Nutritional Status Of Young Children Research Articles

Domestic violence and child nutrition in Liberia

Domestic violence against women is endemic globally and is an important social problem in its own right. A compounding concern is the impact of domestic violence against mothers on the nutritional status of their children. Liberia is an apt setting to examine this understudied topic, given the poor nutritional status of young children, high rate of domestic violence against women, and prolonged period of conflict that included systematic sexual violence against women. We expected that maternal exposure to domestic violence would predict lower anthropometric z-scores and higher odds of stunting, wasting, and underweight in children less than five years. Using data from 2467 mother-child dyads in the 2007 Liberia Demographic and Health Survey (LDHS) undertaken between December 24, 2006 and April 19, 2007, we conducted descriptive and multivariate analyses to examine the total, unadjusted and adjusted associations of maternal exposure to domestic violence with these anthropometric measures in children. Maternal reports of sexual domestic violence in the prior year predicted lower adjusted z-scores for height-for-age and weight-for-height as well as higher odds of stunting and underweight. The findings underscore the needs to (1) enhance and enforce conventional and customary laws to prevent the occurrence of domestic violence; (2) treat maternal survivors of domestic violence and screen their children for nutritional deficits; (3) heighten awareness of the intergenerational implications especially of recent sexual domestic violence; and (4) clarify the biological and behavior pathways by which domestic violence may influence child growth, thereby mitigating early growth failure and its adverse implications into adulthood.

Dietary Diversity is Associated with Nutrient Intakes and Nutritional Status of Children in Ghana

Objective: The study was conducted with the objective of assessing the possible associations between dietary diversity, nutrient intakes and young child nutritional status in Ghana. Material & Methods: A cross-sectional survey involving one hundred mothers with young children between the ages of 6 and 18 months was conducted using a combination of methods. Structured interview using questionnaire, dietary assessment and anthropometry were used to collect the data. Dietary diversity was assessed by using food group count. The WHO (1998) recommended daily nutrient needs from complementary foods for infants receiving average breast milk intakes were used to assess the energy and nutrient content of the diets consumed by the children. The WHO (1983) reference was used to assess child nutritional status. The data was analyzed using Statistical Package for Social Science (SPSS) version 16 in Windows. Results: About 16% of the study children were underweight whiles 8% were both stunted and wasted. The mean dietary diversity score was 4.6. Significant differences were observed between dietary diversity groupings and energy/nutrient intakes of the children. Generally, as dietary diversity improved, energy and nutrients intakes also in-creased. Again, dietary diversity was significantly associated with weight-for-age, length-for-age and weight-for-length. As dietary diversity increased, child nutritional status also improved. Children who had low dietary diversity exhibited low scores in terms of weight for age, length for age and weight for length. Conclusion: High dietary diversity improves energy and nutrients intakes, and hence dietary adequacy, as well as child growth and nutrition. Key Words: Dietary Diversity; Nutrient Intakes; Child Nutritional Status DOI: http://dx.doi.org/10.3126/ajms.v2i2.4179 Asian Journal of Medical Sciences 2 (2011) 105-109

Role of Methylmercury Exposure (from Fish Consumption) on Growth and Neurodevelopment of Children Under 5 Years of Age Living in a Transitioning (Tin-Mining) Area of the Western Amazon, Brazil

