Initiation Of Complementary Feeding Research Articles

Clinical profile and major co-morbidities among hospitalized children with severe acute malnutrition: experience from a tertiary care teaching hospital of North India

Background: Malnutrition is still a leading cause of morbidity and mortality in children aged less than 5 years and responsible for 60% of the 10 million deaths. The study was designed to evaluate the clinical profile and major clinical co-morbidities among hospitalized children with severe acute malnutrition (SAM).Methods: A prospective study was conducted in a pediatric department of a tertiary care teaching hospital of Haryana. All children aged 6 months to 5 years with SAM admitted between 1st April 2018 to 31st March 2019 were included in the study. The socio-demographic details, anthropometry, clinical details and outcome were recorded in a pre-designed structured performa. Statistical analysis was done using SPSS software version 16. P value<0.05 was considered significant.Results: After screening a total of 131 children, 102 children met the inclusion criteria and were enrolled in the study. Out of these, 50 were males and 52 were females. Majority of children (i.e., 59.8%) belonged to 6-12 months age group. Majority (92.16%) belonged to lower socio-economic status. Exclusive breastfeeding during first 6 months was documented in 74.51% of the children. Delayed initiation of complementary feeds was observed in 78.43% of children and had a significant association with poor future outcome (p<0.05). Major clinical co-morbidities were severe anemia (56.86%), diarrhea (27.45%) and lower respiratory tract infection (19.6%).Conclusions: In our study, most vulnerable age group for severe malnutrition was 6-12 months infants. Low socioeconomic status of family and delayed initiation of complementary feeding were the major risk factors. Most common co-morbidities were severe anemia, diarrhea, lower respiratory tract infections and sepsis emphasizing the need to target these factors.

Determinants for inappropriate initiation of complementary feeding to children aged 6–24 months in Gondar Health Centers, Northwest Ethiopia, 2019

BackgroundThe practice of the timely initiation of complementary feeding is serious for the achievement of healthy advancement and progress. The timely initiation complementary feeding practice failure was the main leading issues of the under nutrition. ObjectiveTo assess timely initiation of complementary feeding practice and associated factors to children aged 6–24 months at Gondar town Health institutions, Northwest Ethiopia, 2019. MethodsAn institution-based cross- sectional study was conducted from May 01 to 30/2019. A sample of 381 subjects, were selected by using systematic random sampling technique. Data were collected using pre-tested interviewer-administered structured and semi-structured questionnaires. The data were cleaned, coded, entered in to EPI-INFO version 7, and transferred and analyzed using SPSS version 21. ResultsOut of 381 study participants, 252 (66.1%) had initiated complementary feeding practices to their children timely. Mothers’ grade level one up to eight [AOR = 2.26], antenatal care visit greater than or equal to three times [AOR = 1.85], number of children two up to four [AOR = 2.30], family size four up to six [AOR = 1.79], and knowledgeable mothers [AOR = 1.98] times were positively associated with timely initiation of complementary feeding practices. ConclusionsTimely initiation of complementary feeding practice was more than three among five participants (i.e. 252 (66.1%)). Mothers’ educational level, number of children, antenatal care visit, family size and mothers’ knowledge were the main factors for the timely initiation of complementary feeding.

Prevalence and determinants of protein energy malnutrition among under five children in slums of Kannauj district

Introduction: Protein Energy Malnutrition (PEM) in children is a leading public health problem in developing countries like India and is a direct or indirect cause of most of infant and child morbidity and mortality. Objective: To study the prevalence and determinants of protein energy malnutrition among under five children of Kannauj district. Materials and Methods: The present study was a cross-sectional study conducted among children in the age group 0-60 months in the slums of Kannauj district. The statistical tools used for analysis were percentages, Pearson's Chi-square test and multiple logistic regression. Results: The prevalence of PEM in the study population was found to be 59.1%. The study revealed a significant association of age (OR=0.438), timing initiation of breast feeding (OR=0.682), colostrum feeding (OR=0.364), practice of breast feeding (OR=3.611) and initiation of complementary feeding at 6 months (OR=2.651) were significantly associated with PEM. Conclusion: The present study emphasizes the need to correct behavioural factors like breast feeding practices among Indian mothers to bring down the problem of PEM in under five children. Keywords: PEM, Under five children, Malnutrition, Determinants.

