The Role of Breastfeeding in the Prevention of Childhood Malnutrition

Galactagogue activity of poly-herbal decoction from Indonesia: a randomized open label controlled trial

OBJECTIVES

Indonesia have several herbs empirically used as galactagogue. However there are limited clinical evidence regarding the efficacy and safety of this herbs especially poly-herb. The aim of this study was to assess the efficacy and safety of polyherbal galactagogue (PHG) consist of katuk leaves, torbangun leaves and papaya leaves compared to commercial galactagogue capsules (CGC) that contain a single plant extract, katuk leaves.

METHODS

This study was an open label randomized controlled trial with 120 subjects that randomly assigned into two groups, PHG and CGC. This study was conducted at the herbal medicine research house (Rumah Riset Jamu/RRJ) Hortus Medicus and 30 subsites in Central Java and Jogjakarta provinces from July to November 2018. Duration of intervention 28 days. Parameter of efficacy breast milk volume, baby weight, prolactin level and parameter of safety ALT, AST, Urea, Creatinin were performed at baseline, day 14 and 28. The symptom of side effects also recorded every week.

RESULTS

Breast milk volume and infant's weight increased at day-14 and 28 in both groups. However, prolactin level in both groups decreased. There were no significant differences of efficacy parameters at baseline in both groups. At three times measurement of ALT, AST, Urea and Ceratinin average levels were within the normal range. About 3-5% mothers experience higher ALT, AST and nausea that can tolerated well. No side effect was found in infants.

CONCLUSIONS

PHG and CGC have the equal efficacy and safety as a galactagogue. The optimal used is for 14 days.

Undernutrition among children and its determinants across the parliamentary constituencies of India: a geospatial analysis

In India, undernutrition among children has been extremely critical for the last few decades. Most analyses of undernutrition among Indian children have used the administrative boundaries of a state or a district level as a unit of analysis. This paper departs from such a practice and focuses instead on the political boundaries of a parliamentary constituency (PC) as the unit of analysis. The PC is a critical geopolitical unit where political parties and party candidates make election promises and implement programmes to improve the socio-economic condition of their electorate. A focus on child undernutrition at this level has the potential for greater policy and political traction and could lead to a paradigm shift in the strategy to tackle the problem by creating a demand for political accountability. Different dimensions and new approaches are also required to evaluate the socio-economic status and generate concrete evidence to find solutions to the problem. Given the significance of advanced analytical methods and models embedded into geographic information system (GIS), the current study, for the first time, uses GIS tools and techniques at the PC level, conducting in-depth analysis of undernutrition and its predictors. Hence, this paper examines the spatial heterogeneity in undernutrition across PCs by using geospatial techniques such as univariate and bivariate local indicator of spatial association and spatial regression models. The analysis highlights the high-low burden areas in terms of local hotspots and identifies the potential spatial risk factors of undernutrition across the constituencies. Striking variations in the prevalence of undernutrition across the constituencies were observed. Most of these constituencies that performed poorly both in terms of child nutrition and socio-economic indicators were located in the northern, western, and eastern parts of India. A statistically significant association of biological, socio-economic, and environmental factors such as women's body mass index, anaemia in children, poverty, household sanitation facilities, and institutional births was established. The results highlight the need to bring in a mechanism of political accountability that directly connects elected representatives to maternal and child health outcomes. The spatial variability and pattern of undernutrition indicators and their correlates indicate that priority setting in research may also be greatly influenced by the neighbourhood association.

Micronutrients in infants suffering from cow's milk allergy fed with dietary formulas and breast milk

INTRODUCTION

Cow's milk allergy (CMA) is the most common food allergy in infants. As this food allergy indicates a wide range of clinical syndromes due to immunological reactions to cow's milk proteins, we aimed to evaluate the status of micronutrients in infants suffering from cow's milk allergy.

METHODS

In this historical cohort study, infants with CMA were divided into two equal groups: breastfeeding and diet formula feeding. Data were gathered by a form, including the micronutrients such as iron, selenium, calcium, phosphorus, zinc, and vitamin D. Groups were compared and data were analyzed by the IBM SPSS version 21.

RESULTS

This study involved 60 six-month-old infants, and the findings revealed no significant difference between the two groups concerning magnesium, phosphorus, zinc, and vitamin D. However, infants in the formula-feeding group exhibited significantly elevated mean serum levels of iron and selenium, whereas breastfed infants displayed higher levels of calcium.

CONCLUSION

The findings of this research revealed a significant difference in calcium, selenium, and iron levels between formula-fed and breastfed infants, even though all variables were within the normal range for both groups. In light of these results, conducting further studies with a larger sample size and extended follow-up periods becomes imperative.

Parents' experiences of infant and young child feeding during the COVID-19 pandemic in Ireland

OBJECTIVE

The WHO has urged member states to develop preparedness plans for infant and young child feeding (IYCF) during emergencies. Ireland has no such plan. We aimed to identify the needs of caregivers in Ireland with regards IYCF during the COVID-19 pandemic.

DESIGN

Online survey conducted in May-June 2020.

SETTING

Ireland, during the first period of severely restricted movement due to COVID-19 (lockdown).

PARTICIPANTS

Respondents (n 745) were primary caregivers of a child under 2 years; they were primarily well educated and likely of higher socio-economic status.

RESULTS

Among those who breastfed, being unable to access breast-feeding support groups and being unable to access in-person, one-to-one breast-feeding assistance were the biggest challenges reported. Nearly three quarters of those who had their babies during lockdown reported these challenges: 72·8 % and 68·8 %, respectively. For those using formula, the main challenges were structural in nature; approximately two-thirds of those who had their baby prior to lockdown feared there would be formula shortages and a third were unable to purchase formula due to shortages.

CONCLUSIONS

Regardless of how their babies were fed, parents in Ireland experienced multiple challenges with infant feeding during the COVID-19 crisis. Breast-feeding should be protected, supported and promoted, particularly during an infectious disease pandemic. Additionally, assurances around supply of infant formula could reduce parental stress during a pandemic or emergency. An IYCF in emergencies plan would clearly set out how we could best support and protect the nutrition of the most vulnerable members of our population.

