Care practices during pregnancy, infant feeding practices and their association with nutritional status of infants in Gujarat, India

Background: Infant feeding practices plays an important role in nutritional status of children. Aims & Objectives: To assess ante-natal care, delivery and infant feeding practices and their association with nutritional status. Material & Methods: A community-based, cross-sectional study was carried out in all the districts using systematic random sampling. Information was collected from the selected household on socio-demographic, delivery and feeding practices and anthropometric measurements were carried out. Nutritional status was assessed using WHO Child Growth Standard. Proportion test, bivariate and multivariate regression analysis was done. Results: The overall prevalence of underweight, stunting and wasting was 26%, 21.5% and 16.5% respectively. Logistic regression analysis showed that the risk of underweight and stunting was 1.4-1.5 times higher among infant whose mother had undergone ≤3 ANCs or not availed ANCs, 1.4 times higher among infants delivered at home, having morbidity during previous fortnight and 3.6 times higher among low birth weight children. The risk of underweight and wasting was 1.2 times higher among infants with birth interval less than 2 years and 1.3-1.5 times higher among children whose mothers were washing their hands only with water after defecation. Conclusion: The undernutrition is associated with ante-natal care, delivery practices, low birth weight and hygienic practices

Screening and management options for severe thinness during pregnancy in India

This paper answers research questions on screening and management of severe thinness in pregnancy, approaches that may potentially work in India, and what more is needed for implementing these approaches at scale. A desk review of studies in the last decade in South Asian countries was carried out collating evidence on six sets of strategies like balanced energy supplementation (BEP) alone and in combination with other interventions like nutrition education. Policies and guidelines from South Asian countries were reviewed to understand the approaches being used. A 10-point grid covering public health dimensions covered by World Health Organization and others was created for discussion with policymakers and implementers, and review of government documents sourced from Ministry of Health and Family Welfare. Eighteen studies were shortlisted covering Bangladesh, India, Nepal, and Pakistan. BEP for longer duration, preconception initiation of supplementation, and better pre-supplementation body mass index (BMI) positively influenced birthweight. Multiple micronutrient supplementation was more effective in improving gestational weight gain among women with better pre-supplementation BMI. Behavior change communication and nutrition education showed positive outcomes on dietary practices like higher dietary diversity. Among South Asian countries, Sri Lanka and Nepal are the only two countries to have management of maternal thinness in their country guidelines. India has at least nine variations of supplementary foods and three variations of full meals for pregnant women, which can be modified to meet additional nutritional needs of those severely thin. Under the National Nutrition Mission, almost all of the globally recommended maternal nutrition interventions are covered, but the challenge of reaching, identifying, and managing cases of maternal severe thinness persists. This paper provides four actions for addressing maternal severe thinness through available public health programs, infrastructure, and human resources.</p

Population estimates and determinants of severe maternal thinness in India

Objective: To examine prevalence, risk factors, and consequences of maternal severe thinness in India. Methods: This mixed methods study analyzed data from the Indian National Family Health Survey (NFHS)-4 (2015–2016) to estimate the prevalence of and risk factors for severe thinness, followed by a desk review of literature from India. Results: Prevalence of severe thinness (defined by World Health Organization as body mass index [BMI] &lt;16 in adult and BMI for age Z score &lt; –2 SD in adolescents) was higher among pregnant adolescents (4.3%) compared with pregnant adult women (1.9%) and among postpartum adolescent women (6.3%) than postpartum adult women (2.4%) 2–6 months after delivery. Identified research studies showed prevalence of 4%–12% in pregnant women. Only 13/640 districts had at least three cases of severely thin pregnant women; others had lower numbers. Three or more postpartum women aged ≥20 years were severely thin in 32 districts. Among pregnant adolescents, earlier parity increased odds (OR 1.96; 95% CI, 1.18–3.27) of severe thinness. Access to household toilet facility reduced odds (OR 0.72; 95% CI, 0.52–0.99]. Among mothers aged ≥20 years, increasing education level was associated with decreasing odds of severe thinness (secondary: OR 0.74; 95% CI, 0.57–0.96 and Higher: OR 0.54; 95% CI, 0.32–0.91, compared with no education); household wealth and caste were also associated with severe thinness. Conclusion: This paper reveals the geographic pockets that need priority focus for managing severe thinness among pregnant women and mothers in India to limit the immediate and intergenerational adverse consequences emanating from these deprivations.</p