Malnourished Infants Research Articles

Motor Development in Malnourished Children in Indonesia

Severe protein-energy malnutrition during infancy is closely related to physical growth and mental development. Very few reports mention the effects on motor development of mildly to moderately malnourished infants. Our study was conducted to clarify the relationship between malnutrition and motor development during infancy. We examined 1,065 children at Posyandu (Integrated Service Posts) in North Sumatera, Indonesia. Motor development, such as sitting and walking, was significantly more delayed in malnourished children than in well-nourished children. Parachute reaction showed no significant differences between well-nourished and malnourished children. Parachute reaction is a very simple technique and can differentiate between children with cerebral-palsy and malnourished children unable to walk. It might be one of the most appropriate technologies for use at the primary care level.

Evidence-based interventions for improvement of maternal and child nutrition in low-income settings: what's new?

Maternal and child malnutrition continues to disproportionately affect low and middle-income countries, contributing to high rates of morbidity, mortality, and suboptimal development. This article reviews evidence from recent systematic reviews and studies on the effectiveness of interventions to improve nutritional status in these especially vulnerable populations. Macronutrients provided to expectant mothers in the form of balanced protein energy supplements can improve fetal growth and birth outcomes, and new research suggests that lipid nutrient supplements can reduce both stunting and wasting in newborns. Maternal multiple micronutrient supplementations can also improve fetal growth, and reduce the risk of stillbirth. Nutrition education and supplementation provided to pregnant adolescents can also improve birth outcomes in this vulnerable population. New evidence is broadening our understanding of the development of gut microbiota in malnourished infants, and the possible protective role of breastmilk. The reviewed evidence on nutrition interventions reinforces the importance of packaging interventions delivered within critical windows throughout the life course: before conception, during pregnancy, and throughout childhood. Emerging evidence continues to refine our understanding of which populations and contexts benefit from which intervention components, which should allow for more nuanced and tailored approaches to the implementation of nutrition interventions.

Effectiveness of supplementary suckling technique in underweight infants

Background: The period from birth to 6 months is part of a larger critical ‘window of opportunity’ within which the impact of undernutrition has both immediate and long term adverse consequences. Protocols for older children are often extended to this age group owing to the absence of evidence-based treatment protocols. The following study was carried out to assess the effectiveness of supplementary suckling technique and lactation counselling over counselling alone in management of malnourished infants in the age group of 1- 6 months.Methods: After IRB clearance, all underweight infants with weight for age <-2SD by WHO charts were enrolled in the study. Once identified as lactation failure, the infants were randomly allocated into two groups using SAS 9.2 package. Both, cases and controls were counselled regarding breast feeding practices as per WHO module. Cases were additionally started on supplementary feeds by Supplementary Suckling Technique (SST) for the 1st week. Weight gain was monitored at enrolment, on day 7 and day 14. Weight gain >20gm/day in the 2nd week was considered successful re-lactation. Data was analysed using student unpaired t test and chi square test.Results: Mean weight gain per day in 1st and 2nd week in the cases was significantly higher than that in the controls (p= <0.001). In 2nd week, maximum weight gain i.e. 20-30 g/day was found in 93.3% cases as against 13.3% controls (p=0.01) depicting successful re-lactation.Conclusions: Lactation counselling along with supplementary suckling technique should be the standard of care in management of malnourished infants.

261 Assessment of skin parameters of malnourished and well-nourished infants and children

261 Assessment of skin parameters of malnourished and well-nourished infants and children

Distributed Thermistor for Continuous Temperature Monitoring of Malnourished Infants at Risk for Hypothermia

Distributed Thermistor for Continuous Temperature Monitoring of Malnourished Infants at Risk for Hypothermia

A Randomized Controlled Trial of Two Ready-to-Use Supplementary Foods Demonstrates Benefit of the Higher Dairy Supplement for Reduced Wasting in Mothers, and Differential Impact in Infants and Children Associated With Maternal Supplement Response

