1.  Title: Undernutrition malnutrition in infants in developing countries [letter] Author: Ashorn P; Phuka JC; Maleta K; Thakwalakwa C; Cheung YB; Briend A; Manary MJ Source: Archives of Pediatrics and Adolescent Medicine. 2009 Feb;163(2):186. Abstract: We commend Dr Humphrey on an insightful and well-written editorial on infant underweight malnutrition and thank her for her interest in our study on this topic. In our trial, provision of fortified spread, a novel lipid-based nutrient supplement, to Malawian infants was associated with a markedly reduced incidence of severe stunting between 6 and 18 months of age. Yet, there was a large decrease in mean height-for-age, indicating that even the infants given supplementation often failed to maintain normal growth during this critical age. Dr Humphrey proposes 2 explanations for how this might be linked to insufficient dietary intakes: breast-milk displacement and increased energy and nutrient needs due to high rates of disease. Whereas the former has been documented in other settings, we found little evidence supporting this theory in our study area. Diarrhea, malaria, and respiratory infections, on the other hand, are common and associated with infant stunting in this population. Malaria incidence has recently declined, apparently owing to the frequent use of bed nets, but other childhood infections may well have contributed to the growth faltering of our study participants. Besides events after birth, we would like to emphasize the importance of antenatal factors for linear growth failure in many low-income countries. Due to a high proportion of preterm births and the frequency of intrauterine growth retardation, Malawian children are already shorter than expected at birth. In the present trial, mean length-for-age was below a -1 z score by age 6 months.1 In such conditions, it is difficult to prevent growth faltering solely with postnatal interventions; instead, these interventions need to be complemented with others that address antenatal problems, such as maternal undernutrition and infections. On the other hand, when fetal conditions are less distressing and stunting has not started by 6 months of age, an isolated nutrition intervention may prove sufficient. This was illustrated in a recent trial in Ghana, where infants who were given a lipid-based nutrient supplement that was not very different from the one we used in Malawi lost no length-for-age between 6 and 12 months of age. (full-text) Language: English Keywords: MALAWI | CRITIQUE | INFANT | MALNUTRITION | CALORIC INTAKE | SUPPLEMENTARY FEEDING | INTRAUTERINE GROWTH RETARDATION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition Disorders | Diseases | Nutrition | Health | Infant Nutrition | Congenital Abnormalities | Neonatal Diseases and Abnormalities Document Number: 330227 |
| 2. Peer Reviewed Title: A feeding education program to prevent mother-to-child transmission of HIV in Haiti. Author: Deschamps MM; Devieux JG; Theodore H; Saint-Jean G; Antillus L; Cadot I; Pape JW; Malow RM Source: AIDS Care. 2009 Mar;21(3):349-54. Abstract: In Haiti, as in most of the developing world, vertical transmission of HIV from infected mother to infant through postpartum breastfeeding remains a significant mode of transmission. As part of their prevention of mother-to-child transmission program, the Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) Centers developed a feeding education program in which over 83% of the HIV-positive pregnant women who were eligible to participate, enrolled. Bivariate and adjusted multivariate logistic regression analyses were used to compare feeding choices of the 290 women who participated in the feeding education program to 58 who did not. Of those who participated, 91.7% chose to use replacement formulas for their newborns, while 75.9% of those who did not participate chose replacement feeding. After adjustment for socio-demographic variables, analyses revealed that the no education group was less likely to adopt replacement feeding and more likely to use mixed feeding (OR=0.31, p=0.004; and OR=2.74, p=0.05, respectively). This suggests that a targeted and culturally appropriate education program can be effective in encouraging replacement feeding, even in those countries where breastfeeding is the norm. Language: English Keywords: HAITI | RESEARCH REPORT | CONTROL GROUPS | PREGNANT WOMEN | PERSONS LIVING WITH HIV/AIDS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HEALTH EDUCATION | BREASTFEEDING, EXCLUSIVE | WEANING | SUPPLEMENTARY FEEDING | ANTIRETROVIRAL THERAPY | Developing Countries | Caribbean | Americas | Research Methodology | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Disease Transmission Control | Prevention and Control | Education | Breastfeeding | Infant Nutrition | Nutrition | Health | HIV Document Number: 341855 |
| 3. Peer Reviewed Title: Trends in infant nutrition in Saudi Arabia: compliance with WHO recommendations. Author: El Mouzan MI; Al Omar AA; Al Salloum AA; Al Herbish AS; Qurachi MM Source: Annals of Saudi Medicine. 2009 Jan-Feb;29(1):20-3. Abstract: BACKGROUND AND OBJECTIVE: The WHO recommends exclusive breastfeeding in the first 6 months of life. Our objective was to evaluate trends in infant nutrition in Saudi Arabia and the degree of compliance with WHO recommendations. SUBJECTS AND METHODS: A nationwide nutritional survey of a sample of Saudi households was selected by the multistage probability sampling procedure. A validated questionnaire was administered to mothers of children less than 3 years of age. RESULTS: Of 5339 children in the sample, 4889 received breast milk at birth indicating a prevalence of initiation of 91.6%. Initiation of breastfeeding was delayed beyond 6 hours after birth in 28.1% of the infants. Bottle feeding was introduced by 1 month of age to 2174/4260 (51.4%) and to 3831/4260 (90%) by 6 months of age. The majority of infants 3870/4787 (80.8%) were introduced to "solid foods" between 4 to 6 months of age and whole milk feedings were given to 40% of children younger than 12 months of age. CONCLUSIONS: The current practice of feeding of Saudi infants is very far from compliance with even the most conservative WHO recommendations of exclusive breastfeeding for 4 to 6 months. The high prevalence of breastfeeding initiation at birth indicates the willingness of Saudi mothers to breastfeed. However, early introduction of complementary feedings reduced the period of exclusive breastfeeding. Research in infant nutrition should be a public health priority to improve the rate of breastfeeding and to minimize other inappropriate practices. Language: English Keywords: SAUDI ARABIA | RESEARCH REPORT | NUTRITION SURVEYS | INFANT | HOUSEHOLDS | INFANT NUTRITION | WHO | STANDARDS | BREASTFEEDING, EXCLUSIVE | PREVALENCE | TIME FACTORS | SUPPLEMENTARY FEEDING | AGE FACTORS | BREASTFEEDING | Middle East | Developing Countries | Nutrition | Health | Youth | Population Characteristics | Demographic Factors | Population | Family and Household | Sociocultural Factors | UN | International Agencies | Organizations | Political Factors | Research Methodology | Measurement | Population Dynamics Document Number: 331138 |
| 4. Title: Need to optimise infant feeding counselling: a cross-sectional survey among HIV-positive mothers in Eastern Uganda. Author: Fadnes LT; Engebretsen IM; Wamani H; Wangisi J; Tumwine JK; Tylleskar T Source: BMC Pediatrics. 