do not exist or need improving. This study tests two analysis programs developed by different countries to compare the nutrition status data calculated by two different analysts to highlight the importance of developing an appropriate nutrition analysis tool. An interview-administered 24-h dietary recall method was conducted with 100 adults aged 40∼59 years in Vientiane, Laos. Analysts from Korea and Laos, respectively, calculated nutrient intake using the Institute of Nutrition, Mahidol University CALculation (INMUCAL) nutritional analysis program (Bangkok, Thailand). Nutrient intake was also compared using two different analysis tools, INMUCAL and computer aided nutrition-al analysis program (CAN-Pro) 5.0 software (Seoul, Korea). The average nutrient intake calculated by the different analysts using INMUCAL were not significantly different. Furthermore, macronutrient intake calculated by CAN-Pro 5.0 and INMUCAL did not significantly differ, aside for intake of iron, thiamin, and vitamin C. Nutrient intake calculated by one analysis program differed from those calculated by a different program in Laos. Therefore, it is necessary to develop an appropriate nutritional analysis program that reflects the diet behavior and food culture in Laos and to understand the nutritional status of Laotians.
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Affiliation(s)
- Yeseung Jeong
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea
| | - Kyungock Yi
- Division of Kinesiology & Sports Studies, College of Science and Industry Convergence, Ewha Womans University Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Korea
| | - Visanou Hansana
- Institute of Research and Education Development, University of Health Sciences, Vientiane 7444, Lao People's Democratic Republic
| | - Ji-Myung Kim
- Food and Nutrition Major, Division of Food Science and Culinary Arts, Shinhan University, Gyeonggi 11644, Korea
| | - Yuri Kim
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea
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Phommachanh S, Essink DR, Wright PE, Broerse JEW, Mayxay M. Maternal health literacy on mother and child health care: A community cluster survey in two southern provinces in Laos. PLoS One 2021; 16:e0244181. [PMID: 33780460 PMCID: PMC8007003 DOI: 10.1371/journal.pone.0244181] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/04/2020] [Indexed: 11/18/2022] Open
Abstract
RATIONAL Increased maternal health literacy (MHL) has contributed considerably to maternal and child health outcomes in many countries. Malnutrition, and low coverage of child vaccination and breastfeeding are major health concerns in Laos, but there is little insight into mothers' literacy on these issues. The aim of this study was to identify the level of MHL of Lao mothers and to explore factors influencing it, in order to provide evidence that can inform policies and planning of health services. METHODS A cross-sectional survey was conducted using a questionnaire on health literacy (ability to access, understand, appraise and apply health-related information) in relation to care during pregnancy, childbirth, and the postpartum period. We interviewed 384 mothers with children aged under five years; 197 from urban and 187 from rural areas. Descriptive and inferential statistics were applied to analyze the data. RESULTS Overall, MHL of Lao mothers was very low in both urban and rural areas; 80% of mothers had either inadequate or problematic MHL, while only 17.4% had sufficient and 3.5% excellent MHL. The MHL scores were significantly higher in urban than in rural areas. One third of mothers found it very difficult to access, understand, appraise and apply information on mother and child (MCH). Health personnel were the main source of MCH information for the mothers. Years of schooling, own income, health status, and number of ANC visits significantly predicted a higher level of MHL (R square = 0.250; adjusted R square = 0.240, P = <0.001). CONCLUSIONS MHL of Lao mothers was inadequate in both urban and rural areas. Socio-demographics and key practices of the mothers were significantly associated with a better level of MHL. Health education on MHL to mothers in both urban and rural areas needs attention, and could best be done by improving the quality of health providers' provision of information.
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Affiliation(s)
- Sysavanh Phommachanh
- Institute of Research and Education Development, University of Health Sciences, Ministry of Health, Vientiane, Lao PDR
| | - Dirk R. Essink
- Vrije Universiteit Amsterdam, Athena Institute and Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Pamela E. Wright
- Guelph International Health Consulting, Amsterdam, The Netherlands
| | - Jacqueline E. W. Broerse
- Vrije Universiteit Amsterdam, Athena Institute and Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Mayfong Mayxay
- Institute of Research and Education Development, University of Health Sciences, Ministry of Health, Vientiane, Lao PDR
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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Keokenchanh S, Kounnavong S, Midorikawa K, Ikeda W, Morita A, Kitajima T, Sokejima S. Prevalence of anemia and its associated factors among children aged 6-59 months in the Lao People's Democratic Republic: A multilevel analysis. PLoS One 2021; 16:e0248969. [PMID: 33765048 PMCID: PMC7993607 DOI: 10.1371/journal.pone.0248969] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/08/2021] [Indexed: 11/19/2022] Open
Abstract
Anemia is a major public health concern among children aged <5 years in the Lao People’s Democratic Republic. Thus far, no study has determined the factors associated with anemia among children aged <5 years in the Lao People’s Democratic Republic using a nationwide representative sample. Therefore, this study aimed to evaluate the prevalence of anemia and its associated factors with multilevel variations among children aged 6–59 months. This quantitative, cross-sectional study used a nationally representative sample from the Lao Social Indicator Survey II, 2017. Children aged 6–59 months tested for anemia were included in this study through multistage sampling approaches. Anemia was defined as a hemoglobin level of <11.0 g/dL. Multilevel binary logistic regression analyses were used to determine the adjusted effect of the factors associated with anemia. Among the 5,087 children included, the overall prevalence of anemia was 43.0%. Three factors were associated with higher odds of developing anemia—male sex (adjusted odds ratio, 1.16; 95% confidence interval, 1.01–1.34), underweight (adjusted odds ratio, 1.30; 95% confidence interval, 1.09–1.55), and residence in central provinces (adjusted odds ratio, 1.59; 95% confidence interval, 1.30–1.95) and southern provinces (adjusted odds ratio, 1.42; 95% confidence interval, 1.11–1.81). However, the other three factors—age, educational level of the household head, and Hmong-Mien ethnicity—were inversely associated with anemia. To resolve the problem regarding the severity of the anemia among children aged <5 years in the Lao People’s Democratic Republic. Our findings highlight the need for designing an effective approach to address each factor associated with childhood anemia. Interventions should focus on the prevention of childhood anemia, which is considered a major priority of public health intervention in the Lao People’s Democratic Republic.
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Affiliation(s)
- Sengtavanh Keokenchanh
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, Tsu-shi, Mie, Japan
- Foreign Relation Division, Cabinet of the Ministry of Health, Sisattanack District, Vientiane Capital, Lao PDR
- * E-mail:
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Sisattanack district, Vientiane Capital, Lao PDR
| | - Kaoru Midorikawa
- Faculty of Child Education, Suzuka University, Suzuka, Mie, Japan
| | - Wakaha Ikeda
- Epidemiology Centre for Disease Control and Prevention, Mie University Hospital, Tsu-shi, Mie, Japan
| | - Akemi Morita
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, Tsu-shi, Mie, Japan
| | - Takumi Kitajima
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, Tsu-shi, Mie, Japan
| | - Shigeru Sokejima
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, Tsu-shi, Mie, Japan
- Epidemiology Centre for Disease Control and Prevention, Mie University Hospital, Tsu-shi, Mie, Japan
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13
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Sastry UMK, M J, Kumar RK, Ghosh S, A P B, Subramanian A, Managuli A, Gangadhara M, Manjunath CN. Thiamine-responsive acute severe pulmonary hypertension in exclusively breastfeeding infants: a prospective observational study. Arch Dis Child 2021; 106:241-246. [PMID: 32883659 DOI: 10.1136/archdischild-2019-318777] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 07/20/2020] [Accepted: 08/02/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Severe pulmonary hypertension (PH) causing right heart failure can occur due to thiamine deficiency in exclusively breastfeeding infants. This study describes the clinical profile and management of thiamine-responsive acute pulmonary hypertension. METHODS A prospective observational study of infants presenting with severe PH without any other significant heart or lung disease. History of symptoms, clinical examination, echocardiography and basic investigations were performed. Dietary patterns of mothers were recorded. Thiamine was administered and serial echocardiography was performed. RESULTS A total of 250 infants had severe PH and 231 infants responded to thiamine. The mean age was 3.2±1.2 months. Fast breathing, poor feeding, vomiting and aphonia were the main symptoms. Tachypnoea, tachycardia and hepatomegaly were found on examination. Echocardiogram revealed grossly dilated right heart with severe PH. Intravenous thiamine was administered to all the babies based on clinical suspicion. Clinical improvement with complete resolution of PH was noticed within 24-48 hours. Babies were followed up to a maximum of 60 months with no recurrence of PH. All the mothers consumed polished rice and followed postpartum food restriction. CONCLUSION Thiamine deficiency is still prevalent in selected parts of India. It can cause life-threatening PH in exclusively breastfeeding infants of mothers who are on a restricted diet predominantly consisting of polished rice. It can contribute to infant mortality. Thiamine administration based on clinical suspicion leads to remarkable recovery. High degree of awareness and thiamine supplementation in relevant geographical areas is required to tackle this fatal disease.
