International Journal of Child Health and Nutrition

9-16

Authors: Thana’ Y. ALjaraedah, Reema F. Tayyem, Hamed R. Takruri

Background: This study was conductedto examine the dietary intakes of macro- and micronutrients for a Jordanian adolescents based on gender and compare their intake to the Dietary Recommended Intakes (DRIs). Methods: A sample of 398 male and female adolescents, aged 14-18 years, were recruited from private and public schools using convenience sampling. Socio-demographic questionnaire and 3-days food record were self-reported. Bodyweight and height were measured and body mass index (BMI) was calculated for all participants. Results: There were no significant differences between male and female adolescents regarding the intake of micro and macronutrientsexcept for protein, insoluble fibre, saturated fat, cholesterol, omega-6, vitamin E and calcium. The intake of insoluble fibre (g/day), omega-6(g/day), and vitamin E (mg/day) was significantly higher in female adolescents (3.1±0.1, 5.6±0.5, and 3.1±0.3, respectively, P≤0.05) compared to male adolescents (2.9±0.1, 5.1±0.4, and 2.5±0.2, respectively, P≤0.05). On the other hand, the intakes of protein (g/day), saturated fat (g/day), cholesterol (mg/day), calcium (mg/day) were significantly higher in male adolescents (90.1±2.3, 31.7±1.0, 339.2±18.3, and 651.5±27.8) as compared with female adolescents (79.2±2.1, 29.2±1.2, 263.6±14.9, and 555.2±21.7) (P≤ 0.05). Comparing of the adolescents’ nutrients intake to the DRIs, many nutrients were found to be below or above the recommendations.Conclusion: The study findings highlighted that there is an urgent need to establish a plan of action to combat malnutrition among adolescents in Jordan

26-33

Authors: Nathalie Chahine, Moni Nader, Wissam Chalhoub, Ramez Chahine

Context: Several decades of dietary research recommended the consumption of antioxidants and vitamins rich foods as a protective tool against a broad portfolio of diseasesAims: This study aims to test if oral supplementation of natural antioxidants and vitamins before the winter season, may reduce the occurrence of upper respiratory tract infection (URTI) in adolescents.Settings and Design: Natural antioxidants and vitamins supplements were given to 90 adolescents (45 males, and 45 females) from an orphanage against a placebo during three months in a double-blind fashion.Methods and Material: Saliva was collected before and after supplementation. The antioxidant activity of saliva was determined in vitro using electrolysis as a free radical generating system. Additionally, total antioxidant activity, glutathione and ascorbic acid levels in the saliva were evaluated before and after supplementation. The URTI frequency was recorded throughout the winter season (3 months). Statistical Analysis: All values were expressed as means ± SEM. Significance of the results was assessed using Student's t-test and Fisher’s test Results: Data indicated that only five individuals from the group that received antioxidants and vitamins supplements manifested URTI while 14 adolescents from the non-supplemented group showed symptoms of URTI. Biochemical analysis revealed that the saliva in provenance from the supplemented group exhibited a higher capacity to scavenge free radicals compared to its capacity before supplementation. This supplementation also increased the total antioxidant activity and the levels of both ascorbic acid and glutathione in the saliva. Conclusions: We concluded that oral intake of antioxidants and vitamins protects against URTI through increased antioxidant activity

115-127

Authors: Myia L. Graves, Laura A. Nabors, Amy L. Bernard, Rebecca A. Vidourek

Photovoice is a community-based participatory research method where participants can showcase their life experiences through photography. The objective of this study was to have adolescent girls attending an after-school program use photovoice to represent their perceptions of physical activity practices. Photovoice was used to allow adolescent girls to express their perspectives, through photographs and narratives, of their personal and community strengths and concerns related to their involvement in physical activity. The phenomenological methodology was used as a framework for the study. Qualitative analyses were conducted throughout the research process. Constant comparison was used to analyze the focus group, scrapbook data, and notes recorded by the author to determine key themes and ideas. Participants for the study included 14 girls attending a school in an urban area. Benefits of physical activity as provided by the girls in their personal lives and the community included: understanding activity contributed to wellness, increased social opportunities, and the school as a hub of activities. Personal and community barriers to physical activity included: lack of neighbourhood safety, being involved in other sedentary activities, parental rules restricting outside play, outside conditions, personal choices to not exercise, and a lack of opportunity to exercise. Potential ways to increase physical activity among these participants are to create more group games and activities at the after-school program daily. Involving parents in activities with the girls at home may increase physical activity levels while at home.