2009;9:2. Abstract: BACKGROUND: The choice of infant feeding method is important for HIV-positive mothers in order to optimise the chance of survival of their infants and to minimise the risk of HIV transmission. The aim of this study was to investigate feeding practices, including breastfeeding, in the context of PMTCT for infants and children under two years of age born to HIV-positive mothers in Uganda. METHODS: In collaboration with The Aids Support Organisation Mbale, we conducted a cross-sectional survey involving 235 HIV-positive mothers in Uganda. Infant feeding practices, reasons for stopping breastfeeding, and breast health problems were studied. Breastfeeding duration was analysed using the Kaplan-Meier method based on retrospective recall. RESULTS: Breastfeeding was initiated by most of the mothers, but 20 of them (8.5%) opted exclusively for replacement feeding. Pre-lacteal feeding was given to 150 (64%) infants and 65 (28%) practised exclusive breastfeeding during the first three days. One-fifth of the infants less than 6 months old were exclusively breastfed, the majority being complementary fed including breast milk. The median duration of breastfeeding was 12 months (95% confidence interval [CI] 11.5 to 12.5). Adjusted Cox regression analysis indicated that a mother's education, socio-economic status, participation in the PMTCT-program and her positive attitude to breastfeeding exclusively, were all associated with a reduction in breastfeeding duration. Median duration was 3 months (95% CI 0-10.2) among the most educated mothers, and 18 months (95% CI 15.0-21.0) among uneducated mothers. Participation in the PMTCT program and being socio-economically better-off were also associated with earlier cessation of breastfeeding (9 months [95% CI 7.2-10.8] vs. 14 months [95% CI 10.8-17.2] and 8 months [95% CI 5.9-10.1] vs. 17 months [95% CI 15.2-18.8], respectively). The main reasons for stopping breastfeeding were reported as: advice from health workers, maternal illness, and the HIV-positive status of the mother. CONCLUSION: Exclusive breastfeeding was uncommon. Exclusive replacement feeding was practised by few HIV-positive mothers. Well-educated mothers, mothers who were socio-economically better-off and PMTCT-attendees had the shortest durations of breastfeeding. Further efforts are needed to optimise infant feeding counselling and to increase the feasibility of the recommendations. Language: English Keywords: UGANDA | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | MOTHERS | PERSONS LIVING WITH HIV/AIDS | WOMEN IN DEVELOPMENT | INFANT | HIV PREVENTION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | INFANT NUTRITION | BREASTFEEDING | SUPPLEMENTARY FEEDING | BREASTFEEDING, EXCLUSIVE | TIME FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Economic Development | Economic Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Disease Transmission Control | Prevention and Control | Nutrition | Health | Population Dynamics Document Number: 341171 |
| 5. Peer Reviewed Title: Influence of wasting and stunting at the onset of the rainy season on subsequent malaria morbidity among rural preschool children in Senegal. Author: Fillol F; Cournil A; Boulanger D; Cisse B; Sokhna C; Targett G; Trape JF; Simondon F; Greenwood B; Simondon KB Source: American Journal of Tropical Medicine and Hygiene. 2009 Feb;80(2):202-8. Abstract: In sub-Saharan Africa, malaria and malnutrition are major causes of morbidity and mortality in children less than five years of age. To explore the impact of malnutrition on subsequent susceptibility to malaria, a cohort of 874 rural preschool children in Senegal was followed-up during one malaria transmission season from July through December. Data on nutritional status and Plasmodium falciparum parasitemia were collected at baseline. Malaria morbidity was monitored through weekly home visits. Wasted children (weight-for-height z-score < -2) were at lower risk of having at least one subsequent clinical malaria attack (odds ratio = 0.33; 95% confidence interval = 0.13-0.81, P = 0.02), whereas stunting (height-for-age z-score < -2) or being underweight (weight-for-age z-score < -2) was not associated with clinical malaria. Although non-biological explanations such as overprotection of wasted children by their mothers should be considered, immunomodulation according to nutritional status could explain the lower risk of malaria attack among wasted children. Language: English Keywords: IRAN | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | MOTHERS | CHILD CARE | KNOWLEDGE | ATTITUDES | BREASTFEEDING | DEMOGRAPHIC FACTORS | TIME FACTORS | BREASTFEEDING, EXCLUSIVE | SUPPLEMENTARY FEEDING | EDUCATIONAL STATUS | Middle East | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Child Rearing | Behavior | Psychological Factors | Infant Nutrition | Nutrition | Health | Population | Population Dynamics | Socioeconomic Status | Socioeconomic Factors Document Number: 330300 |
| 6. Title: Traditional postpartum practices of women and infants and the factors influencing such practices in South Eastern Turkey. Author: Geckil E; Sahin T; Ege E Source: Midwifery. 2009 Feb;25(1):62-71. Abstract: OBJECTIVE: to gain an understanding of traditional postpartum practices for women and babies, and to investigate the factors influencing such practices. DESIGN: descriptive study. SETTING: Maternity and Children's Hospital in Adiyaman city, Turkey. PARTICIPANTS: 273 women who gave birth at the Maternity and Children's Hospital in Adiyaman city from March to June 2004. FINDINGS: more than half of the 273 women (55.7%) were aged between 25 and 32 years (mean 27.85, standard deviation [SD] 5.45). A total of 22.3% of women were illiterate, and most were unemployed. The most popular practices among new mothers were eating a kind of dessert, called 'Bulamac' (82.8%). A number of women (69.6%) drank a mixture of grape molasses and butter, 64.5% had their abdomen tightly wrapped, 62.6% were not left alone at home, and more than half of the women (57.9%) avoided sexual intercourse for 40 days after giving birth. Nearly, half of the women (45.4%) fed their babies with water containing sugar just after the birth, and 77.1% of women kept their babies' umbilical cord in a special place. Afterwards, the mothers threw the cords into a river or they buried them in the grounds of a mosque or a school. Most of the mothers (89%) reported that they covered their babies with a yellow cloth in order to protect them from jaundice. A relationship between traditional postpartum practices and demographic characteristics of women was observed. The women's mothers and mothers-in-law (66.7%) usually encouraged such practices. KEY CONCLUSIONS: postpartum care of women and their babies are important cultural practices. Some of these practices may have harmful effects on women and their babies. IMPLICATIONS FOR PRACTICE: it is important to gain an understanding of cultural beliefs and traditional practices relating to the postpartum care of women and their babies. Midwives and nurses should discuss these findings and their implications when they educate new mothers and their families about contemporary methods of postnatal maternal and infant care. Language: English Keywords: TURKEY | RESEARCH REPORT | KAP SURVEYS | POSTPARTUM WOMEN | WOMEN IN DEVELOPMENT | INFANT | POSTPARTUM | DIET | MATERNAL NUTRITION | BEHAVIOR | POSTPARTUM ABSTINENCE | TIME FACTORS | SUPPLEMENTARY FEEDING | TRADITIONAL HEALTH PRACTICES | DEMOGRAPHIC FACTORS | Europe, Southeastern | Europe | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Puerperium | Reproduction | Economic Development | Economic Factors | Youth | Age Factors | Population Characteristics | Population | Nutrition | Health | Abstinence | Family Planning, Behavioral Methods | Family Planning | Population Dynamics | Infant Nutrition | Culture | Sociocultural Factors Document Number: 331293 |
| 7. Title: An update on HIV and infant feeding issues in developed and developing countries. Author: Jackson DJ; Goga AE; Doherty T; Chopra M Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2009 Mar-Apr;38(2):219-29. Abstract: The field of mother to child transmission of human-immunodeficiency virus is rapidly evolving. In the United States, prevention focuses on implementation of universal human-immunodeficiency virus testing to assure compliance with recommended treatment regimens and infant-feeding strategies. In most cases, this is the avoidance of all breastfeeding. In developing countries, avoidance of breastfeeding places infants at higher risk of morbidity and mortality. Current World Health Organization recommendations require individualized counseling to determine the best feeding method for each woman. Language: English Keywords: GLOBAL | RECOMMENDATIONS | INFANT NUTRITION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | BREASTFEEDING | RISK FACTORS | CHILD SURVIVAL | ANTIRETROVIRAL THERAPY | BREASTFEEDING, EXCLUSIVE | SUPPLEMENTARY FEEDING | COUNSELING | INTERVENTIONS | Nutrition | Health | Disease Transmission Control | Prevention and Control | Diseases | Survivorship | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population | HIV | HIV Infections | Viral Diseases | Clinic Activities | Program Activities | Programs | Organization and Administration Document Number: 341948 |