Human occupation of the Amazon region has recently increased, bringing deforestation for agriculture and open-cast mining, activities that cause environmental degradation and pollution. Families of new settlers in mining areas might have a diet less dependent on abundant fish and their children might also be impacted by exposures to mining environments. Therefore, there is compounded interest in assessing young children's nutritional status and neurobehavioral development with regard to family fish consumption. Anthropometric (z-scores, WHO standards) and neurologic [Gesell developmental scores (GDS)] development in 688 preschool children (1-59 months of age) was studied. Overall, the prevalence of malnutrition [i.e., moderate stunting (≤2 H/A-Z), underweight (≤2 W/A-Z), and wasting (≤2 W/H-Z) were respectively 0.3% (n = 2), 1.6% (n = 11), and 2.5% (n = 17). Children's mean hair Hg (HHg) concentration was 2.56 μg/g (SD = 1.67); only 14% of children had HHg concentrations lower than 1 μg/g and 1.7% had ≥5 μg/g. The biomarker of fish consumption was weakly but positively correlated with GDS (Spearman r = 0.080; p = 0.035). In the bivariate model, attained W/H-Z scores were not significantly correlated with GDS. A moderate level of GDS deficits (70-84%) was seen in 20% of children. There was significant correlation between family fish consumption and children's hair Hg (HHg) (Spearman r = 0.1756; p < 0.0001) but no significant correlation between children's HHg and W/H-Z scores. However, the multivariate model showed that breastfeeding, a fish consumption biomarker (HHg), maternal education, and child's age were statistically significant associated with specific domains (language and personal-social) of the Gesell scale. In this mining environment, family fish-eating did not affect children's linear growth, but it showed a positive influence (along with maternal variables) on neurodevelopment. Health hazards attendant on a high prevalence of moderate neurodevelopment delays coexisting with exposure to multiple neurotoxic substances merits further investigation in poor environmental settings of tin-mining areas.

Maternal nutrition in rural Kenya: health and socio‐demographic determinants and its association with child nutrition

High levels of food insecurity and human immunodeficiency virus (HIV) infection place most breastfeeding mothers in Kenya at high risk of malnutrition. We examined the role of selected socio-economic, demographic and health factors as determinants of nutritional status among HIV-infected and HIV-uninfected mothers in rural Kenya and further examined the interrelationship between maternal nutritional and child nutritional status within this population. A cross-sectional design was used to collect data from non-pregnant mothers with children ages 4-24 months in Kisumu District, Kenya. Over 80% of the mothers were breastfeeding at the time of the study. Mean maternal body mass index (BMI) (21.60 ± 3.15) and percent body fat (22.29 ± 4.86) values were lower than among lactating mothers in other Sub-Sahara African countries. Maternal HIV status was not significantly associated with any of the maternal nutritional indicators assessed in the study. Breastfeeding, recent severe illness and having multiple children below 2 years of age were negatively associated with maternal nutritional status, while higher maternal age, socio-economic status and household food security were each positively associated with maternal nutritional status. Significant positive association was reported between maternal weight, height, BMI, mid-upper arm circumference (MUAC), body fat and fat-free mass estimates, and children's height-for-age, weight-for-age, weight-for-height and MUAC-for-age z-score. This analysis identifies determinants of maternal nutritional status in rural Kenya and highlights the importance of interventions that address malnutrition in both HIV-infected and HIV-uninfected mothers in rural Kenya. Significant association between maternal and child nutritional status stresses the importance of addressing maternal and young child nutritional status as interrelated factors.

Situational analysis of infant and young child nutrition policies and programmatic activities in Senegal.

Progress towards reducing mortality and malnutrition among children <5 years of age has been less than needed to achieve related Millennium Development Goals (MDGs). Therefore, several international agencies joined to 'Reposition children's right to adequate nutrition in the Sahel', starting with an analysis of current activities related to infant and young child nutrition (IYCN). The main objectives of the situational analysis are to compile, analyse and interpret available information on infant and child feeding and the nutrition situation of children <2 years of age in Senegal, as one of the six targeted countries. These findings will be used to assist in identifying inconsistencies and filling gaps in current programming. Between August and December 2008, key informants responsible for conducting IYCN-related activities in Senegal were interviewed, and 157 documents were examined on the following themes: optimal breastfeeding and complementary feeding practices, prevention of micronutrient deficiencies, prevention of mother-to-child transmission of HIV, management of acute malnutrition, food security and hygienic practices. Nearly all of the key IYCN topics were addressed, specifically or generally, in national policy documents. Senegal reported substantial improvements since the 1990s towards reducing infant and young child mortality and underweight, and increasing exclusive breastfeeding among infants <6 months of age (34%). Senegal is one of the few countries in the region that is nearly on track for reaching related MDGs. Notable activities that may have played a role include: (1) vitamin A supplementation was expanded to nearly semi-annual national campaigns starting in 1994; (2) the Ministry of Health partnered with several national and international agencies to scale up child survival activities under the umbrella of the Basic Support for Institutionalizing Child Survival (1994-2006); (3) a national nutrition division was developed to support a national nutrition strengthening programme; (4) the national nutrition counsel was organized to coordinate nutritional activities across various organizations and governmental sectors, involving representatives from health, agriculture and surveillance; and (5) an integrated communications programme was developed to support harmonized behaviour change communication tools for the health and nutrition sectors. Along with these activities, a number of programme evaluations were conducted to ensure that programmes obtain desired results. Although useful, these evaluations were not rigorous enough to identify effective programmes that contributed to the mentioned reductions in the prevalence of underweight and mortality, and increases in exclusive breastfeeding. The policy and programme framework is well established for support of optimal IYCN practices in Senegal. Despite the recent improvements in infant and young child nutritional status indicators, there is still much to do. Greater resources and continued capacity building are needed to: (1) conduct necessary research for adapting training materials and programme protocols to programmatic needs; (2) improve and carry out monitoring and evaluation that identify effective programme components; and (3) apply these findings in developing, expanding and improving effective programmes.