Influence of the Suchana intervention on exclusive breastfeeding and stunting among children aged under 6 months in the Sylhet region of Bangladesh

Exclusive breastfeeding (EBF) provides significant health benefits to children. However, mothers may find it difficult to continue EBF for 6 months. The present analysis aimed to examine the influence of the Suchana intervention-a large-scale programme implemented with the aim of improving the health and nutritional status of mothers and children from poor households in the Sylhet region of Bangladesh-on EBF and stunting among children under 6 months. Baseline and endline data were obtained from the Suchana evaluation. EBF was defined as an infant (<6 months) only receiving breast milk in the previous 24 h. Childhood stunting was defined as a length-for-age z-score of less than -2 among children of the same age. Multiple logistic regression analysis was used to assess the associations of the Suchana intervention with EBF and stunting. EBF prevalence improved from 64% at baseline to 85% at the endline in the intervention area, with the intervention group having 2.25 times higher odds of EBF compared to the control group. Stunting prevalence reduced from 28% at baseline to 24% at the endline in the intervention group, but after controlling for covariates, the association between stunting and the intervention was not significant. However, the interaction analysis showed significantly lower stunting prevalence among EBF children in both intervention and control areas. The Suchana intervention had a positive impact on the EBF practice of rural children in a vulnerable region of Bangladesh, and EBF was identified as a significant factor associated with stunting. The findings suggest that the continuation of the EBF intervention has the potential to have an impact on reducing stunting in the region, highlighting the importance of promoting EBF to improve child health and development.

Treatment Outcomes of Severe Acute Malnutrition and Its Determinants Among Paediatric Patients in Quetta City, Pakistan

Purpose

Severe acute malnutrition (SAM) is the most prevalent reason for admission to a paediatric unit, and it is a leading cause of mortality in many countries, including Pakistan. This study aimed to assess treatment outcomes and associated factors among children aged 6-59 months with severe acute malnutrition.

Patients and Methods

A retrospective cohort study was conducted at the Outpatient Therapeutic Feeding Program Centre established at the Sheikh Khalifa bin Zayed Al Nahyan Medical Complex Quetta. Out of 225 patients' records, data from 182 (80.8%) records were analysed based on the inclusion criteria. The SAM logbook was used as a source of data. Predictors of treatment outcomes were identified by applying a regression model with p<0.05 taken as significant.

Results

One hundred and twenty (65.9%) of the children were diagnosed with SAM, while the remaining 34.1% had Moderate Acute Malnutrition. Ninety-five (52.2%) children were included in the marasmus, while 47.8% were included in the Kwashiorkor cohort. The recovery rate was 68.6%; 22.5% were non-responsive, 11% defaulted on the program, and 3.5% died during management. The multivariate logistic regression identified the presence of diarrhea and the use of amoxicillin as significant prognosticators of treatment outcomes. Consequently, the odds of recovery on SAM among children with diarrhea [AOR = 0.60, 95% CI: (0.35-0.75)] were lower than those without diarrhea. Likewise, children on PO amoxicillin had higher chances of recovery [AOR = 2.45, 95% CI: (2.21-4.68)].

Conclusion

This study found that the recovery rate among children treated for SAM was poor based on the established Sphere Standard recommendation. In addition to community-based educational campaigns, capacity enhancement of OTP and frequent monitoring of services as well as program evaluation based on the management protocol is recommended to reduce the frequency of SAM among children.

Fortified balanced energy-protein supplementation during pregnancy and lactation and infant growth in rural Burkina Faso: A 2 × 2 factorial individually randomized controlled trial

BACKGROUND

Optimal nutrition is crucial during the critical period of the first 1,000 days from conception to 2 years after birth. Prenatal and postnatal supplementation of mothers with multimicronutrient-fortified balanced energy-protein (BEP) supplements is a potential nutritional intervention. However, evidence on the long-term effects of BEP supplementation on child growth is inconsistent. We evaluated the efficacy of daily fortified BEP supplementation during pregnancy and lactation on infant growth in rural Burkina Faso.

METHODS AND FINDINGS

A 2 × 2 factorial individually randomized controlled trial (MISAME-III) was implemented in 6 health center catchment areas in Houndé district under the Hauts-Bassins region. From October 2019 to December 2020, 1,897 pregnant women aged 15 to 40 years with gestational age <21 completed weeks were enrolled. Women were randomly assigned to the prenatal intervention arms receiving either fortified BEP supplements and iron-folic acid (IFA) tablets (i.e., intervention) or IFA alone (i.e., control), which is the standard of care during pregnancy. The same women were concurrently randomized to receive either of the postnatal intervention, which comprised fortified BEP supplementation during the first 6 months postpartum in combination with IFA for the first 6 weeks (i.e., intervention), or the postnatal control, which comprised IFA alone for 6 weeks postpartum (i.e., control). Supplements were provided by trained village-based project workers under direct observation during daily home visits. We previously reported the effect of prenatal BEP supplementation on birth outcomes. The primary postnatal study outcome was length-for-age z-score (LAZ) at 6 months of age. Secondary outcomes were anthropometric indices of growth (weight-for length and weight-for-age z-scores, and arm and head circumferences) and nutritional status (prevalence rates of stunting, wasting, underweight, anemia, and hemoglobin concentration) at 6 months. Additionally, the longitudinal prevalence of common childhood morbidities, incidence of wasting, number of months of exclusive breastfeeding, and trajectories of anthropometric indices from birth to 12 months were evaluated. Prenatal BEP supplementation resulted in a significantly higher LAZ (0.11 standard deviation (SD), 95% confidence interval (CI) [0.01 to 0.21], p = 0.032) and lower stunting prevalence (-3.18 percentage points (pp), 95% CI [-5.86 to -0.51], p = 0.020) at 6 months of age, whereas the postnatal BEP supplementation did not have statistically significant effects on LAZ or stunting at 6 months. On the other hand, postnatal BEP supplementation did modestly improve the rate of monthly LAZ increment during the first 12 months postpartum (0.01 z-score/month, 95% CI [0.00 to 0.02], p = 0.030), whereas no differences in growth trajectories were detected between the prenatal study arms. Furthermore, except for the trend towards a lower prevalence of underweight found for the prenatal BEP intervention at 6 months (-2.74 pp, 95% CI [-5.65 to 1.17], p = 0.065), no other secondary outcome was significantly affected by the pre- or postnatal BEP supplementation.

