Feeding Mothers Research Articles

Pendidikan Kesehatan tentang Pemberian Makanan Pendamping ASI pada Ibu yang Mempunyai Bayi 6-24 Bulan

Growth in infants and nutritional problems in children are often caused by the inaccuracy of parents in their habits of inappropriate breastfeeding and complementary feeding, and mothers are less aware that babies aged 6 months already need complementary feeding. mothers in good quantity and quality. At the age of 6 months apart from breastmilk, the baby can start to be given complementary foods, because at this age the baby already has a chewing reflex with stronger digestion. In giving baby food, it is necessary to pay attention to the punctuality of delivery, frequency, type, quantity, foodstuff, and method of manufacture, improper infant feeding habits, such as feeding too early or too late, insufficient food given and inadequate frequency. this can have an impact on the health and nutritional status of the baby. Based on the data obtained from the health office, it is known that from 12 districts the prevalence of malnutrition and malnutrition based on the BB / U indicator is 17.2% and based on the TB / U indicator is 20.2%. This community service aims to provide information and improve the skills of mothers in complementary feeding of breast milk. This community service was carried out in the Work Area of the Simpang Kawat Puskesmas, at the time of January 2020 the service method used a survey approach, lectures and discussions. The results obtained by mothers can understand the meaning of complementary foods for breast milk, the benefits of complementary foods for breast milk and the schedule for which they are given.

Evaluation of Nutrient Composition in Breast Milk of Breast Feeding Mothers in Urban and Sub-Urban Subjects in Rivers State

The human breast milk is considered to be the perfect food for infants, specifically adapted to their needs. Changes in lifestyle and environment may impact on breast milk composition. This study was aimed at comparing the nutrients composition in breast milk in postpartum women in urban and sub-urban areas in Rivers State. The cross-sectional study was conducted among 59 postpartum subjects between 0 and 10days of child delivery in each group. Sampling was done through a simple random sampling method. Human breast milk was collected by means of a manual breast pump for the analysis of carbohydrate, protein and lipid using ClegAnthrone Method, Kjedahl Method and Soxhelt Extraction Method respectively. The results revealed that carbohydrate level was 6.1±0.5% in urban group and 5.0±0.1% in sub-urban group which was statistically significant (t-value=2.2; p-value=0.04). Protein level was 3.5±0.6% in urban group and 3.9±0.3% in sub-urban group which was statistically non-significant (t-value=0.6; p-value=0.57). Lipid level was 6.1±0.5% and 5.0±0.1% in urban and sub-urban groups respectively which was statistically non- significant (t-value=1.2; p-value=0.27). This study has revealed that differences in settlements (urban and sub-urban) have no impact on breast milk composition except in carbohydrate.

Hormones regulating energy homeostasis in breastfeeding versus formula feeding mothers.

To meet energy demands for lactogenesis and to sustain homeostatic conditions post-partum, the organism of breastfeeding mother undergoes combined endocrine and metabolic regulation. The main objective of this study was to determine basal serum concentrations of hormones involved in the maintenance and defense of energy balance in breastfeeding (BF) and formula feeding (FF) mothers. Twenty healthy exclusively breastfeeding mothers at 3rd month of lactation (EBF3), 17 healthy partially breastfeeding at 6th month of lactation (PB6) and 17 healthy FF mothers participated in this study. Fasting serum prolactin (PRL), acylated ghrelin (aGhr), total ghrelin (tGhr), leptin, adiponectin, insulin, and cortisol were determined for all study participants and correlations between studied parameters were calculated for BF women. We found significantly lower basal insulin (p = 0.0048) and cortisol (p = 0.0002) and significantly elevated basal prolactin (p = 0.0020) and leptin (p = 0.0416) in BF when compared with FF women. The differences were not associated with the duration of lactation (3 vs. 6 months), except for PRL, which was highest in EBF3. Levels of Ghr and adiponectin did not differ between study groups. In the BF group, the negative correlations were found between: aGhr and insulin, aGhr and adiponectin, leptin and cortisol, leptin and adiponectin, insulin and adiponectin, cortisol and adiponectin. Positive associations were noted between: insulin and leptin, leptin and aGhr, PRL and leptin, PRL and aGhr. Leptin and insulin correlated positively, whereas adiponectin negatively with BMI. These data may suggest that EBF3 and PB6 as compared with FF mothers, exhibit hormonal regulation which tends to be more advantageous for their metabolic profile and is not related to the duration of breastfeeding within the first 6 months of lactation.