Geospatial variations in trends of reproductive, maternal, newborn and child health and nutrition indicators at block level in Bihar, India, during scale-up of Ananya program interventions

Background Geographical variations in the levels and trajectory of health indicators at local level can inform the adaptation of interventions and development of targeted approaches for efficient scale-up of intervention impact. We examined the hypothesis that time trends of a set of reproductive, maternal, newborn, and child health and nutrition (RMNCHN) indicators varied at block-level during the statewide scale-up phase of the Ananya program in Bihar, India. Methods We used data on 22 selected indicators from four rounds of the Community-based Household Survey carried out between 2014 and 2017. Indicator levels at each round were estimated for each block. We used hierarchical Bayesian spatiotemporal modelling to smooth the raw estimates for each block with the estimates from its neighbouring blocks, and to examine space-time interaction models for evidence of variations in trends of indicators across blocks. We expressed the uncertainty around the smoothed levels and the trends with 95% credible intervals. Results There was evidence of variations in trends at block level in all but three indicators: facility delivery, public facility delivery, and age-appropriate initiation of complementary feeding. Fifteen indicators showed trends in opposite directions (increases in some blocks and declines in others). All blocks had at least 97.5% probability of a rise in immediate breastfeeding, early pregnancy registration, and having at least four antenatal care visits. All blocks had at least 97.5% probability of a decline in seeking care for pregnancy complications. Conclusions The findings underscore the value of monitoring and evaluation at local level for targeted implementation of RMNCHN interventions. There is a need for identifying systematic factors leading to universal trends, or variable contextual or implementation factors leading to variable trends, in order to optimise primary health care program impact. Study registration ClinicalTrials.gov number NCT02726230.

Geospatial variations in trends of reproductive, maternal, newborn and child health and nutrition indicators at block level in Bihar, India, during scale-up of Ananya program interventions.

BackgroundGeographical variations in the levels and trajectory of health indicators at local level can inform the adaptation of interventions and development of targeted approaches for efficient scale-up of intervention impact. We examined the hypothesis that time trends of a set of reproductive, maternal, newborn, and child health and nutrition (RMNCHN) indicators varied at block-level during the statewide scale-up phase of the Ananya program in Bihar, India.MethodsWe used data on 22 selected indicators from four rounds of the Community-based Household Survey carried out between 2014 and 2017. Indicator levels at each round were estimated for each block. We used hierarchical Bayesian spatiotemporal modelling to smooth the raw estimates for each block with the estimates from its neighbouring blocks, and to examine space-time interaction models for evidence of variations in trends of indicators across blocks. We expressed the uncertainty around the smoothed levels and the trends with 95% credible intervals.ResultsThere was evidence of variations in trends at block level in all but three indicators: facility delivery, public facility delivery, and age-appropriate initiation of complementary feeding. Fifteen indicators showed trends in opposite directions (increases in some blocks and declines in others). All blocks had at least 97.5% probability of a rise in immediate breastfeeding, early pregnancy registration, and having at least four antenatal care visits. All blocks had at least 97.5% probability of a decline in seeking care for pregnancy complications.ConclusionsThe findings underscore the value of monitoring and evaluation at local level for targeted implementation of RMNCHN interventions. There is a need for identifying systematic factors leading to universal trends, or variable contextual or implementation factors leading to variable trends, in order to optimise primary health care program impact.Study registrationClinicalTrials.gov number NCT02726230.

