Complementary feeding practices and nutrient intakes of children aged 6-24 months from Bangladeshi background living in Tower Hamlets, East London: a feasibility study

Optimum birth interval (36-48 months) may reduce the risk of undernutrition in children: A meta-analysis

Background

Although some studies have highlighted short birth interval as a risk factor for adverse child nutrition outcomes, the question of whether and to what extent long birth interval affects better nutritional outcomes in children remains unclear.

Methods

In this quantitative meta-analysis, we evaluate the relationship between different birth interval groups and child nutrition outcomes, including underweight, wasting, and stunting.

Results

Forty-six studies with a total of 898,860 children were included in the study. Compared with a short birth interval of <24 months, birth interval of ≥24 months and risk of being underweight showed a U-shape that the optimum birth interval group of 36-48 months yielded the most protective effect (OR = 0.54, 95% CI = 0.32-0.89). Moreover, a birth interval of ≥24 months was significantly associated with decreased risk of stunting (OR = 0.61, 95% CI = 0.55-0.67) and wasting (OR = 0.63, 95%CI = 0.50-0.79) when compared with the birth interval of <24 months.

Conclusion

The findings of this study show that longer birth intervals (≥24 months) are significantly associated with decreased risk of childhood undernutrition and that an optimum birth interval of 36-48 months might be appropriate to reduce the prevalence of poor nutritional outcomes in children, especially underweight. This information would be useful to government policymakers and development partners in maternal and child health programs, especially those involved in family planning and childhood nutritional programs.

Vitamin D deficiency in British South Asians, a persistent but avoidable problem associated with many health risks (including rickets, T2DM, CVD, COVID-19 and pregnancy complications): the case for correcting this deficiency

High vitamin D deficiency rates, with rickets and osteomalacia, have been common in South Asians (SAs) arriving in Britain since the 1950s with preventable infant deaths from hypocalcaemic status-epilepticus and cardiomyopathy. Vitamin D deficiency increases common SA disorders (type 2 diabetes and cardiovascular disease), recent trials and non-linear Mendelian randomisation studies having shown deficiency to be causal for both disorders. Ethnic minority, obesity, diabetes and social deprivation are recognised COVID-19 risk factors, but vitamin D deficiency is not, despite convincing mechanistic evidence of it. Adjusting analyses for obesity/ethnicity abolishes vitamin D deficiency in COVID-19 risk prediction, but both factors lower serum 25(OH)D specifically. Social deprivation inadequately explains increased ethnic minority COVID-19 risks. SA vitamin D deficiency remains uncorrected after 70 years, official bodies using 'education', 'assimilation' and 'diet' as 'proxies' for ethnic differences and increasing pressures to assimilate. Meanwhile, English rickets was abolished from ~1940 by free 'welfare foods' (meat, milk, eggs, cod liver oil), for all pregnant/nursing mothers and young children (<5 years old). Cod liver oil was withdrawn from antenatal clinics in 1994 (for excessive vitamin A teratogenicity), without alternative provision. The take-up of the 2006 'Healthy-Start' scheme of food-vouchers for low-income families with young children (<3 years old) has been poor, being inaccessible and poorly publicised. COVID-19 pandemic advice for UK adults in 'lockdown' was '400 IU vitamin D/day', inadequate for correcting the deficiency seen winter/summer at 17.5%/5.9% in White, 38.5%/30% in Black and 57.2%/50.8% in SA people in representative UK Biobank subjects when recruited ~14 years ago and remaining similar in 2018. Vitamin D inadequacy worsens many non-skeletal health risks. Not providing vitamin D for preventing SA rickets and osteomalacia continues to be unacceptable, as deficiency-related health risks increase ethnic health disparities, while abolishing vitamin D deficiency would be easier and more cost-effective than correcting any other factor worsening ethnic minority health in Britain.

The uptake of key Essential Nutrition Action (ENA) messages and its predictors among mothers of children aged 6-24 months in Southern Ethiopia, 2021: A community-based crossectional study

BACKGROUND

Essential nutrition action(ENA) is a framework for managing advocacy, establishing a foundation, and implementing a comprehensive package of preventive nutritional activities. Essential Nutrition Actions study studies provide current information on each nutrition action, allowing health systems to focus more on nutrition, which is critical in tackling the "double burden" of malnutrition: underweight and overweight. Hence, this study aimed at assessing the level of ENA practice and its predictors among mothers of children aged 6 to 24 months in southern Ethiopia.

METHODS

A community-based cross-sectional study was conducted from May 1 to 30, 2021 among randomly selected 633 mothers of children aged 6-24 months. A multi-stage sampling technique was used to access study participants. Data were collected by using a pretested, structured interviewer-administered questionnaire. To identify predictors of ENA practice, bivariable and multivariable logistic regression were used. The strength of the association was measured using an adjusted odds ratio with 95 percent confidence intervals. The statistical significance was declared at a p-value less than 0.05.

RESULTS

A total of 624 participants took part in the study, with a response rate of 98.6%. The uptake of key ENA messages among mothers was measured using 27 items, and it was found to be 47.4% (95% CI: 43.8, 51.4). Complementary feeding was the commonest ENA message practiced by 66.7% of respondents, while prevention of iodine deficiency disorder was practiced by only 33.7% of respondents. Variables namely, mother's education level of college and above [AOR: 3.90, 95% CI: 1.79, 8.51], institutional delivery [AOR: 2.75, 95% CI: 1.17,6.49], having PNC service [AOR: 2.95, 95% CI: 1.91, 4.57], being knowledgeable on ENA message [AOR: 2.37, 95% CI: 1.81, 3.26] and being a model household [AOR: 3.83,95% CI: 2.58, 5.69] were positively associated with a good uptake of key ENA messages. On the other hand, primiparity [AOR: 0.32, 95% CI: 0.21,0.56] was identified as a negative predictor.

