International Journal of Child Health and Nutrition

139-145

Authors: Cougar Hall, Cudjoe Bennett, Benjamin Crookston, Kirk Dearden, Muhamad Hasan, Mary Linehan, Ahmad Syafiq, Scott West, Joshua West

Child undernutrition and stunting remain serious public health problems in Indonesia. According to the Health Belief Model, increasing mothers’ knowledge of stunting is fundamental to establishing accurate threat perceptions predictive of behavior change. The purpose of this study was to increase understanding of factors related to maternal knowledge of stunting in Indonesia by addressing three questions: 1) How familiar with stunting are Indonesian mothers? 2) What antecedent factors do Indonesian mothers associate with stunting? and 3) What health effects do Indonesian mothers associate with stunting?A total of 3,150 mothers participated in structured face-to-face interviews. Study measures targeted four main variables. Mothers were asked: 1) Have you heard of stunting?; 2) Have you heard of shortness?; 3) What causes stunting/shortness?; and 4) What are the effects of stunting? Only 66 (2.1%) mothers reported having heard of, read about, or knew something about stunting. Approximately two-thirds of participants attributed stunting to hereditary factors. Interrupted growth (33.7%), idiocy (13.8%), and easy to get sick (11.8%) were identified as health effects of stunting. Results highlight the need for health promotion and education efforts focused on increasing basic knowledge of stunting, its causes, and its health effects among Indonesian mothers

157-162

Authors: Stacie M. Kirk, Erik P. Kirk

Purpose/Objective: To compare preschool lunch menus that meet dietary guidelines to what is actually served and consumed. Methods: Fifty-two preschoolchildren (mean±SD, age 3y and 10m ± 8m) from a university early childhood center participated in the 10-week study. Dietary intake was measured by a registered dietitian using direct observation for pre and post meal analysis. Energy and nutrient content was completed using Food Processor Nutrition Analysis by ESHA. Results: There was a significant (p<0.05) difference for total kilocalories (kcals) between what was on the menu (448 ±130) and to what was served to the children (523 ± 148) compared to what was consumed (361 ± 178) by the children.There was a significant (p<0.05) difference for grams of fat between what food was listed on the menu (16.0 ± 8.7g), the food served to the children (21.2 ± 9.7g), and the food consumed (14.5 ± 10.0g) by the children. There was a significant (p<0.05) difference for grams of carbohydrate between what food was listed on the menu (55.3 ± 18.9g) and the food served to the children (56.5 ± 20.5g) compared to what was consumed (38.5 ± 21.7g) by the children. Children consumed only 46.9% of the vegetables, 88.9% of dairy products, 82.0% of fruits, 81.8% of grains and 72.8% of meats served, and 77.9% of all fats/sweets served to them at lunch. Conclusion: The results indicated that menus that meet recommended dietary standards do not translate into what children are served or consumed, in particular, for vegetables

169-174

Authors: Merav W. Efrat

Objective: The objective of the study was to determine whether less acculturated, compared to more acculturated, low-income pregnant Latinas, report higher levels of breastfeeding self-efficacy. Data on level of acculturation and breastfeeding self-efficacy were collected from 253 pregnant low-income Latinas.Methods: This study was cross-sectional.Results: This study found that less acculturated, compared to more acculturated, low-income pregnant Latinas had significantly higher breastfeeding self-efficacy.Conclusions: Evidence suggests that breastfeeding self-efficacy is one of the strongest modifiable factors linked to high breastfeeding rates. Moreover, prenatal interventions designed to increase breastfeeding self-efficacy have effectively done so. Taken together it appears that one strategy practitioners and researcher may consider to increase breastfeeding rates among more acculturated low-income Latinas is to design a culturally appropriate prenatal breastfeeding intervention aimed at improving breastfeeding self-efficacy.

184-193

Authors: Sebahat Aydos, Aysel Köksal Akyol

Obesity, which can occur due to numerous causes especially from genetics to nutrition disorders, is a major problem not only for adults but also for children. Childhood obesity causes acute and chronic physical problems in children, but physical effects of obesity, as well as psycho-social effects on children, is a substantial issue. This study was conducted to analyze the effect of different weight status on social-emotional skills of adolescents. The research group comprised 189 female and 194 male of 383 total children who were still on the 6th, 7th and 8th grades at the schools. The General Information Form prepared by the researchers and the "Social Emotional Learning Skills Scale" developed by Kabakçı and Korkut Owen were utilized as data collection tools. Two-way analysis of variance and Tukey tests were performed for the analysis of the data. As a result of the study conducted, it is observed that social-emotional learning skills of adolescents aged 12-14 years are significantly different according to their weight status and gender. It has been found that the communication and social-emotional skills of overweight adolescents are significantly lower than normal adolescents and that obese adolescents have significantly lower communication, problem-solving, coping with stress, self-worth increasing and social-emotional learning skills than thin, normal and overweight adolescents. It is observed that male adolescents have significantly lower communication, problem-solving, stress coping and social-emotional learning skills than female adolescents