A study on infant and young child feeding practices among mothers attending the immunisation clinic of a tertiary care hospital, Kolkata, West Bengal

Background: Age appropriate feeding practices is an essential determinant of physical growth as well as mental health of under-five children. WHO and UNICEF have formulated the infant and young child feeding practices guidelines to enhance appropriate feeding practices in infants and young children.Methods: A descriptive, observational, cross-sectional study was conducted in the immunization clinic of KPC medical college and hospital from October to December 2018 among children in 0-23 months age group. The mothers were interviewed regarding their sociodemographic details as well as the IYCF practices as per WHO.Results: It was found that appropriate practices in terms of prelacteal feeding, colostrum feeding; early initiation of breast feeding and exclusive breast feeding was present in 78.4%, 80%, 77.5% and 50% children respectively. Timely initiation of complementary feeding was found in 81%, breast feeding was continued upto 1 year in 68.8% and consumption of iron rich or iron fortified food was found in 54.5% children. Appropriate practices in terms of minimum meal frequency, minimum dietary diversity and minimum appropriate diet were found in 49.7%, 27% and 32.3% children respectively. Sex wise distributions have found significant association with minimum dietary diversity and minimum acceptable diet. Age wise distribution revealed significant association with minimum dietary frequency, minimum dietary diversity and minimum acceptable diet (p<0.005).Conclusions: Thus infant and young child feeding practices were not satisfactory. Mothers should be made aware about the appropriate feeding practices and health education should be given regarding correct child feeding practices.

Timely Initiation of Complementary Feeding and Associated Factors among Mothers of Children Aged 6-24 Months in Dessie Referral Hospital, Northeast Ethiopia, 2019.

Background Timely, appropriate, safe, adequate, and frequent feeding is essential during the transition period for optimal growth and development as well as vulnerability of the child. The age of initiation of complementary feeding needs to be strongly addressed. Thus, the aim of this study was to determine timely initiation of complementary feeding and associated factors among mothers of children aged 6–24 months in Dessie Referral Hospital. Methods Institutional-based cross-sectional study was conducted among 280 mothers of children aged 6–24 months. A systematic random sampling technique was employed for selection of study participants by considering the 1st comer as a starting point and then at every 5th interval till the sample size was saturated at exit time. Data were collected using pretested and validated structured interviewer-administered questionnaire. Data were entered to Epi data version 3.1 and exported to SPSS version 20.0 software for analysis. Descriptive statistics and binary logistic regression model were used. Results Overall response rate was 98.2%. Among 275 mothers with children aged 6–24 months, 36 (13.1%), 179 (65.1%), and 60 (21.8%) mothers started giving complementary feeding for their children early (before six months), timely (at six months), and late (after six months), respectively. Mothers' educational status of grade 9–12 and college and above [AOR = 3.03; 95% CI (1.13–8.14), and AOR = 3.74; 95% CI (1.19–11.70), respectively], getting counsel [AOR = 2.83; 95% CI (1.54–5.21)], and poor knowledge [AOR = 0.37; 95% CI (0.19–0.72)] were found to be independent predictors. Conclusions Prevalence of timely initiation of complementary feeding was high as compared to the national prevalence. Mothers' educational status, getting counsel about complementary feeding, and knowledge were factors associated with timely initiation of complementary feeding. Therefore, awareness creation, counseling, and health education should be done on society by concerned bodies to improve timely introduction of complementary feeding level more than this result.

Knowledge, Attitude and Practices among Mothers of Children 6 to 24 months of Age Regarding Complementary Feeding.

Complementary foods fill the gap between the total nutritional needs of the child and the amounts provided by breast milk. Inappropriate feeding practices are a major cause of the onset of malnutrition in young children. The objective of this study was to assess the knowledge, attitude, and practices of mothers of children between 6 to 24 months of age regarding complementary feeding. This Knowledge, Attitude, and Practice Study was conducted among 250 mothers in Kathmandu Medical College and Teaching Hospital from June 2019 to November 2019 after obtaining ethical approval from the institutional review committee (Ref no. 150320199). Convenient sampling method was applied. The mothers of children between 6 to 24 months were interviewed using a structured questionnaire to ascertain the knowledge, attitude, and practices regarding complementary feeding. Statistical analysis was done using SPSS version 20. Two hundred and fifty mothers were interviewed. 151 (60.4%) mothers knew initiation of breastfeeding soon after birth and 179 (71.6%) were knowledgeable about exclusive breastfeeding for 6 months. 161 (64.4%) mothers knew the proper age of initiating complementary feeding but only 139 (55.6%) mothers practiced it. Early initiation of complementary feeding was done by 87 (34.8%) mothers while 24 (9.6%) mothers delayed it beyond 6 months. There was a gap in knowledge and practice among mothers regarding adequate age of initiation of complementary feeding, complementary foods, preparation, and practices.