The Effectiveness of Quality Protein Maize in Improving the Nutritional Status of Young Children in the Ethiopian Highlands

Undernutrition is a persistent problem in Africa, especially in rural areas where the poor largely depend on staples and have limited access to a diverse diet. Quality protein maize (QPM) consists of maize varieties biofortified with increased lysine and tryptophan levels. Several studies in controlled settings have indicated the positive impact of QPM on the nutritional status of children. Two 1-year, randomized, controlled studies were undertaken to measure the effect of QPM on the nutritional status of children consuming typical maize-based diets when QPM was cultivated by their households in the western Ethiopian highlands. The first study used a cluster-randomized design with 151 children aged 5 to 29 months; the second study used a completely randomized design with 211 children aged 7 to 56 months. In both studies, half of the households were provided with QPM seed and the other half with seed of an improved conventional maize variety. Undernutrition was pervasive, and maize was the dominant food in the children's complementary diets. In the first study a positive effect of QPM was observed for weight but not height, with children in the QPM group recovering from a drop in weight-for-height. In the second study, children consuming conventional maize progressively faltered in their growth, whereas children consuming QPM did not change significantly in height-for-age and had a marginal increase in weight-for-age. These studies indicate that in major maize-producing and -consuming areas of Africa, home cultivation and use of QPM in children's diets could reduce or prevent growth faltering and may in some cases support catch-up growth in weight.

A prospective, longitudinal study of growth, nutrition and sedentary behaviour in young children with cerebral palsy

BackgroundCerebral palsy is the most common cause of physical disability in childhood, occurring in one in 500 children. It is caused by a static brain lesion in the neonatal period leading to a range of activity limitations. Oral motor and swallowing dysfunction, poor nutritional status and poor growth are reported frequently in young children with cerebral palsy and may impact detrimentally on physical and cognitive development, health care utilisation, participation and quality of life in later childhood. The impact of modifiable factors (dietary intake and physical activity) on growth, nutritional status, and body composition (taking into account motor severity) in this population is poorly understood. This study aims to investigate the relationship between a range of factors - linear growth, body composition, oral motor and feeding dysfunction, dietary intake, and time spent sedentary (adjusting for motor severity) - and health outcomes, health care utilisation, participation and quality of life in young children with cerebral palsy (from corrected age of 18 months to 5 years).Design/MethodsThis prospective, longitudinal, population-based study aims to recruit a total of 240 young children with cerebral palsy born in Queensland, Australia between 1st September 2006 and 31st December 2009 (80 from each birth year). Data collection will occur at three time points for each child: 17 - 25 months corrected age, 36 ± 1 months and 60 ± 1 months. Outcomes to be assessed include linear growth, body weight, body composition, dietary intake, oral motor function and feeding ability, time spent sedentary, participation, medical resource use and quality of life.DiscussionThis protocol describes a study that will provide the first longitudinal description of the relationship between functional attainment and modifiable lifestyle factors (dietary intake and habitual time spent sedentary) and their impact on the growth, body composition and nutritional status of young children with cerebral palsy across all levels of functional ability.

