Breastfeeding and weaning practices in rural communities of Kelantan

A survey of infant-feeding and weaning practices of 566 mothers, systematically sampled from 15 rural villages, randomly selected in the district of Tumpat, Kelantan was carried out. Almost all mothers (97.3%) breastfed their children, reinforcing the previously reported high incidence of breast-feeding among rural Malaysian mothers. One hundred and seventeen (21.3%) of the 551 children breastfed were also given mixed feeding with infant fomulae as well. Weaning started before 4 months of age in 28.3% of the children and after 6 months of age in 12.8% of the children. The 3 most common type of food used in weaning were Nestum (45.0%), rice porridge or paste (42.6%) and wheat porridge or cakes (11.5%). Forty eight children (12.1%) discontinued breastfeeding once weaning was initiated. The main reasons for initiating weaning was mothers' perception that there was insufficient milk and that the child was always hungry (55.7%). Most mothers were also given advice by the health clinic staff on weaning, including the timing and the suitable weaning foods to give. All of the mothers were able to name at least one commercial weaning food product available in their community.     

Anaemia of pregnancy in Mozambique

To establish the prevalence of anaemia in pregnant women in Mozambique and to determine the locally most important causes of the disease, 881 pregnant women were examined at nine sites in seven of Mozambique's 10 provinces. In Maputo, the capital city, an additional 91 anaemic gravidae were compared to 207 parturients chosen at random. The study comprised interviews, and clinical and laboratory investigations. Between 5 and 15% of the pregnant women at the different sites had haemoglobin (Hb) values below 90 g/l and 58% had levels below 110 g/l. Inspection of mucosal membranes detected almost all the anaemic women with Hb values below 80 g/l. Nulliparous women were more prone to be anaemic. Iron deficiency and malaria were the main causes of anaemia, with malnutrition also contributing. Occasional cases of folic acid deficiency were found among severely anaemic women but no cases of significant deficiency of vitamin B12 were encountered. Sickle cell disease was not found to contribute significantly to anaemia of pregnancy in Mozambique. The mean corpuscular haemoglobin concentration (MCHC) proved more sensitive, under these conditions, than serum ferritin in detecting iron deficiency in anaemic women. Packed cell volume (PCV) analysis may substitute Hb analysis when screening for pregnancy anaemia in Mozambique.     

Anaemia during pregnancy as a risk factor for infant iron deficiency: report from the Valencia Infant Anaemia Cohort (VIAC) study

A prospective cohort study with a 1-year follow-up of 156 neonates was carried out specifically designed to test the hypothesis that there is a positive relationship between iron deficiency during pregnancy and the development of the same disease in newborn infants. Exposure was defined as being born of a mother with ferropenic anaemia at delivery, and cases as the infants who developed iron deficiency during their first year of life. A statistically significant positive association was detected with an odds ratio of 6.57 (95% confidence limits 1.81-25.97). A stratified analysis was also performed to control the effect of potential confounders such as socio-economic variables, feeding practices and other factors linked with the iron status of infants. This second analytical procedure showed no alteration in the association detected in the simple analysis but that there was a statistically significant strong interaction between the quantity of cow's milk intake and the ferropenic status of the mother. These results show a relationship between iron deficiency of the mother at delivery and the development of iron deficiency in the infants. These new findings could be important in the development of new prevention programmes applied to pregnant women.     

Anaemia during pregnancy as a risk factor for infant iron deficiency: report from the Valencia Infant Anaemia Cohort (VIAC) study

Summary. A prospective cohort study with a 1-year follow-up of 156 neonates was carried out specifically designed to test the hypothesis that there is a positive relationship between iron deficiency during pregnancy and the development of the same disease in newborn infants. Exposure was defined as being born of a mother with ferropenic anaemia at delivery, and cases as the infants who developed iron deficiency during their first year of life. A statistically significant positive association was detected with an odds ratio of 6.57 (95% confidence limits 1.81–25.97). A stratified analysis was also performed to control the effect of potential confounders such as socio-economic variables, feeding practices and other factors linked with the iron status of infants. This second analytical procedure showed no alteration in the association detected in the simple analysis but that there was a statistically significant strong interaction between the quantity of cow's milk intake and the ferropenic status of the mother. These results show a relationship between iron deficiency of the mother at delivery and the development of iron deficiency in the infants. These new findings could be important in the development of new prevention programmes applied to pregnant women.     