Complementary feeding practice and associated factors among children aged 6 to 12 months attending governmental health facilities in Addis Ababa: Ethiopia

BACKGROUND: Inappropriate feeding practices, coupled with high rates of infectious diseases, are the proximate causes of malnutrition during the first two years of life. Around 10 million under-five children died annually of which over one-third were due to inappropriate complementary feeding. OBJECTIVE: To assess factors associated with timely initiation of complementary feeding among children aged 6 to 12 months in public health care facilities of Addis Ababa Ethiopia. METHODS: An institutional-based cross-sectional study design was conducted. Data was collected using a pretested structured questionnaire. Binary and multivariable logistic regressions analyses were performed. Variables with p-value ≤0.05 were considered as statistically significant. RESULTS: The proportion of timely initiation of complementary feeding was 65.2% (95% CI = 60.8, 69.5). Being married [AOR = 2.622, 95% CI: 1.182–5.817], belongs to 18–24 years age at first marriage [AOR = 1.671, 95% CI: 1.019–2.742], being grade 9 and above [AOR = 1.910, 95% CI: 1.401–2.258], average income > 1500 Ethiopian birr [AOR = 2.138, 95% CI: 1.762–2.347], and postnatal care follow up [AOR = 1.641, 95% CI:1.435–3.224] were significantly associated with complementary feeding. CONCLUSIONS: In this study, the magnitude of timely initiation complementary feeding was higher as compared to the country level figure. Implementing nutrition strategy which scales-up mother’s living standards improve complementary feedings practices.

The state of child nutrition in Ethiopia: an umbrella review of systematic review and meta-analysis reports

BackgroundMalnutrition remains to be a major public health problem in developing countries, particularly among children under-5 years of age children who are more vulnerable to both macro and micro-nutrient deficiencies. Various systematic review and meta-analysis (SRM) studies were done on nutritional statuses of children in Ethiopia, but no summary of the findings was done on the topic. Thus, this umbrella review was done to summarize the evidence from SRM studies on the magnitude and determinants of malnutrition and poor feeding practices among under-5 children in Ethiopia.MethodsPubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Database of s of Reviews of Effects, and Google Scholar were searched for SRM studies on magnitude and risk factors of malnutrition and child feeding practice indicators in Ethiopia. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. The estimates of the included SRM studies on the prevalence and determinants of stunting, wasting, underweight, and poor child feeding practices were pooled and summarized with random-effects meta-analysis models.ResultWe included nine SRM studies, containing a total of 214,458 under-5 children from 255 observation studies. The summary estimates of prevalence of stunting, underweight, and wasting were 42% (95%CI = 37–46%), 33% (95%CI = 27–39%), and 15% (95%CI = 12–19%), respectively. The proportion of children who met the recommendations for timely initiation of breastfeeding, exclusive breastfeeding during the first 6 months, and timely initiation of complementary feeding were 65, 60, and 62%, respectively. The proportion of children who met the recommendations for dietary diversity and meal frequency were 20, and 56%, respectively. Only 10% of children fulfilled the minimum criteria of acceptable diet. There was a strong relationship between poor feeding practices and the state of malnutrition, and both conditions were related to various health, socio-economic, and environmental factors.ConclusionChild malnutrition and poor feeding practices are highly prevalent and of significant public health concern in Ethiopia. Only a few children are getting proper complementary feeding. Multi-sectoral efforts are needed to improve children’s feeding practices and reduce the high burden of malnutrition in the country.