Prevalence of early childhood malnutrition and influencing factors in peri urban areas of Kabarole district, western Uganda

Uganda has one of the highest levels of childhood stunting in sub-Saharan Africa. It is well documented that the nutritional status of young children is one of the most sensitive indicators of sudden changes in health status and food availability, acting as a proxy indicator of socio-economic development. Kabarole District, the focus of the present study, is one of the most fertile areas in Uganda, with high per capita output of most foods. However, earlier studies in Kabarole District found that over 40% of children below five years of age were stunted. The objective of this study was, therefore, to asses the prevalence of malnutrition and the factors influencing the nutritional status of children below five years of age, in a peri-urban environment in Kabarole District, western Uganda. The study design was a cross sectional descriptive survey, using both qualitative and quantitative methods of data collection. A questionnaire was administered to 93 caretakers of children 6-59 months in randomly selected households, which explored the various factors that could be affecting the nutritional status of the children. Key information was also sought from a focus group discussion of a few selected mothers. Results revealed that stunting was highly prevalent with 41.6% of the children stunted. Under-weight and wasting were established at 15.7% and 3.4%, respectively. Education level of mother/caretaker (p=0.02), age of child (p=0.03), receipt of information on child feeding (p=0.009), illness (p=0.004) and time of introduction of other foods (p=0031) were significantly related to child stunting. On the other hand, household size, number of meals per day and awareness about the causes of malnutrition, were non significantly associated with child stunting. These findings indicate that malnutrition, especially stunting, in this cohort of children in peri-urban areas of Kabalore District, is a big problem. Poor education levels of the mothers/caretakers and poor child feeding practices are some of the factors identified as major contributors to this problem. It is therefore recommended that appropriate nutrition interventions, particularly equipping mothers/caretakers with knowledge and skills in child feeding, child health, sanitation and other best practices for proper childcare, be put in place to address the problem of childhood malnutrition in Kabarole District and other areas in Uganda, and indeed in Sub-Saharan Africa, with similar settings.

Complementary Feeding Practices and its Impact on Nutritional Status of Under two old Children in the Urban Area of the Kathmandu, Nepal

Kathmandu valley. Methods The study was based on primary data collected by applying the 30 cluster sampling method. Target populations of the study were young children aged 0-24 months. Interview was taken with the mothers of the children. A set of questionnaire was used for interview of the respondents 150 households. Anthropometric assessment focus group discussion, twenty-four hours dietary recalls, nutrient analysis of the complementary foods and market survey were adopted as a research methodology for data collection. Results Finding of the study indicated that traditional about 92 percent households were found practicing traditionally complementary feeding practices (TCFP) were 8 percent households were found practicing commercial Complementary Feeding Practicing (CCFP). Traditional complementary foods given to the children were found lacking in macronutrient carbohydrate and protein severely, therefore, not fulfilling the nutritional requirement of the children. Among traditional complementary food fed children, 63 percent of children were found suffering from mild to severe from of malnutrition where as among commercial food fed, only 41 percent of children were found suffering from such form of malnutrition. About 33 percent of the children suffering from severe malnutrition were come from the household of employees. Children from Newar ethnicity of Lalitpur district were found more suffering from severe type of malnutrition compared to other ethnic groups. In addition baby boys were found suffering more from severe type of malnutrition compared to baby girls. Conclusion Nutritional status of children from Kathmandu district found better compared to young children from other district. Children from Lalitpur district were found more severely malnourished. Surprisingly baby boys found more severely malnourished compared to baby girls. Traditional foods fed children were found more severely malnourished compared to commercial complementary food fed. Finding of this study clearly indicated that complementary feeding practices have direct impact on nutritional status of young children.

Home-based practices of complementary foods improvement are associated with better height-for-age Z score in 12-23 months-old children from a rural district of Burkina Faso.