| 8. Peer Reviewed Title: Prognostic accuracy of WHO growth standards to predict mortality in a large-scale nutritional program in Niger. Author: Lapidus N; Luquero FJ; Gaboulaud V; Shepherd S; Grais RF Source: PLoS Medicine. 2009 Mar 3;6(3):e39. Abstract: BACKGROUND: Important differences exist in the diagnosis of malnutrition when comparing the 2006 World Health Organization (WHO) Child Growth Standards and the 1977 National Center for Health Statistics (NCHS) reference. However, their relationship with mortality has not been studied. Here, we assessed the accuracy of the WHO standards and the NCHS reference in predicting death in a population of malnourished children in a large nutritional program in Niger. METHODS AND FINDINGS: We analyzed data from 64,484 children aged 6-59 mo admitted with malnutrition (<80% weight-for-height percentage of the median [WH]% [NCHS] and/or mid-upper arm circumference [MUAC] <110 mm and/or presence of edema) in 2006 into the Medecins Sans Frontieres (MSF) nutritional program in Maradi, Niger. Sensitivity and specificity of weight-for-height in terms of Z score (WHZ) and WH% for both WHO standards and NCHS reference were calculated using mortality as the gold standard. Sensitivity and specificity of MUAC were also calculated. The receiver operating characteristic (ROC) curve was traced for these cutoffs and its area under curve (AUC) estimated. In predicting mortality, WHZ (NCHS) and WH% (NCHS) showed AUC values of 0.63 (95% confidence interval [CI] 0.60-0.66) and 0.71 (CI 0.68-0.74), respectively. WHZ (WHO) and WH% (WHO) appeared to provide higher accuracy with AUC values of 0.76 (CI 0.75-0.80) and 0.77 (CI 0.75-0.80), respectively. The relationship between MUAC and mortality risk appeared to be relatively weak, with AUC = 0.63 (CI 0.60-0.67). Analyses stratified by sex and age yielded similar results. CONCLUSIONS: These results suggest that in this population of children being treated for malnutrition, WH indicators calculated using WHO standards were more accurate for predicting mortality risk than those calculated using the NCHS reference. The findings are valid for a population of already malnourished children and are not necessarily generalizable to a population of children being screened for malnutrition. Future work is needed to assess which criteria are best for admission purposes to identify children most likely to benefit from therapeutic or supplementary feeding programs. Language: English Keywords: NIGER | RESEARCH REPORT | DATA ANALYSIS | CHILDREN | MALNUTRITION | DEATH RATE | CHILD MORTALITY | SUPPLEMENTARY FEEDING | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition Disorders | Diseases | Mortality | Population Dynamics | Infant Nutrition | Nutrition | Health Document Number: 341230 |
| 9. Peer Reviewed Title: Nutritional status of Malawian adults on antiretroviral therapy 1 year after supplementary feeding in the first 3 months of therapy. Author: Ndekha M; van Oosterhout JJ; Saloojee H; Pettifor J; Manary M Source: Tropical Medicine and International Health. 2009 Sep;14(9):1059-63. Abstract: OBJECTIVE: To test the hypothesis that individuals on antiretroviral therapy (ART) for 3 months with a greater body mass index (BMI) as a result of supplementary feeding with ready-to-use fortified spread would maintain a higher BMI 9 months after the feeding ended. METHODS: Two cohorts of wasted adults with AIDS, after 12 months of ART and 3 months of supplementary feeding with either ready-to-use fortified spread, an energy dense lipid paste; or corn/soy blended flour, were assessed for clinical and anthropometric status, quality of life, and ART adherence after 3 and 9 months. RESULTS: 336 ART patients participated: 162 who had received ready-to-use fortified spread and 174 who had received corn/soy blended flour. 9 months after stopping food supplements, both groups had a similar BMI, fat-free body mass, hospitalization rate and mortality. Binary logistic regression modelling showed that lower BMI, lower CD4 count, and older age at baseline were associated with a higher risk of death (odds ratio for BMI = 0.63, 95% CI 0.47-0.79). Adherence to the ART regimen and quality of life were similar in both cohorts. CONCLUSION: While supplementary feeding with ready-to-use fortified spread can ameliorate the BMI, an established risk factor for mortality, this effect is sustained only during the time of the intervention. Supplementary feeding of wasted patients for longer than 3 months should be investigated. Language: English Keywords: MALAWI | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | HIV | ANTIRETROVIRAL THERAPY | NUTRITION | SUPPLEMENTARY FEEDING | BODY WEIGHT | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | HIV Infections | Viral Diseases | Diseases | Health | Infant Nutrition | Physiology | Biology Document Number: 342976 |
| 10. Title: Continuation of breastfeeding: is this a problem in Southeast Iran? Author: Rakhshani F; Mohammadi M Source: Breastfeeding Medicine. 2009 Jun;4(2):97-100. Abstract: BACKGROUND: Despite widespread knowledge about breastfeeding benefits for mothers and neonates, duration of breastfeeding is decreasing in most countries. Many factors have an effect on continuation of breastfeeding. This study was designed to evaluate duration of breastfeeding and its associated factors in rural and urban children. METHODS: In a historical cohort study, health files of 1,264 Iranian children under 3 years old were selected by the multistage sampling method in the Zabol district, located in southeast Iran. Two lists of rural and urban health centers based on their distance were prepared, and by systematic sampling technique three centers were selected in each list. Tables, Kaplan-Meier analysis, and median and mean O SD values were used for data description; log-rank test and the Cox proportional hazard model were applied for data analysis. RESULTS: The mean duration of exclusive breastfeeding was 5.6 +/- 1.3 months, and the mean duration of any breastfeeding was 20.8 +/- 4.69 months. All children had started breastfeeding at birth. Breastfeeding continuation at 6, 12, 18, and 24 months was 98%, 92%, 76%, and 0.97%, respectively. Maternal age, mother's job, education level, living area, child's birth weight, child's birth rank, birth intervals, and age of onset of supplementary food had a significant relationship with breastfeeding continuation. CONCLUSIONS: Some risk factors for breastfeeding continuation were found, and it is suggested that more attention be paid to them in education programs by the health system. Language: English Keywords: IRAN | RESEARCH REPORT | COHORT ANALYSIS | MOTHERS | BREASTFEEDING | BREASTFEEDING, EXCLUSIVE | TIME FACTORS | MATERNAL AGE | BIRTH WEIGHT | BIRTH INTERVALS | BIRTH ORDER | EDUCATIONAL STATUS | SUPPLEMENTARY FEEDING | Middle East | Developing Countries | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Infant Nutrition | Nutrition | Health | Population Dynamics | Demographic Factors | Population | Parental Age | Age Factors | Population Characteristics | Body Weight | Physiology | Biology | Fertility Measurements | Fertility | Socioeconomic Status | Socioeconomic Factors | Economic Factors Document Number: 341958 |
| 11. Title: Effect of preventive supplementation on young children in Niger [letter] Author: Roberfroid D; Huybregts L; Kolsteren P Source: JAMA. 2009 Jun 3;301(21):2208; author reply 2209. Abstract: In their randomized controlled trial, Ms. Isanaka and colleagues found that providing children younger than 5 years with ready-to-use therapeutic food during periods of food insecurity can prevent cases of malnutrition. However, their study presents 2 important methodological difficulties. First, the authors used different reference distributions to define malnutrition at inclusion in the study (National Center for Health Statistics/World Health Organization [NCHS/WHO], 1978) and at inclusion in the analysis (WHO Child Growth Standards, 2006). A proportion of participants were thus excluded from the analysis on the grounds that they were already malnourished at recruitment according to the WHO reference. This proportion was likely substantial and would be expected to consist mainly of children younger than 24 months because the 2 references yield different diagnoses principally in that age range. Unfortunately, this age range has the highest risk of malnutrition. This compromises the internal validity of the study, and extrapolation of results to children aged 6 to 60 months requires caution. The problem could be amplified by the interaction of the intervention with child age at baseline (P=.07), a result not fully discussed by the authors. Second, the authors chose purposively a small number of villages that experienced a high prevalence of wasting during the 2005 food crisis. This crisis was an extreme manifestation of a long-term problem, including weak markets, land degradation, and poor access to health services. As a result, the study villages were likely to differ from other villages by a number of key characteristics, putting the external validity of the study in question. In addition, it indicates that without addressing the causal complexity of malnutrition any intervention will have limited impact on malnutrition. The intervention in the study by Isanaka et al reduced the rate of wasting by only 36%. (full-text) Language: English Keywords: NIGER | CRITIQUE | CHILDREN | SUPPLEMENTARY FEEDING | NUTRITION PROGRAMS | PREVENTION AND CONTROL | FOOD SECURITY | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infant Nutrition | Nutrition | Health | Primary Health Care | Health Services | Delivery of Health Care | Diseases | Food Supply | Natural Resources | Environment Document Number: 341623 |
