Maternal beliefs, feeding practices and nutritional status in Afro-Colombian infants

This study describes maternal practices and beliefs on children feeding and their relationship with nutritional status of Afro-Colombian children aged 6 to 18 months. We combined ethnographic and epidemiological data. We collected information using a food frequency questionnaire. Nine focus groups and 5 deep interviews to mothers of children less than 2 years of age were performed. Our data showed a prevalence of wasting of 2.6% (< -2 SD weight-for-length) and prevalence of stunting of 9.8% (< -2 SD height-for-age). These practices are characterized by a universal onset of breastfeeding, that lasted 10 months in average, and an early introduction of complementary food (mean: 3 months). Breastfeeding is a cultural norm. Weaning is related to new pregnancy, to low milk production and to negative effects of breast process on mothers' health. Early complementary feeding and bottle-feeding are highly valued due to their positive effect on nutritional status and adaptation of children to adult-type diets. The introduction of complementary food after 4 months, the quality of the first food introduced and the diversity of complementary food predicted better nutritional status (p < 0.05). We conclude that nutritional illiteracy and mothers' erroneous beliefs result in 50% of the mothers having inadequate feeding practices. We suggest focused interventions on those beliefs limiting good practices.     

Homes for the migrants: the pueblos jovenes of Lima--a study of socioeconomic determinants of child malnutrition

The family ecology of 68 preschool children attending a health care center in a pueblo joven (low-income peripheral settlement) of Lima, Perú, was investigated to determine its bearing on their nutritional status. Some of the variables studied included family income, income available to mothers, household composition, migratory history of mothers, child feeding practices and housing conditions. Nutritional status of the children was assessed through anthropometric and dietary means. Results indicated that chronic malnutrition was widespread. Breast-feeding was common, but the weaning diets had little diversity and low-caloric value. The family diet relied heavily on soups and starchy foodstuffs, and children participated fully in the family meals by the age of two. Child growth was negatively correlated with the number of preschool children and birth order, and positively correlated with income spent on water. In its turn, the children's diet was positively correlated with the income available to the mothers and the income spent on food.     

Factors associated with infants’ and young children’s (6–23 months) dietary diversity in Pakistan: evidence from the demographic and health survey 2012–13

Background

Optimum nutrition and good feeding practices amongst infants and young children are the key determinants of growth for a healthy life. Dietary diversity is considered to be a reliable and easy-to-measure proxy variable to assess young children’s feeding practices for dietary adequacy and nutritional intake. This research aims to examine the current practices of dietary diversity amongst infants and young children aged 6–23 months in Pakistan and the various associated factors at child, maternal, household and community levels.

Methods

Secondary data analysis was performed for this research using the nationally representative dataset of the Pakistan Demographic and Health Survey 2012–13. Data on the last-born infants and young children aged 6–23 months (n?=?1102) was taken from their mothers’ interviews, who reported on their child’s consumption of 7 food groups during the 24 h immediately preceding the survey. Data was analysed, using IBM® SPSS® Complex Sample to measure the association between children’s dietary diversity and various factors at child, maternal, household and community levels through multiple linear regressions.

Results

Our research uncovered positive associations between children’s dietary diversity and other sociodemographic variables. Overall, a variation was observed in consumption of 7 food groups across the youngest, middle and oldest age-groups of children. Multivariate analysis revealed that the children’s Dietary Diversity Score (scale from 0 to 7) increases to 0.56 (95% CI: 0.18–0.94) amongst children in the middle age-group (12–17 months). Furthermore, the children who were still breastfeeding, with mothers who had a primary level of schooling and whose mothers also received information/services from lady health workers (LHWs) on maternal and child health were found to be a statistically significant predictor of infants’ and young children’s dietary diversity. Nevertheless, amongst them, the DDS had a negative association with the children’s status of still breastfeeding and mothers’ primary level of schooling, whereas it had a positive association with children being in the middle age-group and with mothers who received information/services from LHWs.

