International Journal of Child Health and Nutrition

56-62

Authors: Justina S. Owusu, Esi K. Colecraft, Richmond N.O. Aryeetey, Joan A. Vaccaro, Fatma G. Huffman

Background:Malnutrition of children in Ghana continues during school years. There is limited information on how school meals meet nutrient recommendations in Ghana.Objectives:The aim of this study was to compare energy and nutrient content of meals served by Ghana School Feeding Programme (GSFP) and Non-Governmental School Feeding Programme (NGSFP) and adherence to nutrient recommendations.Methods:This was a cross sectional study design involving observation of school meals at two sites: GSFP and NGSFP. Average weights of a week’s meal were converted to energy and nutrient equivalence and compared with international recommendations. Differences assessed with t-tests.Results:NGSFP provided significantly higher portion size (416 ± 96 g vs. 243 ± 50 g; p=0.007), energy (776 ± 427 kcal vs. 315 ± 24 kcal; p=0.042) and fats (17± 8 vs. 6 ± 2; p=0.019) but similar micronutrient contributions to GSFP. NGSFP met energy and macronutrient recommendation set by World Food Programme; whereas, GSFP did not meet the recommendations.Conclusion and Recommendations:The NGSFP had more energy and macronutrients per serving size than the GSFP. Regulation of meals served by GSFP should be reviewed to ensure they contribute to the adequacy of children’s diets as well as meet recommendations set by World Food Programme

75-78

Authors: Adam W. Pickens, Mark E. Benden, Drew E. Schneider, Hongwei Zhao

Background:The purpose of this pilot study was to identify differences between sitting and standing time in high school students’ pre and post stand-biased desk intervention. Methods:ActivPal3™ activity monitors were affixed to 25 Bryan Collegiate High School students’ to monitor their standing time and activity levels. Data were collected at the beginning of the school year (fall) in traditional seated desks and in the spring in stand-biased desks. After attrition, 18 of the original 25 students were included in the final analysis. The physical activity data (steps) as well as standing and sitting time data provided by the monitors was used for within subject intervention analyses. Results:Descriptive statistics and a two-sided t-test were used to analyse differences between pre and post intervention sitting and standing times. Analysis indicated a significant reduction of sitting time post stand-biased desk intervention (p<0.0001) and a significant increase in standing time, post stand-biased desk intervention (p<0.0001). Analysis also revealed a non-statistically significant (p < 0.0619) average increase of 2,286 steps per school day when comparing mean steps pre-intervention (6,612) and post-intervention (8,898). Conclusions:Standing desks have the potential to reduce sedentary behavior and increase light to moderate physical activity for high school students during the school day.

10-16

Authors: Lawrence Kotlow

Physicians are often asked to diagnose and treat infants with clinical signs of gastroesophageal reflux (GER) symptoms and in extreme cases gastroesophageal reflux disease (GERD). Some infants are left to work out their pain, regurgitation and vomiting until they outgrow the symptoms while others may undergo expensive, invasive endoscopic procedures in the operating room under general anesthesia. Initial treatment is often for infants to be placed on prescription adult acid reflux medications, which have limited benefits [1]. Drugs prescribed include: H-2 blockers such as ranitidine (Zantac), a proton pump inhibitor such as omeprazole (Prilosec) or lansoprazole (Prevacid). TOTS may cause aerophagia, a condition where the infant’s latch onto the mother’s breast or bottle allows the infant to swallow excessive amounts of air into the stomach during feeding. This aerophagia may be responsible for symptoms mimicking GER or GERD [2]. When these infants are examined for symptoms of GER the differential diagnosis of tethered oral tissues (TOTS) may not be addressed [3]. Tethered oral tissues may involve ankyloglossia (tongue-tied), maxillary and /or mandibular frenum lip-ties and in some instances buccal frenum ties. These tethered oral tissues (TOTS) prevent the infant from achieving a good seal onto the breast and or bottle with the resulting ingestion of excessive amounts of air. Background: When assessing infants presenting with gastroesophageal reflux symptoms, aerophagia secondary to tethered oral tissues (tongue-ties ,Lip-ties) should be considered in the differential diagnosis since the release of these tissues may eliminate the need for invasive gastrointestinal investigations and pharmacologic treatment of gastroesophageal reflux. Patient Pool: 340 infants ranging from 1 week to 3 months were referred for the evaluation and release of lingual and maxillary lips which were interfering with infant’s ability to achieve a good seal and latch onto the mother’s breast of infant bottle .The survey the parents completed indicated that 208 or 61% of the infants had signs of gastroesophageal reflux (GER) such as; vomiting, regurgitation, inability to sleep lying supine, fussiness, crying after nursing and morning congestion. Of the 208 infants 40% (83 infants) were or had been treated for GER with pharmacologic medications such as proton pump inhibitors or H2 blockers without any resolution of the symptoms. Findings: All of the infants presenting with these signs and symptoms underwent laser revisions of the tethered attachments. Upon completion of the procedure and at a 48 hour post-surgical follow-up discussion with the parents 93% (194 infants) of the infants showed immediate improvements and were able to breastfeed successfully without signs or symptoms of GER. Survey returned at the end of two weeks post-surgery had similar results Conclusion: Infants presenting with signs of GER should also be evaluated for restrictive tethered oral tissues (TOTS) such as ankyloglossia, lip and buccal ties. If they are present, strong consideration should be given to the release of these tissues as an initial approach. This may eliminate the need for pharmacologic treatment of GER.