Predictors of undernutrition and anemia among children aged 6–24 months in a low-resourced setting of Ghana: a baseline survey

PurposeThe purpose of this study was to identify the predictors of child undernutrition and anemia among children 6–24 months old in the East Mamprusi district, Northern region, Ghana.Design/methodology/approachThis cross-sectional study recruited 153 children and their mothers. Weight, height and hemoglobin levels of the children were measured. A structured questionnaire based on the World Health Organization's indicators for assessing infant and young child feeding practices was used to collect data on parents' socioeconomic status, household characteristics, hygiene and sanitation practices, mothers' knowledge on feeding practices such as child's meal frequency and dietary diversity and child morbidity within the past two weeks. Predictors of child nutritional status were determined using multinomial logistic regression analysis.FindingsUnderweight in the children was significantly predicted by maternal knowledge on protein foods (AOR = 0.045, p = 0.008), time of initiation of complementary feeding (AOR = 0.222, p = 0.032) and maternal age (AOR = 9.455, p = 0.017). Feeding child from separate bowls (AOR = 0.239, p = 0.005), minimum meal frequency per child's age (AOR = 0.189, p = 0.007) and time of initiation of complementary feeding (AOR = 0.144, p = 0.009) were significant determinants of stunting among the children. Exclusive breast feeding (AOR = 7.975, p = 0.012) and child's past morbidity (AOR = 0.014, p = 0.001) significantly contributed to anemia among the children.Research limitations/implicationsThis is a cross-sectional study and cannot establish causality. The small sample size also limits the generalizability of study findings. However, findings of the study highlight factors which could potentially influence the high rate of child undernutrition in the study setting.Practical implicationsThis study identifies determinants of undernutrition in the East Mamprusi district, an underresourced area in Ghana. This information could inform the development/reformulation of locally sensitive key messages and targeted intervention strategies to curb the high levels of child undernutrition in the East Mamprusi district of Ghana.Originality/valueThis study identifies maternal care practices as key potential drivers of undernutrition in a low-resource setting known for high prevalence of child undernutrition. It suggests insight for large-scale studies on the predictors of child undernutrition in Northern Ghana and other resource-poor settings.

Study on knowledge, attitude and practice about breast feeding and complementary feeding among the mothers attending health camp

Background: Malnutrition among under 5 children is a major public health concern in India, sub-optimal feeding and inadequate knowledge of mothers on optimal child feeding practice not only increases the risk of infections and malnutrition but also considered as an important determinant of under-5 children mortality. Objective: Assess knowledge, attitude and practice on breastfeeding, and complementary feeding among mothers with the children under-2 years of age attending the health camp.Methods: This cross-sectional study was conducted on all the mothers with the children under 2 years of age attending the health camp at Shri B. M. Patil Medical College Hospital and Research Center, Vijayapura. A verbal consent was taken and pre structured questionnaire was used to assess knowledge, attitude and practice on breastfeeding and complementary feeding in the mother attending the health camp.Results: In the present study, only 42.1% of the mothers had practiced early initiation breastfeeding and only 38.3% of mothers had practice exclusive breastfeeding for the first 6 months. 36% of the mothers had given prelactial feeds, 62.8% of mothers had fed their children with colostrum and timely initiation of complementary feeding was practiced only among 18.2% of mothers.Conclusions: This study shows inadequate knowledge among mothers regarding infant and young child feeding methods and faulty child feeding practices were followed by mothers.

Timely Initiation of Complementary Feeding Practices in Gondar Town Northwest Ethiopia: A Cross-sectional Study

ABSTRACT Background The time of introduction and nutritionally adequate, safe, age-appropriate complementary feeding is extremely important for the child’s optimal growth, development, and health within the first 2 years of life. Despite a number of interventions to improve infant and young child feeding practices and nutritional status, appropriate feeding practices are far away from the recommendation. Therefore, the study aimed to assess timely initiation of complementary feeding practices and associated factors among children aged 6–23 months in Gondar town, northwest Ethiopia. Methods A community-based cross-sectional study was conducted in December 2017. A multistage sampling technique was employed to select 632 mother-child pairs. Pretested structured and interviewer-administered questionnaire was used to collect data. Data were entered into Epi–info version 7 and transferred to SPSS version 20.0 for analysis. Both bivariable and multivariable logistic regression analysis were used to identify factors associated with timely initiation of complementary feeding. Finally, variables with a P-value of <0.05 were considered as statistically significant. Results The prevalence of timely initiation of complementary feeding was 47.3% (95%CI: 43.0, 51.3). Being housewife in maternal occupation (AOR = 2.03, 95%CI: 1.21, 3.43), good mother’s knowledge about complementary feeding (AOR = 1.80, 95% CI: 1.28, 2.53) and attending post-natal care checkup (AOR = 3.90, 95%CI: 1.26, 12.04) were significantly associated with timely initiation of complementary feeding. Conclusion This study revealed that timely initiation of complementary feeding was low within the study area. Around half of the children started complementary feeding at their 6 months of age. Therefore, special emphasis should be given to mothers who have poor knowledge about complementary feeding and encourage all mothers to have postnatal follow-up is crucial.