CONCLUSIONS

This study provides evidence that the benefits obtained from prenatal BEP supplementation on size at birth are sustained during infancy in terms of linear growth. Maternal BEP supplementation during lactation may lead to a slightly better linear growth towards the second half of infancy. These findings suggest that BEP supplementation during pregnancy can contribute to the efforts to reduce the high burden of child growth faltering in low- and middle-income countries.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03533712.

Recovery rate of severe acute malnourished children aged 6-59 months enrolled in outpatient therapeutic program at health posts of Central Gondar zone, Ethiopia

Background: Inadequate intake of food is one of the causes of malnutrition and has significant impact on the deaths of children in low-income countries. Community-based management of acute malnutrition was endorsed as a strategy to alleviate such burdens of child morbidity and mortality associated with malnutrition. Despite outpatient therapeutic program has decentralized to health post level, there is still a lack of adequate evidence regarding the recovery rates from outpatient therapeutic program at health post level in Ethiopia. In addition, the previous body of articles did not show the local situations, particularly the recovery rates of severe acute malnutrition children from outpatient therapeutic program in the central Gondar zone, Ethiopia. Aim: This study aimed to assess recovery rate and associated factors among severe acute malnourished children enrolled to outpatient therapeutic program at health posts of Central Gondar zone, Ethiopia. Methods: This study was a facility-based retrospective cross-sectional study conducted on 349 children who had managed for severe acute malnutrition in outpatient therapeutic program in Central Gondar zone from March to May 2021. A structured and pre-tested data extraction checklist adapted from literatures was used to collect the data. The children were selected using consecutive sampling from 39 health posts. Data were entered, cleaned, coded and analyzed using Stata version 14 software. Binary logistic regression was fitted to identify factors associated with recovery rate from outpatient therapeutic program. Adjusted odds ratio with 95% confidence interval and p-value <0.05 were used to declare the variables statistically significant with the recovery rate from outpatient therapeutic program. Results: The successful recovery rate for severe acute malnourished children admitted to outpatient therapeutic program was 74.2% (95% CI: 69.3, 78.6). False recovery, death, default, non-responder and medical transfer out rates were 12.6%, 8.6%, 2.9%, 0.9% and 0.9%, respectively. In addition, the average weight gain of children was 4.4 g/kg/day for the length of stays, and the average length of stay was also 6.7 (±1.3SD) weeks. Breastfeeding status (AOR = 1.72; 95% CI: 1.05, 2.83), antibiotics (amoxicillin) provision (AOR = 2.14; 95% CI: 1.07, 4.25) and vitamin A supplementation (AOR = 1.93; 95% CI: 1.13, 3.30) were positively associated with the recovery rate of severe acute malnourished children admitted to outpatient therapeutic program. Conclusion: In this study, we found that the recovery, death and default rates were in the acceptable ranges of sphere standards. Therefore, health extension workers shall manage to shape service providers of outpatient therapeutic program with severe acute malnutrition management protocol. Special attention was also needed to build capacity of health extension workers to alleviate knowledge gaps on children enrolled to and discharge from outpatient therapeutic program at health posts. Dietary counselling is essentially required to improve maternal diets, which can affect the nutritional status of breastmilk.

Association of breastfeeding with undernutrition among children under 5 years of age in developing countries: A systematic review and meta-analysis

OBJECTIVE

This meta-analysis was conducted to examine the association between breastfeeding and undernutrition among children under 5 years of age in developing countries.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

A comprehensive literature search was conducted of datasets from Embase, CINHAL, PubMed, Cochrane Library, and Indonesian databases to include eligible studies. Comprehensive Meta-Analysis 3.0 statistical software was used to perform data entry and data analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were extracted from each study or were calculated based on the reported number of cases and controls in each study. Random-effects models or fixed-effects models were used to demonstrate overall risk estimates. A moderator analysis was conducted to examine possible moderators explaining the heterogeneity across studies.

FINDINGS

In total, 33 studies were included which examined the association of breastfeeding with undernutrition. A random-effects model showed that breastfeeding had inverse correlations with overall undernutrition (OR = 0.82, 95% CI = 0.68, 0.99) and the stunting type of undernutrition (OR = 0.73, 95% CI = 0.55, 0.95). A moderator analysis showed that studies which included exclusive breastfeeding and unclear birth weights had low risks of overall undernutrition (p < 0.05). Moreover, studies which included exclusive breastfeeding and adopted a case-control study design exhibited a low risk of the stunting type of undernutrition (p < 0.05).

CONCLUSIONS

Providing breastfeeding or exclusive breastfeeding can benefit children under 5 years of age in developing countries reduce overall undernutrition and the stunting type of undernutrition.

CLINICAL RELEVANCE

Healthcare professionals should develop and implement suitable strategies to increase awareness regarding the importance of breastfeeding and enhance breastfeeding and exclusive breastfeeding adherence.

Decomposing inequality of opportunity in child health in Tanzania: The role of access to water and sanitation

Poor child nutrition is a major public health challenge in Tanzania. Large between and within regional nutritional inequalities exist in rural and urban areas. We looked at how locational circumstances hinder children from having an equal opportunity for good nutrition. We used the 2008/09 Living Standards Measurement Study data for Tanzania to identify the part played by water and sanitation in rural and urban inequality of opportunity in child nutrition. We used the dissimilarity index and the Shapley decomposition technique to quantify and decompose inequality of opportunity in nutrition. We find that 16% of the circumstance-driven inequality of opportunity needs to be redistributed for equality of opportunity to prevail. We find that in rural areas, about 42% of the inequality of opportunity in nutrition is due to water and sanitation problems and 22% to child age. In urban areas, we find that the inequality of opportunity is related mainly to the child's sex, price fluctuations and intergenerational factors. The findings suggest that policies to improve water and sanitation coverage could help equalize opportunities for children in rural areas. In urban areas, policies that could help equalize opportunities require incentives to change social norms and behavior around feeding practices and vaccination.