Repositioning nutrition is central to development. Childcare practices, which include feeding practices, appear in the conceptual framework of malnutrition. The objective of this study was to analyze the nutritional status of young children in relation to feeding practices. This cross-sectional, community-based study was conducted in the rural district of Kongoussi (Burkina Faso). Three hundred ninety nine children (95% of expected 420 children: 30 clusters of 14 children), 6-23 months of age, were recruited by “probability proportionate-tosize” cluster sampling. Items related to the early and current breastfeeding patterns and the mode of complementary feeding were recorded by interview of the mothers. Fortified cereals were defined as home-based improved flours by mixing “soumbala,” fishmeal, toasted groundnut, or several of these local foods with cereal. Soumbala is a fermented product from the African bean tree used both as a condiment and as a meat substitute in soups, because it is rich in protein and micronutrients. The height-for-age Z-score (HAZ) and weight-for-height Z-score (WHZ) were computed using height and weight measurements. Adjusted mean HAZ and WHZ were derived from multiple linear regression models and compared using analysis of variance (ANOVA) and post hoc t-test with Bonferroni correction. The prevalence of wasting was 26.3% (95% CI: 21.5% - 30.5%). The mean WHZ (± standard deviation) was –1.39 (± 1.14). The WHZ was associated with the children's age and the mother's nutritional status. The prevalence of stunting was 35.8% (95% CI: 29.4% - 41.1%). The mean HAZ was –1.68 (± 1.15). After adjustment for children, mothers and household characteristics, and for current and past breastfeeding patterns, the HAZ remained associated with the mode of complementary feeding among children 12-23 months of age (p=0.018), but not among children 6-11 months of age (p=0.136). Among children 12-23 months of age, the adjusted mean HAZ (standard error) was –1.33 (0.63), -1.61 (0.30), and –2.11 (0.32) for children using fortified cereals, unfortified cereals, or no complementary feeding, respectively (p=0.018). These results underline the high frequency of malnutrition in the rural district of Kongoussi, and the great need for nutritional intervention. The prevention of growth impairment in this area could be based on home fortification of complementary foods using locally available foods; this is more sustainable. Thorough research is needed to specify and standardize the procedures of utilisation of the available foods in the prevention of growth impairment. Keywords: Fortification, Cereals, Stunting, Children, BurkinaAJFAND Vol. 8 (2) 2008 pp. 204-218

Training in complementary feeding counselling of healthcare workers and its influence on maternal behaviours and child growth: a cluster-randomized controlled trial in Lahore, Pakistan.

Malnutrition is common among children aged 6-24 months in developing countries. It increases the risk of mortality. Interventions to improve infant-feeding hold the promise of reducing malnutrition among these children. A study in Brazil has shown the success of training in communication and counselling skills among health workers in improving the nutritional status of young children. Questions were raised whether the method used in the study in Brazil would also be effective when applied in other countries. The aim of the present study was to reduce growth faltering in young children through proper nutrition-promotion techniques. The objective of the study was to determine the efficacy of training health workers in nutrition counselling in enhancing their communication skills and performance, improving feeding practices, and reducing growth faltering in children aged 6-24 months. A cluster-randomized controlled trial was carried out. The method used in this study was a replica of the method in a similar study in Pelotas, Brazil. Forty health centres were paired, and one centre of each pair was randomly allocated to the intervention group, and the other to the control group. The Integrated Management of Childhood Illness (IMCI) module-'Counsel the mother'-was used for training health workers in the health centres in the intervention group. Data from 36 paired health centres and 375 mothers and their children aged 6-24 months recruited from these health centres following consultation with health workers were included in analysis. Independent observers, masked to the intervention status, examined the performance of health workers within the first month after training. Mother-child pairs were visited at home within two weeks, 45 days, and 180 days after recruitment. Information was recorded on the feeding practices, recall of the recommendations of health workers, and sociodemographic variables at these home-visits. Weight and length of the child were measured at each contact. The communication skills and consultation performance of health workers were significantly better in the intervention group than in the control group. The mothers' recall of the recommendation of health workers and reported infant-feeding practices were also significantly better in the intervention group than in the control group, even 180 days after the recruitment consultation. Growth faltering was less in the intervention group, with the largest effect observed among children in the age-group of 12 + months. These results indicate that training in IMCI feeding counselling can enhance the communication skills and performance of health workers. Improved feeding practices of counselled mothers can, in turn, reduce growth faltering in their children.