136-144

Authors: Anwaar Shahbar, Suhad Bahijri, Janet Weber, Noura M.S. Eid

This paper presents a longitudinal study of breastfeeding at two private hospitals in Jeddah, Saudi Arabia. Soliman Fakeeh (SF) follows the WHO's baby-friendly hospital initiative (BFHI), Saudi Germany Hospital (SGH) does not. Participants were 102 women in both hospitals (52 BFHI, 50 non-BFHI). Two semi-quantitative questionnaires, translated into Arabic, were used at baseline and one month postpartum. Results showed that most women in the study have initiated breastfeeding but turned to mixed feedings after one month. We also found that self-efficacy has the biggest influence on breastfeeding practice at one month, measured by the Breastfeeding Self-Efficacy Scale (BSES) and regardless of other variables. The BFHI made breast milk the first nutritive substance infants received and had a higher percentage of early initiation of breastfeeding than the non-BFHI. The BFHI hospital supported women to breastfeed practically and educationally. Support was provided by books, internet, and educational sessions. Yet, any effects no longer existed at one month postpartum, at which point most women had shifted to mixed feeding. There was no relationship between the BSES and BFHI status. Thus, we recommend developing breastfeeding promotion programs before delivery and at least a six-months follow-up after delivery, in addition to peer counselling approaches.

154-161

Authors: Ferdousi Begum, Afiqul Islam, Rashidul Haque, Mohammad Abdal Miah, Kazi Khairul Alam, Mohammad Anwarul Karim, Momena Begum, Farida Yasmin

Background:Clostridium difficile Associated Diarrhea (CDAD) is considered to be one of the commonest causes of nosocomial diarrhoea worldwide. Gastrointestinal infections in the form of diarrhoea are common in pediatric oncology patients in Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh. The study was conducted to find out the frequency of Clostridium difficile infection (CDI) among diarrheal children with haematological malignancy.Materials and Methods:This prospective observational study was conducted from April 2012 to March 2013 at the Pediatric Hematology and Oncology Unit, BSMMU, Bangladesh. Total 58 diarrheal episodes occurred in 51 children with various types of haematological malignancies were included consecutively. Faecal samples of the children were sent to International Centre for Diarrheal Disease Research, Bangladesh (ICDDR, B) laboratory for detection of Clostridium difficile antigen (GDH) and toxins (A and/ or B) by Enzyme Immunoassay (EIA). Results:Among 58 diarrheal episodes 22.4% faecal samples were positive for GDH, but none of the faecal samples was positive for toxin A and or B. There were a significant association with leucopenia, severe neutropenia; usage of meropenem plus vancomycin, cefepime plus amikacin, imipenem, cytarabine and omeprazole with GDH positive diarrheal episodes. Conclusion:Positive GDH antigen with a negative result for toxin indicates C. difficile colonization. Among GDH positive episodes, a significantly higher proportion of children had leucopenia, severe neutropenia and usage of some drugs known as risk factors for C. difficile infection. To confirm the CDI advanced tests are needed.

