Feeding patterns, diarrhoeal illness and linear growth in 0-24-month-old children

Maternal and health care workers' perceptions of the effects of exclusive breastfeeding by HIV positive mothers on maternal and infant health in Blantyre, Malawi

Background

HIV-positive mothers are likely to exclusively breastfeed if they perceive exclusive breastfeeding (EBF) beneficial to them and their infants. Nevertheless, very little is known in Malawi about HIV-positive mothers’ perceptions regarding EBF. In order to effectively promote EBF among these mothers, it is important to first understand their perceptions on benefits of exclusive breastfeeding. This study therefore, explored maternal and health care workers’ perceptions of the effects of exclusive breastfeeding on HIV-positive mothers’ health and that of their infants.

Methods

This was a qualitative study within a larger project. Face-to-face in-depth interviews and focus group discussions using a semi- structured interview and focus group guide were conducted. Sixteen HIV-positive breastfeeding mothers, between 18 and 35 years old, were interviewed and data saturation was achieved. Two focus group discussions (FGDs) comprising of five and six adult women of unknown HIV status who were personal assistants to maternity patients, and one FGD with five nurse-midwives working in the maternity wards of Queen Elizabeth Central Hospital in Blantyre, Malawi, were also conducted. Thematic content data analysis was utilized.

Results

The study revealed more positive than negative perceived effects of exclusive breastfeeding. However, the fear of transmitting HIV to infants through breast milk featured strongly in the study participants’ reports including those of the nurse-midwives. Only one nurse-midwife and a few HIV-positive mothers believed that EBF prevents mother-to-child transmission of HIV. Furthermore, participants, especially the HIV-positive mothers felt that exclusive breastfeeding leads to maternal ill- health and would accelerate their progression to full blown AIDS.

Conclusion

While most participants considered exclusive breastfeeding as an important component of the wellbeing of their infants’ health, they did not share the worldwide acknowledged benefits of exclusive breastfeeding in the prevention of mother-to-child transmission (PMTCT) of HIV. These results suggest a need for more breastfeeding education for all mothers, communities and nurse-midwives involved in breastfeeding counseling in the context of HIV infection. Maternal wellbeing promotion activities such as nutrition supplementation need to be included in all PMTCT of HIV programs.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2393-14-247) contains supplementary material, which is available to authorized users.

Promoting appropriate management of diarrhea: a systematic review of literature for advocacy and action: UNICEF-PHFI series on newborn and child health, India

BACKGROUND

Scaling up of evidence-based management and prevention of childhood diarrhea is a public health priority in India, and necessitates robust literature review, for advocacy and action.

OBJECTIVE

To identify, synthesize and summarize current evidence to guide scaling up of management of diarrhea among under-five children in India, and identify existing knowledge gaps.

METHODS

A set of questions pertaining to the management (prevention, treatment, and control) of childhood diarrhea was identified through a consultative process. A modified systematic review process developed a priori was used to identify, synthesize and summarize, research evidence and operational information, pertaining to the problem in India. Areas with limited or no evidence were identified as knowledge gaps.

RESULTS

Childhood diarrhea is a significant public health problem in India; the point (two weeks) prevalence is 9 to 20%. Diarrhea accounts for 14% of the total deaths in under-five children in India. Infants aged 6 to 24 months are at the highest risk of diarrhea. There is a lack of robust nation-wide data on etiology; rotavirus and diarrheogenic E.coli are the most common organisms identified. The current National Guidelines are sufficient for case-management of childhood diarrhea. Exclusive breastfeeding, handwashing and point of use water treatment are effective strategies for prevention of all-cause diarrhea; rotavirus vaccines are efficacious to prevent rotavirus specific diarrhea. ORS and zinc are the mainstay of management during an episode of childhood diarrhea but have low coverage in India due to policy and programmatic barriers, whereas indiscriminate use of antibiotics and other drugs is common. Zinc therapy given during diarrhea can be upscaled through existing infrastructure is introducing the training component and information, education and communication activities.

CONCLUSION

This systematic review summarizes current evidence on childhood diarrhea and provides evidence to inform child health programs in India.

Systematic review of birth cohort studies in South East Asia and Eastern Mediterranean regions

BACKGROUND

Few longitudinal studies of children have taken place in the developing world, despite child mortality being concentrated there. This review summarises the methodologies and main outcomes of longitudinal studies of pre-school children (0 to 59 months) in the World Health Organization's South East Asia (SEA) and Eastern Mediterranean (EM) Regions.

METHODS

A systematic search of literature using pre-defined criteria revealed 7863 papers. After application of quality criteria, 120 studies were selected for analysis.

RESULTS

The search revealed 83 studies in the SEA region and 37 in the EM region, of which 92 were community-based and 8 facility-based. Objectives were diverse but topics included growth (n = 49 studies), mortality (n = 28), nutrition (n = 24), and infectious diseases (n = 33). Only 12 studies focused on non-communicable diseases. Duration ranged from 7 to 384 months. Measurements included anthropometric (n = 56 studies), socioeconomic (n = 50) and biological sampling (n = 25), but only one study was DNA-based.

CONCLUSION

Biobanks have emerged as the most successful approach to generating knowledge about disease causes and mechanisms. Little of this is possible to undertake in the in SEA or EM regions, however. Further longitudinal studies of young children with DNA sampling should be set up to better understand determinants of diseases in low-income countries.