Infant Feeding Practices, Nutrition, and Associated Health Factors during the First Six Months of Life among Syrian Refugees in Greater Beirut, Lebanon: A Mixed Methods Study

The objective was to describe infant feeding practices, nutrition and related health aspects of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with infants under six months in July-October 2018 (N = 114). Additionally, eleven focus group discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding was low (31%), and exclusive breastfeeding very low (24.6%). One-fifth of the infants were anemic (20.5%) and 9.6% were wasted. A significantly higher proportion of non-exclusively breastfed infants had a fever and took medicines than those who were exclusively breastfed. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and exclusive breastfeeding, along with receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes' distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees, awareness on proper breastfeeding practices, maternal nutrition, and psychosocial support should be provided to mothers and family members alike.

Effects of dairy intake on anthropometric failure in children ages 6 to 23 mo consuming vegetarian diets and fulfilling minimum dietary diversity in India

OBJECTIVES

In India, although nutritional conditions have improved, a high prevalence of anthropometric failure is still reported in children. Unfortunately, there are knowledge gaps surrounding nutrient and anthropometric shortcomings as well as dietary patterns. More than half of children are consuming a vegetarian diet. This study aimed to evaluate the effects of dietary adequacy levels on anthropometric failure in 5772 vegetarian children (ages 6-23 mo) satisfying minimum dietary diversity.

METHODS

Data were collected from the National Family Health Survey 2015-16. We created three food combinations: maximum adequacy (dairy and four food groups), medium adequacy (dairy and three food groups), and minimum adequacy (four food groups excluding dairy). We calculated odds ratios (ORs) for the association between dietary adequacy levels and anthropometric failures with 95% confidence intervals (CIs) using logistic regression models. The modification effect of breastfeeding status was also explored.

RESULTS

Approximately 35% of children had stunted growth. ORs showed a significant increase in the risk of anthropometric failure, notably wasting, and underweight in children with minimum-adequacy diets (OR, 1.46; 95% CI, 1.15-1.86) compared with children with maximum-adequacy diets. Those associations were more pronounced among children who were not breastfed (OR, 2.44; 95% CI, 1.19-5.00) than among children who were (OR, 1.35; 95% CI, 1.04-1.74; P value for the interaction = 0.07). Similar associations were observed for wasting among children who were not breastfed (OR, 2.82; 95% CI, 1.34-5.95) and who were breastfed(OR, 1.12; 95% CI, 0.85-1.5; P value for the interaction = 0.03).

CONCLUSIONS

Dairy is an essential source of nutrients that are required for healthy growth and development in children younger than 2 y, even if they satisfy minimum dietary diversity conditions in India.

Age differences in the impact of a Positive Deviance/Hearth programme on the nutritional status of children in rural Bangladesh

OBJECTIVE

To examine the difference in the rehabilitation rate from underweight by child age at enrolment in the Positive Deviance (PD)/Hearth programme.

DESIGN

This secondary data analysis used programme monitoring records of underweight children aged 6-60 months attending a 2-week PD/Hearth session and followed up for 6 months from September 2018 to March 2019. Data were analysed using multilevel mixed-effect regression and Poisson regression with robust variance.

SETTING

Rajshahi Division, Bangladesh.

PARTICIPANTS

A total of 5227 underweight (weight-for-age Z-score (WAZ) <-2) children attended the PD/Hearth sessions.

RESULTS

From enrolment to 6 months follow-up, the mean WAZ improved from -2·80 to -2·09, and the percentage of underweight children decreased to 54·5 %. Compared to the enrolment age of 6-11 months, the estimated monthly change in WAZ at 6 months of follow-up were 0·05 lower for 12-23 months, 0·06 lower for 24-35 months, and 0·09 lower for 36-60 months of the enrolment age (all P < 0·001). The probability of rehabilitation at 6 months of follow-up were lower by 16·7 % for 12-23 months (RR = 0·83; 95 % CI 0·77, 0·91), 15·5 % for 24-35 months (RR = 0·84; 95 % CI 0·78, 0·92), and 34·9 % for 36-60 months of the enrolment age (RR = 0·65; 95 % CI 0·59, 0·72), compared to the enrolment age of 6-11 months.

CONCLUSIONS

Enrolment in the PD/Hearth programme at a younger age had the advantage of greater rehabilitation from underweight than older age. Our findings provide a better understanding of the successes and failures of the PD/Hearth programme to achieve more sustainable and cost-effective impacts.

Father involvement, maternal depression and child nutritional outcomes in Soweto, South Africa

Father involvement in South Africa is low, despite evidence that it can improve maternal and child health and wellbeing. Within a larger randomised controlled trial, we assessed whether father involvement during and after pregnancy increased birth weight and exclusive breastfeeding through improved maternal mental health. At 6-week postnatal, mothers completed questionnaires on birth, feeding practices, social support, father involvement and postnatal depression. Father involvement during pregnancy was measured by their attendance at antenatal care and the study intervention, whereas postnatal involvement was measured by attendance at antenatal care and type of paternal support provided. Structural equation modelling was used to identify associations between father involvement, maternal depression, low birth weight and exclusive breastfeeding. Among the 212 mother-baby pairs, father involvement was very low with only 43%, 33% and 1% of partners attending early ultrasound, antenatal care and the birth of the child, respectively. Twenty-nine percent of the mothers showed signs of depression during pregnancy, compared with 7% after birth. Eighteen percent of the infants were born low birth weight, and 57% of mothers reported exclusively breastfeeding at 6 weeks. Father involvement was directly associated with postnatal depression, but it did not directly or indirectly impact exclusive breastfeeding or low birth weight. We conclude that postnatal father involvement can improve postnatal maternal depression and that men would benefit from specific guidance on how they can support mothers during and after pregnancy.