Conclusion

The dietary diversity of infants and young children aged 6–23 months has a modest, nevertheless statistically significant, relationship with sociodemographic characteristics in Pakistan. There is a need for practical efforts to change the behaviour of communities to encourage more diverse foods to promote the healthy growth of children.

     

Lactation behavior and delivery care in a group of women from a Mexican rural community]

This article presents a brief discussion on the role that "medical practice" plays, related to the type of infant lactation after delivery, and breast-feeding practice during the first months of life. Data on hospital routines and how these predispose artificial feeding practices are seen from a critical angle. The information presented in this paper corresponds to a project carried out in a rural community of the state of México, called Malinalco, where the lactation behavior of 65 women after birth of the child, was followed as of their last period of pregnancy. The main objectives of the study were to determine the relationship between the place of delivery (hospital or home delivery) and the type of lactation practiced by the mothers, as well as to determine the infants nutritional status during their first year of life. Results showed that the greater part of women from the sample were young others (less than 30 years old) with one or two children. As to the place where delivery took place, 72% of the sample were attended by midwives at their own homes, and at last 65% practiced breast feeding exclusively during the first three months. No significant correlation between these two indicators (place of delivery and type of lactation) was found, although a tendency to a more prolonged breast-feeding practice was observed in those women who delivered at home. Problems related to weaning practices were detected, since they start this only with bean broth after five months of life. Finally, information on nutritional status during the first 12 months of life, shows serious nutritional problem after the child's third month of life, since the normality percentage starts decreasing while there occurs a significant increase of 1st an 2nd degree malnutrition.     

Efficacy of a national program to promote breast feeding: Chile 1993-2002

Promotion of breast feeding is a priority in Chilean health's policies. The aim of the study was to evaluate the tendency of breastfeeding (exclusive, continued, partial), in children less than 18 months old, controlled in the Chilean public health system, based in four national surveys. Through a 24 h food intake recall (breastfeeding, water, juice, infant formula, solids) food patterns were explored every 3 years, as well as maternal participation in jobs located away from home. the sample consisted of approximately 10 thousand children, less than 18 months old of the 28 health services throughout the country. The prevalence of children with exclusive breastfeeding, predominant (breastfeeding, water or juice), complemented (breastfeeding plus solids) or any other way of feeding for each month of age in each survey, and changes in period studied, was determined. Between 1993 and 2002, exclusive breastfeeding for 6 months increased from 16 to 43.1% (p<0.001) and predominant breastfeeding from 25.4 to 57.4%. at the same time, complemented breastfeeding at 12 months increased from 10.7 to 21.3%, and partial or complemented breastfeeding in 12 to 18 month old children went from 24.1 to 46.7%. Maternal work located away from home was inversely associated with the prevalence of exclusive and complemented breastfeeding during the first year (p<0.001). There has been a significant increase of maternal breastfeeding in the period analyzed. The negative effects of maternal labor on breastfeeding suggests to explore more effective forms of social support to the working mother.     

Household food distribution behavior in periurban communities of Guatemala: lessons for food distribution programs

Do mothers of undernourished children recognize their offspring's needs? How do they feed these target children compared to other households members when food supplements are available? Which cultural principles of intra-household food distribution are associated with feeding behavior? How do household members perceive and use food supplements that are donated for undernourished target children? Answers were sought in a dietary-ethnographic study of 45 households receiving supplements for a low-weight child between one and five years, of age in two periurban low-income communities of the City of Guatemala. The central hypothesis was that we would find four cultural principles of food distribution: contributions, need, equity, and demand. The dietary survey combined direct measure and recall techniques and was done twice for all 230 individuals conforming these households. Ethnographic interviews were carried out with mothers of all target children. T-tests determined the relation between food distribution behavior and cultural rules. Findings revealed that the cultural principles of contributions, needs, and demand are present, but instead of the equity principle, we found one of equality. In the great majority of the feeding events observed, the child's mother prepares and distributes the food. The target child does not receive preferential treatment in the intra-household distribution of food supplements and other foodstuffs. Donated milk is destined principally for the children in the household; all other supplements are distributed among all members. Adult males are favored in the distribution of kcal at regular mealtimes. Children are favored in the distribution of kcal when total daily consumption is calculated. There are significant associations between the expressions of the cultural principle favoring equal distribution and that of contribution which favors adult men, and actual food distribution behavior. These principles seem to operate at formal meal events only. It was found that feeding behavior between meals (snacks, nibbling, etc.) is not subject to these salient principles and tends to compensate those household members who are not given preferential treatment in food distribution at formal mealtimes.     