25-30

Authors: Divya Shakti, Veena Singh, Gertrude Nakigozi, Sarah Kiguli, Deepak Kamat

Delayed umbilical cord clamping and care practices have important implications for infant iron stores and neonatal survival. This is especially important in countries like Uganda, where there is a high prevalence of anemia in women and children coupled with a high newborn mortality rate. This study assesses cord clamping and care practices in home births in a coverage area of 12 health centers in 4 districts near Kampala, Uganda. We interviewed 147 women, most of who had at least primary school education and delivered their babies in the homes of traditional birth attendants. Only 65% of the persons conducting delivery washed hands, and most wore gloves. Most frequent cord ties were threads (86.7%), and glove rims (8.3%). Cords were cut with clean instruments in most (93.1%) deliveries. During cord clamping, newborn was positioned at a higher level than mother in 59%, delayed clamping (
3mins) was reported in 52%. Combination of delayed clamping and positioning of newborn at mother’s level or lower was reported in only 19%. Substances used for cord care included surgical spirit (42.4%), local herbs (24.5%), powder (22.6%), ash (21.6%), saline water (10.3%), and tea (2.8%). Cord care instructions given most commonly were: cleaning with warm saline water (27%), spirit or antiseptics (25%), and herb application (7%). Awareness regarding cord infections was poor (20%). Mother’s education level, and age were not associated with cord clamping or care practices. Our study indicates scope for interventions to help improve hemoglobin levels in infancy. Education regarding cord care practices may reduce infections

203-212

Authors: María del Carmen Enríquez Leal, María del Socorro Saucedo Tamayo, María Guadalupe Vidal Ochoa, Martha Nydia Ballesteros Vásquez, Rosa María Cabrera Pacheco, Cecilia Adriana Montaño Figueroa, María Isabel Ortega Vélez

Objective: To determine barriers related to metabolic control and diabetes care in Mexican children and their families. Design: This was a cross-sectional study designed in two stages. First stage was an assessment of risk factors for inadequate metabolic control (HbA1c higher than ADA guidelines by age group) of diabetic children using a logistic regression model. The data sources were 91 clinical files provided by public health institutions at northwest Mexico. Second stage included the design, implementation and evaluation of an educational program (EP) based on the Medical Nutrition Therapy (MNT) and the Social Cognitive Theory (SCT), accounting for critical risk factors identified previously. Twenty five children (2 to 14 years old) with type 1 diabetes and their parents agreed to participate in the EP, which promoted healthy behavioral changes regarding diet, physical activity and medical treatment over a 4-month period. Results: Metabolic control was related to the joint effects of families low socioeconomic level and mother’s low education attainment (OR= 8.5, CI95%: 1.73, 42.16), as well as following a conventional treatment (OR= 5.0, CI95%: 1.09, 22.82). After program implementation participants’ mean glycated hemoglobin (HbA1c) decreased (9.1%±1.8% to 8.3%±2%; P=0.06). Qualitative content analysis of post-intervention interviews showed that low income, clinical inertia, and lack of social support were barriers to metabolic control of diabetes. Conclusion and Implications: Socioeconomic, educational, and healthcare factors are related to metabolic control in Mexican children with diabetes, although educational programs based on SCT can help increase self-efficacy in patients through modeling and reinforcing activities.