Anemia and Nutritional Status of Syrian Refugee Mothers and Their Children under Five Years in Greater Beirut, Lebanon

The objective was to assess the prevalence of anemia and nutritional status of mothers and children under five years among Syrian refugees in Lebanon and to identify nutritional deficiencies among pregnant, lactating, and non-pregnant non-lactating (NPNLM) mothers. A cross-sectional study was conducted among Syrian refugee mothers with children under five years in Greater Beirut, Lebanon (n = 433). Data on socio-economic status, maternal health, lifestyle characteristics, dietary intake, anthropometric measurements, and hemoglobin concentrations were collected. The prevalence of anemia was 21.7% among mothers and 30.5% among children. NPNLM with overweight/obesity and an at-risk waist circumference (WC) had 14.7-times and 10.9-times higher odds of anemia than mothers with normal WC and weight. Children of anemic mothers had 2.7-times and 4.4-times higher odds of total and mild anemia than those of non-anemic. Higher odds of mild anemia were found among children of lactating mothers than of NPNLM. A high percent energy intake of total fat and sugar was found among all mothers. Nutritional inadequacy was identified in higher proportions of lactating and pregnant mothers than NPNLM. Our findings highlighted the co-existence of overnutrition and anemia among Syrian refugee mothers and undernutrition among children from the same household. Culture-specific interventions are needed to support maternal nutrition, to ensure the health and wellbeing of their offspring.

Prevalence and Predictor of Exclusive Breastfeeding among Mothers of 0 to 6 months Infants from Pastoralists and Hunters' Community in Tanzania; A Community Based Cross-Sectional Study

BACKGROUND

Initiating breastfeeding during the first hour after birth and continuing breastfeeding exclusively for 6 months prevents childhood infections such as diarrhoea. Exclusive breastfeeding (EBF) for the first 6 months of life of the baby is recognised globally as the best and the most effective intervention to ensure the survival of babies. The aim of this study was to determine the prevalence of EBF and its predictors among mothers of 0 to 6 months infants from pastoralists and hunters' community in Manyara region-Tanzania.

METHODS

This was a community-based analytical cross-sectional study that involved 342 mothers of 0 to 6 months infants who were randomly selected through 4 stage multistage sampling technique. Data was collected using an interviewer-administered questionnaire. Collected data was analysed using Statistical Package for Social Sciences (SPSS) version 20. Binary Logistic Regression analysis was used to establish factors associated with EBF practices.

RESULTS

The prevalence of EBF among postnatal women from hunters and pastoralists societies was 47.1% at 95% CI=41.7%-52.5%. After adjusted for confounders, the predictors of EBF practice were age of infants (0-1 months, AOR = 2.838 at 95% CI = 1.326-6.075, p=.007), age of mothers (26-35 years, AOR=1.851 at 95% CI= 1.059-3.234, p=.031), Level of education of infants' mothers (primary education, AOR= 2.374 at 95% CI= 1.321-4.265, p=.004) and knowledge on exclusive breast feeding, AOR=2.51 at 95% CI= 1.435-4.393, p=.001.

CONCLUSION

Majority of mothers from pastoralists' and hunters' societies were not practising EBF. Predictors of EBF practice were; the age of infants, maternal age, level of education of the mother and knowledge on exclusive breastfeeding. Poor EBF practice was mainly contributed to low level of knowledge about the EBF. The low level of knowledge could have been contributed by poor access to maternal services. Nature of living (lack of permanent settlement) of the study population could have contributed to low access to maternal services. An innovative interventional study is highly recommended to come up with strategies that will improve knowledge on EBF and practice of EBF.

Effectiveness of various methods of home fortification in under-5 children: where they work, where they do not. A systematic review and meta-analysis

CONTEXT

The common approaches of home fortification (HF) for prevention and/or treatment of micronutrient deficiencies are micronutrient powders (MNPs), foodlets, and lipid-based nutrient supplements (LNSs). There are mixed results for the impact of HF on growth and nutritional status of young children.

OBJECTIVE

This systematic review was prepared in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to evaluate current evidence from randomized controlled trials including children younger than 5 years to assess the effect of strategies of HF on growth and micronutrient status.

METHODS

The MEDLINE, PubMed, Embase, Cochrane Library, and Google Scholar databases were searched to July 2018. A total of 1301 studies were found in a preliminary search. After screening of titles and abstracts, 30 studies were selected.

RESULTS

Treatment with MNPs, foodlets, and LNSs effectively increased hemoglobin concentrations by at least 2.52 g/L, 4.59 g/L, and 4.4 g/dL, respectively, as compared with a control. There was a significant decrease in risk of anemia development after foodlet intervention compared with a control or iron drops (odds ratio, 0.27; 95%CI, 0.10-0.74; P = 0.01). However, these interventions did not result in any significant improvement in z-scores for changes of height for age, weight for age, and weight for height. The results indicated that MNP (7.16; 95%CI, 0.31-14.01; P = 0.04) and foodlet treatment (4.92; 95%CI, 0.28-9.57; P = 0.04) could increase serum zinc levels. However, none of the home fortification methods improved vitamin A status in the target group.

CONCLUSION

Home fortification can be used as an effective method to improve hemoglobin, iron, and zinc status, although in this study it had no effect on vitamin A or anthropometric indicators of the target population. More investigations are warranted for newer approaches of HF to improve a broader range of micronutrients as well as child growth indices and for evaluation of the coverage, compliance, and consistency of such interventions at the population level.

PROSPERO REGISTRATION NO

CRD42018109279.

Relationship between breastfeeding duration and undernutrition conditions among children aged 0-3 Years in Pakistan

Background

The World Health Organization recommends that a child should be breastfed up to 2 years of age as it is essential for proper growth and development but population-based studies around the world have found conflicting results on the subject. Our study aims to analyze whether there is a relationship between the duration of breastfeeding and undernutrition among children aged from birth up to 3 years of age in Pakistan.

