Management of acute malnutrition in infants aged under 6 months (MAMI): current issues and future directions in policy and research.

BACKGROUND: Globally, some 4.7 million infants aged under 6 months are moderately wasted and 3.8 million are severely wasted. Traditionally, they have been over-looked by clinicians, nutritionists, and policy makers. OBJECTIVE: To present evidence and arguments for why treating acute malnutrition in infants under 6 months of age is important and outline some of the key debates and research questions needed to advance their care. METHODS: Narrative review. RESULTS AND CONCLUSIONS: Treating malnourished infants under 6 months of age is important to avoid malnutrition-associated mortality in the short-term and adverse health and development outcomes in the long-term. Physiological and pathological differences demand a different approach from that in older children; key among these is a focus on exclusive breastfeeding wherever possible. New World Health Organization guidelines for the management of severe acute malnutrition (SAM) include this age group for the first time and are also applicable to management of moderate acute malnutrition (MAM). Community-based breastfeeding support is the core, but not the sole, treatment. The mother-infant dyad is at the heart of approaches, but wider family and community relationships are also important. An urgent priority is to develop better case definitions; criteria based on mid-upper-arm circumference (MUAC) are promising but need further research. To effectively move forward, clinical trials of assessment and treatment are needed to bolster the currently sparse evidence base. In the meantime, nutrition surveys and screening at health facilities should routinely include infants under 6 months of age in order to better define the burden and outcomes of acute malnutrition in this age group

Panel 2.11: Food Security and Nutrition

This is a summary of the presentations and discussion of Panel 2.11, Food Security and Nutrition of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04-06 May 2005. The topics discussed included issues related to food security and nutrition as pertain to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) findings; (2) key questions; (3) discussion; and (4) recommendation

Breastfeeding in infancy: identifying the program-relevant issues in Bangladesh

<p>Abstract</p> <p>Background</p> <p>In Bangladesh, many programs and projects have been promoting breastfeeding since the late 1980 s. Breastfeeding practices, however, have not improved accordingly.</p> <p>Methods</p> <p>For identifying program-relevant issues to improve breastfeeding in infancy, quantitative data were collected through visits to households (n = 356) in rural Chittagong and urban slums in Dhaka, and qualitative data from sub-samples by applying semi-structured in-depth interviews (n = 42), focus group discussions (n = 28), and opportunistic observations (n = 21). Trials of Improved Practices (TIPs) (n = 26) were conducted in the above sites and rural Sylhet to determine how best to design further interventions. Our analysis focused on five breastfeeding practices recommended by the World Health Organization: putting baby to the breast within the first hour of birth, feeding colostrum and not giving fluids, food or other substances in the first days of life, breastfeeding on demand, not feeding anything by bottle, and exclusive breastfeeding for the first six months.</p> <p>Results</p> <p>The biggest gaps were found to be in putting baby to the breast within the first hour of birth (76% gap), feeding colostrum and not giving other fluids, foods or substances within the first three days (54% gap), and exclusive breastfeeding from birth through 180 days (90% gap). Lack of knowledge about dangers of delaying initiation beyond the first hour and giving other fluids, foods or substances, and the common perception of "insufficient milk" were main reasons given by mothers for these practices. Health workers had talked to only 8% of mothers about infant feeding during antenatal and immunization visits, and to 34% of mothers during sick child visits. The major providers of infant feeding information were grandmothers (28%).</p> <p>Conclusions</p> <p>The findings showed that huge gaps continue to exist in breastfeeding behaviors, mostly due to lack of awareness as to why the recommended breastfeeding practices are beneficial, the risks of not practicing them, as well as how to practice them. Health workers' interactions for promoting and supporting optimal breastfeeding are extremely low. Counseling techniques should be used to reinforce specific, priority messages by health facility staff and community-based workers at all contact points with mothers of young infants.</p

