Socioeconomic determinants of breastfeeding practices in South India - A hospital-based cross-sectional study

Background: Breastfeeding is an unparalleled universally recommended intervention for the promotion of health and nutrition of children and reduction of mortality. In spite of the WHO recommendations and baby-friendly hospital initiative, breastfeeding practices are inappropriate due to maternal, infant, socioeconomic, and cultural factors. Objective: The objective of this study was to determine the socioeconomic factors associated with inappropriate breastfeeding practices. Secondary objective was to determine the knowledge level of mothers on ideal breastfeeding recommendations. Materials and Methods: This cross-sectional study was conducted in pediatric wards of a tertiary care teaching institution from January 2017 to July 2017. Mothers having children aged 7–60 months were included in the study. A sample size of one thousand was planned. After obtaining informed consent from mother, detailed feeding history including the timing of initiation of breastfeeding following childbirth, duration of exclusive breastfeeding, and age at which breastfeeding was discontinued was noted. Possible determinants considered were gender of the child, place of residence, maternal age, maternal education, maternal employment, number of children at home, type of family, whether mother was counseled during antenatal period, mode of delivery, and hospitalization in newborn period. Knowledge of mother on breastfeeding was probed and the response recorded. Univariate analysis followed by regression was performed to determine the significant factors. Results: 59% (95% confidence interval 55.9–62.1) of mothers initiated breastfeeding within 1 h of childbirth. 70.2% (95% CI - 67.3–73) exclusively breastfed their babies for 6 months and above. 43.6% (95% CI - 39.2–48.1) of mothers with children of age 25–60 months breastfed their babies up to 2 years and beyond. On univariate analysis, female gender, maternal employment, operative delivery, and hospitalization in the newborn period were identified as risk factors for inappropriate breastfeeding practices, which were confirmed by regression. Overall, only 26.6% (95% CI - 23.9–29.5) of mothers had appropriate knowledge about ideal breastfeeding recommendations. Conclusion: Female gender, maternal employment, operative delivery, and hospitalization in newborn period are significant independent risk factors for inappropriate breastfeeding practices. Only a quarter of mothers had adequate knowledge of breastfeeding recommendations

Comorbidities in children hospitalized with severe acute malnutrition

Background: As per the National Family Health Survey-4 data, 7.9% of under-five children in the state of Tamil Nadu are severely wasted. The outcome of hospitalized severe acute malnutrition (SAM) children is dependent on the comorbidities present. Objective: The objective of this study is to describe the comorbid conditions in SAM children hospitalized in a tertiary care center. Methodology: This study was a hospital-based descriptive study, conducted from July 2015 to June 2016. A total number of 200 children, who were admitted with SAM as per the World Health Organization criteria, were included in the study. Systemic illness, anemia, vitamin deficiencies, sepsis, retroviral infection, tuberculosis, pneumonia, acute gastroenteritis, urinary tract infection (UTI), measles, skin infections, and worm infestations were the comorbidities considered. Results: Among 200 hospitalized SAM children, the median (interquartile) age was 15 (11–21.75) months; there were 93 (46.5%) boys. Acute gastroenteritis (57.5%) was the most common comorbidity, followed by pneumonia (44.5%), anemia (27%), systemic illness (17%), worm infestation (13.5%), UTI (13.5%), sepsis (13%), skin infection (8%), measles (6%), vitamin deficiency (4%), retroviral infections (3.5%), and tuberculosis (1%). The case fatality rate was 10.5%. Conclusion: Prompt identification of comorbidities is crucial in hospitalized SAM children, which will pave way for their treatment, resulting in better outcomes

Mortality and Morbidity among Neonates Born to COVID-19 Positive Mothers in a Tertiary Care Hospital, Chennai: An Ambispective Cohort Study

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus, has had varied clinical impacts across different age groups. Understanding the morbidity and mortality rates among neonates born to COVID-19 positive mothers is crucial for ensuring preparedness within the healthcare system. Aim: To compare the morbidity and mortality rates of newborns born to COVID-19 positive and negative mothers. Materials and Methods: This ambispective cohort study was conducted at a tertiary care hospital in Chennai, Tamil Nadu, India between August 2021 and October 2022. Newborns born to mothers with COVID-19 at the time of delivery were classified as cases, while newborns born to the next two COVID-19 negative pregnant women who delivered immediately after the COVID-19 positive mother were considered as controls. The study included a sample of 214 COVID-19 positive mothers and 426 COVID-19 negative mothers. Clinical data were recorded, and all newborns were followed for one week to assess their morbidity and outcomes. Logistic regression analysis was performed to determine whether COVID-19 infection is a risk factor for adverse neonatal outcomes. Results: Among the newborns, 357 (55.8%) were females, and 333 (52%) were delivered via caesarean section. Of the newborns, 39 (6.1%) were preterm and 95 (14.8%) had low birth weight. The overall mortality rate was 1.25%. Four (1.8%) neonates tested positive for COVID-19. Logistic regression analysis revealed that caesarean section, respiratory distress syndrome, and prematurity were statistically significant morbidities associated with maternal COVID-19 positive status. The odds ratios (with 95% confidence intervals) were 4.090 (2.840-5.882) for caesarean section, 2.291 (1.508-3.480) for respiratory distress syndrome, and 2.359 (1.181-4.712) for prematurity. The mortality and other morbidities were similar between the two groups. Conclusion: Respiratory distress syndrome and prematurity were the common morbidities observed in newborns born to COVID-19 positive mothers