Methods

A secondary analysis of the Pakistan Demographic and Health Survey 2013-2014 with 1072 children aged 3 years and under was conducted. The relationship between breastfeeding duration and undernutrition status was estimated through multiple logistic regression analysis.

Results

The prevalence of stunting, wasting and underweight were 40.6%, 15.8% and 33.9% respectively, while prevalence of severe stunting is at 22.5%; severe wasting at 4.5% and severe underweight at 12.2% in children in our study. Odds of being stunted were significantly higher for children in their 3rd year of life [AOR: 4.35, CI 95% = (2.01, 9.33)] compared to children being breastfed in their 2nd year of life [AOR: 2.43, CI 95% = (1.55, 3.79) after being adjusted for maternal, child, demographic and healthcare access variables. Similarly, children being breastfed in their third year of life were more susceptible to developing severe stunting [AOR: 6.19, CI 95% = (3.31, 11.56)] in comparison to children in their second year [AOR: 2.84, CI 95% = (1.81, 4.46)]. There was no significant association between breastfeeding and wasting/severe wasting, or between breastfeeding and underweight/severe underweight.

Conclusion

Breastfeeding in the 2nd and 3rd year of life was found to have significant relationship with stunting and severe stunting. Mothers need to be educated about the risks of prolonged breastfeeding to reduce the burden of undernutrition in the country.

Less than one-fifth of the mothers practised exclusive breastfeeding in the emerging regions of Ethiopia: a multilevel analysis of the 2016 Ethiopian demographic and health survey

BACKGROUND

The burden of low coverage of exclusive breastfeeding (EBF) has a significant impact on the health of a newborn and also on the family and social economy in the long term. Even though the prevalence of EBF practices in Ethiopia is low, the practices in the pastoral communities, in particular, are significantly low and affected by individual and community-level factors. Besides, its adverse outcomes are mostly unrecognised. Therefore, this study aimed to assess the individual and community-level factors of low coverage of EBF practices in the emerging regions of Ethiopia.

METHODS

In this analysis, data from 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A two-stage stratified sampling technique was used to identify 1406 children aged 0 to 23 months in the emerging regions of Ethiopia. A multilevel mixed-effect binary logistic regression analysis was used to determine the individual and community level factors associated with exclusive breastfeeding practices. In the final model, variables with a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were found to be statistically significant factors that affect exclusive breastfeeding practices.

RESULTS

Overall, 17.6% (95% CI: 15.6-19.6) of the children aged 0 to 23 months have received exclusive breastfeeding. Employed mothers (AOR: 0.33, 95% CI: 0.21-0.53), richer household wealth status (AOR: 0.39, 95% CI: 0.16-0.96), mothers undecided to have more children (AOR: 2.29, 95% CI: 1.21-4.29), a child with a history of diarrhoea (AOR: 0.31, 95% CI: 0.16-0.61) were the individual-level factors, whereas Benishangul region (AOR: 2.63, 95% CI: 1.44-4.82) was the community-level factors associated with the exclusive breastfeeding practices.

CONCLUSIONS

Less than one-fifth of the mothers have practised exclusive breastfeeding in the emerging regions of Ethiopia. The individual-level factors such as mother's employment status, household wealth status, desire for more children, presence of diarrhoea and community-level factors such as region have contributed to the low coverage of exclusive breastfeeding. Therefore, the federal and regional health bureaus and other implementers should emphasise to those emerging regions by creating awareness and strengthening the existing community-based health extension program to enhance exclusive breastfeeding practices.

Determinants of Breastfeeding Practices and Its Association With Infant Anthropometry: Results From a Prospective Cohort Study in South India

Introduction

Despite national efforts for promoting exclusive breastfeeding (EBF) during the first 6 months of the infants' life, breastfeeding rates are low in India. Evidence on the interference of supplementary food on optimal nourishment and growth of the infant has also been well-established. Our study was undertaken to assess the effect of breastfeeding practices on infant anthropometry and determine the various factors affecting breastfeeding practices.

Methods

A prospective cohort study - Maternal antecedents of adiposity and studying the transgenerational role of hyperglycemia and insulin (MAASTHI) was conducted at a tertiary care public hospital in Bengaluru, South India. From the consenting women, data such as obstetric history, infant feeding practices, anthropometry of mother and child, the psychosocial status of the women using the Edinburgh Postnatal Depression Scale (EPDS), was collected at baseline and subsequent follow-up: post-delivery and 14 weeks after birth. In this study, we analyzed data collected from April 2016 to April 2018, with descriptive statistics presented in mean and standard deviation, and logistic regression adjusting for confounders.

Results

Among the 240 women enrolled in the study, 33% (n= 80) were using supplementary food for their infants at 14 weeks of infants age. Infants who received supplementary feeding at age 14 weeks had nearly 2.5 times higher odds of being wasted (OR: 2.449, p-value: 0.002) as compared to exclusively breastfed infants.

Conclusion

Infants between 14 to 16 weeks of age who received supplementary feeding were at risk of wasting as compared to exclusively breastfed infants. Despite strong evidence in support of the benefits of exclusive breastfeeding, awareness in urban women in India is low. Increased focus on promoting exclusive breastfeeding is necessary to ensure proper nutritional intake and healthy growth of infants.

Appropriate Infant and Young Child Feeding Practices in an Emergency for Non-Breastfed Infants Under Six Months: The Rohingya Experience

BACKGROUND

Since 25 August, 2017 over 693,000 Rohingya have been forced from Myanmar due to mass violence, seeking refuge in neighboring Bangladesh. Nutritional surveys during 2017 revealed worrying levels of malnutrition and poor infant feeding practices, including high numbers of infants not exclusively breastfeeding. Infants under 6 months who are not exclusively breastfed are particularly vulnerable to morbidity and mortality and require specialized feeding support, especially in emergency contexts.

RESEARCH AIM

To describe Save the Children International's experiences supporting wet nursing, relactation, and artificial feeding for non-breastfed infants under 6 months in the Rohingya Response, Bangladesh.