| 12. Title: Breastfeeding, complementary feeding, overweight and obesity in pre-school children. Author: Simon VG; Souza JM; Souza SB Source: Revista De Saude Publica. 2009 Feb;43(1):60-9. Abstract: OBJECTIVE: To analyze the association of overweight and obesity with breastfeeding and complementary feeding in pre-school children. METHODS: Cross-sectional study with 566 children, enrolled in private schools of the city of Sao Paulo, Southeastern Brazil, in 2004-2005. The dependent variable was overweight and obesity. Body Mass Index percentile curves were employed to classify children's nutritional status, considering values > or =P85 and Language: EnglishPortuguese Keywords: BRAZIL | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | STATISTICAL REGRESSION | CHILDREN | BREASTFEEDING | SUPPLEMENTARY FEEDING | BODY WEIGHT | OBESITY | CHILD NUTRITION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infant Nutrition | Nutrition | Health | Physiology | Biology Document Number: 341846 |
| 13. Title: Effectiveness of a community-based responsive feeding programme in rural Bangladesh: a cluster randomized field trial. Author: Aboud FE; Moore AC; Akhter S Source: Maternal and Child Nutrition. 2008 Oct;4(4):275-86. Abstract: Responsive complementary feeding, whereby the mother feeds her child in response to child cues of hunger state and psychomotor abilities, is a problem in some countries, and likely contributes to malnutrition. Interventions are needed to evaluate whether promoting responsive feeding would add any benefit. Using a cluster randomized field trial, we evaluated a six-session educational programme that emphasized practice of two key behaviours, namely child self-feeding and maternal responsiveness. One hundred mothers and their 12- to 24-month-olds attended the sessions as part of village clusters randomly assigned to the intervention group. A similar number of controls received sessions on foods to feed and nutritional disorders. Outcomes assessed at pre-test, 2-week post-intervention and again 5-months post-intervention included weight, mouthfuls of food taken, self-feeding and maternal responsiveness. Research assistants, blind to group assignment, observed and coded mother and child behaviours during the midday meal. Secondary measures included foods fed and feeding messages recalled. Analysis was based on intention to treat and accounted for clustering. Only 10% of each group was lost to follow-up. Weight (d = 0.28), weight gain (d = 0.48) and child self-feeding (d = 0.30) were significantly higher in the responsive feeding group. Mouthfuls of food eaten and maternal responsiveness were not significantly increased by the intervention. Mothers in the intervention gave their children more vegetables, and spontaneously recalled more feeding messages at the 5-month follow-up. These results provide evidence that self-feeding and weight gain can improve by targeting specific behaviours, while maternal responsiveness may require more intensive strategies. Language: English Keywords: BANGLADESH | RESEARCH REPORT | RURAL POPULATION | MOTHERS | INFANT NUTRITION | SUPPLEMENTARY FEEDING | BEHAVIOR CHANGE | EDUCATION | BODY WEIGHT | Developing Countries | Asia, Southern | Asia | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Nutrition | Health | Behavior | Physiology | Biology Document Number: 330029 |
| 15. Peer Reviewed Title: Maternal and child undernutrition: Global and regional exposures and health consequences. Author: Black RE; Allen LH; Bhutta ZA; Caulfield LE; de Onis M Source: Lancet. 2008 Jan 19;371(9608):243-260. Abstract: Maternal and child undernutrition is highly prevalent in low-income and middle-income countries, resulting in substantial increases in mortality and overall disease burden. In this paper, we present new analyses to estimate the effects of the risks related to measures of undernutrition, as well as to suboptimum breastfeeding practices on mortality and disease. We estimated that stunting, severe wasting, and intrauterine growth restriction together were responsible for 2.2 million deaths and 21% of disability-adjusted life-years (DALYs) for children younger than 5 years. Deficiencies of vitamin A and zinc were estimated to be responsible for 0.6 million and 0.4 million deaths, respectively, and a combined 9% of global childhood DALYs. Iron and iodine deficiencies resulted in few child deaths, and combined were responsible for about 0.2% of global childhood DALYs. Iron deficiency as a risk factor for maternal mortality added 115 000 deaths and 0.4% of global total DALYs. Suboptimum breastfeeding wasestimated to be responsible for 1.4 million child deaths and 44 million DALYs (10% of DALYs in children younger than 5 years). In an analysis that accounted for co-exposure of these nutrition-related factors, they were together responsible for about 35% of child deaths and 11% of the total global disease burden. The high mortality and disease burden resulting from these nutrition-related factors make a compelling case for the urgent implementation of interventions to reduce their occurrence or ameliorate their consequences. (author's) Language: English Keywords: GLOBAL | DEVELOPING COUNTRIES | RESEARCH REPORT | METHODOLOGICAL STUDIES | MATERNAL NUTRITION | CHILD NUTRITION | MALNUTRITION | PREVALENCE | MORTALITY DETERMINANTS | DIET | DISEASES | DEFICIENCY DISEASES | BODY WEIGHT | BREASTFEEDING | SUPPLEMENTARY FEEDING | Nutrition | Health | Nutrition Disorders | Measurement | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Physiology | Biology | Infant Nutrition Document Number: 323785 |
16.  Peer Reviewed Title: Nutrition: basis for healthy children and mothers in Bangladesh. Author: Faruque AS; Ahmed AM; Ahmed T; Islam MM; Hossain MI; Roy SK; Alam N; Kabir I; Sack DA Source: Journal of Health, Population, and Nutrition. 2008 Sep;26(3):325-39. Abstract: Recent data from the World Health Organization showed that about 60% of all deaths, occurring among children aged less than five years (under-five children) in developing countries, could be attributed to malnutrition. It has been estimated that nearly 50.6 million under-five children are malnourished, and almost 90% of these children are from developing countries. Bangladesh is one of the countries with the highest rate of malnutrition. The recent baseline survey by the National Nutrition Programme (NNP) showed high rates of stunting, underweight, and wasting. However, data from the nutrition surveillance at the ICDDR,B hospital showed that the proportion of children with stunting, underweight, and wasting has actually reduced during 1984-2005. Inappropriate infant and young child-feeding practices (breastfeeding and complementary feeding) have been identified as a major cause of malnutrition. In Bangladesh, although the median duration of breastfeeding is about 30 months, the rate of exclusive breastfeeding until the first six months of life is low, and practice of appropriate complementary feeding is not satisfactory. Different surveys done by the Bangladesh Demographic and Health Survey, United Nations Children's Fund (UNICEF), and Bangladesh Breastfeeding Foundation (BBF) showed a rate of exclusive breastfeeding to be around 32-52%, which have actually remained same or declined over time. The NNP baseline survey using a strict definition of exclusive breastfeeding showed a rate of exclusive breastfeeding (12.8%) until six months of age. Another study from the Abhoynagar field site of ICDDR,B reported the prevalence of exclusive breastfeeding to be 15% only. Considerable efforts have been made to improve the rates of exclusive breastfeeding. Nationally, initiation of breastfeeding within one hour of birth, feeding colostrum, and exclusive breastfeeding have been promoted through the Baby-Friendly Hospital Initiative (BFHI) implemented and supported by BBF and UNICEF respectively. Since most (87-91%) deliveries take place in home, the BFHI has a limited impact on the breastfeeding practices. Results of a few studies done at ICDDR,B and elsewhere in developing