Malnutrition among children of adolescent mothers in a squatter community of Recife, Brazil

In a study of 357 first time mothers in a squatter community of Recife it was found that 1 in 10 were less than 15 years old and 60 per cent less than 20 at the time of their first delivery. Two groups of mothers were distinguished, viz. adolescent mothers with a mean (SD) age at first delivery of 16.7 (0.78) years and older mothers with a mean (SD) age at first delivery of 25 (0.79). More than a third were living in common-law union. Of the adolescent mothers only 58 per cent were living with the child's father. A further 23 per cent had received financial support from their own parents during the pregnancy. The rest were expelled from home. The adolescent mothers were generally worse off with a per capita income generally half of that of older mothers. About a quarter of all children studied were below the 10th centile of NCHS standards (23 per cent by weight/age; 28 per cent by height/age). The undernourished first born was 2.5 times more likely to have an adolescent mother, four times more likely to be in a household with low income, and two times more likely to have an illiterate mother as compared to the first borns who remain well nourished. The implications of these findings for urban primary health care programmes are further discussed.     

Assessment of gestational age: the value of a maturity scoring system for head circumference and mid-arm circumference

Over a 10-month period, 508 newborn infants were studied in three hospitals to develop a simple maturity scoring system for head circumference and mid-arm circumference (MAC). Maturity scores were based on the 95 per cent confidence intervals on the mean measurements of the parameters for gestational age groups. Combined maturity scores had slightly better correlation with gestational age than scores for MAC and head circumference separately. The model had 90 per cent accuracy in estimating gestational age. It is a simple and reliable method, and is recommended for routine use particularly in developing countries.     

Exclusive breastfeeding and infant growth studies: reference standards for head circumference, length and mid-arm circumference/head circumference ratio for the first 6 months of life

This paper presents the development of reference standards for head circumference (HC), length and mid-arm circumference/head circumference (MAC/HC) ratio for the evaluation of exclusively breastfed infants. A total of 219 exclusively breastfed term appropriate-for-gestational age (AGA) infants were studied and analysed from 1 June 1995 to 31 May 1997 at the Neonatal Follow-up Clinic, University Teaching Hospital, Benin City, Nigeria. Head circumference and length measurements were recorded for the infants at each postnatal completed month. MAC/HC ratios were also computed for each infant at each completed postnatal month. There was a progressive increase in the mean measurements at the completed months with increasing postnatal age and the differences between the mean measurements of length and head circumference at the 4th and 6th completed months were significant (p < 0.001). The head circumference, length and MAC/HC ratio had significant correlations with postnatal age. The standards represent the regression lines of the anthropometric measurements and MAC/HC ratio on postnatal age with the corresponding 95 per cent confidence limits. The standards identified 95 per cent (for head circumference), 93 per cent (for length) and 94 per cent (for MAC/HC ratio) of exclusively breastfed healthy infants as having normal infant growth for age.     

Detection of low birth-weight new born babies by anthropometric measurements in Bangladesh

Birthweight is an important indicator of child survival. Appropriate and timely care of a newborn specially if he is born with low birthweight is important but this is difficult in developing countries since most of the deliveries are conducted at home where adequate facilities to weigh a new born does not exist. This study was conducted to find out a surrogate which could efficiently be used for detecting low birthweight babies at birth when no weighing machine is around. In this study 41% of the newborn babies were found to weigh less than 2,500 gm at birth. Out of this about 52% were females. The mean chest, thigh and mid-arm circumference at birth for males were 30.89 cm, 15.06 cm and 9.27 cm respectively with standard deviations of 1.83 cm, 1.30 cm and 1.04 cm. Corresponding figures for female babies were 30.69 cm, 15.14 cm and 9.25 cm respectively with standard deviations of 2.08 cm, 1.70 cm and 1.16 cm. Correlation co-efficient between normal birthweight and the chest, thigh and mid-arm circumference were 0.867, 0.845 and 0.842 respectively. A liner regression analysis showed that a chest circumference of 30.14 cm, a thigh circumference of 14.56 cm and a mid-arm circumference of 8.90 cm corresponded well with a birthweight of 2,500 gm. On this basis sensitivity, specificity and predictive values of the chest circumference was better than the other two measurements. However, the mid-arm circumference was observed to be more reliable than the other two measurements for detecting birthweight less than 2,000 gm. A home made measuring tape has been devised on this basis to detect brithweights with cut-off values for 2,500 gm, 2,000 gm to 2,500 gm and 2,000 gm in different shades of colour for illiterate birth attendants.     