Knowledge attitude and practice regarding breast feeding mothers of Bundelkhand region of Uttar Pradesh

Background: Breastfeeding is a basic human activity, vital to infant and maternal health and it has massive economic value to households and societies. It has been proved that early initiation of breastfeeding lowers the risk of postpartum hemorrhage and anemia to the mothers, boosts their immunity and reduces the incidence of certain diseases like diabetes and cancer. In this study we assess the socio-demographic characteristics, knowledge, attitude and practice of the mothers regarding breast feeding.Methods: This was a cross-sectional study. It was conducted for a period of nine month from July 2019 to March 2020 at Government Allopathic Medical College, Banda. Total 160 children in the age group of 0-6 months came at immunization clinic of pediatric OPD.Results: Total numbers of children studied during the study period were 160 out of which 54.37% were male and 46.62% were females. Maximum number of mothers (38.75%) belong to the age group of 25-30 years followed by 21-25 years (26.87%). 38.12% of the mothers start breastfeeding within one hour, 46.87% between 1-6 hour and 60% of the mothers breastfed their babies on demand.Conclusions: The participants had good knowledge and attitude regarding breastfeeding but there was a noticeable deficit in the use of this knowledge in the breastfeeding practices which points towards the gap in the education and counselling of women regarding breast feeding.

Eliminating Mother to Child Transmission of HIV in Arua District Through Mother–Baby–Pair Points

Introduction: Mother-to-child transmission is the leading cause of HIV infection in children. Without treatment, half of these HIV infected children die before their second birthday.Purpose: To establish the contribution of mother-baby-pair points approach to eMTCT outcomes in Arua District Uganda.Material and Methods: A descriptive and analytical cross sectional study design which employed mixed methods approach was used. 196 HIV positive breast feeding mothers from three government hospitals (Arua Regional Referral Hospital, Adumi Health Center IV and Oli Health Center IV) were interviewed. Data was collected using structured questionnaires, focus group discussions and interviews guides.Results: Majority 168 (85.7%) of the respondents and their babies were enrolled to eMTCT care immediately after delivery and up to 17(8.7%) were enrolled beyond two weeks after delivery. Reasons for enrolment into care included; counseling before, during and after pregnancy on the importance of adherence to ART, early enrolment into care and delivery in a health facility. Most of the babies enrolled in mother-baby-points were HIV sero-negative (75.5%) with only 6.6% of them being sero-positive, thus signifying the contribution of mother-baby-points towards eliminating mother-child-transmission of HIV. Age of mothers was associated with retention on eMTCT care (χ2(5) =11.19, p=0.048). Again, having had any form of education on eMTCT was associated with retention on eMTCT care (p=0.001).Conclusion: The degree of enrollment in to eMTCT care was high but some mothers who still enrolled late. This affects early infant diagnosis, uptake of eMTCT services and retention of mothers and their infants.

Factors associated with feeding practices of black immigrant mothers of African and Caribbean origin living in Ottawa, Canada

In Canada, Black immigrant women and their children are at higher risk of developing obesity. Factors that could influence children's weight status include parental feeding practices. Feeding practices such as monitoring, restriction and pressure to eat, are well studied among non-Hispanic White and Latinos groups, however, little is known about the feeding practices of Black immigrant parents of African and Caribbean origin. The aim of this study was to identify factors associated with feeding practices of Black immigrant mothers in Ottawa, Canada. The sample includes 188 Black mothers of African and Caribbean origin and their 6-12-year-old children. The Child Feeding Questionnaire was used to assess mothers' feeding practices. Demographic and socioeconomic data were collected using questionnaires. All participants' weight status was determined from measured weight and height. Pearson Chi-square tests and multivariate logistic regressions were performed. Results showed that mothers who felt responsible for feeding their children were more likely to monitor their children's food intake (p < 0.05). While mothers of children with underweight or normal weight were more like to use pressure to eat (p < 0.01), mothers of children with overweight or obesity were more like to use restriction (P < 0.05). Recent immigrant mothers were also more likely to use pressure to eat (P < 0.05). This study also provides evidence for associations between maternal feeding practices and mothers' weight status, household income and food security status. Findings build on previous research suggesting that parental feeding practices vary based on parents' and children's characteristics. Longitudinal studies are needed to assess the directionality of the association between mothers' feeding practices, and children's weight, diet quality and health in this population.