Estado nutricional y condiciones de vida de los niños menores de cinco años del área urbana del municipio de Turbo, Antioquia, Colombia, 2004

Malnutrition is a problem for the persons who suffer it and for the future of the societies to whom they belong. It is important to know its magnitude in order formulate solutions. The nutritional status of young children was evaluated in an urban area using anthropometric indices and factors associated with risk of malnutrition were identified--socio-demographic,environmental, nutritional, and health factors. In 2004, a cross-sectional descriptive survey was applied to 606 children, aged less than 5 years, in Turbo, a municipality in northwestern Colombia. A proportional, randomized, statistically significant sample of all the neighborhoods of the urban area in Turbo was used. Anthropometric evaluation (weight, height and age) was performed in all subjects, and a questionnaire regarding the socio-economical and nutritional background of the children was submitted to mothers and caregivers. The prevalence percentages were as follows: low weight (11.1%-CI 8.5-13.6), stunting (11.7%-CI 9.1-14.4) and starvation (2.8%- CI 1.4-4.2). When a cut-off point of -1 Z score was applied, the prevalence increased to 41.7% (CI 37.7-45.8), 36.9% (CI 33.0-40.9) and 24.6% (CI 21.1-28.1) respectively. Bivariate analyses showed greater risks of global, severe and chronic malnutrition for males. Greater risk for global and chronic malnutrition occurred for children older than one year. Risk of chronic malnutrition was associated with the following conditions: children belonging to households with more than five people, children of mothers with low educational level, for children being breastfed for more than one year, and children who have a higher number of brothers. An increased risk of malnutrition was present in the Turbo population when compared with the national anthropometric indices. The nutritional status of Turbo urban children is associated with several distinct socio-economical factors; these must be considered when implementing programs for the nutritional rehabilitation of this population.

Influence of care practices on nutritional status of Ghanaian children.

A community-based longitudinal study was conducted in the Manya Krobo District of the Eastern Region of Ghana with the objective of assessing how caregiving practices influence nutritional status of young children in Ghana. The study subjects were one hundred mothers with infants between the ages of 6 and 12 months. Each child was visited at home monthly for a period of six months. On each visit, information was collected on caregiver household and personal hygiene, child's immunization status, child's dietary diversity, caregiver responsiveness during feeding, caregiver hygienic practices related to feeding and child's weight and length. At the end of the study, summary scores were generated for each variable and quality of care practice determined based on their distribution. Classification of child nutritional status was based on z-scores for both weight-for-age and length-for-age. The results revealed that caregivers who exhibited better quality of care practice had well-nourished children. Such caregivers were more likely to practice good household and personal hygiene than those of poorly nourished children (97.1% vs 31.8%, p<0.001). They were also more likely to complete their children's immunization schedules (88.2% vs 62.2%, p< 0.001), provide good quality diets from highly diversified sources (79% vs 23%, p<0.001), exhibit high responsiveness during feeding (100% vs 22.7%, p<0.001) and feed under hygienic conditions (100% vs 22.7%, p<0.001). Based on the findings it was concluded that good caregiving practices are associated with improved child nutritional status.

Surviving but Not Quite Thriving: Anthropometric Survey of Children Aged 6 to 59 Months in a Rural Western Uganda District