Skin-to-skin contact after birth : Developing a research and practice guideline

Funding Information: Funding for the two in‐person meetings (one of the Steering Group and one of the Expert Panel) was provided through a grant from Healthy Children Project, Inc., a not‐for‐profit (501c3) non‐governmental organisation (NGO) located in the United States. Publisher Copyright: © 2023 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica. © 2023 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.Aim: Skin-to-skin contact immediately after birth is recognised as an evidence-based best practice and an acknowledged contributor to improved short- and long-term health outcomes including decreased infant mortality. However, the implementation and definition of skin-to-skin contact is inconsistent in both practice and research studies. This project utilised the World Health Organization guideline process to clarify best practice and improve the consistency of application. Methods: The rigorous guideline development process combines a systematic review with acumen and judgement of experts with a wide range of credentials and experience. Results: The developed guideline received a strong recommendation from the Expert Panel. The result concluded that there was a high level of confidence in the evidence and that the practice is not resource intensive. Research gaps were identified and areas for continued work were delineated. Conclusion: The World Health Organization guideline development process reached the conclusion immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and all babies (from 1000 g with experienced staff if assistance is needed), after all modes of birth. Delaying non-essential routine care in favour of uninterrupted skin-to-skin contact after birth has been shown to be safe and allows for the progression of newborns through their instinctive behaviours.Peer reviewe

Impact of peer counsellors on breastfeeding practices in Dhaka, Bangladesh.

In Bangladesh, mothers rarely breastfeed exclusively. The national programme promoting exclusive breastfeeding has focused mainly on hospitals, but the majority of mothers deliver at home, and it is important to reach them there. This research aimed to assess the impact of community-based peer counsellors on the prevalence of exclusive breastfeeding. Other objectives were to assess the impact on infant morbidity and growth, and the acceptability of the lactational amenorrhoea method (LAM) for contraception. In Dhaka, 40 localities were randomised as intervention and control clusters. One woman in each intervention cluster was trained as a peer counsellor. The intervention comprised a minimum of fifteen counselling visits (two in the third trimester of pregnancy, two within 5 days of delivery, one between 10-14 days and then fortnightly), to help mothers establish and continue exclusive breastfeeding for 5 months. A total of 726 mothers, with mean of 4.5 years of school, from the lower-middle socioeconomic class, were enrolled during 1996, of whom 573 completed 5 months of follow-up. In the intervention group, 69% of mothers fed their infants colostrum as the first food compared to 11% of the controls (p<0.0001), and 70% breastfed exclusively for 5 months versus 6% of the controls (p<0.0001). Despite small differences in morbidity from diarrhoea, cough and fever, there was a substantial impact on weight gain. At the end of 5 months, the mean weight-for-length Z score was +0.1 (SD 0.8) in the intervention group and -0.9 (SD 0.8) in the control group (p<0.0001). The majority of mothers who breastfed exclusively, also accepted and practised the LAM (59% at 5 months). This trial has demonstrated that trained community-based peer counsellors can significantly increase exclusive breastfeeding and appropriate contraceptive practices, with benefits to infant health. Inclusion of peer counsellors in mother and child health programmes is recommended

Supporting exclusive breastfeeding among factory workers and their unemployed neighbors: Peer counseling in Bangladesh

Thirty-six percent of females are employed in Bangladesh, many in the readymade garments manufacturing industry. Inadequate access to health information, care, and long working hours makes exclusive breastfeeding particularly challenging for these employed mothers.To describe the influence of a breastfeeding education and support program on breastfeeding patterns of mothers working in garment and other factories in Bangladesh.A descriptive two-group prospective, mixed methods, longitudinal prospective study was conducted from May 2015 to March 2017. Peer counselors were trained to provide home-based counseling from 6 months of pregnancy until infants completed 6 months for pregnant and lactating factory workers and neighboring unemployed women. The total evaluation sample ( = 304) consisted of participants still employed ( = 190) and unemployed ( = 144). Peer counselors recorded socioeconomic information, weights, and infant feeding patterns. Descriptive statistical analyses examined the peer counselors' influence on breastfeeding practices.Initiation of breastfeeding within 1 hr was high in both groups, 173 (91%) among the employed, and 101 (89%) among the unemployed participants. Exclusive breastfeeding at 6 months was reported by 107 out of 125 (86%) of the employed participants versus 72 out of 76 (95%) of those unemployed.Community-based peer counselors can help to inform, encourage, and support both factory workers and unemployed women with optimal breastfeeding patterns. Factories who have female workers should consider employing outreach peer counselors as part of their community social responsibility, and as a way to contribute to the sustainability of these programs

