Experiences of health professionals with nutritional support of critically ill patients in tertiary hospitals in Malawi

Background: Nutritional support is a recognized determinant of outcome in critically ill patients. Development of critical care services in low-income countries has not been accompanied by certain appropriate ancillary services and interventions, such as adequate nutritional support. This study was designed to investigate the experiences of health professionals who have provided nutritional supportive care to critically ill patients admitted to two major central hospitals in Malawi, with the aim of identifying the common practices in nutritional support in these settings.Materials and Methods: A cross-sectional study in which 50 health professionals working in intensive care and high dependency units, admitting both adult and pediatric patients, were interviewed using a semi-structured questionnaire. Data were coded and then analyzed using SPSS version 16.0. Responses between the two hospitals were compared using Fisher’s exact test.Results: There was no difference in the composition of respondents from the two hospitals. About 60% of respondents had had experience with nutritional supplementation in their patients—mainly enteral. The most commonly used formulations were the “ready-to-use therapeutic feeds,” followed by modified milk. A high percentage of respondents (40%) reported having used dextrose solution as the sole nutritional supplement. Lack of in-service training, nonexistent nutrition protocols pertaining to acutely and critically ill patients, and a lack of clinical nutritionists were the major challenges identified.Conclusion: Knowledge of nutrient supplementation was poor among the respondents. The use of ready-to-use therapeutic feeds was quite common, although there is no evidence of its effectiveness in care of acutely critically ill patients. There is a need to establish nutritional support teams in these tertiary hospitals. Clinical nutritionists would ideally help train and play leadership roles in such teams, who would be responsible for assessing patients for their nutritional needs, and ensuring that the feeds provided to patients are appropriate and adequate for their needs

Influence of gendered roles on legume utilization and improved child dietary intake in Malawi

The relationship between gender roles, legume production, utilization and child feeding practices in rural smallholder households of Dedza and Ntcheu districts in Malawi was investigated and analyzed. A cross-sectional research study was conducted with legume farming households with children aged 6-23 months who were part of the Africa RISING ‘mother trial’ or ‘baby trials’ for two farming seasons (2014/2015 to 2015/2016). Africa RISING project encourages smallholder farmers to grow legumes namely, groundnut (Arachis hypogaea), cowpea (Vigna unguiculata), pigeon pea (Cajanus cajan) and soya bean (Glycin max) as one way of improving the wellbeing of smallholder farmers. The key objective of the research was to assess the influence of gender roles, legume production, utilization and infant and young child dietary intake. In total, 291 households with children 6-23 months were targeted. Eight focus group discussions (FDGs) for in-depth qualitative data were conducted. Two 24-hour dietary recalls and food frequency questionnaires were used to collect data on infant and young child feeding (IYCF) practices. Data collected were extracted, arranged, recorded and analyzed by using SPSS version 21. About 18% of children aged 6-23 months received a minimum dietary diversity (the consumption of four or more food groups from the seven food groups), 2.5% received a minimum acceptable diet (indicator measures both the minimum feeding frequency and minimum dietary diversity, as appropriate for various age groups) and 37.5% of children received a minimum meal frequency (frequency of receiving solid, semi-solid, or soft foods at the minimum numbers of two and three times for children aged 6–8 months, and 9–23 months, respectively). Control on use of income by women had a positive and significant association with minimum dietary diversity (P<0.05), minimum meal frequency (P<0.05) and minimum acceptable diets (P<0.05) among children of both sexes. Children aged 6-23 months from households where women were actively involved in partial processing and budgeting of legumes met minimum dietary diversity than children from nonparticipating households. Women farmers were more knowledgeable about legumes; played an important role in seed selection, storage and processing; however, the findings signal an opportunity to increase women’s income by involving them in market information. Increasing legume production at household level does not mean increasing the nutritional status among children (6-23 months). Several factors related to gender roles, markets accessibility and legume utilization have an effect on infant and young child feeding practices

Knowledge, Attitude and Practice on Infant and Young Child Feeding: A Comparative Study of Radio Listening Club Members and Non-Members of Mudzi Wathu Community Radio in Mchinji District, Malawi

The current case-control study was conducted in Mchinji district in order to evaluate current infant and young child nutrition knowledge, attitudes, and practice (KAP) of radio listeners club (RLC) members and non-RLC members and also to determine if the frequency of listening to Mudzi Wathu Community Radio is directly related to improved knowledge, attitudes and perceptions(KAP) of RLC members. Further, the study examined whether or not community radio listeners club members were more knowledgeable in IYCF nutrition than non-RLC respondents with the purpose of assessing the effectiveness of disseminating nutrition information through mass media in general and through radio in particular and the benefits of having community radio listening clubs on improvement of KAP in communities.Key words: Attitude, Knowledge, Practice, Radio, Radio  Listening Club, community radio, Mudzi Wath

Exclusive breastfeeding and its effect on growth of Malawian infants: results from a cross-sectional study