CONCLUSION

The overall practice of key Essential nutrition action messages in the study area was low as compared to studies. Stakeholders must step up their efforts to improve and hasten the utilization of maternal and child health services, especially institutional delivery and Postnatal care by focusing on uneducated women to promote compliance to key ENA messages. Furthermore, health workers need to focus on awareness-raising and model household creation.

Effect of short-term educational intervention on complementary feeding index among infants in rural Bangladesh: a randomized control trial

BACKGROUND

Timely, adequate and appropriate Complementary Feeding (CF) is essential for the growth and cognitive development of infants, but until today, evidence-based information is scarce in terms of impact evaluation of CF index (CFI). The study aimed to examine the effect of the short-term intervention of promoting CF practices on the nutritional status of infants in rural Bangladesh.

METHODS

An educational-intervention study followed a randomized controlled trial (RCT) design (NCT03024710). Mothers and family members in the intervention arm received intensive counselling on CF through community health workers (CHWs), whereas existing healthcare services were received in the comparison arm. The study was carried out in the rural Matlab sub-district of Bangladesh between April 2011 and March 2013. In the specified study areas among 360 mother-infant pairs systematically assigned into intervention group and comparison group. Short-term educational intervention on CF was provided for the intervention group and existing services were un-intervened for the comparison group. The outcome of interventions was evaluated after the implementation period using Generalized equation estimation model.

RESULTS

At baseline, the study participants were not different except mean height (p = 0.04), weight-for-age Z score (WAZ) (p = 0.03) and religion (p = 0.04) in between two groups. The mean CFI was significantly higher at intervention area than the comparison and higher category of CFI (score 10 or more) was significantly higher at intervention area than comparison. After adjustment, one-unit CFI increased height-for-age z score by 0.07 units and decreased WAZ by 0.13 units in the intervention group but not significantly changed observed at comparison group.

CONCLUSION

Guided short-term nutritional intervention and developed CFI indicated a significantly better score in intervention area than comparison groups and would be a well adaptable tool for future studies.

TRIAL REGISTRATION

The trial was registered ( NCT03024710 ) at clinical trial registration website. Date of registration: 1/19/2017. Name of the registry: Clinical Trial.gov. Date of registration: 19/1/2017 (retrospective registered). URL of trial: https://clinicaltrials.gov/ct2/show/NCT03024710.

Infant and Child Feeding Index and nutritional status of children aged 6 to 24 months in a Metropolitan city

Background:

The nutritional status of children is influenced by feeding practices. Infant and Child Feeding Index (ICFI) is an age-specific composite index to assess the feeding practices of children.

Objectives:

To determine the association between ICFI and the nutritional status of children aged 6 to 24 months. To find whether ICFI has value as a tool for detecting poor nutritional status. To determine the association of ICFI and nutritional status with sociodemographic and other factors.

Methods:

A cross-sectional study was conducted in the urban field practice area of a tertiary care institute among 149 children aged 6 to 24 months and their mothers. Data on feeding practices were obtained and ICFI scores were calculated. The weight and length of the children were measured and Z scores (WAZ, LAZ, and WLZ) were calculated. A Chi-square test was used to find the association between the categorical variables.

Results:

We found no association between ICFI and any of the three nutritional indicators such as WAZ, LAZ, and WLZ. The sensitivity of the ICFI was low for detecting underweight (10.0%), stunting (29.4%), and wasting (11.1%). ICFI was significantly associated with the growth monitoring of children and mothers' education. WAZ was significantly associated with mother's education and socioeconomic class.

Conclusions:

There is no association between ICFI and the nutritional status of children. ICFI has limited value in detecting the poor nutritional status of children in this urban setting. Maternal education and growth monitoring of children play an important role in infant and child feeding practices.

Formulation of nutrient enriched germinated wheat and mung-bean based weaning food compare to locally available similar products in Bangladesh

Poor weaning practice and malnutrition among under 5 (yrs) children are still major public health issues in Bangladesh. This study aimed to develop a cheap and nutritious weaning food for the children of Bangladesh. For this purpose, three weaning formulations of Q1, Q2, and Q3 with different ratios of germinated wheat, germinated mung-bean, and soya-bean, and a constant amount of sweet potato, sugar, salt, and milk flavor were processed and evaluated. The prepared formulations were investigated for proximate composition and sensory evaluation and compared with six commercial weaning food products. The proximate composition values indicated that the fat content of formulated foods ranged between 09.29% and 11.40%. The carbohydrate content was ranged between 52.80% and 61.20%, which was low compared with commercial ones. The protein content of the formulated foods was 20.33%-27.70%, and that was approximately two times more than available commercial foods. The energy content was also more than locally available commercial weaning foods, which were 411.40 ± 1.51 kcal to 419.30 ± 1.12 kcal. Sample Q2 had an 8.4 acceptance score in sensory analysis of a 9-point hedonic scale scorecard, which made it more acceptable than the other two samples. The values of mineral elements (Na, K, Fe) were similar to all analyzed varieties of commercial weaning foods. This nutrient-enriched weaning food will easily be affordable for the people of developing countries like Bangladesh. The results showed that the formulated weaning food had the desired characteristics of a weaning food; hence, it could decrease malnutrition in children.