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Affiliation(s)
- Usha M K Sastry
- Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Jayranganath M
- Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Raman Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Santu Ghosh
- Department of Biostatistics, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Bharath A P
- Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Anand Subramanian
- Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Ameetkumar Managuli
- Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Madhu Gangadhara
- Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
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14
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Smith TJ, Hess SY. Infantile thiamine deficiency in South and Southeast Asia: An age-old problem needing new solutions. NUTR BULL 2021; 46:12-25. [PMID: 33776582 PMCID: PMC7986856 DOI: 10.1111/nbu.12481] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/23/2020] [Accepted: 12/22/2020] [Indexed: 12/29/2022]
Abstract
Infantile beriberi, a potentially fatal disorder caused by thiamine deficiency, is often viewed as a disease confined to history in regions of the world with predominant white rice consumption. Recent case reports have, however, highlighted the persistence of thiamine deficiency as a cause of infant mortality in South and Southeast Asia. Low infant thiamine status and incidence of beriberi is attributable to maternal thiamine deficiency and insufficient breast milk thiamine. Poor dietary diversity, food preparation and cooking practices and traditional post‐partum food restrictions likely play a role in these high‐risk regions. Given the contribution of thiamine deficiency to infant mortality and emerging evidence of long‐lasting neurodevelopmental deficits of severe and even subclinical deficiency in early life, public health strategies to prevent thiamine deficiency are urgently needed. However, efforts are hampered by uncertainties surrounding the identification and assessment of thiamine deficiency, due to the broad non‐specific clinical manifestations, commonly referred to as thiamine deficiency disorders (TDD), that overlap with other conditions resulting in frequent misdiagnosis and missed treatment opportunities, and secondly the lack of readily available and agreed upon biomarker analysis and cut‐off thresholds. This review will discuss the key challenges and limitations in the current understanding of TDD and explore how ongoing initiatives plan to fill persistent knowledge gaps, namely in the development of a standardised case definition to help more accurately diagnose and treat TDD in low‐resource settings. Given more attention and ensuring greater recognition of TDD will support the design and implementation of treatment and prevention programmes, and ensure beriberi can truly be considered ‘the forgotten disease of Asia’.
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Affiliation(s)
- T J Smith
- Institute for Global Nutrition University of California Davis Davis CA USA
| | - S Y Hess
- Institute for Global Nutrition University of California Davis Davis CA USA
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15
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Chan K, Gallant J, Leemaqz S, Baldwin DA, Borath M, Kroeun H, Measelle JR, Ngik R, Prak S, Wieringa FT, Yelland LN, Green TJ, Whitfield KC. Assessment of salt intake to consider salt as a fortification vehicle for thiamine in Cambodia. Ann N Y Acad Sci 2021; 1498:85-95. [PMID: 33415757 PMCID: PMC8451827 DOI: 10.1111/nyas.14562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023]
Abstract
Thiamine deficiency is a public health issue in Cambodia. Thiamine fortification of salt has been proposed; however, the salt intake of lactating women, the target population, is currently unknown. We estimated salt intakes among lactating women (<6 months postpartum) using three methods: repeat observed-weighed intake records and 24-h urinary sodium excretions (n = 104), and household salt disappearance (n = 331). Usual salt intake was estimated by adjusting for intraindividual intakes using the National Cancer Institute method, and a thiamine salt fortification scenario was modeled using a modified estimated average requirement (EAR) cut-point method. Unadjusted salt intake from observed intakes was 9.3 (8.3-10.3) g/day, which was not different from estimated salt intake from urinary sodium excretions, 9.0 (8.4-9.7) g/day (P = 0.3). Estimated salt use from household salt disappearance was 11.3 (10.7-11.9) g/person/day. Usual (adjusted) salt intake from all sources was 7.7 (7.4-8.0) g/day. Assuming no stability losses, a modeled fortification dose of 275 mg thiamine/kg salt could increase thiamine intakes from fortified salt to 2.1 (2.0-2.2) mg/day, with even low salt consumers reaching the EAR of 1.2 mg/day from fortified salt alone. These findings, in conjunction with future sensory and stability research, can inform a potential salt fortification program in Cambodia.
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Affiliation(s)
- Kathleen Chan
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Jelisa Gallant
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Shalem Leemaqz
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Dare A Baldwin
- Department of Psychology, University of Oregon, Eugene, Oregon
| | - Mam Borath
- National Sub-Committee for Food Fortification, Cambodia Ministry of Planning, Phnom Penh, Cambodia
| | - Hou Kroeun
- Cambodia Country Office, Helen Keller International, Cambodia, Phnom Penh, Cambodia
| | | | - Rem Ngik
- Cambodia Country Office, Helen Keller International, Cambodia, Phnom Penh, Cambodia
| | - Sophonneary Prak
- National Nutrition Programme, Cambodia Ministry of Health, Phnom Penh, Cambodia
| | - Frank T Wieringa
- UMR-204 NutriPass, Institut de recherche pour le développement, Montpellier, France
| | - Lisa N Yelland
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Tim J Green
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kyly C Whitfield
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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16
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Traditional postpartum food restrictions among women in northern Laos: preliminary analysis of an ongoing prospective cohort study. Proc Nutr Soc 2021. [DOI: 10.1017/s0029665121000318] [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]
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17
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Louangpradith V, Yamamoto E, Inthaphatha S, Phoummalaysith B, Kariya T, Saw YM, Hamajima N. Trends and risk factors for infant mortality in the Lao People's Democratic Republic. Sci Rep 2020; 10:21723. [PMID: 33303939 PMCID: PMC7730153 DOI: 10.1038/s41598-020-78819-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/01/2020] [Indexed: 11/09/2022] Open
Abstract
A high infant mortality rate (IMR) indicates a failure to meet people's healthcare needs. The IMR in Lao People's Democratic Republic has been decreasing but still remains high. This study aimed to identify the factors involved in the high IMR by analyzing data from 53,727 live births and 2189 women from the 2017 Lao Social Indicator Survey. The estimated IMR decreased from 191 per 1000 live births in 1978-1987 to 39 in 2017. The difference between the IMR and the neonatal mortality rate had declined since 1978 but did not change after 2009. Factors associated with the high IMR in all three models (forced-entry, forward-selection, and backward-selection) of multivariate logistic regression analyses were auxiliary nurses as birth attendants compared to doctors, male infants, and small birth size compared to average in all 2189 women; and 1-3 antenatal care visits compared to four visits, auxiliary nurses as birth attendants compared to doctors, male infants, postnatal baby checks, and being pregnant at the interview in 1950 women whose infants' birth size was average or large. Maternal and child healthcare and family planning should be strengthened including upgrading auxiliary nurses to mid-level nurses and improving antenatal care quality.
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Affiliation(s)
- Viengsakhone Louangpradith
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Healthcare and Rehabilitation, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Souphalak Inthaphatha
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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18
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Factors associated with postpartum depression among women in Vientiane Capital, Lao People's Democratic Republic: A cross-sectional study. PLoS One 2020; 15:e0243463. [PMID: 33275620 PMCID: PMC7717544 DOI: 10.1371/journal.pone.0243463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/21/2020] [Indexed: 12/01/2022] Open
Abstract
Postpartum depression is a worldwide public health concern. The prevalence of postpartum depression is reported to be greater in developing countries than in developed countries. However, to the best of our knowledge, no papers on postpartum depression in the Lao People’s Democratic Republic have been published. In order to strengthen maternal and child health, the current situation of postpartum depression should be understood. This study aims to determine the prevalence of postpartum depression and identify factors associated with postpartum depression in Vientiane Capital, Lao People’s Democratic Republic. Study participants were 428 women 6–8 weeks postpartum who visited four central hospitals in Vientiane Capital for postnatal care from July to August 2019. Structured questionnaires were used to collect socio-demographic, obstetrical and infant, and psychiatric data about the women and their partners. The Edinburgh Postnatal Depression Scale (EPDS) was used to identify suspected cases of postpartum depression with the cut-off score of 9/10. Multivariable logistic regression was used to examine independent factors that were associated with suspected postpartum depression (EPDS ≥10). The mean age of the 428 women was 28.1 years, and the prevalence of suspected postpartum depression was 31.8%. Multivariable logistic regression using variables that were statistically significant on bivariate analyses indicated that three variables were associated with suspected postpartum depression: unintended pregnancy (AOR = 1.66, 95% CI 1.00–2.73, P = 0.049), low birth satisfaction (AOR = 1.85, 95% CI 1.00–3.43, P = 0.049), and depression during pregnancy (AOR = 3.99, 95% CI 2.35–6.77, P <0.001). In this study, unintended pregnancy, low birth satisfaction, and depression during pregnancy were independent risk factors for postpartum depression. These results suggest that the mental health of pregnant women should be monitored, and that health care services, especially family planning and supportive birth care, should be strengthened to prevent postpartum depression.
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19
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Lee YQ, Loh J, Ang RSE, Chong MFF. Tracking of Maternal Diet from Pregnancy to Postpregnancy: A Systematic Review of Observational Studies. Curr Dev Nutr 2020; 4:nzaa118. [PMID: 32793849 PMCID: PMC7408223 DOI: 10.1093/cdn/nzaa118] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/18/2022] Open
Abstract
We systematically reviewed studies to examine changes in women's diets from pregnancy to the postpregnancy period and sought to understand the characteristics of women making these changes. From a search of 4 databases and up to November 2019, 17 studies met our inclusion criteria. They reported changes in various dietary aspects. Mixed findings were reported for changes in energy and micronutrient intakes. Most studies reported significant decreases in fruit and vegetable consumption, diet quality, and adherence to a healthier dietary pattern during the transition from pregnancy to postpregnancy, whereas increases in discretionary food and fat intakes were observed. Women with lower education level, lower income, and/or who worked full-time tended to have poorer dietary behaviors postpregnancy. Further research, with better aligned dietary measurement time points during pregnancy and postpartum and standardization of dietary assessment tools, is needed for future studies to be comparable. The systematic review protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews as CRD42020158033.
