Changes in breastfeeding and nutritional status of Nigerian children between 1990 and 2008, and variations by region, area of residence and maternal education and occupation

Background: Inadequate breastfeeding practices contribute to malnutrition in young children. Aims and objectives: This study examined changes in breastfeeding practices and the nutritional status of children (0–35 months, n = 37154) using data from the nationally-representative Nigerian Demographic and Health Surveys for 1990–2008. Methods: The study estimated the relative changes in the proportion of children meeting recommended breastfeeding practices and the anthropometric indices of the children during the study period, by region, place of residence, maternal education and maternal occupation. Results: In each study year, over 97% of the children were ever breastfed. The proportion of infants breastfed within 1 hour and 1 day of birth increased from 34% to 45.8%, and from 63.8% to 82.3%, respectively. Overall, breastfeeding for ≥ 12 months changed from 88.9% to 95.2%, an increase of 7%; however, an increase of 14% was observed in the northern region (from 86.1% to 97.8%) while a decline of 7% was observed in the southern region (from 97.1% to 89.9%). Over the study period, the prevalence of all the assessed indicators of malnutrition (stunting, wasting and underweight) increased in the northern region while the southern region experienced a decline in all except severe wasting. In both urban and rural areas, stunting and wasting increased, while underweight declined. Children of non-formally educated and unemployed mothers were more malnourished in all the study years. Conclusion: Improvement in some breastfeeding practices did not result in improvement in the nutritional status of Nigerian children during 1990–2008, particularly in northern Nigeria and among socially disadvantaged mothers. Improving maternal education and employment, and integrating messages on techniques and benefits of optimal infant feeding with other maternal and child healthcare services could be beneficial

The age of paediatrics

The epidemiological transition towards non-communicable diseases is characterised by an upward shift in age of disease burden across the lifecourse. One response, within a suite of wider actions, would be to extend the upper age limit of paediatric practice to embrace adolescent health. We did an online survey to explore the upper age limit of paediatric care, obtaining responses from 1372 paediatricians in 115 countries. Marked variation in the upper age limit was apparent. Among high-income countries, a higher upper age limit was associated with greater disease burden in adolescents relative to young children (\u3c5 years). Although paediatricians reported the mean upper age limit of paediatrics had risen over the past 20 years, the mean preferred age of 18·7 (SD 2·6) years was higher than the mean current age of 17·4 (SD 2·5) years (p\u3c0·0001). Paediatricians reported the main reasons for the rising age over time was their greater awareness of adolescent health and leadership by professional associations. Reports of the quality of adolescent health education within national paediatric training suggest that this education is largely inadequate. A greater focus on adolescent health is required within paediatrics to ensure that the future paediatric workforce is appropriately equipped to respond to the changing disease burden across childhood and adolescence