countries showed that the breastfeeding peer-counselling method could substantially increase the rates of exclusive breastfeeding. Results of a study in urban Dhaka showed that the rate of exclusive breastfeeding was 70% among mothers who were counselled compared to only 6% who were not counselled. Results of another study in rural Bangladesh showed that peer-counselling given either individually or in a group improved the rate of exclusive breastfeeding from 89% to 81% compared to those mothers who received regular health messages only. This implies that scaling up peer-counselling methods and incorporation of breastfeeding counselling in the existing maternal and child heath programme is needed to achieve the Millennium Development Goal of improving child survival. The recent data showed that the prevalence of starting complementary food among infants aged 6-9 months had increased substantially with 76% in the current dataset. However, the adequacy, frequency, and energy density of the complementary food are in question. Remarkable advances have been made in the hospital management of severely-malnourished children. The protocolized management of severe protein-energy malnutrition at the Dhaka hospital of ICDDR,B has reduced the rate of hospital mortality by 50%. A recent study at ICDDR,B has also documented that home-based management of severe protein-energy malnutrition without follow-up was comparable with a hospital-based protocolized management. Although the community nutrition centres of the NNP have been providing food supplementation and performing growth monitoring of children with protein-energy malnutrition, the referral system and management of complicated severely-malnourished children are still not in place. Language: English Keywords: BANGLADESH | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CHILDREN | PREGNANT WOMEN | CHILD SURVIVAL | CHILD NUTRITION | MATERNAL NUTRITION | MALNUTRITION | BREASTFEEDING | BREASTFEEDING, EXCLUSIVE | PREVALENCE | COUNSELING | SUPPLEMENTARY FEEDING | NUTRITION DISORDERS | Developing Countries | Asia, Southern | Asia | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Survivorship | Length of Life | Mortality | Population Dynamics | Nutrition | Health | Diseases | Infant Nutrition | Measurement | Clinic Activities | Program Activities | Programs | Organization and Administration Document Number: 328887 |
| 17. Peer Reviewed Title: Ethiopian adolescents' attitudes and expectations deviate from current infant and young child feeding recommendations. Author: Hadley C; Lindstrom D; Belachew T; Tessema F Source: Journal of Adolescent Health. 2008 Sep;43(3):253-259. Abstract: Suboptimal infant and child feeding practices are highly prevalent in many developing countries for reasons that are not entirely understood. Taking an anthropological perspective, we assessed whether nulliparous youth have formulated attitudes and expectations in the domain of infant and child feeding behaviors, the extent to which these varied by location and gender, and the extent to which they deviated from current international recommendations. A population-based sample of 2077 adolescent girls and boys (13-17 years) in southwest Ethiopia answered a questionnaire on infant and young child feeding behaviors. Results indicate high levels of agreement among adolescents on items relating to infant and young child feeding behaviors. Attitudes and intentions deviated widely from current international recommendations. Youth overwhelmingly endorsed items related to early introduction of nonbreast milk liquids and foods. For girls, fewer than 11% agreed that a 5-month infant should be exclusively breastfed and only 26% agreed that a 6-month infant should be consuming some animal source foods. Few sex differences emerged and youth responses matched larger community patterns. The results indicate that attitudes and expectations deviate widely from current international child feeding guidelines among soon to be parents. To the extent that youth models are directive, these findings suggest that youth enter into parenthood with suboptimal information about infant and child feeding. Such information will reproduce poor health across generations as the largest cohort of adolescents ever become parents. These results suggest specific points of entry for adolescent nutrition education interventions. (author's) Language: English Keywords: ETHIOPIA | RESEARCH REPORT | QUESTIONNAIRES | ADOLESCENTS | INFANT NUTRITION | CHILD NUTRITION | BREASTFEEDING | BREASTFEEDING, EXCLUSIVE | SUPPLEMENTARY FEEDING | ATTITUDES | MISINFORMATION | PARENTING EDUCATION | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition | Health | Psychological Factors | Behavior | Communication | Education Document Number: 327993 |
| 18. Peer Reviewed Title: Effects of energy density and feeding frequency of complementary foods on total daily energy intakes and consumption of breast milk by healthy breastfed Bangladeshi children. Author: Islam MM; Khatun M; Peerson JM; Ahmed T; Mollah MA Source: American Journal of Clinical Nutrition. 2008 Jul;88(1):84-94. Abstract: Information is needed on the minimum energy density and feeding frequency of complementary foods that can provide adequate energy intakes (EIs) for healthy breastfed children. The objectives of the study were to evaluate the effects of various energy densities and feeding frequencies of complementary foods on EI from these foods, breast milk consumption, and total EI from both sources. During 9 separate, randomly ordered dietary periods lasting 3-6 d each, we measured intakes of food and breast milk by 18 healthy breastfed children 8-11 mo of age who, 3, 4, or 5 times/d, were fed porridge with a coded energy density of 0.5, 1.0, or 1.5 kcal/g. Food intake was measured by weighing the feeding bowl before and after meals, and breast milk intake was measured by test weighing. The mean amounts of complementary foods consumed were inversely related to their energy density and positively related to the number of meals/d (P_0.001 for both); EIs from foods were positively related to both factors. Breast milk intake decreased slightly but progressively, with greater energy density and feeding frequency of complementary foods; total EIs (kcal/d) increased in relation to both factors (P < 0.001 for both). The energy density and feeding frequency of complementary foods affect infants' total daily EI and breast milk consumption. Recommendations can be developed for the appropriate combinations of these dietary factors that are compatible with adequate EI, although longer-term effects of complementary feeding practices on breast milk intake and breastfeeding duration need further community-based studies. (author's) Language: English Keywords: BANGLADESH | BREASTFEEDING | SUPPLEMENTARY FEEDING | CHILD NUTRITION | CALORIC INTAKE | Developing Countries | Asia, Southern | Asia | Infant Nutrition | Nutrition | Health Document Number: 327858 |
| 19. Title: The impact of maternal HIV status on infant feeding patterns in Nakuru, Kenya. Author: Kamau-Mbuthia E; Elmadfa I; Mwonya R Source: Journal of Human Lactation. 2008 Feb;24(1):34-41. Abstract: The aim of the study was to assess the impact of maternal HIV status on infant feeding patterns. Two hundred eighty mothers (205 HIV uninfected, 75 infected) and their infants were recruited from the Provincial General Hospital, Nakuru, Kenya, from delivery and were followed for 14 weeks. From the feeding patterns, HIV-infected mothers were more likely to exclusively breastfeed in week 1 than HIV-uninfected mothers (71.7% vs 56.3%, P = .001), but there were no differences by week 14 (9.8% vs 4.8% P = .212). Mixed feeding increased for both groups from weeks 1 to 14. In multivariate logistic regression analysis, maternal age (younger mothers, P less than .05) was associated with exclusive breastfeeding in the 6th week and infant birth weight (greater than mean birth weight, P less than .05) in the 10th week. The results indicate a need to reassess adherence to infant feeding recommendations irrespective of maternal HIV status and also the infant feeding counseling process in the hospital. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | INTERVIEWS | QUESTIONNAIRES | MOTHERS | INFANT | HIV | INFANT NUTRITION | BREASTFEEDING, EXCLUSIVE | SUPPLEMENTARY FEEDING | SOCIOECONOMIC STATUS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Data Collection | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Nutrition | Health | Breastfeeding | Socioeconomic Factors | Economic Factors Document Number: 324151 |
