International Journal of Child Health and Nutrition

92-103

Authors: Mahama Saaka, Solomon Addae Takyi, Tetteh Maxwell

Introduction:The main aim of this study was to assess the practice of exclusive breastfeeding (EBF) and explore its determinants in Tamale Metropolis, Northern Ghana. Methods:In this analytical cross-sectional study, systematic random sampling was used to select 355 mother- infant pairs between 0-6 months from among consenting mothers attending post natal care at the Tamale Teaching and West Hospitals in the Tamale Metropolis. Results:The prevalence of EBF among infants < 6 months in the Tamale Metropolis for the past 24 hours was 92.1 % but it was 75.5 % in the one month prior to the study. In logistic regression analyses, factors that had significant positive association with EBR were institutional delivery, current mother’s employment, maternal motivation and household wealth index. Compared to home delivery, women who delivered at a health institution were five times more likely to practice EBF (Adjusted odds ratio [AOR] = 5.17, CI: 2.45 – 10.90). Petty traders were four times more likely to exclusively breastfeed, compared to women who were unemployed (A OR = 4.05, CI: 1.93 – 8.51). EBF provided 80 % (Adjusted OR = 0.2, CI: 0.08-0.37) protection against chronic malnutrition whilst high household index reflecting socio-economic status provided only 10 % protection against chronic malnutrition in the study sample (Adjusted OR = 0.9, CI: 0.81- 0.98). Conclusion and Recommendation:Strategies that target improving knowledge and skills on lactation management among women, as well as strategies to improve health facility delivery especially among non-working mothers, may help to improve EBF in Northern Ghana.

113-134

Authors: Jocelyn E. Finlay

Objective:To examine the association of contraceptive use in the interpregnancy interval with subsequent child health outcomes in low- and middle-income countries. Design: Across-sectional analysis of nationally representative household samples was performed. A modified Poisson regression model was used to estimate unadjusted and adjusted relative risk ratios for high prevalence outcomes. Setting: Low- and middle-income countries. Population: Births to women aged 12-49 years for which this birth occurred 12-79 months prior to the interview were included. The sample for analysing infant mortality was comprised of 453,795 children from 35 low- and middle-income countries across 67 Demographic and Health Surveys conducted between 1990 and 2011. Main Outcome Measures: Infant mortality, stunting, underweight, wasting, diarrhoea, and anaemia. Results:Contraceptive use in the interpregnancy interval, even if contraceptive failure resulted in birth, had a positiv e effect on all child health outcomes compared to non-use of contraception in the interpregnancy interval. The positiv e effect of contraceptive use was the lengthening of the interpregnancy interval, but it also had a direct positive effect on child health, independent of birth interval. Conclusions:Extending the interval between births had a positive effect on child health outcomes, and contraceptive use had a positive effect on child health independent of the birth spacing effect. Additionally, contraceptive failure did not adversely affect child health outcomes.

148-156

Authors: Mahama Saaka

Objective:Little is known regarding the role of maternal dietary diversity score (DDS) in predicting poor outcomes of pregnancy including preterm delivery, and low birth weight (LBW).The main aim of this studywas to explore the relationship between dietary diversity scores of urban Ghanaian women and infant weight at birth. Methods:This analytical cross-sectional study comprised 524 pregnant women who delivered singleton babies. A Structured questionnaire was used to collect data on socio-demographic variables (e.g. educational status, age, maternal occupation, household wealth index), obstetric history (for example, gravidity, gestational weight gain), dietary intake, malarial infection and Sulphadoxine pyrimethamine (SP) uptake, blood pressure (BP), haemoglobin concentration (Hb), anthropometric measurements (e.g. weight of mother and new born baby). Results:This study showed that maternal dietary diversity as measured by individual dietary diversity score scores (IDDS) was a significant independent predictor for mean birth weight and LBW. Analysis of covariance (ANCOVA) showed there was a significant difference in adjusted mean birth weight between women on low and high diversified diets , F (1, 415) = 8.935, p = 0.003. The results further showed that maternal IDDS was negatively associated with the incidence of LBW (Adjusted OR = 0.43, 95% CI = 0.22–0.85, p = 0.014). Conclusion:In nutritional deprived populations, maternal diet in the third trimester appears to be an important determinant of LBW and that DDS can serve as useful predictive indicator of maternal nutrition during pregnancy and the likelihood of delivering LBW babies.

11-22

Authors: Carol E. O'Neil, Theresa A. Nicklas, Sheryl O. Hughes, Yan Liu

Objective: To examine the energy and nutrient intake of dinner of low income preschool minority groups, African-Americans and Mexican-Americans, attending Head Start (HS). Design: Cross-sectional study of intake at dinner using digital photography was undertaken. Pictorial records were converted to energy and nutrient intakes using NDS-R Nutritional software. Means±SE for total grams of food and beverages, energy, and macro- and micro-nutrients were determined and compared with recommendations. Setting:Home assessment dinner of children enrolled in HS in Houston, TX. Subjects: Low-income children (n=214), 3 to 5 years (mean age 4.4 ± 0.7 years; 48% boys; 53% Mexican-American). Results: Energy from food and beverages and food was 350.29±10.36 kcals and 302.35±10.46 kcals, respectively. Mean protein, carbohydrate, and total fat intakes were 14.22±0.52 g (16.32% of total energy), 44.33±1.25 g (52.24%), and 13.18±0.56 g (32.29%), respectively, which provided 95.4±0.52%, 44.5±1.25%, and 10.4±0.11% of the requirements for protein, carbohydrate, and dietary fiber, respectively; these were consistent with recommendations. Intakes of vitamin D, calcium, and potassium were 0.66±0.08 mcg, 102.61±5.03 mg, and 404.42±13.63 mg, respectively; which constituted only 6.6±0.08%, 12.7±5.03%, and 10.7±13.63% of these nutrients of public health concern. Conclusions:Children participating in HS had low intakes of nutrients of public health concern at the dinner meal. The dinner meal is an integral part of the daily intake of preschool children and this study suggests that micronutrient intakes could be improved. It is important to educate mothers and children as to what constitutes a nutrient-dense meal and to confront barriers to consumption of these meals