201-209

Authors: Lem Ngongalah, Ngwa Niba Rawlings, Wepngong Emerson, Oluwaniyi Titilope, Mumah Sharon

Background: Child malnutrition is highest in Sub-Saharan Africa. Over 45% of children in Cameroon die each year from malnutrition-related causes, most of which are preventable. Exclusive breastfeeding is a well-acknowledgedand cost-effective intervention against malnutrition-related illnesses in children. However, the practice remains low in Cameroon. This study explored perceptions of mothers, care givers and key informants on infant feeding in Cameroon, and barriers to exclusive breastfeeding.Methods: A qualitative methodology was used, comprising key informant interviews and focus group discussions with nursing mothers, grandmothers and health workers; in one urban and one rural area in Cameroon. Participants were selected using convenience, purposive and snowball sampling methods. Data were analysed using thematic analysis.Results: Cameroonian mothers were supportive of breastfeeding. However, knowledge of exclusive breastfeeding and its benefits was poor. Mothers expressed doubts about its feasibility and showed concerns about satisfying their babies’ feeding and health needs. Barriers included factors which either affected women’s abilities to breastfeed or their babies’ satisfaction, family influences, other responsibilities, cultural and societal factors, and lack of support from the healthcare system.Conclusions: This study highlighted a sizeable gap between mothers’ lived experiences and infant feeding recommendations. Living in rural areas was an added disadvantage. Developing effective strategies to increase exclusive breastfeeding rates requires that mothers’ needs be understood and that influencing factors be addressed. Supportive environments are also required to promote and protect the rights and abilities of mothers to breastfeed exclusively.

102-108

Authors: Mandoué Stéphanie Bamba, Grodji Albarin Gbogouri, Edith Adouko Agbo, Dogoré Yolande Digbeu, Kouakou Brou

Objectives: The aim of the study is to evaluate the use of local flours in supplementary feeding for 6 to 24 month old children in relation to their nutritional status in Abidjan.Methods: A cross-sectional survey was conducted on 480 mother-child couples in twelve maternal and child protection centers located in four municipalities in Abidjan. Questionnaires focused on the economic characteristics of mothers, the frequency of use of local flours, sources of local flours, ingredients used for flour production. The local composite flours mainly consumed by the children were sampled for biochemical analysis. Results: Our of the 480 mothers, 73% had an income-generating activity and 27% had no activity, 10% of them were students. About 13% of the mothers with income-generating activities use only local flours, 10% of them mainly use industrial flours and 50% alternately use local flours and industrial flours. All mothers used cereals for flour production, 1% of the mothers used cassava and 98.54% used soya flour as supplement. The local flour mainly consumed, "Anango baka" with two variants, was unbalanced as far as its nutrient composition is concerned. The nutritional status of the children surveyed showed that stunting was the most widespread form of malnutrition with a prevalence of 17.9%.Conclusion: The three local composite flours used by the mothers showed a poor nutritional value. A high rate of chronic malnutrition has been reported for 6 to 24 month old children visiting maternal and child protection centers located in Abidjan

115-121

Authors: Waseem Fatima, Rizwan Fatima, Nida Suhail Anwar

Objective: The study aimed at examining the prevalence and correlates of eating disorder among female college students of Northern Broader University, Arar city, Kingdom of Saudi Arabia.Methods: A cross sectional survey was conducted among female college students. The total sample size was 160 (66.66% of total population of college) and stratified random sampling technique was used to select female students age ranged between 18 and 23 years from faculty of medical and faculty of applied medical science. Subjects were ask to fill pre tested questionnaire about socioeconomic status, age at menarche, body image and Eating attitude test 26 (EAT 26), there height and weight were measured and BMI was calculated. Results: Out of 160 female college students only 120 (75%) returned completely filled questionnaires and they were considered for statistical analysis. It was found that, 32 (26.66%) of study population scored 20 or above, which is the cutoff point of EAT-26, indicating negative eating attitudes. There was significant difference found in prevalence of disordered eating attitudes in different BMI ranges. However, the association between student’s age at menarche and abnormal eating attitude was not statistically significant. Conclusion: The findings support our hypothesis of a relatively high rate of abnormal eating attitudes (as reflected by high EAT-26 score) in this population. The results have important implication for increasing awareness about an emerging clinical problem. The prevalence of eating disorder is the most useful measure for planning health care facilities, as it indicates the demand for care