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Affiliation(s)
- Yu Qi Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jason Loh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Rebekah Su Ern Ang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
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20
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Ratsavong K, van Elsacker T, Doungvichit D, Siengsounthone L, Kounnavong S, Essink D. Are dietary intake and nutritional status influenced by gender? The pattern of dietary intake in Lao PDR: a developing country. Nutr J 2020; 19:31. [PMID: 32278347 PMCID: PMC7151640 DOI: 10.1186/s12937-020-00545-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/20/2020] [Indexed: 11/28/2022] Open
Abstract
Background Recognition of discrepancies between men and women in nutritional intake is important to tackle food and nutrition insecurity and the often-double burden of malnutrition. The purpose of this study was to assess nutritional status and dietary intake of the Lao population, with a focus on possible influences of gender. Methods Dietary intake was assessed in a national cross-sectional study of 1771 randomized participants aged from 1.01 to 89 years, using 24-h dietary recall. Dietary reference intakes were used to assess nutrient insufficiency. Chi-square test was used to evaluate gender differences and multiple univariate logistic regression to examine associations between gender, nutritional status, demographics and nutrient insufficiency. Results Nutrient insufficiencies were higher among pregnant and lactating women than other adult men and women, especially for protein and micronutrients such as vitamin B3, B1, C and other vitamins. Dietary intake and BMI were similar between men and women; all had insufficient intake of all types of nutrients, except sodium. However, women had lower intake than men for almost all nutrients and age groups. The prevalence of overnutrition was higher among those aged 18 years and over for both sexes. Among adult women (15–49.9 years old) and older adult women (50 years old or above), the proportions were: underweight 8.6% (both groups), overweight 18.4 and 20.5%, and obese 34.2 and 39.1%, respectively. Among pregnant and lactating women, the rates of underweight were 7.5 and 1.4%, of overweight were 17.8 and 27.1%, and obese, 21.9 and 40.0%. Among adult and older men, 3.2 and 8.3% were underweight; 21.0 and 18.6% were overweight and 28.2 and 27.6% were obese. Multiple univariate logistic regressions revealed that the factors rural area, dry season and Northern-Lowland region were associated with inadequate micronutrient intake among children, adolescents and adults of both genders. Conclusions Dietary intakes were alarmingly micronutrient-insufficient. Macronutrient imbalance and double burden of malnutrition were confirmed in both sexes. Gender differences were limited; men and women had similarly insufficient intakes, but pregnant and lactating women were disproportionately affected. Nutritional interventions should also take men and older people into account to solve nutrition problems.
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Affiliation(s)
| | | | | | | | | | - Dirk Essink
- Athena Institute, Vrije University, Amsterdam, the Netherlands
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21
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Hess SY, Smith TJ, Fischer PR, Trehan I, Hiffler L, Arnold CD, Sitthideth D, Tancredi DJ, Schick MA, Yeh J, Stein-Wexler R, McBeth CN, Tan X, Nhiacha K, Kounnavong S. Establishing a case definition of thiamine responsive disorders among infants and young children in Lao PDR: protocol for a prospective cohort study. BMJ Open 2020; 10:e036539. [PMID: 32060165 PMCID: PMC7044841 DOI: 10.1136/bmjopen-2019-036539] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Diagnosis of infantile thiamine deficiency disorders (TDD) is challenging due to the non-specific, highly variable clinical presentation, often leading to misdiagnosis. Our primary objective is to develop a case definition for thiamine responsive disorders (TRD) to determine among hospitalised infants and young children, which clinical features and risk factors identify those who respond positively to thiamine administration. METHODS AND ANALYSIS This prospective study will enrol 662 children (aged 21 days to <18 months) seeking treatment for TDD symptoms. Children will be treated with intravenous or intramuscular thiamine (100 mg daily for a minimum of 3 days) alongside other interventions deemed appropriate. Baseline assessments, prior to thiamine administration, include a physical examination, echocardiogram and venous blood draw for the determination of thiamine biomarkers. Follow-up assessments include physical examinations (after 4, 8, 12, 24, 36, 48 and 72 hours), echocardiogram (after 24 and 48 hours) and one cranial ultrasound. During the hospital stay, maternal blood and breast-milk samples and diet, health, anthropometric and socio-demographic information will be collected for mother-child pairs. Using these data, a panel of expert paediatricians will determine TRD status for use as the dependent variable in logistic regression models. Models identifying predictors of TRD will be developed and validated for various scenarios. Clinical prediction model performance will be quantified by empirical area under the receiver operating characteristic curve, using resampling cross validation. A frequency-matched community-based cohort of mother-child pairs (n=265) will serve as comparison group for evaluation of potential risk factors for TRD. ETHICS AND DISSEMINATION Ethical approval has been obtained from The National Ethics Committee for Health Research, Ministry of Health, Lao PDR and the Institutional Review Board of the University of California Davis. The results will be disseminated via scientific articles, presentations and workshops with representatives of the Ministry of Health. TRIAL REGISTRATION NUMBER NCT03626337.
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Affiliation(s)
- Sonja Y Hess
- Department of Nutrition, Institute for Global Nutrition, University of California Davis, Davis, California, USA
| | - Taryn J Smith
- Department of Nutrition, Institute for Global Nutrition, University of California Davis, Davis, California, USA
| | - Philip R Fischer
- Pediatric and Adolescent Medicine, Mayo, Rochester, Minnesota, USA
| | - Indi Trehan
- Department of Pediatrics and Department of Global Health, University of Washington, Seattle, Washington, USA
- Lao Friends Hospital for Children, Luang Prabang, Lao People's Democratic Republic
| | | | - Charles D Arnold
- Department of Nutrition, Institute for Global Nutrition, University of California Davis, Davis, California, USA
| | - Dalaphone Sitthideth
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Daniel J Tancredi
- Department of Pediatrics, University of California Davis Health System, Sacramento, California, USA
| | - Michael A Schick
- Emergency Medicine, University of California Davis Health System, Sacramento, California, USA
| | - Jay Yeh
- Department of Pediatrics, Division of Cardiology, University of California Davis Health System, Sacramento, California, USA
| | - Rebecca Stein-Wexler
- Department of Radiology, University of California Davis Health System, Sacramento, California, USA
| | - Christine N McBeth
- Emergency Medicine, University of California Davis Health System, Sacramento, California, USA
| | - Xiuping Tan
- Department of Nutrition, Institute for Global Nutrition, University of California Davis, Davis, California, USA
| | - Kouyang Nhiacha
- Lao-Korea Children Hospital, Vientiane, Lao People's Democratic Republic
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
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22
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Pauly M, Sayasinh K, Muller CP, Sayasone S, Black AP. High prevalence of helminth infections in mother-child pairs from three central provinces of Lao People's Democratic Republic. Parasite Epidemiol Control 2019; 7:e00122. [PMID: 31872091 PMCID: PMC6911889 DOI: 10.1016/j.parepi.2019.e00122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/30/2019] [Accepted: 10/27/2019] [Indexed: 11/16/2022] Open
Abstract
In Southeast Asia, the large majority of the population remains affected by parasitic worms despite longstanding mass treatment and health education campaigns. Soil-transmitted helminths and also the fish-borne liver fluke negatively affect development during early childhood. Here, the prevalence of helminth infections in stool samples of 610 mother-child pairs from Khammouane, Bolikhamxay and Vientiane provinces in Lao People's Democratic Republic was determined by formalin-ethyl acetate concentration technique. Overall, 15.1% of the children and 46.9% of the mothers were positive for at least one helminth species. Helminth detection rates varied significantly by province with the highest prevelance in Khammouane and the lowest in Bolikhamxay province. Mothers that were positive for soil-transmitted helminths were significantly more likely to have children positive for the same helminth species (p < 0.01) but this was not the case for the liver fluke Opisthorchis viverrini. A protective effect of breastfeeding against soil-transmitted helminths was revealed. Our data reconfirm the generally high helminth burden among mother-child pairs who likely share a number of risky lifestyle behaviors also with other family members. To reduce maternal burden of helminths, we propose that anti-helmintic treatment of women of childbearing age and of mothers during postnatal care should be included in the national strategy.
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Affiliation(s)
- Maude Pauly
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Kong Sayasinh
- Lao Tropical and Public Health Institute, Vientiane, Lao Democratic People's Republic.,Lao-Lux-Laboratory, Institute Pasteur Du Laos, Vientiane, Lao Democratic People's Republic
| | - Claude P Muller
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.,Lao-Lux-Laboratory, Institute Pasteur Du Laos, Vientiane, Lao Democratic People's Republic.,Laboratoire National de Santé, Dudelange, Luxembourg
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Vientiane, Lao Democratic People's Republic
| | - Antony P Black
- Lao-Lux-Laboratory, Institute Pasteur Du Laos, Vientiane, Lao Democratic People's Republic
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Hashmi AH, Nyein PB, Pilaseng K, Paw MK, Darakamon MC, Min AM, Charunwatthana P, Nosten F, McGready R, Carrara VI. Feeding practices and risk factors for chronic infant undernutrition among refugees and migrants along the Thailand-Myanmar border: a mixed-methods study. BMC Public Health 2019; 19:1586. [PMID: 31779599 PMCID: PMC6883662 DOI: 10.1186/s12889-019-7825-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/21/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND This study aims to provide a comprehensive understanding of maternal risk factors, infant risk factors and maternal infant feeding practices among refugees and migrants along the Thailand-Myanmar border. METHODS This study employed a mixed-methods approach with two components: (1) cross-sectional survey (n = 390) and (2) focus group discussions (n = 63). Participants were chosen from one of three clinics providing antenatal and delivery services for Karen and Burman refugees and migrants along the border. Participants were pregnant women and mother-infant dyads. RESULTS Refugee and migrant mothers demonstrated high rates of suboptimal breastfeeding and low rates of minimum dietary diversity and acceptable diet. Multivariable regression models showed infant stunting (AOR: 2.08, 95% CI: 1.12, 3.84, p = 0.020) and underweight (AOR: 2.26, 95% CI: 1.17, 4.36, p = 0.015) to have increased odds among migrants, while each 5 cm increase in maternal height had decreased odds of stunting (AOR: 0.50, 95% CI: 0.38, 0.66, p < 0.001) and underweight (AOR: 0.64, 95% CI: 0.48, 0.85, p = 0.002). In addition, small-for-gestational-age adjusted for length of gestation, infant age and gender increased odds of infant's stunting (AOR: 3.42, 95% CI: 1.88, 6.22, p < 0.001) and underweight (AOR: 4.44, 95% CI: 2.36, 8.34, p < 0.001). Using the Integrated Behavioural Model, focus group discussions explained the cross-sectional findings in characterising attitudes, perceived norms, and personal agency as they relate to maternal nutrition, infant malnutrition, and infant feeding practices. CONCLUSIONS Inadequate infant feeding practices are widespread in refugee and migrant communities along the Thailand-Myanmar border. Risk factors particular to maternal nutrition and infant birth should be considered for future programming to reduce the burden of chronic malnutrition in infants.