Pengaruh Edukasi Gizi terhadap Praktik Pemberian Makan Pada Baduta Stunting di Kabupaten Bengkulu Utara

Stunting is a less chronic nutritional problem. The practice of feeding is one of the factors that contribute to stunting, so there is a need for nutrition education regarding the practice of providing food. This study aims to discuss nutrition education interventions on the practice of feeding mothers who have stunting. The study design used a quasi-experimental design with a pre-posttest design of two groups. The research location was Kerkap health centre as an intervention and Air Lais health centre as a control with a sample of 40 people each. The test used in this study paired-sample t-test and independent t-test. The different tests' results depend on the average meal management between the control groups and comparison with p values of 0,000 and 0.168, and independent tests between the intervention group and the control group of 0,000. Nutrition education is a particular program to improve the practice of family feeding of stunting children.

Influencias familiares en las prácticas de alimentación materna a niños preescolares de familias vulnerables de la Región Metropolitana de Chile

ObjectiveTo explore family members’ influences on mothers’ feeding practices of preschoolers in Chilean families residing in vulnerable neighborhoods from the Metropolitan Region of Santiago, Chile. DesignQualitative study. LocationNine child care centers in Región Metropolitana, Santiago, Chile. ParticipantsTwenty-four mothers and one father of preschool children. MethodPhoto-elicitation techniques were applied to 25 semi-structured interviews and their subsequent inductive thematic analysis of family influences. ResultsThe participants described that the family influences on their feeding practices depended on the family structure and the interpersonal closeness between relatives. Some influences directly affected child eating behavior, especially in relatives who live together, while others were mediated by the relationships generated between parents and other members of the family. Fathers, in two-parent families, and grandparents are the most influential relatives on the participants’ feeding practices. Generally, fathers participated and were in line with the mother's feeding practices of their children. Grandparents enriched their grandchildren's eating experiences by offering homemade preparations, expressing affection with food, including unhealthy options, and supporting parents to diversifying and structuring feeding practices. ConclusionsAccording to their interpersonal closeness or cohabitation, parental feeding practices and child eating behaviors were impacted by family members and their dynamics. The development of strategies to prevent and treat childhood obesity should consider a family approach in vulnerable families.

Levels of Total Antioxidant Capacity, sCD14, and TGF-β2 in Breast Milk Plasma of HIV-Infected and HIV-Uninfected Lactating Women.

Introduction: Breast milk provides nourishment for infants and nonnutritive bioactive factors, which possess key protective and developmental benefits essential in shaping the infant immune system. However, the impact of human immunodeficiency virus (HIV) and universal antiretroviral therapy (ART) on breast milk nutritional composition and immunity status is not well documented. Objective: The study aimed to compare breast milk immune factors; total antioxidant capacity (TAC), soluble cluster of differentiation 14 (sCD14), and transcription growth factor-beta 2 (TGF-β2) levels between HIV-infected and HIV-uninfected lactating mothers and determine the association between breast milk parameters with HIV disease progression and duration of ART. Methods: Breast milk sCD14, TAC, and TGF-β2 were quantified using enzyme-linked immunosorbent assays and spectrophotometric techniques in 57 HIV-infected breast feeding mothers on option B+ therapy for prevention of vertical transmission of HIV and 57 HIV-uninfected mothers at 6 weeks postpartum. The plasma HIV viral load was measured on enrollment and demographic data were recorded. Results: Mean breast milk plasma TAC levels were significantly lower in HIV-infected mothers (1,250.5 ± 280.4 μmolTE/L) compared to the HIV-uninfected participants (1,915.4 ± 326 μmolTE/L; p < 0.001). Soluble CD14 levels in HIV-infected mothers were significantly higher (7,059.3 ± 1,604.7 ng/mL) compared to the HIV-uninfected group (5,670.7 ± 1,268.3 pg/mL; p < 0.001). Similarly, TGF-β2 concentration was also significantly elevated in the HIV-infected mothers (1,426.1 ± 695.4 pg/mL) compared to the HIV-uninfected counterparts (709.2 ± 196.8 pg/mL; p < 0.001). A positive correlation was observed between breast milk plasma sCD14 concentration and the plasma viral load (r = 0.576, p < 0.001), while a significant negative correlation was observed with the duration of ART (r = -0.285, p = 0.032). TAC and TGF-β2 concentrations were inversely correlated with plasma viral load levels. Conclusion: HIV-infected mothers are at risk of oxidative stress. Nutritional intervention with antioxidant rich foods is recommended for this vulnerable group during breastfeeding.