47-62

Authors: Theresa A. Nicklas, Carol E. O’Neil, Victor L. Fulgoni III

Objectives:The objective of this study was to examine whether there was significant risk associated with types of beverages consumed on the weight status in children.Design: Nationally representative cross-sectional sample.Setting:Demographic information was obtained from the NHANES interviews. Dietary intake data were obtained from Day 1, in-person 24-hour dietary recall interviews administered using an automated multiple-pass method. Height and weight were obtained according to NHANES Anthropometry Procedures Manual.Subjects:Children 2-18 years of age.Results:The likelihood of being overweight or obese was not significant for any of the beverages studied between consumers and non-consumers. For the total sample, for every 29.6 mL of water consumed the risk of being obese was 1%. For ages 6-11 years water consumption increased the risk of being obese and in ages 2-5 years, consumption of sugar sweetened beverages (SSB) increased the risk of being obese. The risk of being obese was significant p <0.05 for Hispanic males for every 29.6 mL of water consumed and for 100% fruit juice and SSB for other males; increased risk was ≤3%. The risk of being obese increased for White females for every 29.6 mL of flavored milk consumed and water consumption for both Black females and Hispanic females; the significant p<0.05 increased risk of obesity was ≤7%. Conclusions: Beverage consumption was not consistently associated with weight status in the diets of a nationally representative sample of children. In some cases the increased risk was very small

74-81

Authors: Corina Zugravu, Michaela Iuliana Nanu, Florentina Moldovanu, Oana Cristina Arghir, Cristina Maria Mihai, Marina Ruxandra O?elea, Simona Claudia Cambrea

Objectives: to evaluate factors influencing breastfeeding duration in an integrative model, considering both the organization of medical care and the perinatal education. Methods:We conducted a cross sectional study with data collected in a face to face interview of 1,008 mothers with children aged between 9 and 14 months The questionnaire focused on the main characteristics of a Mother-Baby Friendly Hospital initiative and the type of perinatal education received by pregnant women. Correlation and partial correlation tests, non-parametric tests and classification tests were applied. Data were processed in SPSS 12.0 software.Results: The positive effects of Mother Baby Friendly Hospitals Organization initiative organization were confirmed. However, the main differentiator for breastfeeding duration was the level of formal education of pregnant mothers and the active seeking of perinatal education (r = 0.22, p< 0.001). The perinatal counseling was correlated with breastfeeding duration only for the subgroup participating to structured, dedicated time slot apart from the regular medical consultation (r = 0.079; p = 0.014), independently of mother’s age, education, residence, time to first breastfeeding contact, type of birth delivery and rooming in. Our results support a broader approach to perinatal education than medical counseling during pregnancy to increase the voluntary participation of future mothers to the perinatal educational programs.Conclusion: As mothers’ motivation to maintain the optimum duration of breastfeeding is a determinant factor, an earlier and sustained educational process, before pregnancy and after birth delivery, is necessary in order to create a general favorability for exclusive breastfeeding

9-14

Authors: Kyle M. Morrison, Steven Smith

This study examined the benefits of a 10-week childhood obesity intervention program on various measures of health. The program involved parents and children who met once weekly for two hours. Each session of the intervention program consisted of a structured dynamic warm-up an aerobic exercise component in a game play setting and a motor-skill specific instruction period. Subjects were recruited from pediatrician recommendation and a total of 99 subjects (n=48 boys, n=51 girls) completed both pretest and posttest intervention measures. The mean age was 9.86 (SD=0.02 years). Each of the following were assessed on pediatric assessment prior to and following the intervention program: height, weight, body mass index (BMI), waist circumference, resting heart rate, resting blood pressure, habitual physical activity, percent body fat, and quality of life. Assessment of the participant’s cardiovascular fitness and the state of home environment in regards to nutrition and physical activity were completed as part of the first and tenth (final) intervention program sessions. Results indicated that the changes observed that were statistically significant included the categories of systolic blood pressure, height, weight, quality of life, habitual physical activity, FNPA score, and PACER scores. Improvements in outcomes measured were modest but this result was expected due to the short intervention program of only ten-weeks duration. Recommendations include increasing the length of the intervention and conducting follow-up assessment to determine long-term impact.