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Affiliation(s)
- A H Hashmi
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand. .,Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
| | - P B Nyein
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - K Pilaseng
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - M K Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - M C Darakamon
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - A M Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - P Charunwatthana
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - F Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX37FZ, UK
| | - R McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX37FZ, UK
| | - V I Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.,Department of Medicine, Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051, Basel, Switzerland
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Johnson CR, Fischer PR, Thacher TD, Topazian MD, Bourassa MW, Combs GF. Thiamin deficiency in low- and middle-income countries: Disorders, prevalences, previous interventions and current recommendations. Nutr Health 2019; 25:127-151. [PMID: 30798767 DOI: 10.1177/0260106019830847] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Thiamin deficiency is a major public health concern in several low- and middle-income countries (LMICs)-current attention to the problem is lacking. AIM This review discusses prevalence of thiamin insufficiency and thiamin-deficiency disorders (TDDs) in LMICs, outlines programmatic experience with thiamin interventions, and offers recommendations to improve public-health and research attention to thiamin in LMICs. DISCUSSION Thiamin insufficiency, i.e. low-blood-thiamin status, is endemic among several Southeast Asian countries: Cambodia (70-100% of infants and 27-100% of reproductive-age women); Laos (13% of hospitalized infants); Thailand (16-25% of children and 30% of elderly adults). Thiamin deficiency accounts for up to 45% of under-5 deaths in Cambodia, 34% of infant deaths in Laos, and 17% of infant deaths in Myanmar. Deficiency also exists in Africa, Asia, and the Americas, but these instances have typically been isolated. Exclusively breastfed infants of thiamin-deficient mothers are at highest risk for TDD and related death. Intervention strategies that have been employed to combat thiamin deficiency include food processing, fortification, supplementation, dietary diversification, and dietary behaviors, all of which have shown varying levels of effectiveness. CONCLUSIONS We recommend universal thiamin-fortification of context-specific staple-foods in LMICs as a promising solution, as well as thiamin supplementation, particularly for pregnant and lactating women. Food processing regulations, dietary diversification, and modification of dietary behaviors to increase consumption of thiamin-rich foods may provide benefits in some circumstances, especially in countries without universal fortification programs or in populations dependent on food aid.
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Affiliation(s)
| | - Philip R Fischer
- 2 Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, USA
| | | | - Mark D Topazian
- 4 Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA
| | - Megan W Bourassa
- 5 The Sackler Institute for Nutrition Science, The New York Academy of Sciences, New York, USA
| | - Gerald F Combs
- 6 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, USA
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25
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Köhler R, Lambert C, Biesalski HK. Animal-based food taboos during pregnancy and the postpartum period of Southeast Asian women - A review of literature. Food Res Int 2018; 115:480-486. [PMID: 30599968 DOI: 10.1016/j.foodres.2018.10.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/03/2018] [Accepted: 10/07/2018] [Indexed: 11/17/2022]
Abstract
This paper gives an overview of the various taboos on animal products and the reasons behind such practices among women in the member countries of the Association of Southeast Asian Nations (ASEAN), while they are pregnant, during their postpartum period, and while breastfeeding. Three data search engines, Google® Scholar, PubMed and Scopus, were used one after the other, to generate the papers for this review. The online searches using the term food taboo, its synonyms, and truncations, in combination with the terms pregnancy, postpartum, and breastfeeding, and with the country name, were conducted from January to February 2017. In total, 28 papers were pooled and included in this review. The taboos and the justification for avoidance were collated and grouped per their occurrence, and according to the country where they are practiced. Nine papers provided information on the food taboos during pregnancy, 16 on postpartum food taboos, and six on breastfeeding. The food taboos included various river or seafood, meat from terrestrial animals, and derived products like fish paste, blood and internal organs. Healthcare providers should be aware of the food taboos being adhered to in the region to provide the right information and guidance to the women practicing them. There is a need to educate the public in general, and women, in particular, about the risk of malnutrition when food taboos are followed, and to support their nutritional requirements during pregnancy and the postpartum period by promoting dietary diversification. More research could be conducted to fill in the gap in information with regards to the food taboos and their impact in some of the ASEAN members. Culture-sensitive health interventions based on timely research work can contribute to the attainment of the sustainable development goal of reducing the maternal and under-five mortality ratios in Southeast Asia.
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26
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Whitfield KC, Bourassa MW, Adamolekun B, Bergeron G, Bettendorff L, Brown KH, Cox L, Fattal‐Valevski A, Fischer PR, Frank EL, Hiffler L, Hlaing LM, Jefferds ME, Kapner H, Kounnavong S, Mousavi MP, Roth DE, Tsaloglou M, Wieringa F, Combs GF. Thiamine deficiency disorders: diagnosis, prevalence, and a roadmap for global control programs. Ann N Y Acad Sci 2018; 1430:3-43. [PMID: 30151974 PMCID: PMC6392124 DOI: 10.1111/nyas.13919] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 12/20/2022]
Abstract
Thiamine is an essential micronutrient that plays a key role in energy metabolism. Many populations worldwide may be at risk of clinical or subclinical thiamine deficiencies, due to famine, reliance on staple crops with low thiamine content, or food preparation practices, such as milling grains and washing milled rice. Clinical manifestations of thiamine deficiency are variable; this, along with the lack of a readily accessible and widely agreed upon biomarker of thiamine status, complicates efforts to diagnose thiamine deficiency and assess its global prevalence. Strategies to identify regions at risk of thiamine deficiency through proxy measures, such as analysis of food balance sheet data and month-specific infant mortality rates, may be valuable for understanding the scope of thiamine deficiency. Urgent public health responses are warranted in high-risk regions, considering the contribution of thiamine deficiency to infant mortality and research suggesting that even subclinical thiamine deficiency in childhood may have lifelong neurodevelopmental consequences. Food fortification and maternal and/or infant thiamine supplementation have proven effective in raising thiamine status and reducing the incidence of infantile beriberi in regions where thiamine deficiency is prevalent, but trial data are limited. Efforts to determine culturally and environmentally appropriate food vehicles for thiamine fortification are ongoing.
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Affiliation(s)
- Kyly C. Whitfield
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Megan W. Bourassa
- The Sackler Institute for Nutrition ScienceThe New York Academy of SciencesNew YorkNew York
| | - Bola Adamolekun
- University of Tennessee Health Science CenterMemphisTennessee
| | - Gilles Bergeron
- The Sackler Institute for Nutrition ScienceThe New York Academy of SciencesNew YorkNew York
| | - Lucien Bettendorff
- Laboratory of Neurophysiology, GIGA‐NeurosciencesUniversity of LiègeLiègeBelgium
| | | | - Lorna Cox
- Medical Research Council Elsie Widdowson LaboratoryCambridgeUnited Kingdom
| | - Aviva Fattal‐Valevski
- Tel Aviv Medical Center, Dana‐Dwek Children's Hospital, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | | | | | | | - Lwin Mar Hlaing
- National Nutrition Center, Ministry of Health and SportsMyanmar
| | | | | | - Sengchanh Kounnavong
- The Lao Tropical and Public Health Institute, Ministry of HealthVientianeLao PDR
| | - Maral P.S. Mousavi
- Department of Chemistry and Chemical BiologyHarvard UniversityCambridgeMassachusetts
| | - Daniel E. Roth
- Hospital for Sick Children and University of TorontoTorontoOntarioCanada
| | | | - Frank Wieringa
- Institut de Recherche pour le DeveloppmentMontpellierFrance
| | - Gerald F. Combs
- Jean Mayer USDA Human Nutrition Research CenterTufts UniversityBostonMassachusetts
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Ferguson EL, Watson L, Berger J, Chea M, Chittchang U, Fahmida U, Khov K, Kounnavong S, Le BM, Rojroongwasinkul N, Santika O, Sok S, Sok D, Do TT, Thi LT, Vonglokham M, Wieringa F, Wasantwisut E, Winichagoon P. Realistic Food-Based Approaches Alone May Not Ensure Dietary Adequacy for Women and Young Children in South-East Asia. Matern Child Health J 2018; 23:55-66. [DOI: 10.1007/s10995-018-2638-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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28
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Köhler R, Sae-tan S, Lambert C, Biesalski HK. Plant-based food taboos in pregnancy and the postpartum period in Southeast Asia – a systematic review of literature. ACTA ACUST UNITED AC 2018. [DOI: 10.1108/nfs-02-2018-0059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Food taboos during pregnancy and the postpartum period have been linked to increased risk of maternal and neonatal death. This paper aims to present plant-based food restrictions on Southeast Asian women during pregnancy and after giving birth and the rationale behind such cultural practices.
Design/methodology/approach
Google® Scholar, PubMed and Scopus search using the term food taboo, its synonyms and truncations, in combination with the terms pregnancy, postpartum and breastfeeding, and with the name of the Southeast Asian countries, was conducted from January to February 2017. Articles were included in the review if their full texts were accessible online, in English, published from 2005 to 2016 and if they contained primary data from either quantitative or qualitative method.
Findings
A total of 281 articles were downloaded, and 28 were included in this review. The food taboos and the reasons for avoidance were collated and grouped per their occurrence and according to the country or countries where they are practiced. In total, 14 papers generated data on food taboos during pregnancy, 16 papers on postpartum food taboos and/or 6 on breastfeeding.
Research limitations/implications
This review pools together relevant information about plant-based food taboos Southeast Asian women adhere to during pregnancy and after giving birth. However, data are absent for some of the Association of Southeast Asian Nations (ASEAN) countries, and there is a need for more research to get up-to-date information on the local women’s adherence to these cultural practices.
Practical implication
The knowledge of these practices can support stakeholders who are contributing to the reduction of maternal and under-five mortality ratios in Southeast Asia.
Originality/value
This is the first review paper on food taboos covering all ASEAN members and highlighting the need for cultural sensitivity to properly address maternal and child health problems in the region.