| 20. Title: Knowledge of pregnant women on transmission of HIV infection through breast feeding. Author: Kasinga F; Mogotlane SM; van Rensburg GH Source: Curationis. 2008 Sep;31(3):21-6. Abstract: Although breast-feeding is nature's way of providing nutrition to the baby, in HIV positive mothers this has been identified as one of the means through which HIV infection is transmitted from the mother to the child. In Africa where children under the age of 5 are killed by preventable diseases like diarrhoea, the issue of HIV transmission through breast feeding poses an added huge problem. Research has, however shown that exclusive infant feeding, be it breast or formula, reduces the risk substantially. It is imperative that mothers be informed about safer methods of infant feeding so that HIV infection is kept to a minimum. The objective of the study was to explore and describe the knowledge that pregnant women had about mother to child transmission of HIV infection through breast-feeding. A non-experimental quantitative exploratory and descriptive research design was used to explore the knowledge women had on mother to child transmission of HIV infection through breast-feeding. From the data collected, it showed that although women were aware of the susceptibility of children to HIV infection if fed on breast and formula feeds simultaneously by HIV positive mothers, exclusive feeding was a problem as people associated the practise with a positive HIV status. Women who had not disclosed their HIV status and were HIV positive, found it difficult to comply with the requirement to exclusively feed their infants. These either continued with complementary feeds or did not collect the free formula milk supply preferring instead to buy the formula feeds privately. In this study it was recommended that information on transmission of HIV infection from mother to child through breast -feeding including the benefits of exclusive infant feeding, be it breast or formula, for the first three to six months be provided to the community so that relatives can support the mother on infant feeding method of choice. Language: English Keywords: AFRICA | RESEARCH REPORT | INFANT | PREGNANT WOMEN | BREASTFEEDING, EXCLUSIVE | SUPPLEMENTARY FEEDING | HIV TRANSMISSION | HIV INFECTIONS | KNOWLEDGE | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Breastfeeding | Infant Nutrition | Nutrition | Health | Viral Diseases | Diseases | Sociocultural Factors Document Number: 330888 |
| 21. Peer Reviewed Title: "We grandmothers know plenty": Breastfeeding, complementary feeding and the multifaceted role of grandmothers in Malawi. Author: Kerr RB; Dakishoni L; Shumba L; Msachi R; Chirwa M Source: Social Science and Medicine. 2008 Mar;66(5):1095-1105. Abstract: This paper has two purposes: first of all, we examine grandmothers' role and views of child feeding practices in northern Malawi, and their influence on younger women's practices. Secondly, we consider the implications of these findings for health promotion activities and models of health education. Data were collected from semi-structured interviews, focus groups and a participatory workshop. Findings demonstrate that, to address child feeding practices which have an effect on nutrition, attention must be paid to the broader context that influences child nutrition, including extended family relations. Paternal grandmothers have a powerful and multifaceted role within the extended family in northern Malawi, both in terms of childcare and in other arenas such as agricultural practices and marital relations. Grandmothers often differ in their ideas about early child feeding from conventional Western medicine. Some practices have existed in the area at least since colonial times, and have strong cultural significance. Despite the important integrated role, older women have within households and communities in this part of Malawi, hospital personnel often have disparaging and paternalistic attitudes towards 'grannies' and their knowledge. Health education rarely involves grandmothers, and even if they are involved, their perspectives are not taken into consideration. Hospital staff often reject grandmother knowledge as part of a broader modernization paradigm which views 'traditional knowledge' as backward. Grandmothers view current child health conditions within a broader context of changing livelihood conditions and a high prevalence of HIV/ AIDS. The paper concludes by discussing the challenges of involving grandmothers in health education, and the difficulties of incorporating local knowledge into a medical system that largely rejects it. (author's) Language: English Keywords: MALAWI | RESEARCH REPORT | KAP SURVEYS | FOCUS GROUPS | GRANDPARENTS | WOMEN IN DEVELOPMENT | HOSPITAL PERSONNEL | SUPPLEMENTARY FEEDING | BREASTFEEDING | FAMILY RELATIONSHIPS | INFANT NUTRITION | WORKSHOPS | CHILD CARE | STAFF ATTITUDE | TRADITIONAL HEALTH PRACTICES | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Data Collection | Family Characteristics | Family and Household | Sociocultural Factors | Economic Development | Economic Factors | Health Personnel | Delivery of Health Care | Health | Nutrition | Education | Child Rearing | Behavior | Attitudes | Psychological Factors | Culture Document Number: 324417 |
| 22. Title: Guidance on infant feeding and HIV in the context of refugees and displaced populations. Author: Lhotska L; McGrath M Source: Geneva, Switzerland, United Nations High Commissioner for Refugees [UNHCR], 2008 Apr. 20 p. Abstract: This Guidance on Infant feeding and HIV aims to assist UNHCR, its implementing and operational partners, and governments on policies and decision- making strategies on infant feeding and HIV in refugees and displaced populations. Its purpose is to provide an overview of the current technical and programmatic consensus on infant feeding and HIV, and give guidance to facilitate elective implementation of HIV and infant feeding programmes in refugee and displaced situations, in emergency contexts, and as an integral element of coordinated approach to public health, HIV and nutrition programming. The goal of this guidance is to provide tools to prevent malnutrition, improve the nutritional status of infants and young children, to reduce the transmission of HIV infection from mother to child after delivery, and to increase HIV-free survival of infants. Language: English Keywords: DEVELOPING COUNTRIES | SUMMARY REPORT | INTERNALLY DISPLACED PERSONS | REFUGEES | MOTHERS | INFANT HEALTH | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | BREASTFEEDING, EXCLUSIVE | SUPPLEMENTARY FEEDING | HIV PREVENTION | RISK FACTORS | CHILD SURVIVAL | HUMAN MILK | HEALTH POLICY | UN | STANDARDS | CULTURE | PROGRAM ACCEPTABILITY | Settlement and Resettlement | Migration | Population Dynamics | Demographic Factors | Population | Migrants | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Child Health | Health | Disease Transmission Control | Prevention and Control | Diseases | Breastfeeding | Infant Nutrition | Nutrition | HIV Infections | Viral Diseases | Survivorship | Length of Life | Mortality | Lactation | Maternal Physiology | Physiology | Biology | Policy | Political Factors | International Agencies | Organizations | Research Methodology | Program Evaluation | Programs | Organization and Administration Document Number: 329087 |
| 23. Title: An energy-dense complementary food is associated with a modest increase in weight gain when compared with a fortified porridge in Malawian children aged 6 - 18 months. Author: Lin CA; Manary MJ; Maleta K; Briend A; Ashorn P Source: Journal of Nutrition. 2008 Mar;138:593-598. Abstract: Poor complementary feeding practices are associated with stunting and growth faltering throughout the developing world. The objective was to compare the effect of using peanut-/soy-based fortified spread (FS) and corn porridge fortified with fish powder (FP) as complementary foods on growth in rural Malawian children. A total of 240 children were enrolled at the age of 6 mo and randomized to receive FS or FP. Both complementary foods provided 836 kJ/d from 6 to 9 mo of age and 1254 kJ/d from 9 to 18 mo of age. Children were followed monthly for anthropometry and fortnightly for the symptoms of fever, cough, or diarrhea until they were 18 mo old. Zn and Se status were assessed at 6 and 12 mo. The primary outcomes were the rates of weight and length gain from 6-12 mo and from 12-18 mo. Children who received FS gained 110 g more (95% CI 220 to 10) from 6-12 mo of age than children receiving FP. Weight gain did not differ between children receiving FS and FP between 12 and 18 mo of age, nor did statural growth from 6 to 12 mo or 12 to 18 mo. A total of 23% of all children were Zn deficient at 6 mo of age and this increased to 37% at 12 mo of age. Neither FS nor FP was associated with significantly improved Zn status. FS was associated with better weight gain from 6-12 mo of age and may be useful in conjunction with additional interventions to improve infant growth in the developing world. (author's) Language: English Keywords: MALAWI | RESEARCH REPORT | COMPARATIVE STUDIES | CLINICAL RESEARCH | INFANT | SUPPLEMENTARY FEEDING | FOOD SUPPLEMENTATION | BODY WEIGHT | ANTHROPOMETRY | FEVER | DIARRHEA | GROWTH | SERUM ZINC LEVEL | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infant Nutrition | Nutrition | Health | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Physiology | Biology | Measurement | Body Temperature | Diseases | Child Development | Hemic System Document Number: 324774 |