Initiation of Breast Milk Expression and Associated Factors Among Mothers of Preterm and Low Birth Weight Neonates Admitted to Neonatal Intensive Care Units of Government Hospitals in Addis Ababa, Ethiopia,2020.

BackgroundIn early preterm and very low birth weight, breast milk expression is an optimal solution to continue with breastfeeding. This study aimed to assess the initiation of breast milk expression and associated factors among preterm and low birth weight mothers in the neonatal intensive care units of public hospitals in Addis Ababa.MethodsInstitution-based cross-sectional study was performed in selected public hospitals, Addis Ababa, among 124 breast feeding mothers chosen from different public health facilities of Addis Ababa; from April 5 to May 15, 2020. Information was collected using questionnaires administered by the interviewer, double data entry was performed using Epi Info version 4.6.02 software, cleaned finally exported to SPSS statistics version 26 for analysis. To predict the association of research variables, logistic regression models were used and adjusted for potential confounders.ResultsAll respondents were started milk expression after six hours following delivery. Getting instruction on the method of their choice (AOR=0.55; CI=0.31 to 0.96) and gestational age ≤32 weeks (AOR=2.39; CI=1.34 to 4.24) were factors significantly associated with initiation of milk expression.ConclusionThe study indicated breast milk expression was poor. Inter-departmental collaboration is required in order to promote good practice of breast milk expression among mothers of neonates with preterm and low birth weight.

Knowledge and Practice of Breast and Complementary Infant Feeding Among Mothers in Shinasha Culture: The Case of Bullen Woreda, Metekel Zone, Ethiopia

The objective of this study was to investigate knowledge and practice of breast and complementary infant feedings among mothers of Shinasha culture in Bullen Woreda. The study was undertaken in four kebeles and 80 participants were selected by using convenient sampling. Questionnaire, interview and focus group discussion were used to collect data. The data were analyzed using SPSS version 26 to compute descriptive statistics, Pearson correlation and one-way ANOVA. The result of analysis reveals that mothers were not given any information about infant feeding before birth of the infant and after birth of the infant mothers got information about breast and complementary infant feeding elder mothers. There is no significant difference among mothers on their knowledge and practice of breast and complementary infant feeding on the three categories of age. Mothers lacked sufficient knowledge about importance of breast feeding for breastfeeding mothers and biased in duration of breastfeeding between both sexes of their infants. The knowledge of complementary infant feeding mothers reported that male infants should start complementary foods earlier than female infants. It is concluded that there is no statistically significant difference among mothers by their knowledge level practices on breast and complementary infant feeding on their age groups. Finally, it was recommended that all concerned bodies of the community, health extension workers etc. should take their parts in educating and creating awareness for mothers about breast and complementary infant feeding.

Last Mile Access to Enriched Children's Complementary Food: Mitigating Malnutrition in Kenya.