Nutritional anthropometry and dietary intake of children from the Las Cuevas region of the Dominican Republic

A nutritional survey was conducted in the "Las Cuevas" watershed located in the southwestern region of the Dominican Republic to assess the nutritional status of preschool children. Height, weight, mid-arm circumference and triceps skinfold measurements were taken of 280 children between 6 to 54 months of age. Dietary recall was elicited from mothers or care givers. Results compared with the National Center for Health Statistics reference data indicate that these children: 1) experience growth failure and poor nutritional status as indicated by low weight for age; 2) suffer chronic malnutrition as revealed by low height for age and reduced muscle mass of the mid-arm; and 3) have appropriate weight for height measurements. A food frequency survey revealed that these children consume a diet high in carbohydrates and low in animal protein. Breast feeding is a common practice although cow's milk was introduced early in 25% of the sample. The mean age at weaning is 12 months. The results indicate that these children experience the greatest growth deficits in the second year of life and that these deficits are indicative of chronic undernutrition rather than acute food shortage or recent disease episodes. This study was carried out to establish baseline data for a resource management project initiated by the Secretariat of Agriculture of the Dominican Republic.     

Relation between food habits and nutritional status of preschool children in a rural community

Food habits in regard to the nutritional status of preschool children and their socioeconomic situation were analyzed in this research. The study was carried out in Cuetzalan, State of Puebla; all families were studied and, besides the presence of a preschool child in the home, both father and mother should also be living in the same house. Forty children considered as well nourished and 40 malnourished in the opposite case, were selected, taking the limits of the Gómez classification. In order to define socioeconomic differences between the two groups, the sample population was divided into different levels, with the following results. The socioeconomic level of the well-nourished children did correlate with a good living standard of their families; in the other case, families with a low socioeconomic status, presented more nutritional problems. A questionnaire was applied to every mother selected. This included two items: a) In the first case, we tried to assess the mother's attitude towards food habits and children's illnesses. b) In the second case, the mother's knowledge concerning pregnancy, breast feeding, feeding of the child during the first year of life, taboos, beliefs and other aspects which could be related to nutrition. On the whole, the main objective of this study was attained, because significant differences were found between these two groups. Firstly, a good relationship between food habits and good nutritional status of the children was found. Secondly, mother with well-nourished children had better food habits and better socioeconomic status than mothers having children with poor health status, and therefore, of a lower socioeconomic status.     

Breast feeding in different income classes in the Municipality of S?o Paulo

The relationship between breast feeding and socioeconomic factors in children below 2 from different social classes in Sao Paulo, Brazil is analyzed. Of a total 200 children, 46 were malnourished and 31 belonged to the lower socioeconomic classes. 39% of mothers from the lower income families breastfed for 6 months, as compared to 13% of mothers from families with higher incomes 18% and 36% of mothers from the 2 classes did not breastfeed; mothers from the middle class breastfed for an average 28 days. The problem of protein-calorie malnutrition in young children is a growing one in Brazil, even in a relatively rich city such as Sao Paulo; one of the factors responsible for this problem is undoubtedly early weaning. Reasons given for early weaning in a group of 351 mothers were deficient amount of milk (49.6%), medical advice (11.1%), "bad" milk (14.3%), and only 1.4% because of occupation outside of the home. When interviewed about their opinion on the best type of milk for infants, 45% out of a group of 500 mothers indicated artificial milk, 37% maternal milk, and 16.2% cow's milk. Out of 492 mothers, 77% had 4 prenatal visits at a public health center, 11% had no prenatal visits, and 12% had 1-3 visits. Prenatal care does not influence attitude in favor of breast feeding; 45.5% of mothers who had not had any prenatal care breastfed for 6 months or more, as compared to 20% of those with 1-3 visits, and 17.5% of those with 4 visits. Those who delivered in a hospital tended to breastfeed more than those who delivered at home. It is obvious that not only mothers but health workers as well must be educated on the importance of breast feeding to fight infant malnutrition in Brazil.     