Anaemia during pregnancy as a risk factor for iron-deficiency anaemia in infancy: a case-control study in Jordan.

BACKGROUND: A high prevalence of 50-65% iron-deficiency anaemia in mothers and infants in Jordan was reported by the United Nations Relief and Works Agency (UNRWA) in 1990. Iron-deficiency in infancy has been shown to delay cognitive and psychomotor development with long-term consequences. While socioeconomic deprivation and inadequate nutrition are known underlying factors, it is unclear whether iron endowment at birth is compromised when mothers are anaemic, further jeopardizing iron status during infancy. A prospective case-control study of infants from birth to one year was conducted in a lower middle-class urban setting in Amman, Jordan. The study objective was to examine the relationship between maternal anaemia and iron-deficiency anaemia during infancy. METHOD: A sample of 107 anaemic (Hb < 11 g/dl) and 125 non-anaemic mothers was selected at 37 weeks' gestation and matched for age and parity, and infant data at birth obtained. The infants were reviewed at 3, 6, 9 and 12 months, to assess growth, current nutrition, infection rates and iron status. The main outcome measure was the incidence of iron-deficiency anaemia in the two groups of infants, defined in the study as Hb < 11 g/dl and either plasma ferritin < 12 mcg/l or zinc protoporphyrin > 35 mcg/dl. RESULTS: Iron endowment in cord blood samples appeared similar between the two groups. The incidence of iron-deficiency anaemia was very high in these infants, at 72% by research criteria, (51% if Hb < 10.5 g/dl), but significantly higher in the infants born to anaemic mothers at all stages of the year, with overall incidence of 81% (n = 91), compared to 65% in controls (n = 112). This was not explained by differences in environmental risk factors. Anaemic mothers had not recovered adequate iron status at 6 months' postpartum, with implications for future pregnancy iron demands. CONCLUSIONS: Anaemia during pregnancy compromises the health of mothers in traditional cultures, where women tend to have several children close together after marriage, with an inadequate interval to replenish nutritional stores. Their infants also appear to be at increased risk of developing iron-deficiency anaemia, undetected at birth.     

Parasitic infections,Anaemia and nutritional status of adolescents in rural Zambia

A Study of 414 rural primary schoolchildren with high prevalence of undernutrition was conducted to determine the relationships between parasitic infections, anaemia and nutritional status. It was found that the mean values for weight‐for‐age, a measure of undernutrition, decreased sharply with increasing age and they varied significantly with the month when the survey was undertaken. It was also found that anaemia was significantly associated with weight‐for‐age percent, weight‐for‐height percent and weight, anthropometric measurements which are susceptible to short‐term fluctuations. Hookworm infection was found to be associated with weight‐for‐age percent only. Multiple regression analysis showed that the presence of anaemia was by far the most important variable of those studied explaining variations in nutritional status of the schoolchildren in this area. Thus, we conclude that parasitic infections may be contributing to the poor growth of the children in this area. The findings in this study suggest that treatment and control of hookworm disease, urinary schistosomiasis and malaria deserve high priority in this area.     

Effect of morbidity during pregnancy on birth weight in a rural guatemalan population