22-29

Authors: Vivienne N. Ibeanu, Uchenna A. Onyechi, Peace N. Ani, Ozioma A. Omeh

Background: Good nutritional status is of paramount importance for a child’s physical, mental and social development after inter-uterine life. Objective: Dietary pattern, anthropometric indices and developmental milestone of children aged 6-60 months in peri-urban communities were investigated.Design:The children (236) were randomly selected from health centers and nursery schools in three selected communities. Data were collected with structured questionnaire and anthropometry. The questionnaire administered to the mothers of the children elicited information on their socioeconomic characteristics, dietary pattern and developmental milestones of the children. Anthropometric parameters of the children were measured using standard instruments and procedures. The mean length/height and weight of the children in relation to their ages were compared with WHO child growth standard. Data collected were statistically analyzed using SPSS version 16.Results: Less than 6% of the mothers introduced complementary food at 6 months, 31.4% introduced before 6 months and 63.2% after 7 months. Majority (97.5%) of the mothers enriched complementary foods with fish (73.7%), infant formular (72.9%), soybean powder (66.5%) and egg (64.0%). A total of 10.6% and 1.7% of the children were moderately and severely stunted, respectively while 4.7% of them had moderate wasting. Underweight was observed more among children within 6 – 24 months. The mean ages for sitting, crawling, standing with support and standing without support reported in this study were 6, 7, 8 and 10 months, respectively. Conclusion: Scaling up actions on optimal complementary feeding of children would go a long way in improving their nutritional status and physical development

132-137E

Authors: R.A. Mustapha, A.A. Oladapo, T.M. Akinola, J.V. Akinlotan, A.P. Oluwagunwa

The growth rate from birth to three months of some breastfed and non-breastfed infants age 0 – 12 weeks delivered in hospitals at Owo metropolis was evaluated with a view to know the effect of breastfeeding on growth rate. A total of one hundred (100) breastfed and non-breastfed neonates were purposely selected in the neonatal sections of three hospitals in Owo, March 2012. Anthropometry measurement was used to assess growth rate for length, weight, head and mid upper arm circumference of the infants on weekly basis using standard length board, digital weighing scale and shakir tape for twelve weeks. Epi-info 2008 nutritional software was used to determine length for – age z-score, weight for – age z-score, Head and mid-upper arm for age z – scores. Data were analyzed using SPSS soft ware (version 17.0). Results show that the rate of growth in length per week ranged between 0.5 – 1.0cm within 4th to 12th weeks of growth while an average rate of growth in weight of 100 – 400g was discovered between 2nd to 6th weeks of growth among both breastfed and non-breastfed infants. Observation shows that between birth to 4th week formula fed babies tend to be leaner in weight compared to their breastfed counterpart which maintained stable weight within this period. The study shows that breastfeeding significantly (P> 0.05) affect rate of growth among the breastfed infants. Growth pattern of infant skewed toward – 2 and 0 when compared with the NCHS/CDC reference population growth curve. In all, 2% of the breastfed and 8% of non-breastfed were severely underweight. There is no alternative to breastfeeding at this critical stage of life for optimum growth of infants. Therefore, mothers should be encouraged to breastfeed exclusively for 6th months in order to achieve optimum growth and development

144-158

Authors: Byron Chapoterera, J. Chideme Maradzika, Anesu Marume, Admire Zikiti

Background: The dietary patterns are becoming a major public health concern. The current data from various studies in Zimbabwe shows that there was an increase in the prevalence of obesity among secondary school adolescents in Harare. There is a link between eating habits and obesity. This study was conducted to explore the factors influencing dietary practices among adolescents in Zimbabwean schools. Methods:A school based analytic cross sectional study was conducted with 283 pupils aged 13-19 years. Systematic random sampling was used. Data was collected using self-administered questionnaire based on the ecological framework. The aim of the study was to identify the relationship between dietary patterns and occurrence of obesity. Bivariate and multivariate logistic regression analysis was used to identify the relationship between dietary patterns and obesity. Findings: The prevalence of obesity was 11.4%. Females were 6.79 (95% CI: 2.17-21.22 p=0.001) more likely to be obese. Consumption of sugar and sweetened beverages were associated with occurrence of obesity; beverages (AOR=3.62, 95%CI=1.99-10.91 p=0.025); eating of snacks in between meals (AOR=2.40, 95%CI=1.03-5.64 p=0.004); so was being located in high density suburb (0R=0.45, 95CI=0.21-0.99 p=0.023); consuming burgers (OR=4.41, CI=1.54-12.64 p=0.006); being a pupil in lower adolescent with age less than 16 (OR=1.99 95%CI=0.99-4.27 p=0.038). Consuming a special diet that is recommended or as a choice was protective from obesity though this was not statistically significant. Not removing visible fat from meat was a risk factor for developing obesity. Eating the traditional maize meal staple food, sadza was protective to being obese (OR=0.3514, 0.16-0.78)Conclusions: The study showed that obesity is a cause for concern among school children as seen by 11.4% prevalence. Choice of meals is done by parents, eating a home cooked meal such as sadza, participating in meal planning was found to be reinforcing factors. There is need to create awareness on students, parents, teachers and the wider community to increase the adoption of healthy dietary practice among school children.