Evaluation of complementary feeding knowledge and behavior of mothers with children between four-twenty four months

Aim: Complementary feeding is important for growth in infancy. In this study, we aimed to determine the knowledge of complementary feeding of mothers who take their children to our hospital and to evaluate the effects of mother’s and baby’s characteristics on complementary feeding. Material and Method: Between December 2018 and February 2019, 259 mothers who admitted to our hospital were included in the study. Mothers’ knowledge and behavior about complementary feeding were questioned. Results: The mean age of 259 mothers was 28.71 ± 5.09 years old. 94 (36.3%) of the participants introduced complementary feeding before six months. The mean time to introduce complementary feeding was 5.67 ± 0.84 months. Complementary feeding was introduced with 48.6% yoghurt, 17.8% fruit puree and 17% soup. The most frequent reason for early onset was the weight gain of the baby and the decrease in breast milk. A significant difference was found between the monthly income of the family, smoking and working of the mother, and early initiation of complementary feeding. The use of feeding bottles and/or pacifiers was also associated with early onset of complementary feeding. Conclusion: Mothers’ time to introduce complementary feeding varies. Mothers should be given more education about complementary feeding for healthy development of babies.

Study on factors affecting complementary feeding practices in infants and young children in a rural area of Bihar

Introduction: Proper infant and young child feeding practices are essential for the prevention of childhood morbidity and mortality. NFHS-4 reported that about half of the children in Bihar are not receiving complementary foods timely. The present study was conducted to assess the factors affecting the complementary feeding of infants and young children. Methods: The present cross-sectional study was conducted upon mothers/ caretakers of 400 children age 6-24 months. Sociodemographic details and complementary feeding practices were noted. Results: The mean age of initiation of complementary feeding was 5.2 months. Cereals were the most common complementary food given while only 19% of children received food from all the food groups. Half of the children (50.8%) were given food of appropriate consistency and 41% were given the proper amount. 53.8% were given marketed foods. A significant association was seen between ideal practices and type of family (p=0.002), mother’s education (p=0.000), socioeconomic status (p=0.000) and IYCF related advice given during immunization sessions (p=0.000). Conclusion: Appropriate feeding practice is very low and effort should be made to increase the appropriate feeding practices.

Knowledge and Hygiene Practices among Mothers While Infant and Young Child Feeding in Raichur, Karnataka:A Cross Sectional Study

Introduction: With the adoption of the 2030 Agenda for Sustainable Development, improving infantand young child feeding practices has never been more urgent. While breastfeeding provides optimal nutrition to the child and prevent infections, the timely initiation and age appropriate complementary feeding can substantially reduce stunting and related burden of disease. Poor hygiene and subsequent diarrhea may also contribute to stunting through chronic gut inflammation. Objective : To study the knowledge and hygiene practices among mothers during infant and young child feeding. Methodology: A cross-sectional study was conducted in the urban field practice area of Navodaya Medical College. A study population of 375 mothers having children of less than two years age were selected by systematic random sampling method. Data was collected after informed consent regarding socio-demographic factors, knowledge and hygiene practices during child feedingfrom mothers. Data was analyzed using EPI Info 7 and expressed in terms of percentages, proportions. Results: The study showed 50.1% of mothers had correct knowledge on duration of exclusive breastfeeding and 42.7% on appropriate time of initiating complementary feeding. 28.35% of mothers had the habit of washing hands with soap and water before feeding the child. Only 12.8% of mothers had given safe water for drinking to child. Conclusion: In our study half of the mothers had the right knowledge on appropriate duration of exclusive breastfeeding while knowledge on initiation of complementary feeding is much less. Hygiene practices are very low and needs more attention.