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29
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Culture and food security. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2018. [DOI: 10.1016/j.gfs.2018.02.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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30
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Withers M, Kharazmi N, Lim E. Traditional beliefs and practices in pregnancy, childbirth and postpartum: A review of the evidence from Asian countries. Midwifery 2018; 56:158-170. [DOI: 10.1016/j.midw.2017.10.019] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 10/22/2017] [Accepted: 10/23/2017] [Indexed: 11/26/2022]
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31
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Hiffler L, Adamolekun B, Fischer PR, Fattal-Vavleski A. Thiamine content of F-75 therapeutic milk for complicated severe acute malnutrition: time for a change? Ann N Y Acad Sci 2017; 1404:20-26. [PMID: 28905406 DOI: 10.1111/nyas.13458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/25/2017] [Accepted: 08/02/2017] [Indexed: 12/01/2022]
Abstract
Since community-based management of severe acute malnutrition has become the standard of care, the clinical profile of severe acutely malnourished patients admitted to hospitals or inpatient therapeutic feeding centers has changed significantly. These patients are usually very ill and often present with several comorbidities, such as shock, sepsis, and pneumonia. Complicated severe acute malnutrition patients are at risk of thiamine insufficiency, and critically ill patients have higher thiamine requirements. The thiamine content of F-75, the therapeutic milk formula used in the early stabilization phase of refeeding in patients with severe acute malnutrition, seems insufficient. Here, we discuss the need and rationale for a substantial increase in the thiamine content of F-75.
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Affiliation(s)
| | - Bola Adamolekun
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Aviva Fattal-Vavleski
- Pediatric Neurology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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32
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Johnson CR, Porter SG, Coats D, Whitfield KC, Mengkheang K, Topazian MD, Fischer PR. No Camphor Toxicity in Cambodian Infants. Glob Pediatr Health 2017; 4:2333794X17702980. [PMID: 28491925 PMCID: PMC5406147 DOI: 10.1177/2333794x17702980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 02/26/2017] [Indexed: 11/17/2022] Open
Abstract
Thiamine deficiency and beriberi are prevalent in Cambodia, although most infants with nonspecific clinical symptoms of beriberi, including tachypnea, lack echocardiographic evidence diagnostic of the disease. Camphor activates transient receptor potential vanilloid 3 (TRPV3), a nonselective ion channel expressed in the medial preoptic nucleus of the hypothalamus and thought to be important for thermo-sensitivity. Because camphorated ointments are used commonly among Cambodian infants, we hypothesized that topical camphor modulates thermoregulatory behaviors, causing beriberi-simulating tachypnea, separate from any influence of thiamine deficiency. We assessed 9 tachypneic and 10 healthy infants for Tiger Balm use and for presence of camphor in whole blood. However, no camphor was found in blood from any infants, indicating that camphor is unrelated to tachypneic illness in Cambodian infants.
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Affiliation(s)
| | - Samuel G Porter
- Via Christi Medical Center, Wichita, KS, USA.,University of Kansas, Lawrence, KS, USA
| | - Debra Coats
- Eastern Mennonite Missions, Prey Veng, Cambodia
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33
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Conkle J, Kounnavong S, Young M, Stein AD. Premastication and length for age among children under 24 months in Laos. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28449357 DOI: 10.1111/mcn.12456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/24/2017] [Accepted: 03/13/2017] [Indexed: 01/03/2023]
Abstract
Premastication of infant food by caregivers is common in Laos. Premastication is hypothesized to have both positive and negative implications for children, but the net effect of premastication on child health and nutrition is largely unknown because of a lack of research. This study quantitatively describes premastication in 5 provinces of Laos and examines the associations between premastication and the length of young children. We analyzed cross-sectional data from the Laos 2015 Food and Nutrition Security Survey to characterize premastication among children under 2 years of age (n = 1,661) and to test associations between premastication and child length-for-age z-score. We explored associations using multilevel mixed effects linear regression. Among children 0-23 months, 27.2% of mothers reported giving premasticated food in the past week. Receipt of premasticated food was inversely associated with length-for-age z-score after controlling for potential confounders (child's age, ethno-linguistic group, wealth, and parity) among children 6-13 months (β -0.36, CI [-0.68, -0.04]) and among children 14-23 months (β -0.43, CI [-0.81, -0.05]). For breastfed children 0-5 months who received complementary food, the coefficient was similar, but the association was not statistically significant (β -0.42, CI [-1.2, 0.37]). Premastication is a common feeding practice for children 0-23 months of age, and many infants consume premasticated food on a daily basis. There was a negative relationship between premastication and child length. However, given the cross-sectional nature of this study and potential unmeasured confounding factors, reverse causality or confounding cannot be ruled out. Longitudinal studies are needed to develop recommendations on premastication.
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Affiliation(s)
- Joel Conkle
- Nutrition and Health Sciences, Emory University, Atlanta, Georgia, USA
| | - Sengchanh Kounnavong
- Division of Health System Research, National Institute of Public Health, The Ministry of Health, Vientiane, Laos
| | - Melissa Young
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
| | - Aryeh D Stein
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Fok D, Aris IM, Ho J, Lim SB, Chua MC, Pang WW, Saw SM, Kwek K, Godfrey KM, Kramer MS, Chong YS. A Comparison of Practices During the Confinement Period among Chinese, Malay, and Indian Mothers in Singapore. Birth 2016; 43:247-54. [PMID: 27018256 PMCID: PMC4992357 DOI: 10.1111/birt.12233] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Confinement (restrictions placed on diet and practices during the month right after delivery) represents a key feature of Asian populations. Few studies, however, have focused specifically on ethnic differences in confinement practices. This study assesses the confinement practices of three ethnic groups in a multi-ethnic Asian population. METHODS Participants were part of a prospective birth cohort study that recruited 1,247 pregnant women (57.2% Chinese, 25.5% Malay, and 17.3% Indian) during their first trimester. The 1,220 participants were followed up 3 weeks postpartum at home when questionnaires were administered to ascertain the frequency of adherence to the following confinement practices: showering; confinement-specific meals; going out with or without the baby; choice of caregiver assistance; and the use of massage therapy. RESULTS Most participants reported that they followed confinement practices during the first 3 weeks postpartum (Chinese: 96.4%, Malay: 92.4%, Indian: 85.6%). Chinese and Indian mothers tended to eat more special confinement diets than Malay mothers (p < 0.001), and Chinese mothers showered less and were more likely to depend on confinement nannies during this period than mothers from the two other ethnic groups (p < 0.001 for all). Malay mothers tended to make greater use of massage therapy (p < 0.001), whilst Indian mothers tended to have their mothers or mothers-in-law as assistant caregivers (p < 0.001). CONCLUSION Most Singapore mothers follow confinement practices, but the three Asian ethnic groups differed in specific confinement practices. Future studies should examine whether ethnic differences persist in later childrearing practices.
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Affiliation(s)
- Doris Fok
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Izzuddin M. Aris
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and
Research (A*STAR), Singapore
| | - Jiahui Ho
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Sok Bee Lim
- Department of Child Development, KK Women’s & Children’s Hospital (KKH), Singapore
| | - Mei Chien Chua
- Department of Neonatology, KK Women’s and Children’s Hospital (KKH)
| | - Wei Wei Pang
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore and Head, Myopia Unit, Singapore Eye Research Institute, Singapore
| | - Kenneth Kwek
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital (KKH)
| | - Keith M. Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, Southampton and Director at NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Michael S. Kramer
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, and Professor at the Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Canada
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) and Senior Consultant and Associate Professor at the Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore
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Sychareun V, Somphet V, Chaleunvong K, Hansana V, Phengsavanh A, Xayavong S, Popenoe R. Perceptions and understandings of pregnancy, antenatal care and postpartum care among rural Lao women and their families. BMC Pregnancy Childbirth 2016; 16:245. [PMID: 27561359 PMCID: PMC4997701 DOI: 10.1186/s12884-016-1031-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/15/2016] [Indexed: 11/30/2022] Open
Abstract
Background Lao People’s Democratic Republic (Lao PDR) has the highest maternal mortality rate (MMR) and infant mortality rate (IMR) due to traditional practice and beliefs on pregnancy, delivery and postpartum. The objective of this study was to get a better understanding of cultural beliefs and practices surrounding pregnancy, ANC and postpartum care among rural women in Lao PDR. Methods Eight focus group discussions and 52 interviews were carried out with delivered women, husbands, mothers, traditional birth attendants, head villagers, Lao Women’s Union members and healthcare workers, in Khammouane and Champasack provinces in Lao PDR. In order to accurately grasp participants’ perceptions and understandings, content analysis was used to analyze the transcripts. Results Most women in the study claimed to have attended ANC, but participants also explained that it was unnecessary to attend ANC and give birth at a clinic if the woman felt healthy. Factors that discouraged ANC attendance and giving birth at clinics included: time and money constraints; the perceived necessity of giving birth on a “hot bed”; the need for “mother-roasting” after giving birth; the belief that preparing for a birth was a bad omen for the birth; the belief that colostrum is unhealthy for the newborn child; and the preference for cutting the umbilical cord with a piece of sharpened bamboo. Conclusions Harmful cultural practices such as discarding colostrum should be discouraged; beneficial practices such as family involvement in birthing and keeping a mother warm after birth could be integrated into biomedical practice. Given the prevalence and importance of the cultural understandings we have described in this study, it is clear that proposed changes in cultural practices need to be addressed with sensitivity and that community stakeholders and trusted leaders will need to be involved.