Comparison of various body fat indices in early and mid-adolescents of South India: School-based cross-sectional study

Background: The most important bottleneck in the management of obesity is a lack of a gold standard measuring tool. Although body mass index (BMI) is the most commonly used index to identify obesity, other indices such as waist circumference and skinfold thickness are more specific in measuring fatness. Objective: The objective of the study was to determine the agreement between BMI, waist circumference, and triceps skinfold thickness (TSFT) against body fat percentage calculated using 7-site skinfold thickness in South Indian adolescents. Methods: This cross-sectional study was performed in selected government-run schools in Chennai from May 2016 to October 2016. Schoolchildren of age 10–16 years without any medical illness which are known to cause discordant body proportions were included in the study. Sample size was fixed at 700. Date of birth, gender, and the anthropometric parameters, namely, height, weight, waist circumference, and skinfold thickness at triceps, chest, axilla, abdomen, thigh, subscapular, and suprailiac regions were measured by standard procedure and noted. Body fat percentage was calculated from 7-site skinfold thickness using Jackson-Pollock formula. Participants were classified as obese and non-obese based on BMI, waist circumference, TSFT, and body fat percentage using appropriate standards. Agreement between various indices was determined using Cohen’s kappa statistic. Results: BMI, waist circumference, and TSFT showed moderate agreement with body fat percentage calculated from 7-site skinfold measurement. BMI and TSFT showed substantial agreement (k=0.608 for BMI and k=648 for TSFT) with body fat percentage in girls and only fair agreement (k=0.366 for BMI and k=0.291 for TSFT) in boys. Waist circumference showed moderate agreement with body fat percentage in boys (k=0.523) and girls (k=0.575). Conclusion: BMI, waist circumference, and TSFT show moderate agreement with body fat percentage calculated from 7-site skinfold measurement in South Indian adolescents. Measurement of waist circumference is recommended to classify an adolescent as obese, especially boys

Determinants of immunization status of children aged 1-5 years attending a tertiary health care facility: A cross-sectional study

Background: Childhood immunization is one of the key health interventions, which is useful in decreasing the under-five mortality. There has been a recent decline in immunization coverage rates in India as shown by the National Family Health Survey 4. Objective: This study was undertaken with the objective of determining the socio-economic and demographic risk factors associated with partial immunization of children aged 1-5 years attending a tertiary care center in South India. Materials and Methods: This cross-sectional study was done at the outpatient department of Institute of Child Health and Hospital for Children, Chennai, from May 2015 to October 2015. Children aged 1-5 years attending the outpatient department were included by convenient sampling. A sample size of 1100 was calculated based on a pilot study. After obtaining parental informed consent, data were collected on immunization and socio-demographic factors, namely, gender, place of residence, parental education and occupation, family income, number of children, birth order, place of delivery, and awareness of the type of vaccines to be given. The WHO definitions were used to classify immunization status as full, partial, and delayed immunization. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors for partial immunization. Results: Totally, 1104 children were included in the study. 1056 (95.7% [95% confidence interval 94.5-96.9]) were fully immunized, whereas 41 (3.7% [2.59-4.81]) were partially immunized and 7 (0.6% [0.14-1.06]) had delayed immunization. None of the children were totally unimmunized. Univariate analysis identified rural residence, home delivery, having more than 2 children, birth order more than 2, lack of maternal and paternal education beyond primary school level, and lack of awareness on immunization as significant risk factors for partial immunization. After multivariate logistic regression, rural residence, having more than 2 children, and lack of awareness on immunization emerged as independent risk factors for partial immunization. Conclusion: Residing in rural areas, having more than 2 children, and lack of awareness on immunization are significant independent risk factors for a child not being fully immunized

Physical Growth of Low Birth Weight Infants in First Six Months of Life: A Prospective Cohort Study

Introduction: Low Birth Weight (LBW) is a commonly encountered problem in developing countries. Growth is the single most important predictor of morbidity and mortality in a LBW infant. LBW babies show a pattern of growth, different from normal weighing babies. Aim: To assess the growth pattern of LBW infants in first six months of life. Materials and Methods: This prospective cohort study was done in Department of Paediatrics, of Kilpauk Medical College and Hospital, a tertiary care hospital in Southern India, from September 2019 to August 2020. Total 310 LBW infants, of which 200 were term and rest preterm were included and followed-up at the ages of three and six months. Clinical details including gender, gestational age, order of birth, length of stay in nursery, maternal and neonatal morbidities, type of feeding and intercurrent illness were noted. The weight, length and head circumference of the infants were measured by standard methods and interpreted using appropriate charts. The anthropometric measures were converted into z-score and compared. The outcome variables were statistically analysed using Chi-square test. Results: Out of 310 babies, 172 (55.5%) were girls and 200 (64.5%) were term babies. Six month follow-up rate was 92%. A total of 228 (79%) infants were on exclusive breastfeeding while the remaining 21% were partially breastfed. The prevalence (95% confidence interval) of undernutrition, short stature and microcephaly at six months were 54.9% (48.93-60.76), 62.2% (56.34-67.88) and 30.7% (25.47-36.47), respectively. Fall in standard deviation score of length, weight and head circumference was observed which was more pronounced in preterm than in term infants (p<0.05). Conclusion: Growth faltering is commonly encountered in more than half of LBW infants on six months follow-up, with the effect being more pronounced in preterm more than term infants