The high prevalence of low birth weight (≤ 2.5 Kg) babies is a major public health problem in many poor communities. Studies in humans suggest that malnutrition during pregnancy is an important factor in accounting for this problem, but almost no information is available about the effect of common maternal diseases during pregnancy. This paper reports the effects of maternal morbidity during pregnancy on birth weight in four rural villages of Guatemala. Maternal morbidity, assessed through fortnightly interviews during pregnancy, showed a consistent inverse association with birth weight (r = —0.149, n = 344, p<0.01). In each village, the proportion of low birth weight babies born to mothers who were ill more than 10 percent of their pregnancy was consistently higher than the proportion of babies born to mothers who were sick 10 percent (or less) of their pregnancy (p<0.01). The relationship between the proportion of time ill and birth weight was basically unchanged (r = —0.182, n = 334, p<0.01) after controlling for maternal height, head circumference, parity, gestational age, socioeconomic status, home energy intake, energy supplementation during pregnancy and number of days surveyed during pregnancy. Moreover, a similar association was found in consecutive pregnancies of the same mother (r = —0.197, n = 50, p = 0.16). It was concluded that maternal morbidity during pregnancy caused a decrease in birth weight.

In addition, an inverse association was observed between the proportion of time ill during pregnancy and home energy intake (r = —0.254, n = 334, p<0.01). However, the amount of birth weight variance explained by morbidity during pregnancy did not decrease significantly after statistically controlling for home energy intake. Therefore, either the diet measurement is imprecise or the decrease in energy intake observed during illness was not an important mechanism.     

Anaemia in pregnancy: possible causes and risk factors in Nepali women

OBJECTIVE: The aim of this study was to investigate the importance of nutritional deficiencies and infections in the development of anaemia in pregnant Nepali women. DESIGN: Case-control study. Setting: Patan Hospital, Kathmandu, Nepal. SUBJECTS: A sub-sample (n=479) of all pregnant women (n=2856) coming for their first antenatal visit in a 12 month period, 1994-1995. Women who had already received any micronutrient supplementation (n=82), and those whose serum samples showed macroscopic haemolysis (n=7) were excluded. The remaining women (n=390) were included in the statistical analysis. They were divided into three groups; a non-anaemic control group, haematocrit (Hct)>33% (n=82), and two case-groups: moderately anaemic, Hct 25-33% (n=254), and severely anaemic, Hct<25% (n=54). RESULTS: We found high prevalences of nutritional deficiencies and intestinal infections, both among cases and controls. The prevalence of low s-ferritin was high, especially among the severely anaemic women (55.6%). In a multiple logistic regression model, the presence of low s-vitamin A, elevated s-C-reactive protein or hookworm infection was associated with a significantly increased risk of severe anaemia. The adjusted odds ratios (95% CI) were 8.38 (1.99, 35.30), 4.91 (1.22, 19.67) and 5.43 (1.20, 24.61), respectively. CONCLUSIONS: In addition to the present routine iron and folate supplementation to pregnant Nepali women, vitamin A supplementation needs to be considered. Prevention and treatment of infections should, together with dietary advice, be emphasized more strongly in the antenatal care. Sponsorship: The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education. European Journal of Clinical Nutrition (2000) 54, 3-8     

Teenage pregnancy experiences in rural Kenya

This community-based survey describes the socio-economic determinants of teenage pregnancy, experiences of health problems during pregnancy, and health care utilization patterns among adolescents (12-19 years old) in rural Kenya. Characteristics of adolescents with repeated pregnancy experiences were compared with first-time pregnancies. The survey covered 3,132 households from 32 randomly selected communities and 1,247 adolescents were interviewed. Data were collected retrospectively through quantitative and qualitative methods. Results showed that 572 (45.9%) adolescents had had sexual intercourse in the past, and of these, 245 (42.8%) had been pregnant at least once. A significant majority of adolescents who had been pregnant were not attending school during the survey period. Fifty-six percent of the first pregnancies occurred while the girl was single. Compared with repeat pregnancies, first pregnancies were more likely to be reported as unwanted (OR = 2.4; 95% CI = 1.1, 5.3). Antenatal care attendance, place of delivery and pregnancy outcomes were not significantly different for first-time and repeat pregnancies. Adolescents' reports on health problems during pregnancy, labour and in the post-partum period were not associated with parity or with age (< 16 years old). A lower proportion of younger primigravidae sought medical attention for health problems that arose during pregnancy (OR = 2.3; 95% CI = 1.1, 4.8) and labor (OR = 3.6; 95% CI = 1.5, 8.7). In conclusion, the study highlighted major unmet reproductive health needs of adolescents in this region. Age and gravida influenced health care seeking which could increase the chances of serious life threatening complications among young primigravidae.     