219-229

Authors: Mahama Saaka, Shaibu Mohammed Osman, Alhassan Abdul-Mumin, Anthony Amponsem, Juventus Ziem, Ernestina Yirkyio, Eliasu Yakubu, Sean Ervin, Gity Sotoudeh, Parvaneh Yavari, Fereydoun Siassi, Prosper Akanbong

Background: Though treatment of severe acute malnutrition cases in both the in-patient care and the out-patient care has been going on since 2011 at the Tamale Teaching Hospital, little is known about the clinical treatment outcomes and factors that may be associated with the recovery rate in the in-patient setting. This study investigated the clinical treatment outcomes and determinant factors likely to be associated with recovery rates at the Hospital. Methods: We performed a retrospective chart review (RCR) of all pediatric patients aged (0-11 years of age) who were diagnosed of severe acute malnutrition between March 2011 and December 2013. Logistic regression modeling was used to determine the risk factors of severe malnutrition. Results:Of the 630 cases that were reviewed, only 19.5 % recovered (having mid-upper-arm-circumference measure
125 mm, or oedema resolved, or gained 5g/kg/body weight for 2 consecutive days at the time of discharge), 1.7 % defaulted, and 65.2 % were referred to out-patient care units for continued treatment. The observed case fatality rate was 13.5 %. Marasmic cases had more chronic co-morbid conditions at admission compared to kwashiorkor patients (81.7% vs. 69.3%, p=0.01). Conclusions: Case fatality rate in this population was quite high. Case referral to out-patient care unit was appropriately high. Malaria was the most common co-morbid condition diagnosed among the cases reviewed. Younger age, 15% or more increase in weight, and type of malnutrition were the main predictors of recovery from severe acute malnutrition in the in-patient care setting.

240-245

Authors: I. Abok, M. Banwat, S. Oguche, S.N. Okolo, Ayuba Zoakah

Background: The lack of Parental supervision, including psycho social problems and decrease access to basic needs such as food, shelter, clothing, education and health care are examples of the enormous challenges faced by Vulnerable children (VC). These challenges pushes VC to adopt survival and coping strategies, of which some are exposure variables of sexually transmitted infection including HIV infection. In addition, some of these children were orphaned and made vulnerable by HIV. As such, VC should benefit from a health provider initiated counseling and testing for HIV as recommended by the Nigerian HIV policy. However, focus on screening VC for HIV infection has been abysmal; it is on this premise that this study set out to determine the HIV prevalence of vulnerable children in Jos, Nigeria. Methods: Vulnerable children were sampled from 3 different institutions and from households in 3 different communities in Jos, Plateau State with the assistance of Non-Governmental organizations involved in the care of VC. All VC enrolled were interviewed, clinically examined and screened for HIV based on national protocol and standard. Data generated were analyzed using CDC epi info version 7. A p value less than 0.05 was considered statistically significant. Results: Out of the 237 children enrolled 145 (61.2%) were male VC while 92(38.8%) were female vulnerable children, giving a male female ratio of 1.0: 0.6. HIV sero - positivity was identified in 9 of the 237 VC giving a prevalence of 3.8%, amongst the study subjects. Out of the 9 HIV positive VC, 7 VC (77.8%) were resident in institutions; only two household VC were HIV positive. There was no statistically significant association between place of residence, age of VC, gender and type of vulnerability and HIV status among the studied population. Conclusion: The HIV prevalence of 3.8% in vulnerable children is enormous and appears to be higher amongst children resident in orphanages than those in household.

