Association between Infant Feeding and Early Postpartum Infant Body Composition: A Pilot Prospective Study

Research studies have produced conflicting results of the impact of breastfeeding on overweight/obesity. This study evaluated the impact of infant feeding on infant body composition. There were two groups of mother-infant pairs (exclusive breastfeeding [EBF; n = 27] and mixed feeding [MF; n = 13]) in this study. At baseline, participants were similar in their demographic characteristics except prepregnancy weight, where MF mothers tended to be heavier than their EBF counterparts (67.3 kg versus 59.9 kg; P = .034). Infant birth weight was slightly higher among the MF group than their EBF counterparts (3.5 kg versus 3.4 kg), although the differences were not statistically significant. At 3 months postpartum, mean infant FMI (4.1 kg/m2 versus 3.8 kg/m2) and percent body fat (24.4% versus 23.1%) were slightly higher among EBF infants than MF infants. In terms of growth velocity, EBF infants gained weight faster than their MF counterparts, although the differences were not statistically significant. The findings from this study suggest that EBF may promote faster weight gain and increase in both fat mass index (FMI) and percent body fat in the early postpartum period in addition to the numerous health benefits enjoyed by the infant and the mother who exclusively breastfeeds her newborn

Infant Nutrition and Feeding in the First 2 Years of Life

Infant feeding is the practice of feeding children who are below two years of age. The World Health Organization recommends that infants be exclusively breastfed for the first 6 months of life, followed by continued breastfeeding and gradual introduction of complementary foods. Breastfeeding is beneficial for both the mother and the infant. Breast milk is safe, sterile, and contains antibodies that protect infants against many childhood illnesses. In the US, infants who are not breastfed have a 21% higher risk of post-neonatal infant mortality. It is recommended that mothers who cannot breastfeed exclusively feed their infants with breast milk for at least four months before introducing complementary foods. Infant formula cannot be an absolute substitute for human breast milk, and the use of infant formula must be the last option to feed infants if mothers cannot breastfeed. Although breast milk continues to be an important source of nutrition for growing infants, at six months and beyond breast milk becomes insufficient to provide all the nutrient needs of infants. Therefore, infants must be introduced to complementary foods in addition to breast milk. Complementary foods should provide sufficient energy, protein, essential fats, oils, and particularly, micronutrients to meet the nutritional needs of infants

Risk factors for malnutrition among children 5-years and younger in the Akuapim-North District in the eastern region of Ghana

Malnutrition remains a significant public health problem in developing countries. The aim of this study was to identify risk factors for malnutrition among preschool children in the Akwapim-North District in the Eastern Region of Ghana. This was a cross-sectional study. Mothers who brought their children to the ＂Well Baby Check-up＂ clinics were invited to participate. Anthropometric measurements (weight and height/length) and blood hemoglobin were measured. Mothers also completed a questionnaire consisting of closed and open-ended questions. A total of 305 pre-school-age children were included in this study. Of this sample, 43.3% were males, and 56.7% were females. The prevalence of wasting, stunting, and underweight was 6.2, 11.4 and 7.3%, respectively. The majority of the children (80.7%) were anemic. Children who were exclusively breastfed for 6 months showed slightly lower prevalence of both anemia (75.5% vs. 89.0%) and stunting (8% vs. 13%) but not wasting (8.3% vs. 4.3% ) or underweight (8.3% vs. 5.2%) compared to their mixed feeding counterparts. Children under 12 months of age showed a higher prevalence of wasting (9.4%) compared to other age groups. Children from homes with electricity showed lower prevalence of stunting (9.7% vs. 17.6%, p = 0.050), and children from households with a radio showed lower prevalence of wasting (5.3% vs. 19.0%, p = 0.033). Nutrition education encouraging exclusive breastfeeding and adequate provision of animal protein to preschool children is important in semi-rural and farming communities in developing countries such as Ghana in order to combat the prevalence of childhood malnutrition (stunting, wasting, underweight and anemia)

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Prevalence of Anemia, Overweight/Obesity, and Undiagnosed Hypertension and Diabetes among Residents of Selected Communities in Ghana