Antisecretory factor as a potential health-promoting molecule in man and animals

Antisecretory factor (AF) is a protein secreted in plasma and other tissue fluids in mammals with proven antisecretory and anti-inflammatory activity; its immunohistological distribution suggests a role in the immune system. The expression level and the distribution of AF protein are altered during an immunological response. Exposure to bacterial toxins induces secretion of AF in plasma, probably reflecting a natural defence mechanism to agents causing diarrhoea, thereby contributing to a favourable clinical outcome and disease termination. An increase of AF levels in plasma by dietary means, such as specially processed cereals (SPC), has been demonstrated in human subjects and animals. Administration of SPC to patients affected by inflammatory bowel disease, gastroenteritis and Ménière's disease relieved symptoms and improved quality of life. A recent study showed the positive effect of SPC diet supplementation on prevention of the effects of exposure to low levels of blast overpressure in rats, reducing the extent of intracranial pressure increase and cognitive function impairment. AF-rich egg yolk powder improved health status in children suffering acute and chronic diarrhoea, reducing the frequency and increasing the consistency of stools. This kind of functional food could be used for prophylaxis in populations exposed to a high risk of morbidity and mortality caused by diarrhoea and as a complementary therapy in patients affected by chronic intestinal inflammatory disease to improve well-being. In pig husbandry AF-inducing diets, owing to their antisecretory activity and anti-inflammatory action, are a suitable option as an alternative to antibiotic growth promoters to counteract post-weaning diarrhoea.

Amamentação no alojamento conjunto

OBJETIVO: avaliar a amamentação em bebês do Alojamento Conjunto, identificar e avaliar as dificuldades no início do aleitamento materno. MÉTODOS: estudo transversal descritivo. A amostra foi constituída de 100 binômios mãe/recém-nascidos, em maternidade pública estadual que atende ao parto de alto risco pelo Sistema Único de Saúde. Utilizando protocolo do Fundo das Nações Unidas para Infância para observação e avaliação da mamada, foram registrados os comportamentos de cada dupla, computando-se a freqüência de comportamentos desfavoráveis ao aleitamento materno exclusivo. Além disso, foram coletados dados no prontuário do bebê e aplicado um questionário com as mães. RESULTADOS: a freqüência de binômios que apresentaram comportamentos sugestivos de sérias dificuldades (escore ruim) com o inicio do aleitamento materno variou entre 16% e 44%, conforme o aspecto da mamada avaliada. As dificuldades encontradas foram: adequação da sucção; má posição corporal da mãe e do bebê durante a mamada; o aspecto da anatomia das mamas; respostas da dupla e afetividade. Estas dificuldades foram mais significantes quando o parto foi cirúrgico (p<0,05) e a mãe não recebeu orientações sobre aleitamento materno (p<0,05). CONCLUSÃO: foi encontrado grande número de binômios mãe/bebê com comportamento sugestivo de dificuldades iniciais na amamentação. Também foi observada a necessidade da realização de um trabalho de orientação junto às mães o quanto antes, a fim de que estas adquiram uma técnica correta de amamentação.

B 221, a medical food containing antisecretory factor reduces child diarrhoea: a placebo controlled trial

AIM

We investigated whether egg yolk in the form of B221 (Salovum), a medical food containing antisecretory factor (AF) might be used for treatment of acute and prolonged diarrhoea.

METHODS

240 children 6-24 months of age, half with acute diarrhoea (<7 days) and half with prolonged diarrhoea (> or = 7 days) were randomly given 2 g of B221 or placebo every 5 h for 3 days, added to an oral rehydration salt solution.

RESULTS

B221 reduced the number of stools in the acute diarrhoea group compared with placebo (day 3, p = 0.0054). Stools normalizing in consistency (day 3, p = 0.053) and recovery within 3 days was commoner in the B221 group (p < 0.001). A successful outcome was recorded in 82.8% in the B221 group, compared to 54.4% in the placebo group. In the group with prolonged diarrhoea the stool consistency normalized earlier in the patients receiving B221 than in the patients receiving placebo (p = 0.008). A successful outcome was obtained in 90.9% and 63.2%, (p = 0.0011) in the B221 and placebo-treated groups respectively.

CONCLUSION

B221, which is a medical food, can be used to significantly improve the condition of children with acute, as well as prolonged diarrhoea caused by a broad range of undefined pathogens.

Duração e fatores associados ao aleitamento materno em crianças menores de 24 meses de idade no estado de Pernambuco

OBJETIVOS: avaliar a duração do aleitamento materno em crianças menores de 24 meses de idade no estado de Pernambuco e verificar a associação de fatores com o aleitamento materno total. MÉTODOS: corte transversal com 852 crianças até 24 meses de idade que fizeram parte da amostra de 2078 menores de cinco anos selecionada para a II Pesquisa Estadual de Saúde e Nutrição. Os dados foram coletados no período de fevereiro a maio de 1997. Utilizou-se a análise de sobrevivência para cálculo da mediana do aleitamento materno e das associações com a situação do domicílio, renda per capita, escolaridade materna, consultas no pré-natal, orientação sobre aleitamento materno, tipo de parto e peso ao nascer. RESULTADOS: através de análise de sobrevivência verificou-se que a duração mediana do aleitamento materno exclusivo, predominante e total foi de 24, 77 e 112 dias, respectivamente. A duração mediana do aleitamento materno total foi significantemente mais prolongada entre as crianças que residiam na Região Metropolitana do Recife (148 dias), cujas mães percebiam um rendimento familiar per capita acima de dois salários mínimos (201 dias), que haviam freqüentado seis ou mais consultas no pré-natal (129 dias) e recebido orientação sobre aleitamento materno durante o pré-natal (126 dias). O peso ao nascer, a alfabetização materna e o tipo de parto não influenciaram significativamente o aleitamento total. CONCLUSÕES: verificou-se um crescimento na duração do aleitamento materno em Pernambuco, particularmente na Região Metropolitana do Recife, demonstrando ser o pré-natal um dos fatores de oportunidade para orientar e incentivar às mães a amamentarem seus filhos.