Characteristics and experiences of peer counsellors in urban Dhaka: a structured interview study

Interventions to promote breastfeeding are the cornerstone of efforts to reduce childhood illness and death from undernutrition. Evidence suggests that one of the most effective strategies to increase breastfeeding is through peer counsellors. However, the experiences of peer counsellors has not been studied in depth. This study aimed to collect and report the experiences of peer counsellors participating in an intervention study to improve breastfeeding in urban Dhaka, Bangladesh.Peer counsellors underwent a 10 day training course in May 2013 which included practical sessions on position and attachment and common difficulties with breastfeeding. Home visits were conducted with new mothers and performance of peer counsellors was monitored by senior breastfeeding counsellors. The number of supervised home visits needed to achieve a satisfactory level of competency was recorded. Demographic data were collected and a structured interview was performed in the first six months of the project (May-September 2013). One structured interview per peer counsellor was conducted by the project manager at the project site office to gain understanding of their experiences in counselling mothers. The interview included some open-ended questions on specific aspects of the training that they found useful, challenges faced, and whether they developed close friendships with the mothers that they were counselling.Seventeen peer counsellors with an average age of 31 years (SD 6.8) and at least six years of schooling participated in the study. All peer counsellors were satisfied with their role and with the training that they received, and most felt that they were able to deal with common breastfeeding problems. The peer counsellors reported that building a personal rapport and establishing a peer-to-peer relationship was most important in supporting mothers to breastfeed. Common challenges included interruption of sessions by relatives/children, as well as mothers being too busy for the visits.In future peer counselling for breastfeeding projects, more focus could be placed on the communications aspects of the training, especially in how to deal with non-supportive family members and managing interruptions effectively, as well as how to motivate and engage busy new mothers

Chart-stimulated Recall as a Learning Tool for Improving Radiology Residents\u27 Reports

RATIONALE AND Objectives: Workplace-based assessments gauge the highest tier of clinical competence. Chart-stimulated recall (CSR) is a workplace-based assessment method that complements chart audit with an interview based on the residents\u27 notes. It allows evaluation of the residents\u27 knowledge and heuristics while providing opportunities for feedback and self-reflection. We evaluated the utility of CSR for improving the radiology residents\u27 reporting skills.MATERIALS AND Methods: Residents in each year of training were randomly assigned to an intervention group (n=12) or a control group (n=13). Five pre-intervention and five post-intervention reports of each resident were independently evaluated by three blinded reviewers using a modified Bristol Radiology Report Assessment Tool. The study intervention comprised a CSR interview tailored to each individual resident\u27s learning needs based on the pre-intervention assessment. The CSR process focused on the clinical relevance of the radiology reports. Student\u27s t test (P\u3c.05) was used to compare pre- and post-intervention scores of each group.Results: A total of 125 pre-intervention and 125 post-intervention reports were evaluated (total 750 assessments). The Cronbach\u27s alpha for the study tool was 0.865. A significant improvement was seen in the cumulative 19-item score (66% versus 73%, P\u3c.001) and the global rating score (59% versus 72%, P\u3c.001) of the intervention group after the CSR. The reports of the control group did not demonstrate any significant improvement.CONCLUSION: CSR is a feasible workplace-based assessment method for improving reporting skills of the radiology residents