Soy beans as an alternative in infant nutrition in a community of northeastern Brazil

The use of a powdered soy extract (30% protein) as a supplement in infant feeding for children from 2-24 months who had stopped breastfeeding was tested for acceptance and impact in two semi-rural communities in the State of Bahia in Northeast Brazil. The product was supplied gratuitously by a Brazilian soy bean processing firm. The introduction of the product was one aspect of a University-sponsored integrated community-action program. Nutritional status was determined by weight for age, using the Gomez classification (Marcondes, Class IV). There was a statistically significant difference in improvement in the nutritional status of those children who received the soy supplement.     

Profile of breastfeeding in children under 2 years old in the city of Itupeva, SP, Brazil

The objective of this study was to estimate the frequency of breastfeeding and to identify variables associated with median breastfeeding length. It is a cross-sectional population-based study carried out in a representative sample of 261 children under 2 years old randomly selected in the urban area of Itupeva city, SP, Brazil. The breastfeeding patterns recommended by WHO were used. The frequency and the median length of breastfeeding were estimated by life tables technique. The Wilcoxon test was used to identify association between breastfeeding and the categorical variables (p<0.05) in the bivariate analysis. For the multivariate analysis, the variables associated with the breastfeeding length (Wilcoxon test; p<0.10) were inserted in a Cox Regression model. Almost 100% of the children have initiated breastfeeding and 41.0% were in breastfeeding at the moment of the interview. The median length of breastfeeding was 7.2 months and exclusive breastfeeding was only 28 days. It was observed association between the breastfeeding length and the following variables: father's schooling, mother's marital status, number of children, sequence of birth, bottle-feeding and pacifier use. The Cox regression model selected as significant variables: sequence of birth (HR=1.68; IC95%=1.03-2.73), bottle-feeding use (HR=15.20; IC95%=3.69-62.01) and pacifier use (HR=2.84; IC95%=1.95-4.19). The current pattern of breastfeeding in Itupeva is still far from the WHO recommendations; therefore, encouragement and support to breastfeeding need to be intensified. Variables influencing breastfeeding should be considered in the attempt to increase breastfeeding. Health workers should dedicate all their efforts to increase the exclusive breastfeeding period in children under 6 months of age and increase the total breastfeeding period.     

Factors determining the breastfeeding in children attending public and not-for-profit daycare centers in São Paulo, Brazil

Cross-sectional study with 270 children and their mothers in eight public and philanthropic daycare centers in the city of S?o Paulo, Brazil. The objective is to identify the determinants of exclusive breastfeeding (EBF) and breastfeeding (BF). The Mann-Whitney/ Wilcoxon test and survival analysis; Kaplan Meier curves and Cox multiple regression models were used for statistical analyses. The median of exclusive breastfeeding duration was 79.1 +/- 55.6 days and breastfeeding was 185.3 +/- 174.2 days. In multivariate analysis, the following risk factors of early weaning for exclusive breastfeeding were identified: pacifier use (HR = 1.65, 95% CI = 1.24 to 2.2); previous hospital admission (HR = 1.35, 95% CI = 1.01 to 1.80); mother working outside home (HR = 1.33, 95% CI = 1.00 to 1.76). For breastfeeding were identified: pacifier use (HR = 2.54, 95% CI = 1.87 to 3.45) and mother who works outside the home (HR = 1.51, 95% CI = 1.14-1.99). The results show that it is necessary to continue to promote and support breastfeeding, mainly the exclusive breastfeeding until six months of age. The daycare centers should incorporate this idea, once they may have direct control over some of the early weaning determinants, and are also good places to deliver messages and guidance on nutrition education to mothers and caregivers in contact with children under three years old.     