28-38

Authors: Sandra C Jones, Lisa Kervin, Samantha Reis, Parri Gregory

The current study sought to explore discrepancies between children’s stated snack food motivations and actual food choices, using the Implicit Association Test (IAT) as a measure of implicit attitudes towards ‘healthy’ and ‘unhealthy’ foods. Participants were children aged 6-12 years (n=118), from two primary schools on the South Coast of NSW, Australia – a public school in a semi-rural suburb south of a sea-side city and a public school in a largely residential northern suburb of the same city. The children completed a questionnaire about motivations for snack choices, participated in an activity, completed two further questionnaires, selected snack foods from an in-class store, and participated in two rounds of an IAT ‘game’ pairing pictures of snack foods with positive and negative words. As hypothesized, the majority of children reported ‘healthiness’ as their primary motivator for snack food choice, but when faced with an actual purchase decision predominantly chose unhealthy snacks. It appears that children may have internalized the ‘moral’ values attributed to healthy and unhealthy foods and that this process influences both their explicit and implicit attitudes. However, their actual food choices are likely to be influenced by other factors, and thus more complex to understand and influence.

44-58

Authors: Fang Fang Zhang, Edward Saltzman, Aviva Must, Susan K. Parsons

Despite advances in cancer treatment, childhood cancer survivors are at higher risk of developing chronic health conditions than peers who have not had cancer. Being overweight or obese adds to the already elevated risk of cardiovascular diseases and metabolic abnormalities. Diet and physical activity are modifiable behaviors that reduc e obesity risk and have been shown to improve cancer survival in adult cancer survivors. Specific guidelines have been developed for cancer survivors that provide advice on nutrition, physical activity and weight management following cancer diagnosis and treatment. In this review, we report on existing nutrition and physical activity guidelines for cancer survivors, supplemented by available literature on diet and physical activity status of childhood cancer survivors and their associations with health-related outcomes. The 2012 American Cancer Society (ACS) and the 2008 Children’s Oncology Group (COG) guidelines provide similar advice on diet but the ACS guidelines also offer specific advice on physical activity and weight management. Thirty-one observational studies and 18 intervention trials published prior to June 2012 that met the inclusion criteria were reviewed. Results suggest that a high proportion of childhood cancer survivors had poor adherence to dietary and physical activity guidelines. Although findings from existing intervention trials are preliminary due to small sample size, available evidence suggests that exercise intervention is safe and feasible for patients and survivors of childhood cancer. Childhood cancer survivors should be encouraged to engage in physical activity, adopt a healthy diet, and maintain a healthy weight throughout cancer survivorship

66-71

Authors: Syed Rehan Ali, Shakeel Ahmed, Sobia Nizami, Maqbool Qadir

Objective: This study aimed to evaluate the accuracy of the urine dipstick in diagnosing UTIs in children at a tertiary care centre in Pakistan. Methods: 72 inpatients at the Aga Khan Hospital pediatric ward, getting laboratory urinalysis due to UTI suspicion, were included. Dipstick tests were done on the urine samples being sent to the lab for microscopy. The sensitivity, specificity and likelihood ratios (LRs) of dipstick LE, and pyuria and bacteriuria on microscopy were calculated and compared, using urine culture results as the gold standard for diagnosis. Results: The specificity of dipstick LE, pyuria and bacteriuria were 77%, 77% and 90% respectively, while the positive likelihood ratios were was 28%, 44% and 49% respectively. Urine cultures were done for 58 patients, with 5 positive cultures, so plausible estimates of sensitivity were not made. Conclusions: Urine microscopy is a more accurate screening test for ruling in UTIs than the dipstick. Keeping in mind its diagnostic limitations, the dipstick can be used to help rule in a UTI, although confirmation by cultures is recommended. Further studies are needed to validate these results in children and to evaluate the dipstick’s sensitivity for ruling out disease.

82-85

Authors: Abel Makubi, D. Soka, J. Makani

Background: Neurological complications are a significant cause of morbidity and mortality in sickle cell patients with reported incidence of stroke in Africa as high as 1
3/100 patient per year [1,2]. There is an association between sickle cell disease (as well as other hemoglobinopathies) and Moyamoya disease [3]. Data on the occurrence of this condition in African sickle patient are scare. Likewise the role of hydroxyurea among patients with both sickle cell anemia and Moyamoya disease in preventing stroke has not yet been studied in Africa. Case presentation: In the present report, we describe an African child who had a recurrent stroke. She was later diagnosed as having Moyamoya disease while already receiving hydroxyurea. Conclusion: Moyamoya disease is a rare condition associated with recurrent stroke in African sickle children. The role of hydroxyurea in this context is still unclear.