ijchn

International Journal of Child Health and Nutrition

Potentials, Experiences and Outcomes of a Comprehensive Community Based Programme to Address Malnutrition in Tribal India
Pages 151-162
Vandana Prasad and Dipa Sinha

DOI: http://dx.doi.org/10.6000/1929-4247.2015.04.03.4

Published: 01 September 2015

 


Abstract:This paper demonstrates the effect of an innovative community-based management programme on acute malnutrition among children under three years of age, through an observationallongitudinalcohort study in tribal blocks in central-eastern India.

The key components of the programme include child care through crèches, community mobilisation and systems strengthening to ensure better child feeding and caring practices and delivery of public health and nutrition services.

For a cohort of 587 children, the increase in children in the non-wasting category is from 72% to 80% (p<0.001) and the reduction in Severe Acute Malnutrition (SAM) from 8% to 4% (p<0.005), a reduction of 46.6%. Normalcy is fairly well maintained at 89%. Among the severely wasted, 16% show no improvement, 49% moved into a moderate wasting category and 36% to normalcy over 4-6 months. Among the moderately wasted, 26% showed no improvement and 7% declined to a severely wasted category, and 67% moved to normalcy. The average Weight for Height Z-score (WHZ) for the cohort improved from -1.41 in the initial period to -1.13 in November (p<0.0001).

This study suggests that this medium term strategy using a rights-based participatory approach for community based management of malnutrition may be comparatively effective by current WHO guidelines and other known community based interventions in terms of mortality, cost, degree and pace of improvements.

Keywords: Malnutrition, wasting, SAM, crèche, community based management of malnutrition, acute malnutrition, underweight, CMAM, growth monitoring.

Download Full Article

International Journal of Child Health and Nutrition

Developing an Instrument to Evaluate Psychosocial and Environmental Determinants of Parental Monitoring of Sugar-Sweetened Beverages
Pages 163-173
Paul Branscum and Alexandra Housley

DOI: http://dx.doi.org/10.6000/1929-4247.2015.04.03.5

Published: 01 September 2015

 


Abstract: Sugar-sweetened beverage (SSB) consumption among children and adolescents is a public health concern, as up to 88% consume them on a daily basis. While much research has been done regarding what types of foods parents feed their children and how that is linked to various health outcomes, research determining how parents monitor there children’s SSB consumption has not been well studied. Identifying important environmental and psychosocial determinants of parental-monitoring behaviors is a greatly needed area for investigation. The purpose of this study was to develop and validate a theory-based instrument related to this parenting practice. Initially, a 41-item instrument was developed and face and content validity were established using a panel of 6 experts. Next, the survey was administered to 270 parents (29 parents completed the survey twice). Psychometric properties tested of the instrument included construct validity, using the maximum likelihood extraction method of factor analysis, internal consistency reliability, using Cronbach’s alpha, and test-retest reliability using Pearson-product moment correlations between instrument results taken at two separate occasions. Initial results suggested some scales required re-specification, which included removing weak and/or non-related items. Results from this study can be used to assist future health professionals and researchers for measuring theory-based determinants of parental practices related to monitoring SSB consumption. This process can also be replicated to construct instruments measuring other critical obesogenic behaviors, such as monitoring fruit and vegetable consumption, or physical activity.

Keywords: Sugar sweetened beverage consumption, parental monitoring, childhood obesity.

Download Full Article

International Journal of Child Health and Nutrition

Impact of School-Based Interventions on Children’s Healthful Nutritional Outcomes (2009-2013): Implications for Future Research
Pages 180-193
Paloma Rohlfs Domínguez

DOI: http://dx.doi.org/10.6000/1929-4247.2015.04.03.7

Published: 01 September 2015

 


Abstract: Objective:The objective wasto reviewthe literature on school-based interventions during compulsory education (published in 2009-2013) that may be effective in increasing healthful nutritional outcomes in children. Specific strategies and their limitations will be identified.

Methods: A qualitative systematic analysis of seventeen school-based interventions applied to six-eleven year-old children, and published in peer-reviewed journals from 2009-2013 was carried out.