There is no consensus over best approaches to reliably prevent malnutrition in rural communities in low-income countries. We compared the effectiveness of 2 lipid-based ready-to-use supplementary foods (RUSFs) differing in dairy protein content to improve the nutritional status of mothers and at-risk infants and young children in rural Guinea-Bissau. A 3-month cluster-randomized controlled pilot trial of 2 RUSFs was conducted with 692 mothers and 580 mildly or moderately malnourished infants (6-23 months) and children (24-59 months) from 13 villages. The RUSFs contained either 478 (mothers, children) or 239 kcal/d (infants) with 15% or 33% of protein from dairy and were distributed at community health centers 5 d/wk. Controls were wait-listed to receive RUSF. Primary outcomes were mid-upper arm circumference (MUAC) in mothers, and weight-for-age and height-for-age z-scores (WAZ and HAZ) in infants and children. There was a significant effect of the RUSF-33% on MUAC in mothers ( P = .03). The WAZ and HAZ increased substantially, by ≈1 z-score, in infants and children ( P < .01) independent of group randomization. In children, but not infants, baseline WAZ and change in maternal MUAC were associated with change in WAZ (β = .07, P = .02). Ready-to-use supplementary foods with higher dairy protein content had a significant benefit in village mothers, supporting a comparable recent finding in preschool children. In addition, supplementation of children <2 years resulted in improved growth independent of family nutritional status, whereas success in older children was associated with change in maternal nutrition, suggesting the need for community-level education about preventing malnutrition in older, as well as younger, children.

Gluten Sensitivity among Egyptian Infants with Congenital Heart Disease.

BACKGROUND:Gastrointestinal symptoms are a common feature in infants with congenital heart disease.AIM:This study was designed to evaluate age-dependent serum levels of antigliadin antibodies among malnourished Egyptian infants with congenital heart disease (CHD) and gastrointestinal symptoms.SUBJECTS AND METHODS:This case-control study conducted on 60 infants with established congenital heart disease. They were subdivided into cyanotic and acyanotic groups, and each group includes 30 patients compared with thirty apparently healthy infants of matched age, sex, and social class. Serum antigliadin antibodies levels were measured using ELISA.RESULTS:The mean age of introduction of cereals in the diet and appearance of gastrointestinal symptoms were six months. On comparison with controls, patients showed highly significant higher serum levels of antigliadin antibodies (P < 0.000). On analysing risk factors using odds ratio, the age at onset of GIT symptoms, diarrhoea, abdominal pain, and distension had been found to be significantly associated with high serum antigliadin antibodies among malnourished CHD infants with a prediction of 95%.CONCLUSION:Serum IgA, IgM, and IgG class antibodies to gliadin play a significant role in the pathogenesis of malnutrition in infants with CHD. Gluten containing foods should never be introduced before the end of the six months.

Fructans in the first 1000 days of life and beyond, and for pregnancy.

Inulin-based prebiotics are non-digestible polysaccharides that influence the composition of the gut microbiota in infants and children, notably eliciting a bifidogenic effect with high short chain fatty acid levels. Inulin, a generic term that comprises β-(2,1)-linked linear fructans, is typically isolated from the chicory plant root, and derivatives such as oligofructose and long chain inulin appear to have different physiological properties. The first 1000 days of a child's life are increasingly recognized as a critical timeframe for health also into adulthood, whereby nutrition plays a key role. There is an ever increasing association between nutrition and gut microbiota composition and development, with life health status of an individual. This review summarizes the latest knowledge in the infant gut microbiota from preterms to healthy newborns, as well as in malnourished children in developing countries. The impact of inulin or mixtures thereof on infants, toddlers and young children with respect to intestinal function and immunity in general, is reviewed. Possible benefits of prebiotics to support the gut microbiome of malnourished infants and children, especially those with infections in the developing world, are considered, as well as for the pregnant mothers health. Importantly, novel insights in metabolic programming are covered, which are being increasing recognized for remarkable impact on long term offspring health, and eventual potential beneficial role of prebiotic inulins. Overall increasing findings prompt the potential for gut microbiota-based therapy to support health or prevent the development of certain diseases from conception to adulthood where inulin prebiotics may play a role.

