Effects of maternal subclinical mammary inflammation on infant growth

Breastfeeding is unquestionably the best nourishment for infants. Current epidemiological as well as experimental evidence has repeatedly demonstrated the nutritional, immunological, and psychosocial benefits attributable to breastfeeding. However, suboptimal breast health may compromise maternal ability to breastfeed and the well-being of breastfeeding infants. Subclinical mastitis (SCM) is an asymptomatic inflammatory condition of the lactating breast that is associated with a number of adverse outcomes including lactation failure, infant growth faltering during the early postpartum period, and increased risk of mother-to-child transmission of the human immunodeficiency virus (HIV).;Three studies were carried out in Ghana with the overall aim of describing the mechanistic pathway(s) linking SCM and infant growth faltering. The specific objectives of the studies were to determine: (1) the prevalence of SCM among lactating women in Ghana, (2) whether SCM is associated with reduced breast milk intake by the infant, and (3) whether SCM occurring beyond the third month postpartum had an adverse effect on infant growth between the third and sixth month postpartum. Two cross-sectional studies were designed with respect to the first two objectives. Data were collected in a longitudinal study to examine the third objective.;All data from the three studies were collected from infant-mother pairs residing in the Eastern region of Ghana. Maternal data included demographic, health, and anthropometric data as well as breast milk samples that were analyzed to determine maternal SCM status. Maternal SCM was primarily diagnosed as elevated breast milk sodium:potassium ratio (Na/K) above 1.0. California mastitis test (CMT) was also used in the cross-sectional studies to diagnose SCM. Infant breast milk intake was estimated using the test weighing procedure. Infant data included feeding, health, and growth measured as weight, length, head circumference, and mid-upper arm circumference.;In the first cross-sectional study, SCM (Na/K \u3e 1.0) was observed among 45.3% of women at three or four months postpartum. About 30% of the observed SCM occurred in only one breast. In the second cross-sectional study, infants whose mothers had Na/K \u3e 1.0 as well as CMT score ≥ 1 had significantly lower breast milk intake (-88.9 g; 95% CI: -171.1 g, -6.9 g). However, the observed milk intake difference across SCM groups disappeared when infant weight and feeding frequency were controlled in multivariate analyses. The longitudinal study did not find an association between maternal episodes of SCM (Na/K) occurring between the 3rd and 6th month postpartum and infant growth occurring during the same period.;In conclusion, our results indicate that SCM is a common condition among women in the Eastern region of Ghana. However, we did not find a reduction in breast milk intake of infants whose mothers had SCM. There was, also, no association between maternal SCM occurring between the 3rd and 6th postpartum and infant growth during the same period

Compliance Audit of Processed Complementary Foods in Urban Ghana

Background and objectives: Although Processed Complementary Foods (PCF) can contribute to meeting dietary needs of infants and young children, it has been associated with unethical marketing practices which undermine practice of exclusive breastfeeding for six months. The current study assessed PCF labeling compliance to the International Code of marketing of Breast Milk Substitutes (CMBMS), and the National Breastfeeding Promotion Regulation (NBPR), in Ghana. Methods: A variety of PCF were purchased from child welfare clinics, fuel station shops, supermarkets, ‘mother/baby’ care shops and pharmacies in the La and Osu Klottey sub-metropolitan areas in Accra. The labels were evaluated against best practice indicators proposed by the Maternal Infant and Young Child Nutrition (MIYCN) Working Group based on the international CMBMS, and also indicators based on the NBPR. An overall compliance estimate was determined based on intensity of compliance to the indicators. Results: The PCF purchased included cereal-based products, fruit juices, fruit and vegetable purees, milk-based products, and combination meals; seventy-five percent of PCF were imported. One hundred of the 108 products identified were labeled in English and thus included in analysis. None of the products complied with all labeling requirements of CMBMS or NBPR; 84% and 17% of product labels complied with at least 50% of NBPR and 50% of CMBMS indicators, respectively. Only 5% of labels had content indicating importance of exclusive breastfeeding for 6 months. Additionally, only 5% of labels warned against the hazard of introducing PCF earlier than 6 months as required by the NBPR. Conclusions: Labeling of most PCF sold by selected retailers in Accra did not comply with NBPR and CMBMS labelling requirements. Enforcement of local law on labeling of PCF is urgently needed