251-254

Authors: Sunday O. Ochigbo, Offiong E. Ikpeme, Atana U. Ewa, Ntia A. Happiness

Background:Asymptomatic Human Immunodeficiency Virus (HIV) infected children are prone to serious bacterial infection as a result of poor immunity.Objective:This wasto determine the common pathogenic organisms responsible for bacteremia among asymptomatic HIV infected children attending the outpatient clinics at the University of Calabar Teaching Hospital, Nigeria. Subjectsand Methods:This prospective non randomized cross-sectional study was conducted over 6months from January 1st to 30th June 2014 among cohorts of HIV infected Anti-retroviral (ARV) naive and experienced children attending the clinic. Ethical approval was obtained from the ethical committee of the institution. Blood culture specimens were collected from all HIV infected patients who met the criteria for enrollment. All specimens with isolated bacteria organisms were treated with antibiotics according to the sensitivity pattern, in addition to administered Anti-retroviral drugs.Results:Out of the total of 109 patients recruited, 38(34.9%) had bacteremia. There were more males (57.9%), and most of them (63.2%) had Highly Active Anti-Retroviral Therapy (HAART) for more than 24weeks. Bacteremia was inversely proportional to the CD4 count. The commonest organism isolated was unclassified Coliforms (47.3%) followed by Staphyloccocus aureus (39.5%). Conclusions: HIV infected children are prone to bacteremia especially among those with low CD4 count. Coliform was the commonest organism isolated. We recommend that HIV infected children be routinely investigated for bacteremia.

135-140

Authors: Fatima Elshikh Elhadi, Ibrahim Awad Ibrahim

Objectives: To assess the coverage rate of measles vaccine among children 12 to 23 months old and causes behind non-immunization in Internally Displaced Persons (IDPs) settlements. Methods: A multistage cluster sampling, community-based, descriptive cross-sectional study was conducted in IDPs Settlements of Khartoum State, Sudan, in 2009. Questionnaires were collected from 210 children (12 to 23 months) old to determine the coverage rate and causes behind non-immunization with measles vaccine. Results: Almost one quarter (24.8%) of children was not vaccinated by measles and the coverage rate was 75.2%; most of them had a vaccination card (86%) which means a high documentation and verification of mothers answers and only 14% verified the immunization status of their children by memory. The major cause of none vaccination was because of the busyness of the mother to take her child for vaccination, which comprises 10% of the children, followed by 6.2% of children not vaccinated because their mothers give no reason for not vaccinating their children. There was evidence of a significant association (P-Value = 0.037) between education level of the mothers' and numbers of children under five years in the family with the immunization of Measles. Conclusion: Coverage of measles vaccination among children aged 12-23 months in IDPs settlements in Khartoum state was reasonably acceptable. The most common reasons for non-immunization were that the caretakers were busy to take their children for vaccination and being unaware of need to return for measles vaccine. Apply a health promotion program and use of different comprehensive interventions to convince mothers to complete measles immunization and increases coverage rate, also plan and implement an effective health education program to increase the awareness of mothers on the importance of measles vaccination.

151-162

Authors: Vandana Prasad, Dipa Sinha

This paper demonstrates the effect of an innovative community-based management programme on acute malnutrition among children under three years of age, through an observationallongitudinalcohort study in tribal blocks in central-eastern India. The key components of the programme include child care through crèches, community mobilisation and systems strengthening to ensure better child feeding and caring practices and delivery of public health and nutrition services. For a cohort of 587 children, the increase in children in the non-wasting category is from 72% to 80% (p<0.001) and the reduction in Severe Acute Malnutrition (SAM) from 8% to 4% (p<0.005), a reduction of 46.6%. Normalcy is fairly well maintained at 89%. Among the severely wasted, 16% show no improvement, 49% moved into a moderate wasting category and 36% to normalcy over 4-6 months. Among the moderately wasted, 26% showed no improvement and 7% declined to a severely wasted category, and 67% moved to normalcy. The average Weight for Height Z-score (WHZ) for the cohort improved from -1.41 in the initial period to -1.13 in November (p<0.0001). This study suggests that this medium term strategy using a rights-based participatory approach for community based management of malnutrition may be comparatively effective by current WHO guidelines and other known community based interventions in terms of mortality, cost, degree and pace of improvements.

174-179

Authors: Paolo Polidori, Ambra Ariani, Silvia Vincenzetti

Human breast milk is the best nutritional support that insure the right development and influence immune status of the newborn infant. However, when it is not possible to breast feeding may be necessary to use commercial infant formulas that mimic, where possible, the levels and types of vitamins, minerals and other nutrients present in human milk. Despite this, some formula-fed infant develops allergy, atopic disease and differences in response to infection with respect to breast-fed infants. Donkey milk may be considered a good substitute for dairy cow’s milk derivatives in feeding children with severe Cow’s Milk Protein Allergy (CMPA) since its composition is closer to human milk compared to other species commonly bred. It has been proposed as an alternative to cow’s milk for children affected by CMPA when it is not possible breast feeding. Donkey milk is characterized by a low casein content, with values very close to human milk, and also total whey protein content in donkey milk is very close to that found in human milk but higher compared to bovine milk. Donkey milk has been used in several clinical trials involving children affected by CMPA because of the low allergenicity of this milk. The results shown in this review confirmed the nutritional characteristics of the protein fractions of donkey milk and the possibility of using donkey milk in feeding children with CMPA, particularly after an adequate lipid integration, including children with multiple food allergies.