安徽城乡孕妇孕期营养来源状况研究

目的:了解安徽城乡孕妇孕期营养来源情况,为制定相关标准提供依据.方法:随机选取定期在安徽医科大学第一附属医院、安徽省妇幼保健院和利辛县的两个乡镇卫生院进行产前检查的317例单胎妊娠中期(16 ～27周)妇女为研究对象,调查其过去1周强化食品、过去1个月营养素补充剂的食用状况,称重法调查其2×24 h传统食物摄人种类和数量的情况,分析其营养素的来源情况.结果:城市孕妇从传统食物、强化食品和营养补充剂中获得的能量分别占总能量的99.37％、8.62％、0.01％,钙分别占总钙的64.17％、23.42％、12.41％,铁分别占总铁的67.34％、22.15％、10.51％,锌分别占总锌的78.51％、12.42％、9.07％,维生素A分别为总维生素A的75.31％、14.10％、10.59％.农村孕妇从传统食物、强化食品和营养素补充剂获得的能量分别占总能量的93.74％、6.23％、0.03％,钙分别占总钙的73.46％、11.36％、15.58％,铁分别占总铁的86.79％、6.83％、6.38％,锌分别为总锌的84.28％、6.84％、8.88％,维生素A分别占总维生素A的67.74％、25.64％、6.62％.结论:安徽城乡孕妇能量及营养素的主要来源以传统食物为主.其中城市孕妇从强化食品中获得的钙和铁较多,从营养素补充剂中获得的维生素B1和维生素B2较多;农村孕妇从强化食品中获得的维生素A和维生素B1较多,从营养素补充剂中获得的钙和维生素B2较多.     

Energy stress during pregnancy and lactation: consequences for maternal nutrition in rural Bangladesh

OBJECTIVE: To assess the relationship of energy stress during pregnancy and lactation to maternal body stores in marginally nourished rural Bangladeshi women. SUBJECTS AND METHODS: Two-hundred and fifty-two women were followed from 5-7 months of pregnancy until 6 months postpartum. Energy intake was estimated during pregnancy and at 1, 3 and 6 month(s) postpartum using 24 h dietary recall. Body weight was measured on enrollment, another once or twice during pregnancy, and at 1, 3 and 6 month(s) postpartum. The weekly rates of pregnancy weight gain and postpartum weight changes were determined. Weight and length of the infants were measured at birth and at approximately 1, 3 and 6 month(s). RESULTS: Maternal energy intake at 5-7 months of gestation was 1464+/-416 kcal/day (mean+/-s.d.). Women gained a mean of 200 g/week or a total of 4 kg during the second half of pregnancy. An analysis of maternal weight showed no indication of accrual of fat stores during pregnancy. Dietary energy during lactation exceeded the intake during pregnancy by 248-354 kcal/day. Mothers lost an estimated average of 1 kg of weight during the first 6 months of lactation. The mean (+/-s.d.) birth weight was 2.55+/-0.38 kg, and the prevalence of low birth weight (<2500 g) was 48%. Infants exhibited some catch-up growth only during the first 3 months but overall growth during the first 6 months did not change from their relative status at birth when compared with NCHS reference. CONCLUSIONS: These rural Bangladeshi women failed to gain sufficient weight during the last half of pregnancy to maintain body weight during lactation when the energy demand is high. Poor growth of their primarily breastfed infants raises concern about the adequacy of lactation in this community.     