Catch-up growth, muscle and fat accretion, and body proportionality of infants one year after newborn intensive care

We studied catch-up growth, muscle and fat accretion, and body proportionality at 4 and 12 months of age corrected for prematurity in 30 very low birth weight (VLBW) (less than 1500 gm), 30 low birth weight (LBW) (1500 to 2499 gm) and 30 normal birth weight (greater than or equal to 2500 gm) infants who required newborn intensive care. At 4 and 12 months, the VLBW infants had significantly lower mean weight and length (p less than 0.01), but not lower occipitofrontal circumference percentiles, than the LBW and normal birth weight groups, and showed no catch-up weight or length growth between 4 and 12 months. All three groups had significant increases in mean upper mid-arm circumferences, mid-arm muscle circumferences, and arm muscle areas between 4 and 12 months. Mean mid-arm muscle circumferences and arm muscle areas were similar among the three groups at 4 months but became significantly stratified by birth weight groups by 12 months, with VLBW infants having the lowest mean value. In contrast, analysis of fat stores by triceps skin-fold thickness and arm fat area demonstrated no significant increases in any group between 4 and 12 months, except for arm fat area in the LBW group. The VLBW infants had significantly less fat than normal birth weight infants at 4 and 12 months. All three groups had proportional growth at both visits, as assessed by mid-arm circumference/head circumference ratio and weight-length percentile for age. The VLBW infants were significantly lighter for their length than normal birth weight infants. We conclude that VLBW infants have no first-year catch-up growth, remaining smaller than higher birth weight infants, although appropriately proportional. Somatic growth during the first year is due more to muscle than to fat accretion, especially in VLBW infants.     

Anthropometric measurements and physical characteristics in the assessment of neonatal maturity

Summary 800 singly born normal newborn infants were studied for their anthropometry. All the physical measurements tended to be lower than those for their Western counterparts. Out of 651 infants born after 37 weeks of gestation, 25.34 per cent weighed 2500 G. or less; 18.12 per cent had a crown heel length less than 47 cm.; 91.24 per cent had a crown rump length less than 32 cm., 14.44 per cent had a head circumference less than 33 cm. and 12.3 per cent had a chest circumference less than 30 cm.     

Current breastfeeding knowledge, attitude, and practices of mothers in five rural communities in the Savannah region of Nigeria

The knowledge, attitude, and practices regarding breastfeeding of 310 mothers in five rural communities in Toto Local Government in Nassarawa State, Nigeria were investigated using a questionnaire. One hundred and sixty-two (52.3 per cent) mothers were illiterate while 148 (47.7 per cent) had either primary or secondary school education. Apart from giving babies colostrum, which was seen more amongst mothers with higher levels of education (p < 0.001), other practices investigated such as exclusive breastfeeding, demand feeding, 'rooming-in', and time of first breastfeed were not influenced by the mother's level of education. Fifty-four per cent of mothers did not give their babies colostrum. All mothers attended the antenatal clinic but only 103 (33.3 per cent) received instructions from the health worker on breastfeeding and 46.8 per cent delivered at home. Only 28.6 per cent of babies were breastfed within 24 hours of birth. The mean time after birth for the first breastfeed was 47.7 hours. Although breastfeeding is widely practiced, none of the babies was exclusively breastfed, and prelacteal feeds ranging from water, formula, or herbal tea were given by all the mothers. The practice of discarding colostrum and replacing it with a wide range of prelacteal feeds and late initiation of breastfeeding has implications for health education programmes and neonatal feeding strategies.     