Prevalence of sub-clinical vitamin A deficiency and malnutrition in slum children in Maraicabo - Venezuela

The present cross sectional study was carried out to estimate the prevalence of vitamin A deficiency among children by means of clinics and conjunctival impression cytology (CIC), and nutritional status by anthropometric indicators H//A, W//A, W//H. The study population included 157 children 2-6 y old, from urban and rural slums of Maracaibo, Venezuela, Conjunctival impression cytology was performed by ICEPO standard procedure. Z-score was applied to anthropometric data with reference values of NCHS-WHO. No evidence of clinical or ophthalmologic signs of vitamin A deficiency were detected. The prevalence of subclinical vitamin A deficiency, as detected by abnormal CIC, was 35.4%, being higher in rural children (48.3%). These prevalence values are higher than the criteria laid down by WHO/UNICEF to indicate a public health problem (> 20%). Mild or moderate protein-energy global malnutrition and stunting were detected in 36.1% and 44.6% of children, respectively. Abnormal CIC was indistinctly observed (approximately equal to 35%) as much in children with adequate nutrition as in malnourished ones. There was no significant difference in the distribution of the CIC results in relation to nutritional status. The findings indicate that CIC and Z-score of nutritional anthropometric data are useful to characterize the risk of vitamin A deficiency and of malnutrition in communities. Beside the implementation of an integral nutritional program which includes supplementation, food fortification and dietary diversification, improvement of socio-economic and sanitation conditions and also the educational level, with emphasis on nutritional and health education, are highly recommended.     

Socioeconomic and nutritional localization, quantification and characterization of functional groups in Panama

Even though there has been an increase in the coverage of governmental services and an adequate national food availability, malnutrition continues to exist in Panamanian children. In order to geographically and administratively identify those groups more seriously affected by this problem and orient governmental actions towards them, data from the National Nutrition Survey carried out in 1980 in 14 occupational (functional) groups were classified. Social, economic and cultural characteristics of each functional group were associated with food and nutrition problems. More than half of the malnourished children fall within the functional groups who work in the agricultural/sector. Within them, more than 40% of the malnourished live in homes where two-thirds of their income is derived from work performed outside their own farms. In urban as well as in rural areas low food availability exists at the family level in 25% of the families with inadequate diets studied. The food problem in the rural area is worsened due to limited access to health services and poor environmental conditions. Therefore, the malnutrition problem in Panama is linked to low incomes that prevent acquisition of sufficient foods and other goods and services, as well as to the difficulty of accessibility to public services by an important part of the population.     

Relation of socioeconomic and environmental indicators to the nutritional status of preschool children in a community of Sierra Norte de Puebla, México

A brief discussión on "the social" approach in nutritional research is presented. The relevance that socioeconomic factors have acquired in recent years for this type of studies, is also discussed. The main purpose of our communication was to identify and validate some socioeconomic and environmental indicators and their association with the nutritional status of preschool children in a Mexican indigenous community (Sierra Norte de Puebla). A total of 89 children below five years of age were studied and classified according to their nutritional status. A socioeconomic questionnaire was applied to their parents. Results revealed ample correlation between the degree of malnutrition of the preschool child and the following indicators: housing conditions, father's main occupation, land tenure, income, etc. It is argued that the analysis of these indicators is relevant, emphasizing the importance that the combination of anthropometrical, food consumption and socioeconomic data have for detecting population groups vulnerable to malnutrition. The obtention of these indicators is therefore highly recommended, but should not imply great obstacles; on the contrary, they should be highly sensitive and easy to detect.     