Feeding Pattern of Malnourished Infants &lt;6 Months of Age and Their Response to Treatment Using Diluted F-100 Formula

Severe acute malnutrition is associated with mortality in young infants. Associated risk factors and management were not well addressed. The aims of this study were to identify factors associated with severe acute malnutrition in children < 6 months of age and to evaluate the outcome of treatment after feeding them diluted therapeutic formula milk (F-100) along with breast-feeding. This interventional hospital-based study was conducted at 2 major children hospitals in Khartoum during the period between September 2011 and January 2014 among malnourished children less than 6 month of age. Infants' demographic, clinical and anthropometric measurements were recorded and then received routine medications and breastfeeding and/or 130ml/kg/day diluted F100 formula for 5 consecutive days and weight gain was recorded. All recruited infants (N=83) received diluted F-100 with breast milk. They had a mean±SD age of 3.8±5.8 months. The male to female a ratio was 1.3. The majority was from poor socioeconomic background and most mothers were below 40 years of age. Only 36 (43.3%) were exclusively breastfed and 37 (44.6%) of infants fed on food other than milk. Following feeding for 5 days, 76 out of 83 (91.6%) malnourished under the age of 6 months infants were discharged with adequate weight gain, 5 (6%) prematurely left the hospital and thus the study, 2 (2.4%) were defaulters and there was no deaths. Infants <6 months of age with severe acute malnutrition were mostly from poor backgrounds and developed malnutrition despite breast-feeding. Diluted F-100 formula was beneficial in treatment along with breastfeeding.

Carbohydrate malabsorption in acutely malnourished children and infants: a systematic review

Context: Severe acute malnutrition (SAM) accounts for approximately 1 million child deaths per year. High mortality is linked with comorbidities, such as diarrhea and pneumonia. Objective: The aim of this systematic review was to determine the extent to which carbohydrate malabsorption occurs in children with SAM. Data Sources: The PubMed and Embase databases were searched. Reference lists of selected articles were checked. Data Extraction: All observational and controlled intervention studies involving children with SAM in which direct or indirect measures of carbohydrate absorption were analyzed were eligible for inclusion. A total of 20 articles were selected for this review. Data Synthesis: Most studies reported carbohydrate malabsorption, particularly lactose malabsorption, and suggested an increase in diarrhea and reduced weight gain in children on a lactose-containing diet. As most studies reviewed were observational, there was no conclusive scientific evidence of a causal relationship between lactose malabsorption and a worse clinical outcome among malnourished children. Conclusion: The combined data indicate that carbohydrate malabsorption is prevalent in children with SAM. Additional well-designed intervention studies are needed to determine whether outcomes of SAM complicated by carbohydrate malabsorption could be improved by altering the carbohydrate/lactose content of therapeutic feeds and to elucidate the precise mechanisms involved.

Immunogenicity of poliovirus vaccines in chronically malnourished infants: A randomized controlled trial in Pakistan