The fidelity and dose of message delivery on infant and young child feeding practice and nutrition sensitive agriculture in Ethiopia: a qualitative study from the Sustainable Undernutrition Reduction in Ethiopia (SURE) programme

BackgroundIn Ethiopia, 38% of children under 5 years of age are stunted (low height for age). A novel government-led intervention called the Sustainable Undernutrition Reduction in Ethiopia (SURE) aims to tackle the burden of stunting by improving complementary feeding and dietary diversity among young children. The SURE programme design applies a transtheoretical model of behaviour change, whereby exposure to recommended infant and young child feeding (IYCF) and nutrition-sensitive agriculture messages is a first stage to adopting key behaviours. This qualitative study explored the fidelity and dose of the IYCF and nutrition-sensitive agriculture messages delivered by extension workers.MethodsA qualitative study was conducted across four regions in Ethiopia (Oromiya, Amhara, SNNP and Tigray) between April and October 2017. Across the four regions, 81 key informant interviews, 90 FGDs and 81 observations were conducted with 180 extension workers, 18 development agents and 54 mother-father pairs. Digitally recorded audio files were transcribed verbatim, and the data were analysed based on a framework analysis approach using NVivo (version 12) by coding and categorising texts into major themes and sub-themes.ResultsSURE target households had the intended exposure to messages about exclusive breastfeeding, timing of initiation of complementary feeding, food groups, diversified food consumption, irrigation, rearing small animals and vegetables. Few households reported receiving messages on the content or frequency of complementary feeding of a child beyond 6 months of age. Frequency of household visits and hence exposure to SURE messages was also variable. Agricultural messages delivered during household visits focussed on improving standard agricultural practices and rarely covered the importance of nutrition-sensitive agriculture to improve household or child nutrition.ConclusionDespite variability observed in the breadth and depth of messages delivered, large-scale behaviour change communication programmes can achieve moderate to good message exposure among target groups. Qualitative data provide an in-depth insight into fidelity and may supplement our understanding of programme roll-out and implementation. Further research is required to understand longer-term message saturation including frequency and reach.

Prevalence of diarrhoea and child care practices among under-five children in tea gardens of Jorhat district, Assam

Background: Globally diarrhoea remains the second leading cause of mortality among children of below five years age. Objective was to find out the prevalence of diarrhoea and child care practices associated with diarrhoea in under five children of tea garden workers of Jorhat district, Assam.Methods: A community based cross sectional study was conducted among the under five children of selected tea gardens of Jorhat district of Assam, India from July 2017 to June 2018.Results: Prevalence of diarrhoea among the study participants in last 2 weeks was found to be 26.4%. Out of 315 study participants, 24.1% belonged to the age group of 12-24 months, 55.2% were males. Exclusive breast feeding was recorded in 95.9% of the children. Prevalence of diarrhoea was less among exclusively breast fed children 25.5% as compared to not exclusively breastfed 46.1%. Health advice during diarrhea was sought by 97.8% of the respondents. Available records showed almost all of the children 99.3% got vaccinated with measles vaccine and contrary to this majority 64.4% study participants had not received Rota virus vaccination.Conclusions: Diarrhoea is still a significant public health problem among fewer than five children of tea garden workers with low Rota virus vaccine coverage. Our study findings recommends for the awareness building among the tea garden dwellers in regard to hand hygiene, timely initiation of complementary feeding, importance of vaccinating children with Rota virus vaccine as a part of containment programme.

Association between exclusive breastfeeding and atopic dermatitis in a third level of care hospital

To assess whether exclusive breastfeeding is associated with atopic dermatitis in children under seven years of age. Non-paired case and control type study conducted in a third level of care hospital (Lambayeque Regional Hospital) between June 2016 and May 2018 in which 260 cases and 260 controls recruited in outpatient consultation of the Dermatology and Pediatrics services were evaluated. The UK criteria were used for the diagnosis of atopic dermatitis, as well as a survey with possible risk factors. In the bivariate analysis, differences were found between cases and controls in relation to exclusive breastfeeding (p=0.001), family history of atopy (p<0.001), parents' educational level (p<0.001), smoking in the presence of the child (p=0.006), and origin (p=0.002). Exclusive breastfeeding was present in 93 (35.8%) of cases compared to 132 (50.8%) of controls. The multivariate analysis using logistic regression found that exclusive breastfeeding would have a protective effect on the presence of atopic dermatitis (OR= 0.62; 95% CI= 0.41-0.94) adjusted by age, sex, background, parents' educational level, initiation of complementary feeding, family member with atopy, and smoking habit. Exclusive breastfeeding would have a protective effect on the appearance of atopic dermatitis in children under the age of seven.