Kangaroo mother care for low birth weight infants: a randomized controlled trial

OBJECTIVE: To compare the effect of Kangaroo mother care (KMC) and conventional methods of care (CMC) on growth in LBW babies (> 2000 g). STUDY DESIGN: Randomized controlled trial. SETTING: Level III NICU of a teaching institution in western India. SUBJECTS: 206 neonates with birth weight < 2000 g. INTERVENTION: The subjects were randomized into two groups: the intervention group (KMC-103) received Kangaroo mother care. The control group (CMC: 103) received conventional care. OUTCOME MEASURES: Growth, as measured by average daily weight gain and by other anthropometrical parameters at 40 weeks postmenstrual age in preterm babies and at 2500 g in term SGA infants was assessed. RESULTS: The KMC babies had better average weight gain per day (KMC: 23.99 g vs CMC: 15.58 g, P< 0.0001). The weekly increments in head circumference (KMC: 0.75 cm vs CMC: 0.49 cm, P = 0.02) and length (KMC: 0.99 cm vs CMC: 0.7 cm, P = 0.008) were higher in the KMC group. A significantly higher number of babies in the CMC group suffered from hypothermia, hypoglycemia, and sepsis. There was no effect on time to discharge. More KMC babies were exclusively breastfed at the end of the study (98% vs 76%). KMC was acceptable to most mothers and families at home. CONCLUSION: Kangaroo mother care improves growth and reduces morbidities in low birth weight infants. It is simple, acceptable to mothers and can be continued at home.     

Developmental assessment of intrauterine growth retarded babies of varying maternal etiology

Head circumference was measured serially and developmental performance assessed at the age of 9 months in 41 full-term intrauterine growth retarded babies of varying maternal etiologies. 18 full term and 12 preterm babies who were appropriate for gestational age (AGA) served as controls. The IUGR babies of undernourished mothers had maximum retardation in head circumference.The IUGR babies of small sized mothers had head circumference equal to that of fullterm AGA babies. The IUGR babies of mothers with toxemia of pregnancy and idiopathic group also reached very close to that of fullterm AGA babies for head circumference demonstrating catch up growth. 19.5 per cent of IUGR (as homogenous group) babies were found to have delayed development compared to 16.7 per cent of preterm and 5.6 per cent of fullterm AGA babies. Amongst IUGR groups, babies of undernourished mothers were found to suffer most, followed by babies of mothers with toxemia of pregnancy. None of the babies in the idiopathic group and only one out of 12 in small maternal size group were found to have delayed development.     

A study of feeding patterns in young infants

With the aim of studying the feeding patterns in infants under 6 months of age, 451 mothers attending the children's clinic in two university hospitals in the north of Tehran were interviewed. All babies had been born in hospital and > 98 per cent had been breastfed during the first few hours of birth. The rate of full breastfeeding at 6 months of age, with no introduction of the bottle, was 83 per cent; approximately 6.5 per cent of infants were fed on breast and bottle concomitantly, and in about 10.5 per cent breastfeeding had been discontinued before 6 months and the babies were fed on bottle only. About 60 per cent of mothers who stopped breastfeeding, did so during the first postnatal month and another 20 per cent during the 2nd and 3rd month after the babies' birth. The mother's age, education or parity, did not affect the rate of breastfeeding. Low birthweight, especially birthweight less than 2 kg, was a risk factor for early termination of breastfeeding. Caesarean delivery and hospitalization of the infant during the neonatal period was also associated with a higher rate of bottlefeeding compared with newborns who had been delivered normally, discharged early, and nursed at home. Although breastfeeding rates are high, the finding that the majority of mothers who give up breastfeeding do so in the early weeks, calls for better support to all mothers by committed health personnel during the period when breastfeeding is being established, and for extra assistance to women whose infants are hospitalized or have a low birthweight.     

Detecting malnutrition at age 6-12 months: international comparisons of arm circumference v. standard anthropometry.

Growth faltering, which may herald protein-energy malnutrition (PEM) usually begins between ages 6 and 12 months. However, arm circumference (AC or MUAC) has mainly been used to screen for PEM between 12 and 60 months of age, when AC is age-independent. This study of 378 infants aged 6-12 months in Pakistan, Nepal, Sierra Leone, and Papua New Guinea showed that a cut-off 12.5 cm AC selects infants < 80 per cent weight-for-age (WA) with 76 per cent sensitivity and 90 per cent specificity. Of the 378 infants studied 131 (35 per cent) had WA < 80 per cent and 126 (33 per cent) had AC < 12.5 cm. Weight-for-length agreed less well with AC. The inter-regional prevalence range of AC < 12.5 cm was 29-40 per cent, while the WA < 80 per cent range was 27-45 per cent. When AC is plotted against age, a flat 'plateau' (slope = 0.04) shows age-independence between 6 and 12 months in these 378; this contrasts to the 10 per cent AC increase in European reference populations. Because this AC plateau parallels the WA plateau seen between 6 and 12 months of age in most developing nations, AC < 12.5 cm may provide a simple and valid screening test for early PEM in this crucial age bracket. Conformatory studies elsewhere are indicated.     