Risks of excess iodine intake in Ghana: current situation, challenges, and lessons for the future

In Ghana, iodine deficiency was first reported in 1994 among 33% of the population. A nationwide Universal Salt Iodization (USI) program plus other complementary interventions were subsequently implemented as a response. Our paper reviews the current risks of excess iodine status in Ghana and identifies policy and research gaps. A mixed methods review of 12 policies and institutional reports and 13 peer‐reviewed articles was complemented with consultations with 23 key informants (salt producers and distributors, food processors, regulatory agency officials, and healthcare providers) purposively sampled between May and August 2017. The findings show a strong policy environment indicated by regulations on food and salt fortification (Act 851), including the USI regulation. However, currently, only a third of Ghanaian households use adequately iodized salt. Recent evidence shows that voluntarily fortified processed foods (including condiments) supply a considerable amount of iodine to the food system. Limited biological impact data suggest possible household exposure to excessive dietary iodine (\u3e15 parts per million). Currently, there is no systematic tracking of iodine content from fortified foods and other sources. Cross‐sectoral actions are needed to understand this situation better. Key research gap is the lack of comprehensive data on iodine content and intake from other sources in Ghana

Global implications of the new WHO and UNICEF implementation guidance on the revised Baby-Friendly Hospital Initiative

Although breastfeeding confers both short- and long-term benefits for children and their mothers, breastfeeding practice remains suboptimal, globally. In addition to barriers including misperceptions and inappropriate marketing of breast milk substitutes, inadequate support for breastfeeding remains a challenge in many settings. To improve access to appropriate health system support, the World Health Organization (WHO) has reviewed the Baby-Friendly Hospital Initiative (BFHI), which ensures provision of optimal clinical care and support to mothers and their infants. This review has resulted in revision of the Ten Steps to Successful Breastfeeding, which form the core standards of (BFHI). These now consist of critical management procedures to support breastfeeding (Steps 1 and 2) and key clinical practices to support breastfeeding (Steps 3-10). In Step 1, there is now specific emphasis on compliance with the WHO Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions as well as on internal monitoring. There are also significant position shifts like the recommendation to "Counsel mothers on the use and risks of feeding bottles, teats, and pacifiers," which is a departure from the earlier position of avoiding reference to these technologies. These revisions require countries and states to revise activities and tools for their local situation but without compromising the standards. [Abstract copyright: © 2018 John Wiley & Sons Ltd.

Relationship of Subclinical Mastitis in Ghanaian Women and Breast Milk Intake by Infants

Human subclinical mastitis (SCM) is inflammation of mammary tissue without any overt manifestations but is associated with lactation failure, sub-optimal infant growth during the early postpartum period, and increased risk of mother-to-child-transmission of HIV via breast milk. Subclinical mastitis (SCM) has been associated with infant growth faltering but the mechanism explaining this association remains unknown. We hypothesized that SCM is associated with reduced breast milk intake resulting in diminished growth. Ghanaian mothers who were 3-6 months postpartum were screened for SCM using the California mastitis test (CMT). A CMT score of ≥ 1 was categorized as SCM positive (N=37); a CMT score \u3c 1 was considered SCM negative (N=23). SCM diagnosis was confirmed by an elevated breast milk sodium-potassium ratio (Na/K \u3e 1.0). We measured infants’ 12-hour breast milk intake in both groups of mothers using the test weighing methodology. Breast milk intake tended to be lower among infants whose mothers had elevated Na/K \u3e 1.0 (-65.1 g; 95% CI: -141.3 g, 11.1 g). Infants whose mothers were positive for SCM with both CMT and Na/K criteria had significantly lower breast milk intake (-88.9 g; 95% CI: -171.1 g, -6.9 g) compared to those whose mothers tested either negative with both tests or positive on only one. However, in the multiple linear regression analysis, infant weight (p\u3c0.01) and frequency of feeding (p\u3c0.01) but not maternal SCM status were associated with breast milk intake (p = .12). When infant weight and feeding frequency were considered, the observed direct effect of SCM on infant breast milk intake was no longer significant. However, lower breast milk intake (p = .12 in MLRA) coupled with limited subjects and only 12 hr breast intake data warrant further investigation and concerns