Commercial complementary foods are not accessible at the last mile of delivery, despite a veritable stunted growth explosion in Kenya. A Mile for the Brain aims to reduce child malnutrition by solving the pervasive distribution bottlenecks and prohibitive pricing challenges. This paper presents the systematized measurement for change process. We focus on the selection of off-the-shelf complementary foods, training of women entrepreneurs responsible for commercializing these complementary foods, coaching given to mothers on appropriate feeding education, and lastly the learning cycle revolving around feeding mothers, entrepreneurs for the Mile for the Brain social enterprise itself. We highlight the real-life challenges involved in this process in the context of adversity and constrained resources. The results, findings, and policy implications of this study will be reported elsewhere.

The minimal invasive surfactant therapy: experience from a low resource setting

Objective To evaluate all cases managed with the Minimal Invasive Surfactant Therapy (MIST) and its effect on outcome. Background Respiratory distress syndrome (RDS), a major cause of morbidity and mortality in preterm new-borns is common in sub-Saharan Africa. Surfactant replacement therapy (SRT) is less practiced and the new MIST is just introduced in Asaba, Nigeria. Methods This descriptive survey recruited new-borns of consenting parents who provided for the surfactant and other commodities. Demographic characteristics were obtained. Intervention included MIST Surfactant, nasal bubble Continuous Positive Airway Pressure (n b-CPAP). Aminophylline or Caffeine, early breast milk feeding and Kangaroo mother care (KMC). Data were collected over a 1-year period and Standard statistical methods were used for data analysis. Results From 1 May 2019 to 30 April 2020, there were 1801 live births, preterm birth rate of 10.72% (193/1801) at the FMC, Asaba. Admissions to the Neonatal Unit (NNU) comprised a total of 731 newborn: 270 preterms. Of these preterm; 52(19.26%) were extreme preterms; 122 (16.15%) very preterm. Of these 731 total admissions there were 104 (14.23%). Their gestational ages (GA) ranged from 24 to 38 weeks and birthweights from 600 to 3400 g. A total of 51 Newborns received surfactant. Their GA ranged from 24 to 38 Weeks; birth weights 600 to 3400 g. These comprised 48 preterm and 3 terms. All 51 infants with RDS who received MIST surfactant included 48 preterms and 3 terms with perinatal Asphyxia and Meconium Aspiration Syndrome. The obstetric management of five mothers of early preterm included two doses of antenatal cortico-steroids prior to delivery. MIST was successful in 47 of 51 (92.2%) cases. Age range at administration was one to 48 h. Duration of n-bCPAP post surfactant: ranged 6 h to 96 h: 4 babies were weaned off CPAP within 24 h; 12 babies at <48 h, another 9 at <72 h; and 20 beyond 96 h. Five babies received a second dose of MIST after 48 h of the first dose. Twelve of 51 (23.5%) babies died; 4 at 48 h, 2 at 72 h, 3at 96 h and 3 beyond 7 days. Prior to the MIST, respiratory distress (RD) and severity rating as indicated by the Silverman Anderson Score (SA) scores in the survivors ranged from 6/10 to 8/10. Conclusions The MIST, at FMC Asaba, improves outcome of the extreme preterm. Financial barriers remain a major constraint to its use.

Determinants of Adherence to National Infant Feeding Guidelines by Black Mothers Living with HIV.

Worldwide, 160,000 children were newly infected with HIV in 2018; half of these were infected through breastfeeding. Infant feeding guidelines are distinct depending on each country's resources and national or sub-national guidelines. Because of divergent guidelines, the best infant feeding approach to prevent mother-to-child transmission can become unclear. The purpose of this study was to examine the sociocultural and psychosocial factors related to adherence to infant feeding guidelines through a city-level, North-South comparison of Black mothers living with HIV in Nigeria, Canada, and the United States. Using a cross-sectional multi-country survey, a convenience sample of 690 mothers were recruited from June 2016 - December 2019. Socio-cultural and psychosocial factors influencing infant feeding practices were measured. Using binary logistic regression, infant feeding attitudes (OR = 1.10), motherhood experiences (OR = 1.08), low hyper-vigilance score (OR = .93), paternal support (OR = 1.10) and perception that the health care provider supported adherence to infant feeding guidelines (OR = 2.43) were associated with guideline adherence. Mothers who had cultural beliefs that were inconsistent with infant feeding guidelines and mothers with low incomes (OR = 2.62) were less likely adherent with their country's guidelines. City-level factors were not found to influence adherence to infant feeding guidelines; however, socio-cultural and psychosocial factors at community, family and individual levels were significant. Policy formulation and targeted interventions must be cognizant of cultural expectations of motherhood and mindful of psychosocial determinants of adherence to infant feeding guidelines.