Mortality among children in rural areas of the People's Democratic Republic of Yemen

A prospective study on health and mortality of children under 7 years of age was conducted in rural parts of PDR Yemen during 1982-84. Altogether, 2071 children and 976 mothers were followed for 1 year and visited twice. The infant mortality rate (IMR), child mortality rate and under-5 mortality rate were 86, 11 and 129 per 1000, respectively. Sixty per cent of all deaths occurred during infancy. Diarrhoea commonly preceded death during infancy, and symptoms of measles during the 2nd year of life. The mothers of the deceased children were younger than the average rural mother (P less than 0.05) and more often primiparae, whereas illiteracy rates and median income did not differ from families which had not experienced death of a child. The risk of dying within 1 year was three times greater for wasted children in general, but 24 times greater for 1-2-year-olds. No increased risk was found for stunted children at any age. The prevalence of bottle feeding up to 18 months of age was high, and exclusive breastfeeding below 6 months of age was rare in the villages with the highest IMR (P less than 0.05). Infections seemed to be the trigger factor for death, but wasting predisposed to death at least after infancy.     

The role of the village midwives in antenatal care services in the Sudan.

A study was conducted to assess the obstetric care coverage provided by the Sudanese village midwives. Mothers and village midwives, from four villages were interviewed using structured questionnaires. A total of 130 mothers who had delivered within 6 months were included in the study. Seventy per cent of these mothers contacted the village midwives at least once during their pregnancy. The average attendance was 3.8 antenatal contacts per mother. Seventy-one per cent of those who contacted the village midwives did so during the first half of pregnancy. Half of these mothers were seen in the village midwife's own home and only 20 per cent were in the mothers' homes. The village midwife attended 76 per cent of the deliveries, 11 per cent were attended by the traditional birth attendants, and the remainder delivered in hospital. The village midwives demonstrated reasonable standard of knowledge and competence in various aspects of antenatal care, history taking, examination, and selection of cases for referral. They lack adequate support and supervision, and supplies of drugs such as iron, folic acid, and chloroquine tablets.     

Breastfeeding patterns in Fujairah, United Arab Emirates.

The rate of breastfeeding initiation and continuation through the first 6 months of life were assessed via interview and telephone follow-up in a prospective study of 130 mothers who consecutively delivered in hospital in Fujairah, UAE. The rate of initiation (83.2 per cent) and continuation at 2 months (72.6 per cent) was not significantly different from earlier studies. However, the rate of breastfeeding at 6 months (46.9 per cent) was lower than a 1992 study (p = 0.02). There were no significant associated factors with not breastfeeding at discharge from the maternity hospital and 2 months later. However, a significant inverse relationship with the level of general education of the mother for breastfeeding at 6 months was found, which is in contradistinction to Western countries where the rate of breastfeeding rises with increasing general education. This has implications for the type and targeting of future breastfeeding education programmes.     

Growth in the first four years: IV. Correlations with parental measures in small-for-dates and large-for-dates babies

Parent-child correlations for weight, height and head circumference on eight occasions between birth and 4 years were estimated within groups of 212 small-fordates (SFD), 208 average-for-dates (AFD) and 221 large-for-dates (LFD) children. For mothers and fathers in the SFD and AFD groups, and fathers in the LFD group, correlations for weight were generally low in the first year, with moderate increases up to 4 years. No correlations for weight at any age were found between mothers and LFD children. There was a gradual rise in correlations for length in all three groups for both mothers and fathers between birth and 4 years. Head circumference correlations in the AFD and LFD groups were relatively high at birth and showed little change thereafter. Mother-child correlations for head cirumference in the SFD group were absent at birth, but then rose sharply to a value comparable with the AFD parents' correlations at 18 months, with little change thereafter. No SFD father-child correlations for head circumference were found at any age. Children's standards of weight and head circumference adjusted for mid-parental measures would, in some cases, be misleading.     