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Affiliation(s)
- Vanphanom Sychareun
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic.
| | - Vathsana Somphet
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Kongmany Chaleunvong
- Faculty of Basic Sciences, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Visanou Hansana
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Alongkone Phengsavanh
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Sisouvanh Xayavong
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Rebecca Popenoe
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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Nguyen TT, Nguyen PH, Hajeebhoy N, Nguyen HV, Frongillo EA. Infant and young child feeding practices differ by ethnicity of Vietnamese mothers. BMC Pregnancy Childbirth 2016; 16:214. [PMID: 27502920 PMCID: PMC4977888 DOI: 10.1186/s12884-016-0995-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 07/29/2016] [Indexed: 11/10/2022] Open
Abstract
Background Limited studies have examined ethnic variation in breastfeeding and complementary feeding practices in developing countries. This study investigated ethnic variation in feeding practices in mothers with children 0–23 months old in Vietnam. Methods We used data on 1875 women who came from the ethnic majority, Kinh (n = 989, randomly sampled from 9875 surveyed Kinh mothers, 10 % from each province) and three ethnic minorities: E De-Mnong (n = 309), Thai-Muong (n = 229) and Tay-Nung (n = 348). Ethnic minorities were compared with the Kinh group using logistic regression model. Results Prevalence of breastfeeding initiation within an hour of birth was 69 % in Thai-Muong, but ~50 % in other ethnicities. In logistic regression, the prevalence of breastfeeding within one hour was lower in Tay-Nung (OR: 0.54; 95 % CI: 0.38, 0.77) than the majority Kinh. Prevalence of exclusive breastfeeding under 6 months was 18, 10, 17, and 33 % in Kinh, Thai-Muong, Tay-Nung, and E De-Mnong, respectively; compared to the majority Kinh, the prevalence was lower in Thai-Muong (OR: 0.42; 95 % CI: 0.25, 0.71) and higher in E De-Mnong (OR: 1.99; 95 % CI: 1.04, 3.82). Overall prevalence of bottle feeding in Thai-Muong and E De-Mnong (~20 %) was lower than in Kinh (~33 %): Thai-Muong (OR: 0.50; 95 % CI: 0.37, 0.68) and E De-Mnong (OR: 0.69; 95 % CI: 0.50, 0.95). Compared with Kinh (75 %), fewer ethnic minority children received minimum acceptable diets (33 % in Thai-Muong, 46 % in E De-Mnong, and 52 % in Tay-Nung; P < 0.05). Prevalence of minimum acceptable diet (met both dietary frequency and diversity) was lower in Thai-Muong (OR: 0.23; 95 % CI: 0.11, 0.46), Tay-Nung (OR: 0.52; 95 % CI: 0.39, 0.69), and E De-Mnong (OR: 0.55; 95 % CI: 0.33, 0.89) than the majority Kinh. Conclusions Breastfeeding practices were suboptimal and differed by ethnicity, which suggests need for tailored interventions at multiple levels to address ethnic-specific challenges and norms. Complementary feeding practices were less optimal among ethnic minorities compared to Kinh, which suggests need for broad intervention including improved food availability, accessibility, and security. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0995-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tuan T Nguyen
- Technical Specialist in Measurement, Learning & Evaluation, Vietnam, Alive & Thrive, Alive & Thrive Project, FHI 360, 7th floor, Ha Noi Tourist Building, 18 Ly Thuong Kiet street, Ha Noi, Vietnam.
| | - Phuong H Nguyen
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Nemat Hajeebhoy
- Technical Specialist in Measurement, Learning & Evaluation, Vietnam, Alive & Thrive, Alive & Thrive Project, FHI 360, 7th floor, Ha Noi Tourist Building, 18 Ly Thuong Kiet street, Ha Noi, Vietnam.,Present Address: Bill & Melinda Gates Foundation, Seattle, WA, USA
| | | | - Edward A Frongillo
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Hiffler L, Rakotoambinina B, Lafferty N, Martinez Garcia D. Thiamine Deficiency in Tropical Pediatrics: New Insights into a Neglected but Vital Metabolic Challenge. Front Nutr 2016; 3:16. [PMID: 27379239 PMCID: PMC4906235 DOI: 10.3389/fnut.2016.00016] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/25/2016] [Indexed: 12/14/2022] Open
Abstract
In humans, thiamine is a micronutrient prone to depletion that may result in severe clinical abnormalities. This narrative review summarizes current knowledge on thiamine deficiency (TD) and bridges the gap between pathophysiology and clinical presentation by integrating thiamine metabolism at subcellular level with its function to vital organs. The broad clinical spectrum of TD is outlined, with emphasis on conditions encountered in tropical pediatric practice. In particular, TD is associated with type B lactic acidosis and classic forms of beriberi in children, but it is often unrecognized. Other severe acute conditions are associated with hypermetabolism, inducing a functional TD. The crucial role of thiamine in infant cognitive development is also highlighted in this review, along with analysis of the potential impact of TD in refeeding syndrome during severe acute malnutrition (SAM). This review aims to increase clinical awareness of TD in tropical settings where access to diagnostic tests is poor, and advocates for an early therapeutic thiamine challenge in resource-limited settings. Moreover, it provides evidence for thiamine as treatment in critical conditions requiring metabolic resuscitation, and gives rationale to the consideration of increased thiamine supplementation in therapeutic foods for malnourished children.
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Affiliation(s)
- Laurent Hiffler
- Dakar Unit, Medical Department, Médecins Sans Frontières (MSF) , Dakar , Senegal
| | | | - Nadia Lafferty
- Pediatric Team, Medical Department, Médecins Sans Frontières (MSF) , Barcelona , Spain
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Ruchiwit M, Cowawintaweewat S, Pootong A, Wareenil C, Pawloski LR. An Examination of Determinants That Affect the Health-Service Systems and Health Status of People in the Greater Mekong Subregion. Nurs Midwifery Stud 2016. [DOI: 10.17795/nmsjournal33178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Barennes H, Slesak G, Goyet S, Aaron P, Srour LM. Enforcing the International Code of Marketing of Breast-milk Substitutes for Better Promotion of Exclusive Breastfeeding: Can Lessons Be Learned? J Hum Lact 2016; 32:20-7. [PMID: 26416439 DOI: 10.1177/0890334415607816] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 08/25/2015] [Indexed: 11/16/2022]
Abstract
Exclusive breastfeeding, one of the best natural resources, needs protection and promotion. The International Code of Marketing of Breast-milk Substitutes (the Code), which aims to prevent the undermining of breastfeeding by formula advertising, faces implementation challenges. We reviewed frequently overlooked challenges and obstacles that the Code is facing worldwide, but particularly in Southeast Asia. Drawing lessons from various countries where we work, and following the example of successful public health interventions, we discussed legislation, enforcement, and experiences that are needed to successfully implement the Code. Successful holistic approaches that have strengthened the Code need to be scaled up. Community-based actions and peer-to-peer promotions have proved successful. Legislation without stringent enforcement and sufficient penalties is ineffective. The public needs education about the benefits and ways and means to support breastfeeding. It is crucial to combine strong political commitment and leadership with strict national regulations, definitions, and enforcement. National breastfeeding committees, with the authority to improve regulations, investigate violations, and enforce the laws, must be established. Systematic monitoring and reporting are needed to identify companies, individuals, intermediaries, and practices that infringe on the Code. Penalizing violators is crucial. Managers of multinational companies must be held accountable for international violations, and international legislative enforcement needs to be established. Further measures should include improved regulations to protect the breastfeeding mother: large-scale education campaigns; strong penalties for Code violators; exclusion of the formula industry from nutrition, education, and policy roles; supportive legal networks; and independent research of interventions supporting breastfeeding.
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Affiliation(s)
- Hubert Barennes
- Agence Nationale de Recherche sur le VIH et les Hepatites (ANRS), Phnom Penh, Cambodia ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Université de Bordeaux, Bordeaux, France Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia
| | | | - Sophie Goyet
- Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia
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Barennes H, Phimmasane M, Rajaonarivo C. Insect Consumption to Address Undernutrition, a National Survey on the Prevalence of Insect Consumption among Adults and Vendors in Laos. PLoS One 2015; 10:e0136458. [PMID: 26317772 PMCID: PMC4552653 DOI: 10.1371/journal.pone.0136458] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/03/2015] [Indexed: 11/18/2022] Open
Abstract
Background Insect consumption (entomophagy) is a potentially high nutritious and healthy source of food with high fat, protein, vitamin, fiber and micronutrient content. At least 2 billion people globally eat insects (over 1900 edible species) though this habit is regarded negatively by others. There is a limited amount of data on the perception and consumption of insects. We conducted a national cross-sectional survey in the Lao People’s Democratic Republic (Laos) to assess the prevalence and characteristics of insect consumption among adult lay people and insect vendors. Methods We conducted a multi stage randomized national survey in 1303 households in 96 villages in 16 Lao provinces. Three insect vendors or collectors per village were also included. A standardized pretested questionnaire addressed the following issues: socioeconomic characteristics, type of insects consumed and frequency of consumption, reasons and trends in consumption as well as reports on side effects, over the last 10 years. Results A total of 1059 adults (Sex ratio F/M: 1.2, 30 ethnic groups), and 256 vendors were enrolled. A total of 1025 (96.8%) lay people were currently insect consumers, 135 (13.0%) daily or weekly consumers, and 322 (31.1%) consumed several times per month. For the majority (575, 55.6%) the consumption was infrequent (less than a few times per year) and only 22 (2%) had never eaten insects. Consumption started in childhood. Insect availability was seasonal (670, 63.2%) and respondents would have eaten more insects, if they had been more available (919, 86.7%). Hmong and Leu ethnic groups had significantly lower consumption levels than the general population. Eggs of weaver ants, short-tailed crickets, crickets, grasshoppers, and cicadas were the top 5 insects consumed. Consumption had decreased in the last decade, mostly due to less availability (869; 84.0%) and change of life (29; 5.5%). Of 1059, 80 (7.5%) reported allergy problems and 106 (10.0%) reported some use in traditional medicine. A total of 874 (82.6%) were regular collectors. Insect vendors (Sex ratio F/M: 5.3) were also collectors (185; 72.2%). They dedicated a mean time of 4.7 hours during the last harvesting period. The majority sold insects at markets (141, 55.0%). They had earned, on average, USD 6.0 the day before. Five insects (weaver ant eggs; bamboo worms; short-tailed crickets; crickets; wasps) represented 85% of the market. Conclusion Entomophagy is general in Laos, and well accepted despite a decreasing trend in consumption over the last decade. Its contribution to the Lao diet is limited to a minority of frequent consumers. Income through insect sales benefits mostly women. Consumption varies according to ethnicity, residence and season. Development of insect farming is still at an early stage. It could however increase availability of insects and contribute to the generation of income.