86-92

Authors: Issayas Ghirmay Melake, Isaias Tesfu Mirach, Hagos Andom

Introduction:Malnutrition has a significant impact on global disease for the majority of children worldwide, by being responsible for almost half of the deaths of children under the age of five especially in the developing countries including Eritrea. However, there is no clear information on the role of antenatal care and feeding practices in preventing malnutrition. Therefore, assessing the role of antenatal care visit and feeding practices in preventing malnutrition is ofvital importance.Objective:To assess the role of regular ANC visit and feeding practices in preventing malnutrition among children aged 0-59 months, who visited Orotta National Pediatric Referral Hospital from 31st August – 30th September, 2016.Methodology:A cross-sectional, Hospital based study was carried out. Data were collected from mothers (caretakers) using semi-structured questionnaire developed for the purpose. Moreover, anthropometric measurement of the subjects was taken. Data was and entered to the computer and analyzed using SPSS version 20 and p-value <0.05 at 95%CI was considered as statistically significant. Results: The main associated factors of stunting were found to be the frequency of breastfeeding and antenatal care visit. Underweight was associated with weaning of breastfeeding. Frequency of breastfeeding and weaning of breastfeeding were the only variables associated with wasting.Conclusion and Recommendation:Malnutrition remains a major health problem among children aged 0-59 months. Hence, interventions regarding regular antenatal care visits and feeding practices are highly suggested to be given special attention.

103-108

Authors: Hayrunnisa Bekis Bozkurt

Aim: To evaluate serum zinc levels and breast milk intake in pediatric patients with recurrent tonsillopharyngitisMaterial Method: 40 pediatric patients who were admitted to our polyclinics with the diagnosis of tonsillopharyngitis diagnosed as ≥ 7 times a year were included in Group 1; 40 healthy children who applied to the outpatient clinic for routine control in the same period were defined as Group 2. Serum zinc, blood parameters, C-reactive protein (CRP) values were studied from all patients. Patient complaints, breastfeeding time, and family history were questioned.Results: There was no significant difference between the groups in terms of Hemaoglobin(Hb), hematocrit(Hct), white blood cell count(WBC), platelet count(Plt), mean platelet volume(MPV) and CRP values were significantly higher in the patient group (p=0.001).Serum zinc levels were significantly lower in Group 1 than Group 2 (p=0.000; p <0.05). There was no significant difference between the groups regarding the duration of breastfeeding (p=0.086; p> 0.05).Conclusion: Our study showed that zinc deficiency may play a role in the etiopathogenesis of recurrent tonsillopharyngitis. Zinc supplementation may be recommended for children with recurrent tonsillopharyngitisThere is a need for further studies to be done in larger population related to zinc levels in mother's milk content, serum zinc levels in mothers and zinc deficiency

50-54

Authors: Fariba Jahangiri, Seyyed Javad Nasiri, Alireza Negahi, Bahman Nouhifard, Behnood Farazmand, Mostafa Hoseini

Background:Despite the recent advancements, negative appendectomy cases are notable, especially in children. We evaluated the prognostic value of serum fibrinogen level for the prediction of the severity of acute appendicitis.Methods:A cross-sectional study of children and adults who had undergone appendectomy at Ali Asghar and Rasool-e Akram hospitals, Iran, was performed. Before surgery, serum fibrinogen level was assessed by using the Clauss technique. Finally, serum fibrinogen was compared between the two groups of complicated acute appendicitis and uncomplicated ones. Results:In the adult's complicated and uncomplicated appendicitis, no significant differences were noted in gender distribution, WBC count, and segment levels. Serum fibrinogen and C-reactive protein levels in children with complicated appendicitis were significantly higher than those in the uncomplicated ones. Serum fibrinogen level of 450 mg/dl was the optimum cut-off for predicting the severity of appendicitis in children. Serum fibrinogen level in adults with the complicated appendicitis was significantly higher than the uncomplicated appendicitis group. Also, 530 mg/dl was found the best serum fibrinogen cut-off to predict the severity of appendicitis in adults. Conclusion:Serum fibrinogen level is an appropriate diagnostic marker for the distinction of acute complicated appendicitis from uncomplicated appendicitis in children and adults.