Abstract Background: For the optimal nutrition of children under 2 years of age, it is considered important that they be exclusively breastfed for the first 6 months before being given complementary food. Aims and Objectives: A cross-sectional nutritional baseline survey was undertaken in 2011 in the Kasungu and Mzimba Districts of Malawi to assess the nutritional status of children under 2 years of age and its determinants in order to prepare a nutrition education intervention programme. The intention of this study was to assess the nutritional status of infants aged 0–<6 months with regard to food intake. Methods: Interviews were conducted on randomly selected families with children under 2 years; anthropometric measurements were obtained from mothers and their children. Only infants between 0 and <6 months were selected for analysis (n  =  196). An ANCOVA test was performed on age of the infant with mothers’ height and weight as covariates. Results: Prevalence of stunting (infants’ length-for-age Z-score (LAZ) <−2SD) was 39%, wasting (WLZ <−2SD) 2%, and underweight (WAZ <−2SD) 13%. Of the infants under 6 months, 43% were exclusively breastfed. Predominant breastfeeding and mixed breastfeeding were less common (21% and 36%, respectively). The ANCOVA confirmed the association between exclusive breastfeeding and LAZ and WAZ: exclusively breastfed infants had a higher mean (SE) LAZ (−1·13, 0·12) and WAZ (−0·41, 0·13) than infants not being exclusively breastfed (−1·59, 0·11, and −0·97, 0·11, respectively). There was no overall significant association between breastfeeding practice and WLZ. Conclusion: Exclusive breastfeeding of infants under 6 months is associated with higher mean LAZ and WAZ. Promotion of exclusive breastfeeding in low-income countries is important in preventing growth retardation

Exclusive breastfeeding and its effect on growth of Malawian infants: results from a cross-sectional study

Background: For the optimal nutrition of children under 2 years of age, it is considered important that they be exclusively breastfed for the first 6 months before being given complementary food. Aims and Objectives: A cross-sectional nutritional baseline survey was undertaken in 2011 in the Kasungu and Mzimba Districts of Malawi to assess the nutritional status of children under 2 years of age and its determinants in order to prepare a nutrition education intervention programme. The intention of this study was to assess the nutritional status of infants aged 0-,6 months with regard to food intake. Methods: Interviews were conducted on randomly selected families with children under 2 years; anthropometric measurements were obtained from mothers and their children. Only infants between 0 and ,6 months were selected for analysis (n 5 196). An ANCOVA test was performed on age of the infant with mothers&apos; height and weight as covariates. Results: Prevalence of stunting (infants&apos; length-for-age Z-score (LAZ) ,22SD) was 39%, wasting (WLZ ,22SD) 2%, and underweight (WAZ ,22SD) 13%. Of the infants under 6 months, 43% were exclusively breastfed. Predominant breastfeeding and mixed breastfeeding were less common (21% and 36%, respectively). The ANCOVA confirmed the association between exclusive breastfeeding and LAZ and WAZ: exclusively breastfed infants had a higher mean (SE) LAZ (21.13, 0.12) and WAZ (20.41, 0.13) than infants not being exclusively breastfed (21.59, 0.11, and 20.97, 0.11, respectively). There was no overall significant association between breastfeeding practice and WLZ. Conclusion: Exclusive breastfeeding of infants under 6 months is associated with higher mean LAZ and WAZ. Promotion of exclusive breastfeeding in low-income countries is important in preventing growth retardation

Content of nutrition education (FAO 2014).

<p>Content of nutrition education (FAO 2014).</p

Nutrition education improves dietary diversity of children 6-23 months at community-level: Results from a cluster randomized controlled trial in Malawi

<div><p>Background: Low dietary quality and quantity and inappropriate feeding practices can cause undernutrition. Poor nutritional status in early childhood is associated with growth faltering. The objective of the study was to assess the potential of community-based nutrition education to improve height-for-age z-scores in children 6–23 months of age.</p><p>Methods and Findings: We carried out a cluster-randomized-controlled trial to assess the effectiveness of nutrition education. A total of 24 Extension Planning Area Sections served as clusters. The selection criteria were: the position of the extension officer was staffed and the sections had been selected by the project for activities in its first project year. The sections were randomized into intervention and control restricted on mean height for age Z-score using baseline information. In the intervention area, food security activities and community-based nutrition education was implemented. The control area received food security activities only. At baseline (2011) and endline (2014), caregivers with a child below two years of age were enrolled. Data assessment included anthropometric measurements, interviews on socio-economic status, dietary intake and feeding practices. A difference-in-differences estimator was used to calculate intervention effects. A positive impact on child dietary diversity was observed (B (SE) = 0.39 (0.15), p = 0.01; 95%CI 0.09–0.68). There was a non-significant positive intervention effect on mean height-for-age z-scores (B (SE) = 0.17 (0.12), p = 0.15; 95%CI -0.06–0.41). Limitations: The 24h dietary recalls used to measure dietary diversity did not consider quantities of consumed foods. Unrecorded poor quality of consumed foods might have masked a potential benefit of increased child dietary diversity on growth.</p><p>Conclusions: Participatory community-based nutrition education for caregivers improved child dietary diversity even in a food insecure area. Nutrition education should be part of programs in food insecure settings aiming at ameliorating food insecurity among communities.</p></div

Prevalence of food consumption and IYCF indicators at baseline and endline.

<p>Prevalence of food consumption and IYCF indicators at baseline and endline.</p

Characteristics of primary caregivers and children at baseline and endline.

<p>Characteristics of primary caregivers and children at baseline and endline.</p