Tropical obstetrics and gynaecology. 1. Anaemia in pregnancy in tropical Africa

Major causes of anaemia in pregnancy in tropical Africa are malaria, iron deficiency, folate deficiency and haemoglobinopathies: now there is added also the acquired immune deficiency syndrome (AIDS). Anaemia is often multifactorial, with the different causes interacting in a vicious cycle of depressed immunity, infection and malnutrition. Anaemia progresses through 3 stages: compensation, with breathlessness on exertion only; decompensation, with breathlessness at rest and haemoglobin (Hb) below about 70 g/litre; cardiac failure, with Hb below about 40 g/litre. Without treatment, over half of the women with haematocrit less than 0.13 and heart failure die. Maternal anaemia, malaria and deficiencies of iron and folate cause intrauterine growth retardation, premature delivery and, when severe, perinatal mortality. Surviving infants have low birthweights, immune deficiency and poor reserves of iron and folate. They have entered already the vicious cycle of infection, malnutrition and impaired immunity. Treatment with blood transfusions is even more hazardous since the advent of AIDS, and should be limited to saving the life of the mother. Treatment of malaria is complex as chloroquine-resistant strains are now common. Prevention remains relatively easy with proguanil and supplements of iron and folic acid and is highly cost-effective in the improvement of maternal and infant health; it is more important than ever as it avoids the unnecessary exposure of women and infants to HIV transmitted through blood transfusion.     

农村妇女孕期膳食模式对婴儿认知发育的影响

目的 探讨云南农村妇女孕期膳食模式(DP)对婴儿认知发育的影响,为促进婴儿认知发育提供科学依据。方法 依托云南农村出生队列,建立双向性队列,收集孕期膳食资料,自2018年1月-2019年12月共追踪获得228对母子对。随访婴儿既往健康状况、辅食添加种类和主要照护者学历等信息。运用BSID-Ⅲ对婴儿满1岁时进行认知发育评估。采用主成分分析提取孕期DP,运用多元线性回归分析孕期DP对婴儿认知发育的影响。结果 孕早中晚期及合并孕中晚期均得到3种DP:腌制型、动物蛋白型、传统型。腌制型包括腌菜/酸菜、火腿/腌肉;动物蛋白型包括动物内脏、畜肉、禽肉、鱼虾;传统型包括土豆/红薯、米面及制品、蔬菜。228名婴儿认知发育平均得分为98.84±16.66,发育落后20人(8.8%)。多元线性回归分析显示,妇女孕期越偏向选择传统型DP,婴儿认知得分越低(β=-12.272,P=0.002)。主要照护者学历越高,婴儿认知得分越高(β=12.476,P=0.035)。结论 云南农村地区婴儿认知发育水平略低于其他地区,有待提高,孕期传统型DP会延缓婴儿认知发育。     

Birth weight and exposure to kitchen wood smoke during pregnancy in rural Guatemala.

In this study, we aimed to establish whether domestic use of wood fuel is associated with reduced birth weight, independent of key maternal, social, and economic confounding factors. We studied 1,717 women and newborn children in rural and urban communities in rural Guatemala. We identified subjects through home births reported by traditional birth attendants in six rural districts (n = 572) and all public hospital births in Quetzaltenango city during the study period (n = 1,145). All were seen within 72 hr of delivery, and data were collected on the type of household fuel used, fire type, and socioeconomic and other confounding factors. Smoking among women in the study community was negligible. Children born to mothers habitually cooking on open fires (n = 861) had the lowest mean birth weight of 2,819 g [95% confidence interval (CI), 2,790-2,848]; those using a chimney stove (n = 490) had an intermediate mean of 2,863 g (95% CI, 2,824-2,902); and those using the cleanest fuels (electricity or gas, n = 365) had the highest mean of 2,948 g (95% CI, 2,898-2,998) (p< 0.0001). The percentage of low birth weights (< 500 g) in these three groups was 19.9% (open fire), 16.8% (chimney stove), and 16.0% (electricity/gas), (trend (p = 0.08). Confounding factors were strongly associated with fuel type, but after adjustment wood users still had a birth weight 63 g lower (p = 0.05; 95% CI, 0.4-126). This is the first report of an association between biofuel use and reduced birth weight in a human population. Although there is potential for residual confounding despite adjustment, the better-documented evidence on passive smoking and a feasible mechanism through carbon monoxide exposure suggest this association may be real. Because two-thirds of households in developing countries still rely on biofuels and women of childbearing age perform most cooking tasks, the attributable risk arising from this association, if confirmed, could be substantial.