Modelling Predictors of Weight Gain of Children Under-Five

This study examined the determinants of weight gain by children less than five years in the Kintampo municipality of the Bono East Region of Ghana using multivariate analysis of variance (MANOVA) procedure and profile analysis. The study revealed that the minimum weight gain at the first month for males and females are 1.8kg and 1.6kg respectively and that mean weights gain by children under five years was not the same across feeding type. Profile plots of main effect revealed that baby’s age group 0-6, Exclusive Breast Feeding (EBF), parity levels 6, 7 and mothers who were formally employed are associated with lower mean effects since they fall below the average mean weight. However, child age group 13-18, breast milk substitute and parity 7 are above the average mean weight line of 7.5, indicating significant effect. Interaction plots indicated that the relationship between parity, mother’s age group, employment type and weight depend on other predictor variables. Parity depends on mother’s age but mother’s age does not depend on the child age group with respect to weight gain. Also, employment type neither depend on religion nor child age group but it depends on educational level with respect to weight gain. The MANOVA results showed that feeding type, parity and child age are the influential factors in determining the weight gain of children less than five years. Further, the study revealed that there exists some relationship between feeding type and mother’s education, parity and mother’s age group and between occupation and mother’s age group with respect to weight gain confirming the profile results. It is therefore recommended that nursing mothers should be encouraged to feed their children themselves since feeding practice has a great influence in the growth of the child at the infant stage.

Hypothyroidism in infant of breast feeding mother after Radioiodine therapy (for CA thyroid): a case report

Hypothyroidism in infant of breast feeding mother after Radioiodine therapy (for CA thyroid): a case report

Factors Associated With Breastfeeding Very Low Birth Weight Infants at Neonatal Intensive Care Unit Discharge: A Single-Center Brazilian Experience.

The mothers of very low birth weight infants face many challenges to achieve breastfeeding at hospital discharge, especially during long stays. The aim of this study was to describe the incidence and factors associated with breastfeeding rates (exclusive or with formula) at discharge, for very low birth weight infants, in a private Neonatal Intensive Care Unit in southern Brazil. We conducted a prospective longitudinal cohort study of infants (N = 335) with very low birth weight and/or less than 30 weeks gestational age, who survived to discharge and had no contraindication to mother's own milk. Participants were initially divided into three groups (exclusive breastfeeding, some breastfeeding, and no breastfeeding) based on their feedings at discharge; however, later, two groups were analyzed (any breastfeeding, no breastfeeding). Most (93.4%; n = 313) were breastfeeding directly at least once daily at discharge, of which 16.1% (n = 54) were receiving exclusive mother's milk and 77.3% (n = 259) mixed feeding (mother's milk and formula). Breastfeeding at discharge was associated with gestational age ≥ 28 weeks, higher birth weight, not developing neonatal sepsis or bronchopulmonary dysplasia during the hospital stay, shorter lengths of stay, and lower weight at discharge. After Poisson regression, breastfeeding at discharge was associated only with a shorter length of stay (RR 0.98; CI 95% [0.95, 0.99], p < .05). In our single unit experience in Brazil, most infants were breastfeeding at discharge. NICU staff might address mothers of infants who have prolonged hospitalization with specific strategies. Mothers and infants at risk can be identified early and personalized interventions can be developed for improving breastfeeding rates at discharge.