Located in Western Uganda, Bundibugyo District has enjoyed nearly a decade of relative political stability. However, the current nutritional status of young children is not known. A survey conducted in 1999 assessed the prevalence of global malnutrition, but not stunting. The purpose of this study was to estimate the prevalence of global malnutrition and stunting in three of the 10 subcounties in Bundibugyo District, and to describe efforts to address malnutrition in Bundibugyo. An anthropometric survey of children aged 6 to 59 months was conducted, informed by guidelines for two-stage cluster sampling. Ten villages from each subcounty were chosen at random. The following indicators were measured for 30 children (not randomly selected) per village: age in months, sex, weight in kilograms, length/height in centimeters, mid-upper arm circumference in centimeters, presence of edema, presence of mother in the home, and presence of father in the home. The overall prevalence estimate of global malnutrition, defined as weight-for-height less than −2 z scores, was 2.7% (includes severe malnutrition). The prevalence estimate for stunting, defined as height-for-age less than −2 z scores, was 44.8%. There were no observed cases of kwashiorkor. Because results indicate that stunting is a major problem, programmatic efforts should emphasize young child feeding practices that will lead to decreased incidence of stunting, which would likely contribute to the development potential of the district. The authors describe efforts to address global malnutrition as well as stunting in Bundibugyo.

Ability of mothers to diagnose fever and anaemia in their young children, in a malaria-endemic region of West Africa

The rapid and correct diagnosis of fever and anaemia at the household level is a prerequisite for the successful management and control of life-threatening disease among young children, particularly in malaria-endemic areas of Africa. The ability of mothers to diagnose fever and anaemia in their young children has recently been explored, as part of a large, birth-cohort study in rural, north-western Burkina Faso. During a cross-sectional survey in six villages, 345 children aged, <3 years and their mothers were investigated. Each mother was asked if she considered her child to be febrile and/or anaemic before that child's temperature and haematocrit were measured, with an electronic thermometer and portable centrifuge, respectively. The recorded prevalences of fever (> or =37.5 degrees C) and anaemia (haematocrit, <25%) in the children were 12.2% and 21.4%, respectively. The mothers' diagnoses had a sensitivity of 76.2% [95% confidence interval (CI)=60.6%-88.0%] for fever and 4.1% (CI=0.8%-11.4%) for anaemia, with corresponding specificities of 87.1% (CI=82.8%-90.7%) and 95.9% (CI=92.9%-98.0%). Mothers in rural Africa appear to be fairly accurate in detecting fever in their children but less accurate in detecting anaemia. While malaria control needs to employ a mix of preventive and curative measures, anaemia control will benefit from community-based malaria-control measures as well as broader approaches addressing the nutritional status of young children.

P118: Effects of a Nutrition Education Program on Caregiver Feeding Behaviors and Nutritional Status of Young Children

Childhood undernutrition is a global problem which is often aggravated by food insecurity, poverty, and illiteracy. Even when food is available, less literate child-caregivers in less developed communities often lack information about appropriate feeding behaviors and this often limits their ability to fully utilize the available food resources – hence puts their children at risk for undernutrition. The purpose of this Intervention was to test the effectiveness of using nutrition education as a tool to improve feeding behaviors and the nutritional status of children of low-income less literate rural mothers.

NUTRITIONAL STATUS OF YOUNG CHILDREN IN AIDS-AFFECTED HOUSEHOLDS AND CONTROLS IN UGANDA

This study conducted in Uganda assessed the nutritional status of young children and their disease history in the 3-month period before the study. Two groups of children were randomly selected: the first group consisted of 105 children living in homes where a family member fell sick of AIDS, whereas the second group consisted of 100 children who were living in homes where nobody was affected by AIDS. Acute malnutrition (wasting) was rare. There was no difference in the severity of stunting in the two groups (Z scores, -2.1 versus -2.2, P = 0.70). In those children living in AIDS-affected homes, disease episodes were longer (15.7 versus 11.3 days, P = 0.014), but the frequency of disease occurrence was similar in both groups. Fifty-five percent of all children suffered from moderate to severe malnutrition (stunting). The high stunting rate in early childhood suggests a public nutritional intervention program is recommended.