Reaching high population immunity against polioviruses (PV) is essential to achieving global polio eradication. Efficacy of oral poliovirus vaccine (OPV) varies and is lower among children living in tropical areas with impoverished environments. Malnutrition found as a risk factor for lower serological protection against PV. We compared whether inactivated polio vaccine (IPV) can be used to rapidly close the immunity gap among chronically malnourished (stunted) infants in Pakistan who will not be eligible for the 14 week IPV dose in routine EPI schedule. A phase 3, multicenter 4-arm randomized controlled trial conducted at five Primary Health Care (PHC) centers in Karachi, Pakistan. Infants, 9–12 months were stratified by length for age Z score into chronically malnourished and normally nourished. Infants were randomized to receive one dose of either bivalent OPV (bOPV) alone or bOPV+IPV. Baseline seroprevalence of PV antibodies and serum immune response to study vaccine dose were assessed by neutralization assay. Vaccine PV shedding in stool was evaluated 7 days after a bOPV challenge dose. Sera and stool were analyzed from 852/928 (92%) enrolled children. At baseline, the seroprevalence was 85.6% (n=386), 73.6% (n=332), and 70.7% (n=319) in malnourished children against PV types 1, 2 and 3 respectively; and 94.1% (n=448), 87.0% (n=441) and 83.6% (n=397) in the normally nourished group (p<0.05). Children had previously received 9–10 doses of bOPV (80%) or tOPV (20%). One dose of IPV+bOPV given to malnourished children increased their serological protection (PV1, n=201, 97.6%; PV2, n=198, 96.1% and PV3, n=189, 91.7%) to parity with normally nourished children who had not received IPV (p=<0.001). Seroconversion and boosting for all three serotypes was significantly more frequent in children who received IPV+bOPV than in those with bOPV only (p<0.001) in both strata. Shedding of polioviruses in stool did not differ between study groups and ranged from 2.4% (n=5) to 7.1% (n=15). In malnourished children the shedding was reduced after bOPV+IPV compared to bOPV only.Chronically malnourished infants were more likely to be unprotected against polioviruses than normal infants. bOPV+IPV helped close the immunity gap better than bOPV alone.

Management of acute malnutrition in infants aged under 6 months (MAMI): current issues and future directions in policy and research.

Globally, some 4.7 million infants aged under 6 months are moderately wasted and 3.8 million are severely wasted. Traditionally, they have been over-looked by clinicians, nutritionists, and policy makers. To present evidence and arguments for why treating acute malnutrition in infants under 6 months of age is important and outline some of the key debates and research questions needed to advance their care. Narrative review. Treating malnourished infants under 6 months of age is important to avoid malnutrition-associated mortality in the short-term and adverse health and development outcomes in the long-term. Physiological and pathological differences demand a different approach from that in older children; key among these is a focus on exclusive breastfeeding wherever possible. New World Health Organization guidelines for the management of severe acute malnutrition (SAM) include this age group for the first time and are also applicable to management of moderate acute malnutrition (MAM). Community-based breastfeeding support is the core, but not the sole, treatment. The mother-infant dyad is at the heart of approaches, but wider family and community relationships are also important. An urgent priority is to develop better case definitions; criteria based on mid-upper-arm circumference (MUAC) are promising but need further research. To effectively move forward, clinical trials of assessment and treatment are needed to bolster the currently sparse evidence base. In the meantime, nutrition surveys and screening at health facilities should routinely include infants under 6 months of age in order to better define the burden and outcomes of acute malnutrition in this age group.

Predictors of High Serum Casein Antibody Levels among Malnourished Infants and Young Children with Congenital Heart Disease.

BACKGROUND:Factors predictive of growth retardation and malnutrition in patients with congenital heart disease remain unclear.OBJECTIVES:This study aimed to measure antibody response to bovine casein through assessing serum casein antibody levels in malnourished patients three year or younger with CHD, and to determine its relationship to gastrointestinal symptoms, anthropometric measures, and laboratory data.SUBJECTS AND METHODS:This cross sectional case control study was conducted in sixty patients with CHD aged 4 to 72 months. They were subdivided into thirty patients with cyanotic and thirty patients with acyanotic CHD compared with thirty apparently healthy children.RESULTS:On comparison with controls, patients showed highly significant lower anthropometric measures, calcium, iron, hemoglobin levels, and higher serum levels of casein antibody, total iron binding capacity, and alkaline phoshatase activity (P<0.000). Serum levels of casein antibody showed significantly positive correlations with serum total iron binding capacity and alkaline phosphatase activities and negatively correlated with the age at onset of symptoms, anthropometric measures, serum calcium, and iron levels.CONCLUSION:Serum casein antibody levels play a significant role in the pathogenesis of malnutrition. Encouragement of breast feeding and avoidance of early cow’s milk consumption could prevent the development of antibody response to bovine casein.