Results: These studies taken as a whole used a variety of fourteen strategies, such as provision of nutritional and gardening education; repeated exposure to vegetables (V); peer and adult modelling; chefs going into schools to teach healthy nutritional issues. These studies showed four types of limitations: limitations derived from the experimental designs and experimental procedures used and limitations affecting participant samples and data collection. Fifteen recommendations for overcoming the targeted research limitations were identified, such as applying the intervention during longer time intervals; examining the effectiveness of these interventions in different ethnicities and socioeconomic groups; including larger participant samples; using randomized designs. Finally, six new working hypotheses to guide future studies are proposed here. For example, a small number of V offered might lead to insufficient opportunities to learn to like the flavour of V; schools’ previous experience with these interventions might distort children’s post-intervention data related to their nutritional outcomes; providing children with nutritional and gardening education might increase their fruit (F) selection, consumption and preferences and application of evaluative conditioning under more appropriate experimental conditions might increase child V consumption.

Conclusion:seventeen school-based interventions were included. These studies taken as a whole used a variety of strategies (fourteen), and showed four types of limitations. Fifteen recommendations for overcoming the targeted research limitations as well as six new hypotheses are proposed here. Future research in this field should focus on overcoming its research limitations, such as the ones highlighted here, and building new working hypotheses, such as those proposed here.

Keywords: Children, vegetables, fruits, consumption, schools.

Download Full Article

International Journal of Child Health and Nutrition

Use of Donkey Milk in Cases of Cow’s Milk Protein Allergies
Pages 174-179
Paolo Polidori, Ambra Ariani and Silvia Vincenzetti

DOI: http://dx.doi.org/10.6000/1929-4247.2015.04.03.6

Published: 01 September 2015

 


Abstract: Human breast milk is the best nutritional support that insure the right development and influence immune status of the newborn infant. However, when it is not possible to breast feeding may be necessary to use commercial infant formulas that mimic, where possible, the levels and types of vitamins, minerals and other nutrients present in human milk. Despite this, some formula-fed infant develops allergy, atopic disease and differences in response to infection with respect to breast-fed infants. Donkey milk may be considered a good substitute for dairy cow’s milk derivatives in feeding children with severe Cow’s Milk Protein Allergy (CMPA) since its composition is closer to human milk compared to other species commonly bred. It has been proposed as an alternative to cow’s milk for children affected by CMPA when it is not possible breast feeding. Donkey milk is characterized by a low casein content, with values very close to human milk, and also total whey protein content in donkey milk is very close to that found in human milk but higher compared to bovine milk. Donkey milk has been used in several clinical trials involving children affected by CMPA because of the low allergenicity of this milk. The results shown in this review confirmed the nutritional characteristics of the protein fractions of donkey milk and the possibility of using donkey milk in feeding children with CMPA, particularly after an adequate lipid integration, including children with multiple food allergies.

Keywords: Donkey milk, Human milk, Cow’s Milk Protein Allergy, Milk protein fractions, Lysozym.

Download Full Article

International Journal of Child Health and Nutrition

Adolescent Fertility and Child Health: The Interaction of Maternal Age, Parity and Birth Intervals in Determining Child Health Outcomes
Pages 16-33
Jocelyn E. Finlay, Melanie K. Norton and Iván Mejía-Guevara

DOI: http://dx.doi.org/10.6000/1929-4247.2017.06.01.2

Published: 16 March 2017

 


Abstract: Introduction: Contributing to the Sustainable Development Goals, Global Goals, Global Strategy for Women’s, Children’s and Adolescents’ Health 2016-2030, we clarify the interaction between maternal age, parity and birth intervals to examine the effects on child health.

Methods: We use Demographic and Health Survey data from 33 sub-Saharan African countries, and apply multivariate Poisson and logistic models to first examine the effect of maternal age (15-17, 18-19, 20-24, 25-29, 30-39) on infant mortality and stunting, then modify this relationship by parity and account for the confounding effects of short birth intervals.

Results: We find that poor infant mortality outcomes of children born to teen mothers are driven by higher parity children, not first-born children. While first-born children of teen mothers are at a high risk of stunting, they are likely to survive. Short birth intervals have a negative effect on infant survival and stunting outcomes. But controlling for short birth intervals does not completely offset the effect of young age at birth on child survival outcomes.

Discussion: High parity children of young mothers are at a high risk of infant mortality, driven in part – but not completely – by short birth intervals. Policies aimed at delaying first birth are warranted, but should not overshadow the need to support adolescent mothers at risk of multiple births that are tightly spaced.

Keywords: Maternal age, parity, birth intervals, child health, sub-Saharan Africa.

Download