METHODS

A retrospective analysis was conducted of routine program data and documentation from Save the Children International's infant and young child feeding in emergencies interventions for the Rohingya Response, Bangladesh, from November 2017 to April 2018. The study population were infants under 6 months identified as not breastfed during the initial assessment (N = 15).

RESULTS

Although wet nursing was attempted with all infants, it was successful with 6 (40%) of the infants. Additionally, 1 (6.7%) infant's mother was able to successfully relactate. The remaining infants ended up requiring feeding with human milk substitutes.

CONCLUSION

Gaps exist in operational guidance to support non-breastfed infants with wet nursing and relactation in emergency settings, as well as on how to operationalize safe human milk substitute programming in line with national policies and regulations. There is an urgent need to address this gap to protect the lives of non-breastfed infants in emergencies worldwide.

Demystifying the factors associated with rural-urban gaps in severe acute malnutrition among under-five children in low- and middle-income countries: a decomposition analysis

What explains the underlying causes of rural-urban differentials in severe acute malnutrition (SAM) among under-five children is poorly exploited, operationalized, studied and understood in low- and middle-income countries (LMIC). We decomposed the rural-urban inequalities in the associated factors of SAM while controlling for individual, household, and neighbourhood factors using datasets from successive demographic and health survey conducted between 2010 and 2018 in 51 LMIC. The data consisted of 532,680 under-five children nested within 55,823 neighbourhoods across the 51 countries. We applied the Blinder-Oaxaca decomposition technique to quantify the contribution of various associated factors to the observed rural-urban disparities in SAM. In all, 69% of the children lived in rural areas, ranging from 16% in Gabon to 81% in Chad. The overall prevalence of SAM among rural children was 4.8% compared with 4.2% among urban children. SAM prevalence in rural areas was highest in Timor-Leste (11.1%) while the highest urban prevalence was in Honduras (8.5%). Nine countries had statistically significant pro-rural (significantly higher odds of SAM in rural areas) inequality while only Tajikistan and Malawi showed statistically significant pro-urban inequality (p < 0.05). Overall, neighbourhood socioeconomic status, wealth index, toilet types and sources of drinking water were the most significant contributors to pro-rural inequalities. Other contributors to the pro-rural inequalities are birth weight, maternal age and maternal education. Pro-urban inequalities were mostly affected by neighbourhood socioeconomic status and wealth index. Having SAM among under-five children was explained by the individual-, household- and neighbourhood-level factors. However, we found variations in the contributions of these factors. The rural-urban dichotomy in the prevalence of SAM was generally significant with higher odds found in the rural areas. Our findings suggest the need for urgent intervention on child nutrition in the rural areas of most LMIC.

Maternal nutritional status and child feeding practices: a retrospective study in Santal communities, Birbhum District, West Bengal, India

Background

In West Bengal, according to the National Family Health Survey (NFHS-4) 2015-16, undernutrition and anemia are particularly common among scheduled tribe women and children. The purpose of this research is to assess the nutritional status of Adivasi mothers and child feeding patterns, relevant for clinical practice and the design of future preventive actions. These baseline characteristics were obtained in the scope of a feeding trial aimed at improving the hemoglobin concentration of the index child (6–39 months).

Methods

In February 2015, the baseline survey was conducted in 21 tribal villages. In total, 288 mothers and 307 children were recruited for their hemoglobin levels (HemoCue Hb201+), as well as anthropometric indices height/length, weight and MUAC. By questionnaire-based interview aspects on child feeding practices, childcare, family scheduling, and prenatal care were elucidated.

Results

The majority of mothers belong to the Santal tribe (93.8%). Nearly half of mothers suffered from underweight including severe forms (BMI < 18.5: 49.4%), and the majority of mothers were anemic (Hb < 12 g/dl: 86.2%). Similarly, undernutrition was highly prevalent among the index children. Ever breastfeeding was almost universal in the study area (99.6%), with all infants aged < 12 months at the time of the interview still being breastfed. The majority of children were breastfed within the first hour after birth (75.7%), still every third child (32.2%) was deprived of colostrum. Merely 32.9% of infants were exclusively breastfed for 6 months (180 days) according to the recommendations of the WHO/UNICEF. When relating to the proposed complementary feeding (CF) indicator then 89.6% of children have received CF (mainly family foods/biscuits/plain rice) during the first 6 to 8 months, and 46.8% of children aged 6 to 23 months fulfilled the minimum acceptable diet (2 to 3 meals per day and ≥ 4 food groups per day), corresponding to 58.1% among children aged 12 to 23 months versa 25% among infants aged 6 to 11 months.

Conclusion

The maternal nutritional status was poor and showed interrelations with the nutritional status of the index child. Inadequate feeding and caring practices were common. In particular the younger age group (< 12 months) was found at risk of being offered inadequate CF, which needs to be tackled by future programs.

Trial registration

The trial was retrospectively registered at the German Clinical Trials Register on the 1st July 2019 (DRKS00017388).

Breastfeeding and child survival from 0 to 5 years in Côte d'Ivoire

BACKGROUND

One of the main objectives of health policy-makers is to promote children's growth, development, and survival. The current research evaluates the impact of breastfeeding on infant survival and highlights the major socio-economic determinants of child survival from 0 to 5 years old in Côte d'Ivoire.

METHODS

This study uses Probit estimation to evaluate the impact of the type of breastfeeding on the survival of children aged from 0 to 5 years old. The main socio-economic determinants of child survival were identified and analyzed. The sample of the study covers 7776 children under 5 years old drawn from the Côte d'Ivoire Demographic Health Surveys and the Multiple Indicators cluster survey of 2012.

RESULTS

A child is more likely to survive when immediate exclusive breastfeeding was practiced for up to 6 months. The probability of survival increases significantly when the mother lives in a healthy environment, when she has at least a primary school education, and when she plays a leading role in caring for the children. Likewise, when she better controls the market of some breast milk supplement and she chooses the best milk formula to complete feeding for her baby, the child's chances of survival increase significantly.