65-73

Authors: Kaleab Tesfaye Tegegne, Iyasu Estiphanos Berisha

Introduction: Protein energy malnutrition is one of the leading causes of morbidity and mortality in children under the age of five in developing countries. Ethiopia being one of these countries malnutrition is an important public health problem and among the highest in the world Objectives: The main objective of this study is to assess the prevalence and associated factors of protein energy malnutrition among under-five children in pediatric OPDs of public health institutions at Yirgalem town, Dale woreda, Sidama zone, SNNPR, Ethiopia from September 18-26, 2017.Methodology:Institutional based cross sectional study was conducted in pediatric OPDs of public health institutions inYirgalem town, on a total of 204 children age less than five years from September 18-26, 2017. Study subjects were selected by using quota sampling technique. Interviewer administered structured questionnaire and anthropometric measurements were used to collect data. Data was analysed using SPSS version 20.0statistical software. Result:This study indicated that the prevalence of stunting wasting and Under-weight was 41.2%, 1.7% and 25% respectively. Factors showed statistically significant association in multivariate analysis were family planning use by mother, children eat together with older siblings and exclusive breast feeding with P-value (0.02), (0.036) and (0.002) respectively.Conclusion:This study reviled that the prevalence of stunting, wasting and under-weight were higher among under-five children participated in this study. Thus children are at a higher risk of under nutrition related morbidity and mortality. Further progress in under nutrition prevention can be achieved by specifically targeting children at their early age and conducting tailored public education to improve the nutritional status of the study subjects

10-20

Authors: Febronia Kokulengya Kahabuka, Hawa Shariff Mbawalla, Elifuraha Godson Mumghamba, Poul Erik Petersen

Objectives: To identify underlying clusters of general and oral health behaviours and acertain possiblefactors influencing the existence of the behaviours. Materials and Methods: A cross sectional study was conducted among 4,847 school adolescents aged 11 to 17 years.Data were collected using a structured questionnaire in Kiswahili inquiring about general and oral health related behaviours, socio-demographics and adolescents’ school relationship. Principal component analysis was employed to identify clusters of health behaviour. Frequency distribution for proportions, cross tabulations with chi-square and a two stage binary logistic regression were done. Results: Principal component analysis identified four clusters from twelve health behaviours; hygiene practices, dietary behaviours, cigarette smoking & alcohol consumption and sedentary related behaviours. Girls, OR 0.8 (95% CI 0.7, 0.9); secondary school attendees, OR 0.5 (95% CI 0.4, 0.7) and adolescents with good school relationship OR 0.7 (95% CI 0.6, 0.8) were less likely to smoke or use alcohol. Urban residents were less likely OR 0.8, (95% CI 0.7, 0.9) to report acceptable dietary behaviours. Adolescents whose fathers had secondary education or higher, were in secondary schools and had good school relationship were most likely to have acceptable hygiene behaviours, OR 1.4 (95% CI 1.2, 1.6), 1.6 (95% CI 1.1, 2.2) and 1.4 (95% CI 1.3, 1.7), respectively. Conclusion: Oral and general health behaviours of Tanzanian adolescents factored into four clusters with hygiene behaviours being most practiced and physical exercise the least. The clustered behaviours were influenced by socio-demographics and school environment.

26-34

Authors: Dan Yedu Quansah, Daniel Boateng, Louis Boafo Kwantwi, Anthony Owusu-Sekyere, A. Kofi Amegah

Background: Apgar score is an established index of neonatal well-being and development. Nutrition during pregnancy is an accepted risk factor for neonatal low Apgar score.Objective: To investigate the association between dietary diversity score and low Apgar score.Methods:This was a hospital based cross-sectional study. The study participants were 420 mothers who delivered and were attending the postnatal clinic at the Cape Coast Metropolitan Hospital. Mothers’ dietary information during pregnancy was assessed with a food frequency questionnaire. In reference to the FAOs women’s Dietary Diversity Score (DDS), the subjects were categorized into low, medium or high DDS. The primary outcome was Apgar score. Apgar scores < 5 were classified as low.Results: The mean age (± standard deviation, SD) of subjects was 26.7 ± 5.7 years with a range of 17 to 45 years. The prevalence of low Apgar score among the study population was 16.9%. Majority of thestudy participants had a low DDS in relation to low Apgar score whereas 7.5% had high DDS. After adjusting for potential confounding factors, the odds of low Apgar score in the low DDS group was three times higher than those who had high DDS (Adjusted odds ratio, AOR= 3.10, 95% confidence interval, CI=1.23-4.48). Conclusion:Dietary diversity score during pregnancy was associated with a low Apgar score in the study area. The results of this study reinforce the significance of adequate nutrition during pregnancy in the study area.