Ventricular migration of shunt: Chhabra shunt complication

We report a rare complication of Intraventricular migration of whole shunt and discuss the causes of this complication. A 9-month-old child presented in OPD with enlarging head and vomiting. The patient had undergone VP shunt twice before due to congenital hydrocephalus. Imaging was done which suggested of Intraventricular migration of complete shunt. The patient was posted for surgery and the shunt was removed from the lateral ventricle. Patient recovered well and has been followed up for 1 year till the writing of this report. After careful review of literature we found twenty reported cases of intra cranial migration of VP shunts. The probable causes of retrograde migration include technical issues like large burr hole and wide opening of Dura. An increasing number of reported cases are from Indian subcontinent and mostly the Chhabra shunt is implicated in this complication. The probable reasons for migration are: 1) Malnourished infant with thin cortical mantle, large ventricles having reduced pressure and raised intraabdominal pressure due to excess amount of CSF not absorbed in peritoneum. 2) Poor anchorage of shunt chamber along with indiscriminate pressing of cylindrical Chhabra shunt reservoir. To prevent it special care must be taken in neonates and infants in making smaller burr holes, smaller chamber area and stronger anchorage of shunt chamber to periosteum. Further instead of using the cylindrical Chhabra chambers which can easily migrate to ventricles, larger spherical chambers may be used.

"Initial Hunger" for All? A Study on Undernourished Infants

Aim: A meal/satiety pattern dictated by the rhythmic arousal of Initial Hunger (IH and IHMP) is used by overweight people to decrease body weight. We however conceived IHMP to improve intestinal absorption and diminish immune involvement in intestinal mucosa as well as throughout the body (overall subclinical inflammation). The purpose of IHMP may be shown by its early employment in undernourished infants. Methods: Nine malnourished infants (weight per age lower than 70%) with diarrhea in the first 15 months of age were investigated in a controlled, randomized study. Organic diseases were excluded by conventional procedures, including intestinal biopsy. Six infants were assigned to the intervention and 3 to the control group. Compliance, intake, and anthropometry were recorded in hospital for 2 months, and then by frequent visiting and 7-day home diary under intervention for 5 total times in two years. Results: Six subjects under intervention and three controls were followed for at least 2 years. Energy intake decreased from 126±21 kcal/kg/d to 85±6 kcal/kg/d in treated infants and from 111±53 kcal/kg/d to 107±37 kcal/kg/d in the first 2 months of study (P<0.01 on longitudinal differences). Days with vomiting became null after 2 months of treatment, whereas in control subjects, 4 or 5 events every 60 days persisted for all follow-ups. Further longitudinal differences were significant on days with diarrhea after three months, and on plasma triglycerides at the two sampled times during treatment. The difference in the Chi square for trend was significant on energy intake and in the numbers of days with vomiting or diarrhea (P<0.002). Serum triglycerides decreased from 148±27 mg/dL to 70±10 mg/dL under intervention, and increased from 119±47 mg/dl to 139±59mg/dl in controls (P<0.002 on the difference). Values after two years of follow-ups were respectively: 73.2 ± 12.3 mg/dL and 89 ± 37 mg/dL (P<0.05). Toward the end of the study, anthropometric measurements increased per age from recruitment in treated infants with differences from control subjects that were not significant in the longitudinal comparisons between groups. Weight per age reached 88.8±8.7% under intervention, and 79.7±10.2% in controls after two years (not significant). Psychomotor development was normal except for one control infant. Conclusion: High triglycerides (and associated insulin resistance with an overall subclinical inflammation) are involved in the persistence of diarrhea and on malnutrition in these undernourished infants as in the development of functional bowel disorders and over weight in adults. IHMP was an actual solution also for malnourished infants.