Assessment of 24 years of infant growth monitoring in a rural area of Senegal (1969-1992)

Undernutrition in young children in developing countries is associated with an increased risk of death. But in several studies, a decrease in mortality was not associated with any decrease in the prevalence of undernutrition. A rural population of Casamance (Senegal) has been under yearly demographic surveillance by The French National Institute of Demographic Studies (INED) since 1985. Between 1960-1964 and 1990-1994, under-5 and child (1-4 years) mortality rates dropped from 312 to 127 and from 201 to 68 per 1,000, respectively. Since 1961, French Catholic nuns who are also professional nurses have been in charge of a private village dispensary located in a rural area of Casamance. This dispensary delivers permanent, high quality service and is widely attended. GROWTH MONITORING PROGRAMME: A growth-monitoring programme, supported by Cathwell, was initiated in 1969 for 0-5-year-old children (0-3 from 1985). Children were weighed wearing light clothes to the nearest 10g. Weights were recorded in a register that also contained information concerning identity (name, sex, date of birth) and address. All weights were plotted on growth charts kept by the mothers. During the sessions, the nurses provided nutrition education messages (i.e., preparation of high-energy and nutrient-dense infant gruels using local foods), advice on illness management (oral rehydration during diarrhoea) and hygiene (well and water-jar disinfection, construction of pit-latrines), importance of vaccination. From 1975, they also distributed free chloroquine during the malaria transmission season (May-November) for prevention and early presumptive treatment. Most likely thanks to this programme, infant and child mortality reached a low level at the end of the 1980s. In 1990, plasmodium resistance to chloroquine appeared, increasing malaria mortality. All weight measurements taken in 1969-1994 were entered into a database. This paper presents an analysis of weight measurements taken at 3-23 months of age from 1969-1992. A total of 4,636 infants were weighed at least once, but only 3,912 infants (1,983 boys and 1,929 girls) were available for the analysis, 724 being excluded due to missing data. The average coverage of the programme during the month of February was 88% for infants aged 3-23 months. Mean weight was examined at three target ages: 5, 11 and 15 months. Not only did the nutritional status not improve between 1969 and 1989, it even deteriorated in some years for all three age-cohorts. The nutritional status of infants in this community did not differ significantly from that of 12-23 month-old Senegalese children in the 1992-1993 Demographic and Health Survey (DHS). Seasonal differences in mean weight and the prevalence of underweight became significant in the rainy season since 1975. Underweight for the 15-month-old children increased over time during the rainy season. These findings were unexpected, since malaria morbidity is thought to be at least partially responsible for seasonal variations in the nutritional status of young children, and despite the fact that the nurses began a malaria control programme in 1975. The rapid transition towards lower childhood mortality observed in this rural area of Casamance (Senegal), was not concomitant with any improvement in infants' nutritional status from 1969 through 1992. Focused public health interventions such as vaccinations and malaria prevention probably did not improve the nutritional status. Paradoxically, growth monitoring may have been more helpful in improving health than growth. Targeted specific nutritional interventions are needed to significantly improve growth of children in this community.

Improving the Eating Patterns of Infants and Toddlers

Early childhood is a critical time for the development of food preferences and eating patterns. The development of eating behaviors is a complex process involving physiological and psychological underpinnings. Factors that influence dietary intakes and nutritional status of young children include food preferences, food availability, parental modeling, praise or reward for food consumption, and peer behaviors ( 1 Carruth B.R. Skinner J. Houck K. Moran J. Coletta F. Ott D. The phenomenon of “picky eater” A behavioral marker in eating patterns of toddlers. J Am Coll Nutr. 1998; 17: 180-186 Google Scholar , 2 Sullivan S.A. Birch L.L. Infant dietary experience and acceptance of solid foods. Pediatrics. 1994; 93: 271-277 Google Scholar , 3 Birch L.L. Effects of peer models’ food choices and eating behaviors on preschoolers’ food preferences. Child Dev. 1980; 51: 489-496 Google Scholar , 4 Birch L.L. Johnson S.L. Fisher J.A. Children’s eating The development of food-acceptance patterns. Young Child. 1995; 50: 71-78 Google Scholar ). These factors begin to develop during early infancy, a time when human milk or infant formulas are the only sources of nutrition and feeding is a source of reassurance and parent–child attachment, and continue to develop throughout childhood. J. Stang is a project director and continuing education specialist, Leadership Education and Training Program in Maternal and Child Health Nutrition, Division of Epidemiology, University of Minnesota, Minneapolis.

105 The Nutritional Status of Young Children with Carious Teeth

105 The Nutritional Status of Young Children with Carious Teeth