Walnut Kernel administration to mothers during pregnancy and lactation improve learning of their pups. Changes in number of neurons and gene expression of NMDA receptor and BDNF in hippocampus in 80 days rat pups

Abstract Walnut (Juglans regia) from the Juglandaceae family contains high levels of omega 3 fatty acid, vitamin E and melatonin, hence its consumption is beneficial to would be mothers and their offspring. The current study was designed to determine the possible mechanism of walnut consumption by mothers during pregnancy and lactation and the positive effects on learning and memory processes in their offspring. Wistar adult female rats were placed into three groups: control (fed with pellet, 20 g daily during pregnancy and lactation), CASE 1 [fed with Walnut Kernel (WK) 6% of food intake during pregnancy and lactation] and CASE 2 (fed with WK, 9% of food intake during gestation and lactation). In order to evaluate offspring learning and memory, the Morris Water Maze (MWM) test was performed for their adult offspring at 80 days of age. Histological and molecular studies were utilized in order to discover the protective mechanism and efficacy of WK consumption. The results revealed that learning was significantly improved in the females of CASE 2, in comparison to controls, while there was no difference in memory among the different groups. In addition, the number of neurons significantly increased in the CASE 2 group compared to the control group. However, the molecular study demonstrated that there was no significant difference among the study groups. The results herein show that feeding mothers with WK may improve the learning competence of their pups and increase the number of neurons in both sexes.

Predictors of recovery in children aged 6-59 months with uncomplicated severe acute malnutrition: a multicentre study.

To identify predictors of recovery in children with uncomplicated severe acute malnutrition (SAM). This is a secondary data analysis from an individual randomised controlled trial, where children with uncomplicated SAM were randomised to three feeding regimens, namely ready-to-use therapeutic food (RUTF) sourced from Compact India, locally prepared RUTF or augmented home-prepared foods, under two age strata (6-17 months and 18-59 months) for 16 weeks or until recovery. Three sets of predictors that could influence recovery, namely child, family and nutritional predictors, were analysed. Rural and urban slum areas of three states of India, namely Rajasthan, Delhi and Tamil Nadu. In total, 906 children (age: 6-59 months) were analysed to estimate the adjusted hazard ratio (AHR) using the Cox proportional hazard ratio model to identify various predictors. Being a female child (AHR: 1·269 (1·016, 1·584)), better employment status of the child's father (AHR: 1·53 (1·197, 1·95)) and residence in a rental house (AHR: 1·485 (1·137, 1·94)) increased the chances of recovery. No hospitalisation (AHR: 1·778 (1·055, 2·997)), no fever, (AHR: 2·748 (2·161, 3·494)) and ≤ 2 episodes of diarrhoea (AHR: 1·579 (1·035, 2·412)) during the treatment phase; availability of community-based peer support to mothers for feeding (AHR: 1·61 (1·237, 2·097)) and a better weight-for-height Z-score (WHZ) at enrolment (AHR: 1·811 (1·297, 2·529)) predicted higher chances of recovery from SAM. The probability of recovery increases in children with better WHZ and with the initiation of treatment for acute illnesses to avoid hospitalisation, availability of peer support and better employment status of the father.

Assisted Nursing: A Case Study of an Infant With a Complete Unilateral Cleft Lip and Palate.

This case presents a mother's feeding experience of an infant born with a complete unilateral cleft lip and palate from birth until both were repaired. She fed him directly at the breast with assistance, controlling the delivery of the mother's own milk. The infant received only his mother's own milk, no bottles, and the excess expressed milk was donated to a milk bank. The Cleft Team supported the mother's wish to breastfeed but expressed realism that cleft lip and palate infants could not create suction. Success had never been observed in the unit. Instead, the team suggested expressing to deliver as much of the mother's own milk. The mother had previously breastfed her three children and was keen on finding innovative ways to breastfeed. Several techniques were trialed with the help of an International Board Certified Lactation Consultant. The most sustainable and successful was the use of a nipple shield applied to the maternal nipple areola complex to cover the lip palate. Underneath, a nasogastric tube connected to a syringe delivered the mother's own milk. Exclusive expressing protected maternal supply, the infant's nutrition and growth were monitored carefully and this technique reinforced mother-infant bonding. Feeding with the modifications was challenging at times. However, maternal satisfaction was high because the mother had achieved her goal of breastfeeding without assistance post cheiloplasty and palatoplasty. This case adds to the limited body of research about feeding infants with cleft lips and palates directly at the breast.