New Findings on Energy Balance and Established Wisdom

Background. Energy balance in blood and body may differ for a day or two although compensating in a month. Most people (60%) maintain a positive energy balance and a high blood glucose (BG) high energy availability in blood and high resting metabolic rate that correspond to insulin resistance/fattening and ill health. A meal/satiety pattern dictated by the rhythmic arousal of Initial Hunger (IH and IHMP) improved exhaustion of the energy consumed in previous meals and decreased high energy intake, high preprandial BG, high resting metabolic rate (RMR), insulin resistance, overall subclinical inflammation, vascular risks, deteriorations and functional disorders. Methods. We defined Initial Hunger as sensations that spontaneously arise after eating suspension. IH consistently arouse in different groups when BG declined toward 76.6 ± 3.7 mg/dL. A week diary reported assessments of IH and preprandial BG measurements before the three main meals. Mean BG in a week was stratified within normal BG limits, but different subjects pertained to different strata. Thirty-one untrained control adults maintained his/her own mean and BG stratum for five months. After training, these subjects changed his/her own mean BG to the stratum that was associated with IHMP. Measurements reported by diary, of RMR and of total energy expenditure demonstrated this stratum change. From recruitment, the mean decrease was 15.4% by indirect calorimetry and 15.5% by doubly labeled water in a total of 24 toddlers (P < 0.001). Mean BG thus assessed the deviation of a meal pattern from the mean BG associated with IH (IHMP). Results. In San Diego ASN 2014, we showed the effectiveness of IHMP on regression of fattening/insulin resistance for a long term in 181 adults of mixed body weight who had bowel functional disorders and were clinically normal. However we had earlier designed IHMP for a broader aim as compared to a body loss device. We wanted to educate children and future adults to an intestinal low immune involvement and to the best fitting of intake to body regulations. Thus, we tried to publish the recovery of diarrheic malnourished infants by IHMP in an American Society for Nutrition (ASN) Journal. Subjects were aged less than 15 months, had lower body weight per age than 70% and recovered through many months and years. This aim was right opposite to weight loss. The ASN Journal rejected the publication as findings of clinical but no nutritional interest. Med Crave promptly published the findings. In a broader thought, the ASN Journal protected the established assistance beliefs and trusts from the confounding intrusion of an innovative, self-help system (IHMP).

Infantile tremor syndrome associated with cobalamin therapy: A case report

Vitamin B12 (cobalamin) is an essential vitamin and needs to be upplied by diet such as meat, fish, eggs, milk and liver. Infantile obalamin deficiency is observed in malnourished infants. Furhermore, cobalamin deficiency was found in offspring of strict egan mothers or mothers with pernicious anaemia because cobalmin passes from the placenta to the foetus via active transport uring pregnancy and is stored in the liver. Although cobalamin eficient diet can be tolerated by adults from the endogenous ool, deficiency in infants may become symptomatic within –12 months after birth, because they have a limited hepatic eserve [1]. Cobalamin deficiency primarily affects the central nervous sysem. Usually there are clinical features of both myelopathy and eripheral neuropathy in adults with cobalamin deficiency. In infants, the characteristic picture of cobalamin deficiency is naemia, skin pigmentation, hypotonia, developmental retardation nd regression of growth, seizure, lethargy. A delay in the diagnois and treatment of cobalamin deficiency may lead to irreversible sychomotor retardation and neurological damage [1]. Although nvoluntary movements may be an initial symptom of neurologic

Hubungan Perilaku Ibu dalam Pemberian Makan dan Tingkat Kecukupan Energi-Protein dengan Status Gizi Batita Usia 12-36 Bulan di Wilayah Kerja Puskesmas Tersono Kabupaten Batang

Background: The situation at the time of malnourished infants is the result of not giving enough food to meet nutrient in terms of quality and quantity. Less energi and protein in infants may hinder growth, especially vulnerable to diseases and infectious diseases lead to low levels of intelligence.Objectives: To know the relationship between maternal behavior in feeding and energy-sufficiency level of protein in the nutritional status of toddlers aged 12-36 months in the working area health center Tersono Batang regency. Method: The scope of this research is the field of nutritional science community with a location in the working area of Batang regency Tersono Health Center, the research conducted in October-December 2009, this kind of research through a descriptive analytic cross-sectional approach for the dependent and independent variables were collected at the same time. population is aged 12-36 months toddler of 1021, with the number of sample 100 toddlers.Detemination samples taken at random samples using interval sampling. Analysis of the relationship between maternal behavior in the feeding with nutritional status of toddlers aged 12-36 months, the level of energy and protein adequacy with nutritional status of toddlers 12-36 months of age using Chi-Square test. Results: Maternal behavior in the feeding a good of 63% and 37% less, the level of energy sufficiency for good 82% and 18% less, the level of protein adequacy for good 81% and less 19% and good nutritional status as many as 83% and 17% less.The relationship between maternal behavior in the feeding and level of adequacy of nutritional status of energy-protein are significantly ststistik .Conclusions: There is a relationship between maternal behavior in feeding and energy-sufficiency level of protein nutritional status. Suggestions: Suggestions to improve of information about the behavior of mothers in feeding to specially cleaning of toddlers and mothers.