Influence of nutrition on the bone development of children

The effect of nutrition on infant bone age was studied. Bone age was examined in children with different degrees of malnutrition using wrist X-Rays and comparing them with Greulich and Pyle Atlas. There were no differences in the socioeconomic level of the different groups. In obese children bone age was advanced, while in under-nourished, it was retarded. The more severe the undernutrition the more delayed the bone age. A positive correlation between the percentage of variation of bone age and chronological age, and percentage of height for age was found. A greater delay in bone age was detected in undernourished children who had been small for date infants.     

Soybean products for feeding infants,children and adults under nutritional stress

This review points out the good quality of well-processed soya products. Normal infants, children and adults are able to utilize the protein and other nutrients present in the soya, when fed these products in amounts that will cover their needs. Under nutritional stress, such as in infant malnutrition, soya products such as soya-milk have been shown to help in the children’s recovery. Clinical and biochemical data show that their recovery is similar to that obtained with cow’s milk. Milk- or lactose-intolerant children and adults, who present a public health problem in some developing countries, could benefit from the high nutritive value and low cost of soy milk. Soya products have been shown to decrease cholesterol and other levels of blood lipids. Considering the availability of the several soya products in the market, this possibility has to be further explored. The utilization of soya products in preparing liquid formulas for oral or tube-feeding opens new fields for the treatment of several diseases, insuring at the same time adequate nutrition for the patients. From a practical point of view, in spite of all that is known about soybeans and soybean products, its use as human food, even in countries where it is produced in large quantities, is very low. It seems that local governments are not aware of the importance of soya for the solution to their serious food and nutrition problems. What is known on the subject has to leave the laboratories, research centers and universities and be transferred as food for the mouths of the needy populations. This has to be understood as an urgent duty of national governments. There is no doubt that soya is the cheapest and one of the best-quality foods available to help solve the present hunger problem of the world today.     

Protective factors for iron deficiency anemia: prospective study in low-income infants

This study was performed to assess both risk and protective factors associated with iron deficiency anemia in 130 infants with age below 24 months, with low socio-economic status and followed since their births by a primary health care program in the city of S?o Paulo, Brazil. Growth, morbidity and dietary factors were analysed as well as hemoglobin levels (Hb) at regular intervals (6, 9, 12, 18 and 24 months). The portable Hemocue photometer was employed to measure hemoglobin levels and anemia was considered when Hb values were below 11 g/dL. Simple logistic regression was used with socio-economic variables, age group, nutritional status, morbidity, breastfeeding and food intake. Risk factors for anemia in the studied group were intake of cow's milk at 4 months and who has 3 or more old brothers (OR approximately = 2). The protective factors for anemia were age between 18 and 24 months and intake of infant formula, vitamin C, meat and beans at 6 months (OR approximately = 0.5). The prevention of iron deficiency anemia includes encouraging healthy feeding practices starting at 6 months of life.     

The duration of diarrhea and fever is associated with growth faltering in rural Malawian children aged 6-18 months

Nutrition support programs that only focus upon better complementary feeding remain an insufficient means of limiting growth faltering in vulnerable populations of children. To determine if symptoms of acute infections correlate with the incidence of growth faltering in rural Malawian children, the associations between fever, diarrhea, and cough with anthropometric measures of stunting, wasting, and underweight were investigated. Data were analyzed from a trial where 209 children were provided with adequate complementary food and followed fortnightly from 6-18 months of age. Linear mixed model analysis was used to test for associations. Diarrheal disease was inversely associated with changes in height-for-age Z-score (HAZ), mid-upper arm circumference Z-score (MUACZ), and weight-for-age Z-score (WAZ). Fever was also inversely associated with changes in MUACZ and WAZ. These results suggest that initiatives to reduce febrile and diarrheal diseases are needed in conjunction with improved complementary feeding to limit growth faltering in rural Malawi.