| 24. Title: HIV-positive poor women may stop breast-feeding early to protect their infants from HIV infection although available replacement diets are grossly inadequate. Author: Lunney KM; Jenkins AL; Tavengwa NV; Majo F; Chidhanguro D Source: Journal of Nutrition. 2008 Feb;138:351-357. Abstract: Little is known about mothers' perspectives and experiences of early breast-feeding cessation as a strategy to reduce postnatal HIV transmission in rural, resource-constrained settings. We conducted in-depth interviews (IDI) with 15 HIV-positive breast-feeding mothers of infants aged 3-5 mo about their plans for feeding their infants after age 6 mo. We also conducted IDI with 12 HIV-positive mothers who intended to stop breast-feeding after receiving their infant's HIV-PCR negative test result at age 6 mo. Twenty-four-hour dietary recalls were conducted with the same 12 mothers and 16 HIV-negative or status unknown mothers who were breast-feeding their 6- to 9-mo-old infants. Of the 12 mothers who intended to stop breast-feeding, 11 did so by 9 mo. Median energy intake (percent requirement) was 1382 kJ (54%) among weaned infants compared with 2234 kJ (87%) among breast-feeding infants. Median intakes were less than 67% of the recommended levels for 9 and 7 of the 12 micronutrients assessed for weaned and breast-feeding infants, respectively. Factors facilitating early breast-feeding cessation were mothers' knowledge about HIV transmission, family support, and disclosure of their HIV status; food unavailability was the primary barrier. HIV-positive mothers in resource-constrained settings may be so motivated to protect their child from HIV that they stop breast-feeding early even when they cannot provide an adequate replacement diet. As reflected in the new World Health Organization guidance, HIV-positive mothers should continue breastfeeding their infants beyond 6 mo if replacement feeding is still not acceptable, feasible, affordable, sustainable, and safe. (author's) Language: English Keywords: ZIMBABWE | RESEARCH REPORT | INTERVIEWS | MOTHERS | PERSONS LIVING WITH HIV/AIDS | RURAL POPULATION | POVERTY | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | BREASTFEEDING | DIET | NUTRITION | SUPPLEMENTARY FEEDING | INFANT NUTRITION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Data Collection | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Socioeconomic Factors | Economic Factors | Disease Transmission Control | Prevention and Control | Health Document Number: 323789 |
| 25. Title: Association between breast-feeding practices and sucking habits: a cross-sectional study of children in their first year of life. Author: Moimaz SA; Zina LG; Saliba NA; Saliba O Source: Journal of the Indian Society of Pedodontics and Preventive Dentistry. 2008 Sep;26(3):102-6. Abstract: In addition to providing nutrition and immunological protection, breast-feeding has positive effects on the development of the infant's oral cavity. The aim of the present study is to assess breast-feeding patterns and to analyze the influence of breast-feeding practices and maternal sociodemographic variables on the prevalence of non-nutritive sucking habits in a sample of Brazilian infants. This cross-sectional study was carried out in Southern Brazil. A random sample of 100 mothers of infants up to 12 months of age was interviewed during the National Vaccination Campaign Day. The prevalence and median duration of breast-feeding were assessed. Breast-feeding practice, the exposure factor, was categorized as exclusive breast-feeding, predominant breast-feeding, complementary breast-feeding, or weaning. Maternal sociodemographic variables included age, race, marital status, educational level, profession, and family income. The outcome investigated was the prevalence of sucking habits (pacifier use and thumb sucking). We used two-sample tests, the chi-square test and FISHER'S EXACT TEST for statistical analyses of the data. The study revealed that 75% of infants were being breast-fed. Pacifier use and thumb sucking were common in 55%. Bottle-feeding was prevalent in 74% of infants. Breast-feeding was negatively correlated with pacifier use and thumb sucking (OR=0.11; 95% CI: 0.03 to 0.4). Bottle-feeding was strongly associated with weaning (p=0.0003). Among the sociodemographic variables, only marital status showed a statistical association with sucking habits (p=0.04). These findings suggest that breast-feeding can prevent the occurrence of sucking habits. Although we could not evaluate causality assessment, malocclusion prevention seems to be yet one more reason for promoting breast-feeding practices. Language: English Keywords: BRAZIL | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | EPIDEMIOLOGIC METHODS | INFANT | MOTHERS | WOMEN IN DEVELOPMENT | BREASTFEEDING | ORAL EFFECTS | DEMOGRAPHIC FACTORS | PREVALENCE | TIME FACTORS | SUPPLEMENTARY FEEDING | WEANING | Developing Countries | South America, Eastern | South America | Latin America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Economic Development | Economic Factors | Infant Nutrition | Nutrition | Health | Physiology | Biology | Measurement | Population Dynamics Document Number: 330323 |
| 26. Peer Reviewed Title: Challenge of infant feeding choices among HIV infected mothers in Africa [editorial] Author: Musoke RN Source: East African Medical Journal. 2008 Apr;85(4):153-5. Abstract: From the time it was fully documented that the virus can be transmitted through breastmilk, there has been a dilemma on what would be the best feeding option in setting of high infant and child mortality. As early as 1987 the World Health Organisation's (WHO) stand has been that the choice of infant feeding "should take into consideration the socio-economic and ecological environment of the mother/infant pair and to the extent to which alternatives can safely and effectively be used." Subsequent consensus statements from WHO/UNICEF/UNAIDS/UNFPA have endorsed the same sentiments, Choosing breastfeeding: what are the facts and challenges? Prolonged breastfeeding may double the rate of transmission. The baby is at risk as long as breastfeeding continues. Choosing replacement feeding: facts and challenges: For replacement feeding to succeed a suitable breastmilk substitute has to be found. Whatever is used must supply the nutrient needs of the infant. Acceptability of non breastfeeding: In Africa the culture of breastfeeding is strong hence a women who does not breastfeed will raise questions from all around her. So when an HIV infected woman chooses not to breastfeed she faces a lot of challenges and may thus be stigmatised. Language: English Keywords: AFRICA | CRITIQUE | MOTHERS | PERSONS LIVING WITH HIV/AIDS | BREASTFEEDING | RISK FACTORS | HIV TRANSMISSION | SUPPLEMENTARY FEEDING | Developing Countries | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Infant Nutrition | Nutrition | Health Document Number: 328711 |