78-82

Authors: Josephine Oyebimpe Ajala, Abosede Catherine Ojerinde

Anaemia in children under five years old is a public health concern worldwide. In developing countries about 12 million children under five years old die each year from preventable causes. The deaths of over 6 million are either directly or indirectly attributed to malnutrition, mainly under-nutrition that leads to anaemia and constitutes a high percentage of infant and child mortality. This descriptive survey attempted to assess the knowledge of mothers on factors associated with anaemia among children under five years old in the child welfare clinic at Orile-Agege General Hospital, Lagos. The 120 respondents were conveniently selected and data was collected through a close ended question items and analyzed with Pearson Product Moment Correlation. The findings revealed that 111(92.5%) of the respondents agreed that one of the major causes of anaemia was malnutrition. Consequently, respondents agreed that children who suffer from anaemia are prone to infections, delayed psychomotor development, poor academic performance and low scores in intelligent (IQ) tests which deprived them the opportunity to be physically fit and function at optimal level. There was no significant relationship between occurrence of anaemia and mothers’ educational status (r = .29) as well as their socio economic status (r = .091). The religious belief of the respondents also had no bearing with the occurrence of anaemia (r =.152). It was therefore recommended that there is need for more public enlightenment on the causes, prevention and complications of anaemia. Capacity building for health care providers to adequately equip them with updates and facts on the management of prevailing rate of anaemia effectively.

90-93

Authors: Silvia Arboleya, Clara G. de los Reyes-Gavilán, Dimitris Konstantinou, Maria Skouroliakou, Miguel Gueimonde

Preterm babies are born with an immature intestine and are at higher risk for intestinal failure and needing for parenteral nutrition than full-term newborns. These babies show an altered intestinal microbiota, which may results of key importance for later health. However, there is a lack of information on effect of parenteral formulas upon the establishing infant microbiota. Moreover, the microbiota alterations present in preterm newborns have been related with an altered redox-potential which hinders the establishment of strict anaerobes. Thus, interventions aimed at reducing the oxidative stress in these infants, including those under parenteral nutrition, could also affect the intestinal microbiota composition. We assessed the effect upon the gut microbiota of the administration during 30 days of a lipid emulsion, containing ω3 polyunsaturated fatty acids and α-tocopherol, or a control emulsion containing soybean-bases lipids to parenterally-fed preterm newborns. In spite of its high antioxidant potential, the infants receiving the experimental fat emulsion showed a trend to increase of facultative anaerobes such as enterobacteria and specifically of Klebsiella. This study stresses the need of further work monitoring the impact of early-life parenteral nutrition on the establishment of the intestinal microbiota.

112-121

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

Objective: This study examined the impact of various levels of 100% fruit juice (FJ) consumption on intake of nutrients, diet quality, and weight in children using the more recent national data. Methods: This was a cross-sectional study examining the data from children 2-18 years of age (n=6,090). Intake of nutrients and diet quality were assessed using the 24-hr dietary recall and Healthy Eating Index-2010, respectively. Various consumption levels of 100% FJ were determined. Covariate adjusted linear regression means, and standard errors were determined (p<0.01). Results: Average per capita consumption of 100% FJ consumed was 3.6 fl oz (50 kilocalories; 2.9% energy intake); 30% of children 2-6 years exceeded the recommendation for 100% FJ. Among 100% FJ consumers, the mean amount of 100% FJ consumed was 10.6 fl oz (147 kilocalories; 8.4% energy intake). Intakes of vitamin C, magnesium, and potassium and overall diet quality were higher with more 100% FJ consumed; no difference was found in total fiber intake. No trends were seen in weight with increased amounts of 100% FJ consumed. Conclusions: Consumption of 100% FJ should be recommended as a component of a healthy diet.