Prevalence of Subclinical Mastitis in Ghanaian Women Based on Elevated Sodium:Potassium Ratio

Human subclinical mastitis (SCM) is inflammation of mammary tissue without any overt manifestations but is associated with lactation failure, sub-optimal infant growth during the early postpartum period, and increased risk of mother-to-child-transmission of HIV via breast milk. We carried out a rapid survey to determine the prevalence of SCM among lactating Ghanaian women between 3 and 4 months postpartum. Bilateral breast milk samples were obtained from 117 lactating women in Manya Krobo, Ghana and analyzed for sodium (Na) and potassium (K). Additionally we measured maternal mid-upper arm circumference and recorded recent maternal health history. Elevated sodium-potassium ratio above 1.0 was considered indicative of SCM. Overall SCM prevalence among these women was 45.3% of which 29.9% was unilateral. There were no associations between Na/K and maternal health perception, and nutritional status. The high SCM prevalence suggests the need for immediate intervention to reduce SCM and other related maternal and child outcomes

Nutrition intakes and nutritional status of school age children in Ghana

This paper compares nutrition intakes and nutritional status of school children from two public schools in neighbouring communities of Ghana with different school feeding programmes. One hundred and eighty-two caregiver and school-age child pairs were interviewed concerning socio-demographics, dietary practices, and food security in a cross-sectional design. The independent t-test was used to compare the contribution of the publicly funded Ghana School Feeding Programme and private School Feeding Programme meals to total daily nutrient intakes of the children. Predictors of nutritional status of the children were assessed using logistic regression models. The private school feeding programme contributed more energy, protein, and micronutrients as compared to the government school feeding programme. About two-thirds (67.0%) of the children were stunted, underweight, or anaemic. Child’s age was a significant predictor of stunting. Undernutrition was prevalent among children from both programmes. Improved quality of diet from the feeding programmes may contribute to addressing malnutrition in these children

Comparison of Two School Feeding Programmes in Ghana, West Africa

Background: Malnutrition of children in Ghana continues during school years. There is limited information on how school meals meet nutrient recommendations in Ghana. Objectives: The aim of this study was to compare energy and nutrient content of meals served by Ghana School Feeding Programme (GSFP) and Non-Governmental School Feeding Programme (NGSFP) and adherence to nutrient recommendations. Methods: This was a cross sectional study design involving observation of school meals at two sites: GSFP and NGSFP. Average weights of a week’s meal were converted to energy and nutrient equivalence and compared with international recommendations. Differences assessed with t-tests. Results: NGSFP provided significantly higher portion size (416 ± 96 g vs. 243 ± 50 g; p=0.007), energy (776 ± 427 kcal vs. 315 ± 24 kcal; p=0.042) and fats (17± 8 vs. 6 ± 2; p=0.019) but similar micronutrient contributions to GSFP. NGSFP met energy and macronutrient recommendation set by World Food Programme; whereas, GSFP did not meet the recommendations. Conclusion and Recommendations: The NGSFP had more energy and macronutrients per serving size than the GSFP. Regulation of meals served by GSFP should be reviewed to ensure they contribute to the adequacy of children’s diets as well as meet recommendations set by World Food Programme

Heavy marketing of energy-dense nutrient-poor foods around public basic schools in greater Accra region, Ghana

The one- page abstract provided here relates to a study which examined the extent and nature of marketing of foods, alcoholic and non-alcoholic beverages nearby selected schools in Ghana’s most urbanized region, Greater Accra. Policies and actions are needed to protect pupils from marketing practices as found in this study