Mothers/Caregivers Age and Family Structure Predicted Knowledge on Recommended Nutrition Practices for Children under 5 Years

Introduction: There are recommendations regarding infant and young child feeding and when followed children’s growth are optimum. These feeding practices are age definitive, starting from exclusive breastfeeding, to the transition of the child to complementary foods. Objective: The objective of this study was to assess factors that determine nutritional knowledge among mothers/caretaker regarding children under five years. Methods: A cross sectional study design employing quantitative methods was chosen for this study. The study population comprised 285 caregivers and their children aged of 6 and 59 months. Respondents were chosen randomly from four hard-to-reach communities and two peri-urban communities within three sub-municipalities, who lived in and accessed child welfare services during the study period. Face-to-face interviews were used to collect background and nutritional knowledge data from the respondents. Maternal/caretaker knowledge on recommended nutritional practice was split into two with scores were greater than 7 out of the 13 knowledge items was considered as good. STATA version 14 was used to analyze data and statistical significance determine at 95% confidence interval.Results: The average age of the children under 5 years and their mothers/caretakers were 32 months and 29 years respectively. About 73% had nuclear family structure. Results of Chi square and Fisher’s exact tests for association indicated that, mother’s/caretaker’s age (p<0.001), family structure (p=0.010) and access to media information (p<0.001) were significantly associated with mother’s good nutritional knowledge on recommended practices. Mothers/caretakers age (OR=0.17; 95%CI: (0.70-0.43); family structure (OR=0.30; 95% CI (0.11-0.78) and access to media (AOR=5.12; 95% (2.46-10.69) predicted mothers nutritional knowledge. Conclusions: Maternal/caretaker factors predicted nutritional knowledge when feeding a child in both peri-urban and rural areas. These factors should be considered when promoting child nutrition

A mixed method study exploring adherence to and acceptability of small quantity lipid-based nutrient supplements (SQ-LNS) among pregnant and lactating women in Ghana and Malawi

BACKGROUND: Supplementing pregnant and lactating mothers with small quantity lipid-based nutrient supplements (SQ-LNS) has resulted in improvements in birth outcomes in some low-income settings. In order to be effective, SQ-LNS must be consumed regularly over sustained periods. METHODS: The objective was to assess and compare acceptability of and adherence to SQ-LNS consumption among pregnant and lactating women in Ghana and Malawi throughout 12 months of supplementation. We enrolled women before 20 gestation weeks into randomized trials in Ghana (n = 1320) and Malawi (n = 869). In the SQ-LNS group participants received a 20 g sachet of supplement per day during pregnancy and the first 6 months of lactation. In the control groups participants received multiple micronutrients (MMN) during pregnancy and lactation or iron and folic acid (IFA) during pregnancy and calcium during lactation. We used questionnaires to collect data on self-reported adherence to daily use of supplements and conducted in-depth interviews with women in the SQ-LNS group to examine acceptability. RESULTS: The mean self-reported adherence during the supplementation period was lower in Ghana (79.9 %) than in Malawi (91.7 %) for all supplements (difference 11.8 %, P < 0.001). Over time, adherence increased in Malawi but decreased in Ghana. In both countries, adherence in the SQ-LNS group was non-inferior to that in the control groups. Participants typically reported consuming SQ-LNS as instructed but when interviewers queried about experiences, most of the women described incidents of non-adherence. A usual reason for not consuming SQ-LNS was nausea and vomiting during pregnancy. Especially in Malawi, women reported sharing SQ-LNS with families and friends. Sustained use of SQ-LNS was attributed to expected health benefits and favorable sensory attributes. Often women compared their pregnancy to previous ones, and were of the view that SQ-LNS made a positive difference. CONCLUSION: Self-reported sustained adherence to consume SQ-LNS daily was high in both sites but lower in Ghana than in Malawi. In Ghana, adherence decreased over time whereas in Malawi adherence increased. Acceptability and adherence appeared interlinked, complex and context-related. Sustained consumption of SQ-LNS may require tailoring interventions by context.BioMed Central open acces

Maternal vitamin D insufficiency and risk of adverse pregnancy and birth outcomes: A systematic review and meta-analysis of longitudinal studies

<div><p>Background</p><p>Three previous reviews on the association of vitamin D insufficiency in pregnancy with preterm birth (PTB) and stillbirth were limited in scope and deemed inconclusive. With important new evidence accumulating, there is the need to update the previous estimates and assess evidence on other clinically important outcomes such as spontaneous abortion and Apgar score. We conducted a systematic review and meta-analysis to evaluate the quality and strength of the available evidence on the relations between vitamin D nutritional status, and pregnancy and birth outcomes.</p><p>Methods</p><p>PubMed and Scopus databases were searched from their inception to June, 2015 with no language restrictions imposed. Eighteen longitudinal studies satisfied the inclusion criteria. Random effects model was applied in computing the summary effect estimates and their corresponding 95% confidence intervals.</p><p>Results</p><p>Serum 25(OH)D levels <75 nmol/l was associated with 83% (95% CI: 1.23, 2.74) and 13% (95% CI: 0.94, 1.36) increased risk of PTB measured at <32–34 weeks and <35–37 weeks, respectively. An inverse dose-response relation was observed for both PTB outcome. Serum 25(OH)D levels <75 nmol/l was also associated with 11% increased risk of spontaneous PTB (<35–37 weeks; RR = 1.11; 95% CI: 0.75, 1.65) with a dose-response relation also noted. Vitamin D insufficiency was not associated with risk of spontaneous abortion and stillbirth (RR of 1.04 [95% CI: 0.95, 1.13] and 1.02 [95% CI: 0.96, 1.09], respectively), as well as short gestational length (ES = -0.24, 95% CI: -0.69, 0.22), and low Apgar score.</p><p>Conclusions</p><p>We found vitamin D insufficiency to be associated with risk of PTB. Regarding spontaneous abortion and stillbirth, the available evidence suggest no association with low vitamin D levels. The evidence on vitamin D nutrition and Apgar score is conflicting and controversial. Overall, the experimental evidence uncovered was small and weak. Hence, the benefits of vitamin D supplementation during pregnancy should be further evaluated through rigorous intervention studies.</p></div

Maternal vitamin D insufficiency and risk of adverse pregnancy and birth outcomes: A systematic review and meta-analysis of longitudinal studies - Fig 5

<p><b>Funnel plot for the association of vitamin D insufficiency at serum levels of <75 nmol/l with spontaneous abortion (A) and stillbirth (B), and gestational length (C) at low levels</b>.</p

Summary relative risk (RR) and effect size (ES) for the relation of vitamin D insufficiency with pregnancy and birth outcomes.

<p>Summary relative risk (RR) and effect size (ES) for the relation of vitamin D insufficiency with pregnancy and birth outcomes.</p

Characteristics of included studies.

<p>Characteristics of included studies.</p

Summary relative risk (RR) for the relation of vitamin D insufficiency with pregnancy and birth outcomes stratified according to the study characteristics.

<p>Summary relative risk (RR) for the relation of vitamin D insufficiency with pregnancy and birth outcomes stratified according to the study characteristics.</p

Filled funnel plot for the association between vitamin D insufficiency at serum levels of <75 nmol/l and stillbirth.

<p>Filled funnel plot for the association between vitamin D insufficiency at serum levels of <75 nmol/l and stillbirth.</p

Test for publication bias and adjusted summary relative risk.

<p>Test for publication bias and adjusted summary relative risk.</p