Etiology of Diarrhea among Severely Malnourished Infants and Young Children: Observation of Urban-Rural Differences over One Decade in Bangladesh

There is inadequate information on the etiology of diarrhea in severely malnourished (SM) young children. Thus, the study aimed to determine the etiology of diarrhea among severely malnourished (z score < ?3.00 SD) children in rural and urban Bangladesh. From the database (2000-2011) of Diarrheal Disease Surveillance Systems (DDSS) at rural Matlab and urban Dhaka hospitals of icddr,b, 2234 and 3109 under-5 children were found severely malnourished (underweight, stunted or wasted) respectively. Two comparison groups [moderately malnourished (MM) and well-nourished (WN)] were randomly selected in a ratio of 1:1:1. Children with all categories of SM were more likely to be infected with Vibrio cholerae (rural—11%; urban—15%), Shigella (16%; 9%), Salmonella (1%; 2%) and Campylobacter (3%; 4%); and less likely to have rotavirus (25%; 20%) compared to only one SM category. Isolation rate of Vibrio cholerae was significantly higher among SM both in rural and urban children (7%; 13%) than those of MM (5%; 10%) and WN (2%; 8%) and lower for rotavirus (30%; 31%), (34%; 43%), (35%; 47%) respectively (p < 0.01). However, for Shigella it was only higher among rural SM children (11%) [MM (9%), and WN (8%) (p < 0.01)]. The isolation rate of Salmonella in SM (2%) was similar to that in MM (2%; p = 0.72) but significantly higher than that in WN (1%; p < 0.01) among urban children. Isolation rates of bacterial enteric pathogens were higher but rotavirus was lower in SM children in both rural and urban area with geographical heterogeneity.

A study of feeding practices among infants born to HIV-infected mothers and its association with morbidity in infants

<b>Context:</b> Globally, 2.3 million children have been victims of Human Immunodeficiency Virus (HIV) as of December 2006. Transmission through breastfeeding (BF) is estimated to account for one third to one half of all these pediatric HIV infections. <b>Aim:</b> To study the feeding practices followed by HIV-infected mothers in Mumbai. <b>Settings and Design:</b> It is a prospective observational type of study conducted in a tertiary care hospital with antiretroviral treatment center for a period of one year. <b>Materials and Methods:</b> The study was reviewed and approved by the ethical committee of the hospital. Babies aged 0 to 9 months and born to HIV-positive mothers who are brought to integrated HIV outpatient department were included in the study. <b>Statistical Analysis Used:</b> The data entry and analysis was done using SPSS 15 package, Microsoft Excel 2003, and Epi Info. <b>Results:</b> As per the findings of this study, proportion of exclusive BF was 34.2%, top feeding was 42.1%, and mix feeding (MF) was 23.7%. Diarrhea occurred more frequently in mix-fed infants (53.6%) as compared to exclusively breast-fed infants (2.5%) and top-fed infants (12.7%). The percentage of infants who were exclusively breast fed and had normal weight for age was 53.8%. Moderately malnourished infants were 30.8% and 15.4% of infants were severely malnourished. The percentage of severe malnutrition was more in top-fed and mix-fed infants (23.4% and 32.1%, respectively). <b>Conclusion:</b> MF was associated with increased risk of diarrhea and acute respiratory infection. Top-fed and mix-fed infants were more likely to suffer from infectious diseases.