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Affiliation(s)
- Hubert Barennes
- Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao PDR
- Agence Nationale de Recherche sur le VIH et les Hépatites Phnom Penh, Cambodia
- ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Univ. Bordeaux, F-33000 Bordeaux, France
- Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia
- * E-mail:
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Nanthavong N, Black AP, Nouanthong P, Souvannaso C, Vilivong K, Muller CP, Goossens S, Quet F, Buisson Y. Diphtheria in Lao PDR: Insufficient Coverage or Ineffective Vaccine? PLoS One 2015; 10:e0121749. [PMID: 25909365 PMCID: PMC4409043 DOI: 10.1371/journal.pone.0121749] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/03/2015] [Indexed: 11/19/2022] Open
Abstract
Background During late 2012 and early 2013 several outbreaks of diphthe-ria were notified in the North of the Lao People’s Democratic Republic. The aim of this study was to determine whether the re-emergence of this vaccine-preventable disease was due to insufficient vaccination coverage or reduction of vaccine effectiveness within the affected regions. Methods A serosurvey was conducted in the Huaphan Province on a cluster sampling of 132 children aged 12–59 months. Serum samples, socio-demographic data, nutri-tional status and vaccination history were collected when available. Anti-diphtheria and anti-tetanus IgG antibody levels were measured by ELISA. Results Overall, 63.6% of participants had detectable diphtheria antibodies and 71.2% tetanus antibodies. Factors independently associated with non-vaccination against diphtheria were the distance from the health centre (OR: 6.35 [95% CI: 1.4–28.8], p = 0.01), the Lao Theung ethnicity (OR: 12.2 [95% CI:1,74–85, 4], p = 0.01) and the lack of advice on vac-cination given at birth (OR: 9.8 [95% CI: 1.5–63.8], (p = 0.01) while the level of maternal edu-cation was a protective factor (OR: 0.08 [95% CI: 0.008–0.81], p = 0.03). Most respondents claimed financial difficulties as the main reason for non-vaccination. Out of 55 children whose vaccination certificates stated that they were given all 3 doses of diphtheria-containing vaccine, 83.6% had diphtheria antibodies and 92.7% had tetanus antibodies. Furthermore, despite a high prevalence of stunted and underweight children (53% and 25.8%, respectively), the low levels of anti-diphtheria antibodies were not correlated to the nutritional status. Conclusions Our data highlight a significant deficit in both the vaccination coverage and diphtheria vaccine effectiveness within the Huaphan Province. Technical defi-ciencies in the methods of storage and distribution of vaccines as well as unreliability of vac-cination cards are discussed. Several hypotheses are advanced to explain such a decline in immunity against diphtheria and recommendations are provided to prevent future outbreaks.
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Affiliation(s)
| | - Antony P. Black
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao PDR
- Institute of Immunology, Centre de Recherche Public de la Santé / Laboratoire National de Santé, Dudelange, Luxembourg
| | | | | | | | - Claude P. Muller
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao PDR
- Institute of Immunology, Centre de Recherche Public de la Santé / Laboratoire National de Santé, Dudelange, Luxembourg
| | | | - Fabrice Quet
- Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao PDR
| | - Yves Buisson
- Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao PDR
- * E-mail:
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Barennes H, Sengkhamyong K, René JP, Phimmasane M. Beriberi (thiamine deficiency) and high infant mortality in northern Laos. PLoS Negl Trop Dis 2015; 9:e0003581. [PMID: 25781926 PMCID: PMC4363666 DOI: 10.1371/journal.pntd.0003581] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/01/2015] [Indexed: 11/29/2022] Open
Abstract
Background Infantile beriberi (thiamine deficiency) occurs mainly in infants breastfed by mothers with inadequate intake of thiamine, typically among vulnerable populations. We describe possible and probable cases of infantile thiamine deficiency in northern Laos. Methodology/Principal Findings Three surveys were conducted in Luang Namtha Province. First, we performed a retrospective survey of all infants with a diagnosis of thiamine deficiency admitted to the 5 hospitals in the province (2007–2009). Second, we prospectively recorded all infants with cardiac failure at Luang Namtha Hospital. Third, we further investigated all mothers with infants (1–6 months) living in 22 villages of the thiamine deficiency patients’ origin. We performed a cross-sectional survey of all mothers and infants using a pre-tested questionnaire, physical examination and squat test. Infant mortality was estimated by verbal autopsy. From March to June 2010, four suspected infants with thiamine deficiency were admitted to Luang Namtha Provincial hospital. All recovered after parenteral thiamine injection. Between 2007 and 2009, 54 infants with possible/probable thiamine deficiency were diagnosed with acute severe cardiac failure, 49 (90.2%) were cured after parenteral thiamine; three died (5.6%). In the 22 villages, of 468 live born infants, 50 (10.6%, 95% CI: 8.0–13.8) died during the first year. A peak of mortality (36 deaths) was reported between 1 and 3 months. Verbal autopsy suggested that 17 deaths (3.6%) were due to suspected infantile thiamine deficiency. Of 127 mothers, 60 (47.2%) reported edema and paresthesia as well as a positive squat test during pregnancy; 125 (98.4%) respected post-partum food avoidance and all ate polished rice. Of 127 infants, 2 (1.6%) had probable thiamine deficiency, and 8 (6.8%) possible thiamine deficiency. Conclusion Thiamine deficiency may be a major cause of infant mortality among ethnic groups in northern Laos. Mothers’ and children’s symptoms are compatible with thiamine deficiency. The severity of this nutritional situation requires urgent attention in Laos. Infantile thiamine deficiency (beriberi), is rarely seen today after decades of strong public health attention. Infantile beriberi occurs mainly in infants breastfed by mothers with inadequate intake of thiamine. There is evidence of the persistence of infantile thiamine deficiency in Vientiane, the capital of Laos, but insufficient data from outside Vientiane to justify a policy recommendation. We describe possible and probable cases of infantile thiamine deficiency in northern Laos using retrospective and prospective hospital data. In addition we conducted a cross sectional survey in 22 villages where the infants originated. Infantile thiamine deficiency was quite common in retrospective and prospective (hospitals: 54, villages: 17) and cross-sectional surveys (hospital: 4, villages: 10). A second peak of infantile mortality was observed before 6 months and was associated with a high infant mortality in the villages, 106 per 1000 live births (95%CI: 86–128). A total of 60 pregnant mothers and 70 lactating women showed signs of thiamine deficiency. This situation requires urgent attention in Laos.
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Affiliation(s)
- Hubert Barennes
- Agence Nationale de Recherche sur le VIH et les Hépatites, Phnom Penh, Cambodia
- Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao, PDR
- Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia
- ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Univ. Bordeaux, Bordeaux, France
- * E-mail:
| | | | - Jean Pascal René
- Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao, PDR
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Forbes DA. Cross-border promotion of formula milk in Lao People's Democratic Republic and opportunities for breastfeeding promotion. J Paediatr Child Health 2014; 50:575. [PMID: 25041301 DOI: 10.1111/jpc.12663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- David A Forbes
- Paediatrics & Child Health, University of Western Australia, Perth, Western Australia, Australia
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Anderson M, Luangxay K, Sisouk K, Vorlasan L, Soumphonphakdy B, Sengmouang V, Chansamouth V, Phommasone K, Van Dyke R, Chong E, Dance DA, Phetsouvanh R, Newton PN. Epidemiology of bacteremia in young hospitalized infants in Vientiane, Laos, 2000-2011. J Trop Pediatr 2014; 60:10-6. [PMID: 23902672 PMCID: PMC8210834 DOI: 10.1093/tropej/fmt064] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
As data about the causes of neonatal sepsis in low-income countries are inadequate, we reviewed the etiology and antibiotic susceptibilities of bacteremia in young infants in Laos. As Staphylococcus aureus is the leading cause of bacteremia in Lao infants, we also examined risk factors for this infection, in particular the local practice of warming mothers during the first weeks postpartum with hot coals under their beds (hot beds). Clinical and laboratory data regarding infants aged 0-60 days evaluated for sepsis within 72 h of admission to Mahosot Hospital in Vientiane, Laos, were reviewed, and 85 of 1438 (5.9%) infants' blood cultures grew a clinically significant organism. Most common were S. aureus, Escherichia coli and Klebsiella pneumoniae. Whereas no methicillin-resistant S. aureus was found, only 18% of E. coli isolates were susceptible to ampicillin. A history of sleeping on a hot bed with mother was associated with S. aureus bacteremia (odds ratio 4.8; 95% confidence interval 1.2-19.0).
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Affiliation(s)
- Margot Anderson
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Pediatric Department, Tulane University School of Medicine, New Orleans, LA, USA
| | | | | | | | | | | | - Vilada Chansamouth
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Russell Van Dyke
- Pediatric Department, Tulane University School of Medicine, New Orleans, LA, USA
| | - Euming Chong
- Pediatric Department, Tulane University School of Medicine, New Orleans, LA, USA
| | - David A.B. Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Nuffield Department of Medicine, Centre for Tropical Medicine, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, UK
| | - Rattanaphone Phetsouvanh
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Nuffield Department of Medicine, Centre for Tropical Medicine, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, UK
| | - Paul N. Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Nuffield Department of Medicine, Centre for Tropical Medicine, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, UK
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Inoue M, Binns CW. Introducing solid foods to infants in the Asia Pacific region. Nutrients 2014; 6:276-88. [PMID: 24399099 PMCID: PMC3916861 DOI: 10.3390/nu6010276] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 12/20/2013] [Accepted: 12/24/2013] [Indexed: 01/20/2023] Open
Abstract
For infants' optimal growth and development, the introduction of nutritionally suitable solid foods at the appropriate time is essential. However, less attention has been paid to this stage of infant life when compared with studies on breastfeeding initiation and duration. The practice of introducing solid foods, including the types of foods given to infants, in the Asia Pacific region was reviewed. In total nine studies using the same questionnaire on infant feeding practices were analysed to gain a better understanding of trends in the introduction of solid foods in this region. All studies showed less than optimal duration of exclusive breastfeeding indicating an earlier time of introduction of solid foods than recommended by the WHO. Most mothers commonly used rice or rice products as the first feed. In many studies, the timing of introducing solid foods was associated with breastfeeding duration. Compared with the Recommended Nutrient Intakes for infants aged above six months, rice/rice products are of lower energy density and have insufficient micronutrients unless they have been fortified. Although the timing of introducing solid foods to infants is important in terms of preventing later health problems, the quality of the foods should also be considered. Recommendations to improve the introduction of solid foods include measures to discourage prelacteal feeding, facilitating breastfeeding education and providing better information on healthier food choices for infants.