CONCLUSION

Health policy-makers must strengthen programs to promote exclusive breastfeeding up to 6 months through social campaigns. It should also strengthen the capacity of health workers (midwives, nurses, doctors, etc.) to better guide and provide training to mothers and young women about childbearing age to allow them to practice exclusive breastfeeding for up to 6 months. It is only after 6 months that they have to complete infant feeding by providing some semi-solid food rich in vitamins, proteins, and minerals. Taking into account the time constraint when they are engaged in economic activity, they must choose the best formula milk to supplement breastfeeding. It is also important to educate women to improve hygiene in their housing, in their neighborhood and in their community in order to promote the welfare and health of their children.

[Factors associated with dietary patterns in the second half of life]

The aim of this paper is to identify eating patterns of children aged 6, 9 and 12 months and their association with socioeconomic, behavioral, birth and nutrition variables. Cross-sectional study with children from a cohort in Viçosa-MG, with 112 children at 6 months, 149 at 9 months and 117 at 12 months. Food intake was assessed by a 24-hour recall and patterns extracted by cluster analysis. Breast milk was identified in at least one dietary pattern every month. There was a low participation of ultra-processed foods in the identified dietary patterns. At month 6, children with lower family income were less likely to belong to the dietary pattern composed of milk formulas. Already overweight/obesity was 3.69 times higher in children who made up the pattern 2 (dairy formulas, vegetables, vegetables, beef and pear). At 12 months height deficit (PR = 3.28) and bottle use (PR = 4.51) were associated with the dietary pattern composed of milk formulas and cow's milk. The dietary patterns identified reflected the important participation of breast milk in children's diets. Dietary patterns with the presence of other types of milk were associated with nutritional deviations and bottle feeding.

The Possible Beneficial Effect of Breastfeeding on the Clinical Course of Urolithiasis Detected During Infancy

Aim: To evaluate the possible effect of breastfeeding duration on the clinical course and treatment of stones detected during infancy. Materials and Methods: Forty-eight infants with renal stones diagnosed between 0 and 23 months were included in this retrospective cohort study. The children were called for regular follow-up visits for the evaluation of physical examination findings, renal size and parenchymal thickness measured by ultrasonography, localization, size and number of stones, spot urine analysis data, metabolic evaluation findings, and duration of breastfeeding and formula use. The relationship between the disease course (progression or stability) and the duration of breastfeeding were assessed from different aspects by considering the original characteristics of the stones at the time of first diagnosis. Results: The mean follow-up period was 46.21 ± 23.22 months, and the most important metabolic risk factor was hypercalciuria with a rate of 29.2%. The mean duration of breast milk intake was longer in children with no disease progression and in those with a reduced size and/or number of stones. The children receiving only breast milk for the first 6 months of life required treatment less and had less growth retardation. Conclusions: Our findings suggest that breastfeeding has critical effects on infantile urolithiasis. Breastfeeding should be encouraged in children with stones particularly detected during infancy. Further studies with a larger case series are needed to reveal the positive effects of breast milk on the clinical course of urolithiasis in children.

Prevalence, duration, and content of television advertisements for breast milk substitutes and commercially produced complementary foods in Phnom Penh, Cambodia and Dakar, Senegal

Promotion of breast milk substitutes (BMS) and inappropriate marketing of commercially produced complementary foods (CPCF), including through television, can negatively influence infant and young child feeding. The World Health Organization International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly (WHA) resolutions prohibit such advertising and require manufacturers and distributors to comply with its provisions; however, such regulations at national level may vary. Advertisements require Ministry of Health approval in Cambodia but are not regulated in Senegal. Television stations were monitored for 13 months in Phnom Penh and for 3 months in Dakar to assess advertisements for BMS and CPCF. Ten television channels (out of 16) in Phnom Penh and four (out of 20) in Dakar aired advertisements for BMS. Three and five channels, respectively, aired advertisements for CPCF. All BMS advertised in Phnom Penh were for children over 1 year of age. BMS products for children 6+ months of age and 1+ years of age were advertised in Dakar. Average air time for BMS advertisements was 189.5 min per month in Phnom Penh and 29.7 min in Dakar. Air time for CPCF advertisements averaged 3.2 min per month and 13.6 min, respectively. Fewer than half of BMS advertisements and three quarters of CPCF advertisements explicitly stated an age of use for products. Nutrition and health claims were common across BMS advertisements. This study illustrates the need to adopt, regulate, monitor, and enforce legislation prohibiting BMS promotion, as well as to implement regulations to prevent inappropriate promotion of CPCF.

Diurnal Cortisol Concentrations and Growth Indexes of 12- to 48-Month-Old Children From Mexico City

CONTEXT

Early life cortisol plays an important role in bone, muscle, and fat mobilization processes, which could influence body composition, affecting anthropometric indicators such as weight and height.

OBJECTIVE

To explore the association between diurnal cortisol levels and growth indexes in children from 12 to 48 months of age.

DESIGN

This study includes data from 404 children from the Programming Research in Obesity, Growth, Environment and Social Stressors Mexican birth cohort. Cortisol was measured in eight saliva samples collected at four time points during the day (from wakeup to bedtime), over 2 days, when the child was either 12, 18, or 24 months old. Total daytime cortisol levels were calculated by averaging the area under the curve (AUC) for the 2 days. Height and weight were measured from 12 to 48 months of age. Growth indexes were constructed according to z scores following World Health Organization standards: weight-for-age z score (Z-WFA), height/length-for-age z score, weight-for-height/length z score (Z-WFH), and body mass index-for-age z score (Z-BMIFA). Mixed models were used to analyze the association between cortisol AUC quartiles and growth indexes.

RESULTS

Cortisol showed an inverted U-shaped association with the four growth indexes. Compared with the first quartile, all quartiles had a positive association with indexes that include weight, with the second quartile having the strongest association, resulting in an average change of β (95% CI) 0.38 (0.13-0.64) for Z-WFA, 0.36 (0.10-0.62) for Z-WFH, and 0.43 (0.17-0.69) for Z-BMIFA.

CONCLUSIONS

Results suggest that early life daytime cortisol levels, as a reflection of hypothalamic-pituitary-adrenal axis development, might influence growth in early infancy.