Comparative Study of Growth Monitoring & Promotion of Children with Special Care (IYCF Counseling) and without Special Care

This comparative study was conducted to see the challenges and impact of counselling of Infant and Young Child Feeding (IYCF) to the mother’s knowledge and the practices of the mother from case group and control on best IYCF interventions, mainly targeted the behavioral change of the mother and to see the effect on the nutritional status of the children under 2 years. A total of 353; 177 mother of case group for counselling and 176 of control group for non-counselling, eligible mothers having children 0-11 months were approached with the purpose of study and informed consent was obtained from the mothers. Then all 177 mothers from case group received IYCF counseling according to the need of mothers as well as on key IYCF messages. At the same time the 176 mothers from control group didn’t receive any kind of IYCF support and counselling, they received only regular health services counselling and messages on IYCF. IYCF practices have a great impact on the physical and mental development of the child. The objective of this study was the lactating mothers with the children in the age group 0-11 months were studied and delivered IYCF counseling according to their need basis as well as key IYCF messages from case group and at the same time mothers from control group would not receive any kind of message from study and they would receive only regular health program messaging. Low percentage of mothers from the case group had knowledge on early initiation of breast feeding within one hour after birth, the exclusive breast-feeding up to 6 months. Timely initiation of complementary feeding after 6 months (61,0%, 58.7%, 61.6% & 55.4% respectively) before IYCF counselling to mothers. After IYCF counselling to the mothers of case group, they motivated and learnt to early initiation of breast feeding within one hour after birth, the exclusive breast-feeding up to 6 months. Timely initiation of complementary feeding after 6 months (79.1%, 75.7%, 75.2% & 65.5% respectively). For control group the results were 61.9%, 65.3%, 65.9% & 63.6% respectively before study and 66.5%, 67.7%, 66.8% & 64.1% after the study. The study result showed that the impact of IYCF counselling and messaging on the mother knowledge was great and it changed the knowledge level of the mother in dramatic way. The percentage of mothers from the case group & the control group those had children over 6 months practiced the exclusive breast-feeding were (60.2% & 73.5%) before study. After IYCF counselling to the mothers of case group, they motivated and changed their attitude to ensure the exclusive breast feeding for their children (73.5% and 73.9% from case and control group respectively). Before the study Minimum Dietary Diversity (MDD) was observed in only 30.3% & 36.6% respectively from case and control group for the children between 6- and 11months age group and after IYCF counselling mothers from the case group improved their practice for MDD for their children aged 6-23 months and increased to 39.0% in case group and in control group improved to 37.3%. Minimum Meal Frequency (MMF) was observed in the majority (63.6%) of children aged 6–23 months before the study and after IYCF intervention it increased to 74.6% in case group. But in Control group it changed from 72.6% to 73.1%. The indirect effect of IYCF counselling on the nutritional status of the children who are benefited from the improved mother knowledge and practices to good practices. Before the controlled comparative study, the GAM rate of the children was 21.1% & 20.3% respectively for case & control group of wasting (WHZ) and after study it was 20.1% & 20.3% respectively for case & control group. The same happened for underweight (WAZ) & stunting (HAZ). They also changed from 36.9% to 35.4% and 45.4% to 43.8% for underweight & stunting respectively. The IYCF practices are strongly influenced by what people know, think and believe and also affected by social circumstances and economic factors. Effective communication for behavioral change is necessary for ensuring optimal infant and young child feeding. Awareness regarding IYCF practices and their benefits in Maternal and Child Health (MCH) is poor leading to poor compliance. It is important to educate mothers during the antenatal visits. This study showed same impact as stated above.