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Affiliation(s)
- Madoka Inoue
- School of Public Health and Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, GPO Box U1987 Perth, Western Australia 6845, Australia.
| | - Colin W Binns
- School of Public Health and Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, GPO Box U1987 Perth, Western Australia 6845, Australia.
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Phoutthakeo P, Otsuka K, Ito C, Sayamoungkhoun P, Kounnavong S, Jimba M. Cross-border promotion of formula milk in Lao People's Democratic Republic. J Paediatr Child Health 2014; 50:51-6. [PMID: 24134830 DOI: 10.1111/jpc.12391] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This study aims to examine the influence of formula milk promotion via the media from Thailand to Lao People's Democratic Republic (PDR), where a cultural and linguistic proximity are shared. METHODS A cross-sectional study was conducted through a structured questionnaire survey and focus group discussion (FGD) with mothers who had children under 2 years of age and lived in Vientiane Capital, Lao PDR. Multivariate logistic regression models were constructed for quantitative data analysis. Content analysis was used for qualitative data analysis. RESULTS Among infants aged 6-23 months, exclusive breastfeeding (EBF) rate for 6 months was 16.1% (n = 106/658). Among infants aged 0-5 months, 17.6% (n = 61/346) was exclusively breastfed at the time of survey (24 h recall). Of 1022 mothers, 89.9% reported frequent exposure to the Thai media's promotion of formula milk through TV commercials and 79.1% identified TV commercial as influential for them to develop a positive attitude towards the use of formula milk. In multivariate logistic regression analyses, mothers who reported a positive attitude towards Thai TV commercial on the formula use (n = 449) were approximately 75% less likely to practice EBF for 6 months than those who reported a negative attitude (n = 64). FGD further revealed that the participants tend to believe in the information in TV commercial for formula milk. CONCLUSION The promotion of formula milk via media from Thailand negatively affects breastfeeding mothers in Lao PDR. Cross-border impacts of promoting formula milk should be addressed globally.
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Affiliation(s)
- Phonephay Phoutthakeo
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Lee HMH, Durham J, Booth J, Sychareun V. A qualitative study on the breastfeeding experiences of first-time mothers in Vientiane, Lao PDR. BMC Pregnancy Childbirth 2013; 13:223. [PMID: 24304510 PMCID: PMC4235169 DOI: 10.1186/1471-2393-13-223] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 11/29/2013] [Indexed: 11/17/2022] Open
Abstract
Background The benefits of breastfeeding are well-recognised. The majority of first-time mothers in the Lao People's Democratic Republic however do not follow WHO guidelines of exclusively breastfeeding for the first six months, and less than half breastfeed for two years. UNICEF identified lack of exclusive breastfeeding as the second highest risk factor for under 5 mortality in Lao PDR, closely following lack of skilled delivery care. This study explored the reasons and influences behind first-time mothers' breastfeeding practices, as well as the role of attitudes, beliefs and experiences in influencing those practices. Methods A qualitative research design was chosen for this exploratory study. Two districts in Vientiane were selected, and in each district four focus group discussions, two with six first-time mothers and two with health staff were undertaken. In addition, sixteen in-depth interviews with first-time mothers and seven individual key informants were conducted. Results Participants demonstrated positive attitudes towards breastfeeding and recognised its importance. Despite this, breastfeeding practices were suboptimal. Few exclusively breastfed for the first six months of the baby’s life and most of the first-time mothers included in the sample had stopped or planned to stop breastfeeding by the time the infant was 18 months of age. Work was named as one of the main reasons for less than ideal breastfeeding practices. Traditional beliefs and advice from health staff and the first-time mothers' own mothers, were important influences on breastfeeding practices. First-time mothers also cited experiencing tension when there were differences in advice they received from different people. Conclusion Overall, the mothers were well-informed on the benefits of breastfeeding, and displayed positive attitudes towards it. Nevertheless, few maintained optimal breastfeeding practices in the first two years of the infant’s life. Further effort needs to be directed at addressing knowledge and non-knowledge barriers to optimal breastfeeding practices. Of particular importance is working with employers, developing supportive employment policies, providing postnatal support and working with lay people and health professionals. Research is also needed to identify the optimal combination of interventions to promote good breastfeeding practices.
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Affiliation(s)
- Hope Mei Hong Lee
- University of Health Sciences, Faculty of Postgraduate Studies, Vientiane, Laos.
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Nutritional status and functional capacity of community-dwelling elderly in Southern Laos. Environ Health Prev Med 2013; 19:143-50. [PMID: 24218019 DOI: 10.1007/s12199-013-0367-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 10/25/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the nutritional status and functional capacity of 144 community-dwelling elderly in three rural ethnic groups, namely, the Oy, the Brau and the Lao, of southern Laos. METHODS The Mini nutritional assessment (MNA) questionnaire and Determine Your Nutritional Health checklist were used to assess nutritional status. The Barthel Activities of Daily Living questionnaire and Lawton and Brody's Instrumental Activities of Daily Living questionnaire were used to assess the functional capacity of the respondents. RESULTS The MNA score results indicated that 92.5 % of Oy respondents, 85.4 % of Brau respondents and 60 % of Lao respondents were malnourished. Analysis of variance tests showed that the MNA scores of the Oy and Lao ethnic groups and of the Brau and Lao ethnic groups were significantly different ( both p < 0.01), but that there was no significant difference between the MNA scores of the Oy and Brau ethnic groups (p > 0.05). In terms of functional capacity, 47.2 % of Oy respondents, 43.9 % of Brau respondents and 20 % of Lao respondents had limitations in their activities of daily living, whereas 98.1 % of Oy respondents, 97.6 % of Brau respondents and 86 % of Lao respondents had limitations in their instrumental activities of daily living. Body mass index, reduced appetite, number of meals consumed daily and presence of common diseases predicted nutritional status in all three ethnic groups; the remaining factors differed by ethnicity. This result implies that ethnic differences and other factors, such as location of the village, services, resources within the village and respondents' lifestyles, can affect nutritional status. CONCLUSIONS Because predictors of nutritional status varied by ethnicity, there is a need for area-specific interventions aimed at improving the quality of life of the elderly in these areas.
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Ruchiwit M. Determinants affecting the well-being of people in the Greater Mekong Subregion countries. Nurs Health Sci 2012; 15:94-100. [PMID: 23240684 DOI: 10.1111/nhs.12004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 08/23/2012] [Accepted: 09/13/2012] [Indexed: 11/30/2022]
Abstract
The aim of this research was to examine the determinants/factors affecting the well-being of the Thai and Lao people, and the factors that predict the well-being of those respective peoples. Eight hundred and sixty participants were recruited from three major regions of Thailand and Laos and were selected using multistage random sampling. A self-reported well-being questionnaire was developed using the theoretical framework of Maslow's hierarchy of needs, and a questionnaire assessing their perceptions/attitudes concerning the factors affecting their well-being was administered. The major findings were the following: (i) the factors affecting the well-being and the self-reported well-being of Thais and Laotians were significantly different; and (ii) the factors predicting the well-being of Thais included the living and working environment and the availability of medical information and technology at their hospitals. On the other hand, one of the factors predicting the well-being of Laotians was their attitudes toward their society and its cultural values. A comprehensive and system-wide review of mental-health policy planning to improve the well-being of people in Thailand and Laos in accordance with those predicted factors is recommended.
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Affiliation(s)
- Manyat Ruchiwit
- Department of Mental Health and Psychiatric Nursing, Thammasat University, Klong Luang, Pathumthani, Thailand.
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Budzynska K, Gardner ZE, Dugoua JJ, Low Dog T, Gardiner P. Systematic review of breastfeeding and herbs. Breastfeed Med 2012; 7:489-503. [PMID: 22686865 PMCID: PMC3523241 DOI: 10.1089/bfm.2011.0122] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Despite popular and historical use, there has been little modern research conducted to determine the safety and efficacy of herb use during breastfeeding. The purpose of this study was to systematically review the clinical literature on herbal medicine and lactation. METHODS The databases PubMed, CAB Abstracts, Cochrane Central Register of Controlled Trials, HealthSTAR, Cumulative Index to Nursing and Allied Health Literature, and Reprotox were systematically searched for human trials from 1970 until 2010. Reference lists from relevant articles were hand-searched. RESULTS Thirty-two studies met the inclusion criteria. Clinical studies were divided into three categories: survey studies (n=11), safety studies (n=8), and efficacy studies (n=13). Six studies were randomized controlled trials. The most common herbs studied were St. John's wort (Hypericum perforatum L.) (n=3), garlic (Allium sativum L.) extract (n=2), and senna (Cassia senna L.) (n=2). Studies were very heterogeneous with regard to study design, herbal intervention, and outcome measures. Overall, poor methodological quality predominated among the studies. CONCLUSIONS Our review concludes that further research is needed to assess the prevalence, efficacy, and safety of commonly used herbs during breastfeeding.
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Affiliation(s)
- Katarzyna Budzynska
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA
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