The increasing numbers of lifestyle related chronic diseases in developing countries call for awareness, early detection, and effective management. The objective of this paper is to report the prevalence of undiagnosed hypertension, diabetes, overweight/obesity, and anemia among residents of selected communities in Ghana. The data comes from a community screening conducted in Ghana as part of the University of Georgia Summer Service Learning Program. Descriptive statistics were used to summarize the data while chi-square and independent t-test compared groups. A total of 976 participants (37.9% males and 62.1% females), 18 years and older, were screened. Mean age was 46.25±17.14 years, BMI was 25.44±5.26 kgm−2, and hemoglobin was 12.04±2.22 g/dL. 3.1% and 12.6% reported existing diagnosis for diabetes and hypertension, respectively. Almost half (47.8%) were overweight/obese; 27.0% were hypertensive while 34.0% had diabetes. Also, 28.8% males compared to 37.8% females had diabetes (P=0.015), while 28.2% males compared to 26.2% females were hypertensive (P=0.635). There were differences in BMI (P<0.0001), anemia (P=0.007), and undiagnosed diabetes (P<0.0001) and hypertension (P<0.0001) by community (Takoradi versus Cape Coast) where the screening took place. Findings from the screening exercise call for improved public health education with a focus on lifestyle habits and health seeking behaviors among Ghanaians

Impact of peer counseling on exclusive breastfeeding: A randomized controlled trial

We conducted a secondary data analysis to identify reasons for not BF and factors associated with ever BF among low-income mothers in the U.S. This was a retrospective study that used a convenience sample of Puerto Rican women with children younger than 6 years. About half the participants reported to have ever breastfed the index child. The most common reason given for not BF was “mother did not want to breastfeed or mother was embarrassed to breastfeed in public.” Mothers with higher access to social capital were more likely to have breastfed the index child compared with their counterparts with less social capital (OR = 2.25; 95% CI, 1.02–4.95), suggesting that social support is an important predictor of BF in this Puerto Rican community. ^ Findings from this first study and that of another study conducted by our research group in this community, led to the design and conduct of a randomized controlled trial on the efficacy of peer counseling on EBF. Expectant mothers at less than 32 weeks gestation, were recruited in a prenatal clinic and randomly assigned to either an intervention (prenatal, perinatal and postnatal EBF support from a peer counselor) or a control (conventional BF support from the nursing staff) group. Baseline socio-demographic characteristics were similar in both groups except Hispanic origin and language of interview. At hospital discharge 91% in PC compared to 76% in CG had initiated BF (p = 0.025), with the percent EBF being 59% and 44%, respectively (p = 0.072). At 3 months postpartum, 27% in PC and 3% in CG EBF during the previous 24 hours (p \u3c 0.001). Likewise, the percent EBF at 3 months postpartum, using the “since birth” definition was significantly higher (p \u3c 0.001) for PC (21%) than CG (\u3c2%). Women in PC (53%) were more likely than their counterparts in CG (33%) to remain amenorrheic at 3 months postpartum (p = 0.025). Findings remained significant after adjusting for baseline differences in participant characteristics. Thus, our results indicate that timely and well-structured intensive BF support provided by hospital and community based peer counselors is effective at improving EBF rates among low-income, inner-city women in the U.S.

Clinical Study Association between Infant Feeding and Early Postpartum Infant Body Composition: A Pilot Prospective Study

Research studies have produced conflicting results of the impact of breastfeeding on overweight/obesity. This study evaluated the impact of infant feeding on infant body composition. There were two groups of mother-infant pairs (exclusive breastfeeding [EBF; n = 27] and mixed feeding [MF; n = 13]) in this study. At baseline, participants were similar in their demographic characteristics except prepregnancy weight, where MF mothers tended to be heavier than their EBF counterparts (67.3 kg versus 59.9 kg; P = .034). Infant birth weight was slightly higher among the MF group than their EBF counterparts (3.5 kg versus 3.4 kg), although the differences were not statistically significant. At 3 months postpartum, mean infant FMI (4.1 kg/m 2 versus 3.8 kg/m 2 ) and percent body fat (24.4% versus 23.1%) were slightly higher among EBF infants than MF infants. In terms of growth velocity, EBF infants gained weight faster than their MF counterparts, although the differences were not statistically significant. The findings from this study suggest that EBF may promote faster weight gain and increase in both fat mass index (FMI) and percent body fat in the early postpartum period in addition to the numerous health benefits enjoyed by the infant and the mother who exclusively breastfeeds her newborn