A prospective study of the psychological adjustment of parents and families of children with cancer

This study compared the psychological adjustment of parents and families of children with cancer, with the adjustment of parents and families in the community. In the weeks after their children's diagnoses, the mothers of children with cancer reported significantly more anxiety and insomnia, somatic symptoms and social dysfunction than mothers in the community. These problems had declined by the time of a 1 year follow-up assessment However, at the follow-up assessment the mothers of children with cancer reported significantly more symptoms of depression and somatic symptoms than mothers in the community. A similar pattern of findings was evident among the fathers although the fathers generally reported less distress than was reported by the mothers. The results also suggest that a year after the children's diagnoses, the families in which there was a child with cancer were functioning less effectively than the families in the community.     

Parent responses to participation in genetic screening for diabetes risk

Screening for type 1 diabetes (T1DM) risk in newborns has little negative emotional impact on mothers. In this study, the impact on the mother and the father was evaluated both in the general population and in families with diabetes. All parents with a newborn in Skane, Sweden, were invited to a screening for T1DM risk in their children (the Diabetes Prediction in Skane (DiPiS)). Blood was obtained at delivery from the mother and the child. When the child was 2 months old, parents gave written consent and filled out questionnaires, but were not informed about the genetic risk. Of the 10 538 invited families, 6831 (64.8%) consented and 806 (7.7%) declined participation. Five questions addressing both parents were filled out by 6676 (63.4%) mothers and 6099 (57.8%) fathers. In 146/6676 (2.2%) families, one family member had diabetes (D-families). Participation in DiPiS did not affect most parents and the majority was satisfied with the information. The majority of parents (28.9%) were reassured and only 1.1% (140/12,670) reported increased worries because of participation, compared to 2.8% of the mothers in D-families. Parents in D-families more often ascribed diabetes risk to their child as well as the risk being higher. Mothers and fathers differed in their answers on four of the five study questions, with mothers being more satisfied with the information, reporting more knowledge of diabetes, estimating lower risk of their child to get diabetes, but reporting more worries of possible future chronic disease in the child. Parents with lower education, being born abroad, or being younger who reported worries of chronic disease in the child were also reassured by participation in the study. These results confirm that screening for T1DM risk in newborns does not create worries in most parents, but stress that fathers differ from mothers in opinions and reactions, that parents' reactions are affected by diabetes in the family, and that demographic factors might be important for the parents' reports.     

Outcomes and parent-child relationships of former adolescent mothers and their 12-year-old children

This study compared former adolescent mothers and their 12-year-old children with adult child-bearing mothers and their children along three dimensions: mothers' life-course characteristics (e.g., educational attainment, employment status, current annual family income); children's scholastic, psychological, social, and behavioral adjustment; and dimensions of the parent-child relationship (e.g., companionship, affection, intimacy). Results showed that adolescent mothers had significantly lower levels of completed education than adult mothers, and children of teenage mothers exhibited more learning problems (as rated by self, mother, and teacher) than children of adult mothers. Younger childbearing mothers and fathers felt they provided less esteem enhancement support to their children than older childbearing parents. In addition, early childbearing mothers felt less satisfied with their mother-child relationships, and early childbearing fathers shared fewer companionate activities with their children than adult childbearing mothers and fathers, respectively. The long-term implications of adolescent parenting for the adolescent and her child are discussed.     

Normal children with large heads--benign familial megalencephaly.

Fifteen normal children with large heads (circumference greater than 0.5 cm above the 98th centile) were studied. CAT scans were pefrormed to exclude hydrocephalus, and ventricular size was compared with that of hydrocephalic children. In 11 of the 13 families in which the parents' heads were measured, one parent (10 fathers and one mother) was found to have a large head, as had 6 of 17 siblings. Head circumference at birth was large in 7 of 10 babies and rate of head growth was excessive in 8 of 13. Skull x-ray showed suture diastasis in 7 infants. These families have a benign familial megalencephaly. It is important to recognise this so as to avoid unnecessary investigation and anxiety about normal children with large heads.