| 27. Title: Complementary feeding practices and nutrient intake from habitual complementary foods of infants and children aged 6-18 months old in Lusaka, Zambia. Author: Owino VO; Amadi B; Sinkala M; Filteau S; Tomkins A Source: African Journal of Food, Agriculture, Nutrition and Development. 2008 Sep;8(1):28-47. Abstract: Poor quality complementary foods with low nutrient density and inappropriate feeding practices have been identified among the major causes of malnutrition in young children. In many developing countries, complementary foods are introduced too early or too late and the quality and quantity of the foods are insufficient, leading to a great risk of nutritional deficiencies during the second half of infancy. Most of the habitually used complementary foods in developing countries are unfortified cerealbased gruels characterised by low energy and nutrient density and are often inadequate in iron, zinc and pyridoxine and in some populations may be deficient in riboflavin, niacin, calcium, thiamine, folate, ascorbic acid and vitamin A. The aim of this study was to establish current complementary feeding practices of mothers/caretakers living in a medium income urban community in Lusaka, Zambia. The study was the first phase of a larger study designed to develop improved complementary foods based on already-in-use cereals and legumes for the improvement of infant health in urban settings characterised by high HIV prevalence. Complementary feeding practices and nutrient intakes of children 6-18 months old in Lusaka were assessed by qualitative and quantitative methods. Themes generated from three focus group discussions (9 health workers, 7 mothers and 8 fathers) were used to design a semi-structured questionnaire to interview 34 mothers, 20 of whom were observed for 12 hours at home and their infant’s dietary intake measured by 12-h weighed food record and 24-h recall, (assuming medium breast milk intake). The results showed that although mothers had wide knowledge of optimal infant feeding, actual practices were constrained by food cost, maternal HIV status and time availability. Compared with the recommended daily allowance (RDA) at 6-8, 9-11 and 12-18 months of age, the daily nutrient intakes were 88%, 121% and 94% for energy; 33%, 52% and 59% for iron and 30%, 33% and 38% for calcium, respectively. Fortification of complementary foods is necessary to meet infants’ needs for iron and calcium. Language: English Keywords: ZAMBIA | RESEARCH REPORT | INTERVIEWS | QUALITATIVE RESEARCH | INFANT | SUPPLEMENTARY FEEDING | IRON | INFANT NUTRITION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Data Collection | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition | Health | Metals | Vitamins and Minerals | Physiology | Biology Document Number: 322511 |
| 28. Peer Reviewed Title: Complementary feeding with fortified spread and incidence of severe stunting in 6- to 18-month-old rural Malawians. Author: Phuka JC; Maleta K; Thakwalakwa C; Cheung YB; Briend A Source: Archives of Pediatrics and Adolescent Medicine. 2008 Jul;162(7):619-626. Abstract: Objective: To compare growth and incidence of malnutrition in infants receiving long-term dietary supplementation with ready-to-use fortified spread (FS) or micronutrient-fortified maize-soy flour (likuni phala [LP]). Design: Randomized, controlled, single-blind trial. Setting: Rural Malawi. Participants: A total of 182 six-month-old infants. Intervention: Participants were randomized to receive 1 year of daily supplementation with 71 g of LP (282 kcal), 50 g of FS (FS50) (256 kcal), or 25 g of FS (FS25) (127 kcal). Outcome Measures: Weight and length gains and the incidences of severe stunting, underweight, and wasting. Results: Mean weight and length gains in the LP, FS50, and FS25 groups were 2.37, 2.47, and 2.37 kg (P=.66) and 12.7, 13.5, and 13.2 cm (P=.23), respectively. In the same groups, the cumulative 12-month incidence of severe stunting was 13.3%, 0.0%, and 3.5% (P=.01), of severe underweight was 15.0%, 22.5%, and 16.9% (P=.71), and of severe wasting was 1.8%, 1.9%, and 1.8% (P>.99). Compared with LP-supplemented infants, those given FS50 gained a mean of 100 g more weight and 0.8 cm more length. There was a significant interaction between baseline length and intervention (P=.04); in children with below-median length at enrollment, those given FS50 gained a mean of 1.9 cm more than individuals receiving LP. Conclusion: One-year-long complementary feeding with FS does not have a significantly larger effect than LP on mean weight gain in all infants, but it is likely to boost linear growth in the most disadvantaged individuals and, hence, decrease the incidence of severe stunting. (author's) Language: English Keywords: MALAWI | RESEARCH REPORT | CLINICAL TRIALS | CONTROL GROUPS | INFANT | INFANT NUTRITION | INFANT NUTRITION DISORDERS | MALNUTRITION | SUPPLEMENTARY FEEDING | FOOD SUPPLEMENTATION | VITAMINS AND MINERALS | NUTRITION INDEXES | INTERVENTIONS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition | Health | Nutrition Disorders | Diseases | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Physiology | Biology | Programs | Organization and Administration Document Number: 327703 |
| 29. Title: A cohort study of infant feeding practices in city, suburban and rural areas in Zhejiang Province, PR China. Author: Qiu L; Zhao Y; Binns CW; Lee AH; Xie X Source: International Breastfeeding Journal. 2008 Mar 3;3:4. Abstract: Breastfeeding is the basis for appropriate nutrition for infants and is strongly supported by the Ministry of Health in China. However, there are differences in infant feeding practices in different areas of the country. The aim of this study was to compare the infant feeding practices and the prevalence of determinants of initiation and continuing to breastfeed until six months of age in city, suburb and rural areas in Zhejiang Province, PRC. A longitudinal cohort study of infant feeding practices was undertaken in city, suburban and rural areas in 2004/2005. Mothers were recruited and interviewed before discharge from hospitals. A total of 1520 mothers were recruited into the study. Follow-up interviews were administered at 1, 3 and 6 months after birth to obtain details of infant feeding practices. 'Any breastfeeding' rates were high before discharge at all three locations, 96.5% in city, 96.8% in suburb and 97.4% in the rural area. The 'exclusive breastfeeding' rates in the city, suburban andrural areas before discharge were 38.0%, 63.4% and 61.0% respectively. By sixth months the 'any breastfeeding' rates had declined to 62.8%, 76.9% and 83.6% and the 'exclusive breastfeeding' rates had fallen to 0.2%, 0.5% and 7.2% in city, suburb and rural areas respectively. There were differences in feeding practices between the three locations, including the use of prelacteal feeds and the introduction of supplementary feeds. Mothers who lived in the city were least likely to be 'exclusive breastfeeding' at discharge. At six months the city infants also had lower rates of 'any breastfeeding' and 'exclusive breastfeeding'. (author's) Language: English Keywords: CHINA | RESEARCH REPORT | LONGITUDINAL STUDIES | COHORT ANALYSIS | INFANT | MOTHERS | URBAN AREAS | RURAL AREAS | BREASTFEEDING, EXCLUSIVE | SUPPLEMENTARY FEEDING | PREVALENCE | Asia, Eastern | Asia | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Geographic Factors | Breastfeeding | Infant Nutrition | Nutrition | Health | Measurement Document Number: 325077 |
| 30. Peer Reviewed Title: Infant-feeding practices among HIV-infected mothers in an HIV-treatment programme. Author: Sadoh WE; Sadoh AE; Adeniran KA; Abhulimhen-Iyoha BI Source: Journal of Health, Population, and Nutrition. 2008 Dec;26(4):463-7. Abstract: The transmission of HIV via breastmilk has led to various recommendations for HIV-infected mothers. In this study, the feeding practices of HIV-infected mothers in the first six months of their infants' lives were evaluated. In total, 103 consecutive mothers of children, aged 6-24 months, were evaluated for their feeding practices in the first six months of their infants' lives. The mothers were recruited in two cohorts based on their entry (PMTCT cohort) or non-entry (non-PMTCT cohort) to an HIV MTCT-prevention programme. Information obtained included maternal age, socioeconomic class, and the educational level attained. All the babies in the non-PMTCT cohort were breastfed compared to none in the PMTCT cohort. Infant formula was inadequately prepared for 77.42% of babies in the non-PMTCT cohort compared to 18.64% in the PMTCT cohort. The mixed-feeding rate was high (70.45%) in the non-PMTCT cohort. Over 70% of babies in both the cohorts were bottle-fed. Voluntary counselling and testing services in the healthcare system should be strengthened. All mothers should receive infant-feeding counselling, with exclusive breastfeeding being encouraged in those with unknown HIV status. Language: English Keywords: NIGERIA | RESEARCH REPORT | EVALUATION | MOTHERS | INFANT | PERSONS LIVING WITH HIV/AIDS | BREASTFEEDING | COUNSELING | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV INFECTIONS | BOTTLE FEEDING | SUPPLEMENTARY FEEDING | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Infant Nutrition | Nutrition | Health | Clinic Activities | Program Activities | Programs | Organization and Administration | Disease Transmission Control | Prevention and Control Document Number: 330581 |
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