International Journal of Child Health and Nutrition

130-147

Authors: Nèmanan R. Ninamou, Jérémie B. Dupuis, Noël-Marie Zagré, Mamady Daffé, Sonia Blaney

Water provision to infants under six months of age (IU6M) can hamper exclusive breastfeeding (EBF). Understanding factors and their relationships influencing this practice is needed to tailor EBF promotion programs. Using a validated questionnaire, this study aims to identify pathways in which individual factors and the environment interact to affect the provision of water in addition to breast milk among 300 mothers of IU6M. Our finding shows that 75% of mothers intended to provide water in addition to breast milk to their IU6M and that about 60% reported doing it. Results of the final path show that the subjective norm/SN (β = 0.432, p < 0.001), the attitude (β= 0.349, p < 0.001), and to a lesser extent the perceived control/PC (β = 0.141, p = 0.005) predict the intention of mothers to provide water in addition to breast milk to their IU6M. The environment scores predict the attitude (β = 0.210, p = 0.001) and the SN (β = 0.284, p< 0.001). Having the mother practicing early breastfeeding initiation at birth positively predicted the PC score (β = 0.157, p = 0.017) and predicted an increasing score of SN (β = 0.221, p = 0.003). Even though predicting the final behavior is complex, this research provides directions to nutrition education programs to tailor their content to the context and be more efficient in reducing the proportion of women providing water to their IU6M, hence contributing to the improvement of EBF.

154-161

Authors: Allico Mousso Jean Maurel, Agbo Adouko Edith, Séri Kipré Laurent, Boyvin Lydie, Kouamé Christophe, Yapi Houphouët Félix, Djaman Allico Joseph

The objective of this work was to study the impact of food diversification based on sweet potato, soybean, and cowpea on the prognostic inflammatory and nutritional index (PINI) in school-aged children in the Nawa region. This study took place from October 2017 to May 2018 among 240 pupils aged 6 to 12, divided into four groups of 60. Four types of meals were proposed: rice with tomato soup and fish (group 1), sweet potato porridge enriched with green soybeans (group 2), sweet potato porridge enriched with white cowpea (group 3), or sweet potato porridge accompanied by white cowpea with green soybeans (group 4). There were three blood samples: before eating meals (phase 0), the end of the first trimester (phase 1), and the end of the second trimester (phase 2). Blood assay for C-reactive protein (CRP), orosomucoid, albumin, and prealbumin was performed using COBAS c311 analyzer. PINI was calculated. Groups 3 and 4 showed a slight increase in albumin values (42.24 ± 0.95 g/L and 41.51 ± 1.71 g/L, respectively) compared to group 1. CRP decreased from phase 1 for group 1 (2.06 ± 0.26 mg/L) and group 4 (2.38 ± 0.36 mg/L). Orosomucoid increased insignificantly (p > 0.05) in group 3 (0.74 ± 0.04 g/L) and group 4 (0.71 ± 0.04 g/L). PINI was reduced by 0.37 (group 1), 0.36 (group 2), 0.46 (group 3) and 0.44 (group 4). Food diversification based on sweet potato and white cowpea has a positive impact on PINI in more than 80% of pupils

80-87

Authors: Teresia Mbogori, James Muriuki

Objective: To identify the demographic, social, and economic determinants of malnutrition in Kenya's children aged 0-23 months.Methods: Data from the Kenya Demographic and Health Survey (KDHS), a nationally representative cross-sectional study conducted in 2014/2015, were used in this study. Data from children 0-23 months old with complete information on weight, height, age, and sex were used for analysis. Height for Age Z scores (HAZ), Weight for Height Z scores (WHZ), and BMI for age Z scores (BAZ) was determined using WHO guidelines to determine the nutritional status of the children. Chi-square statistics were used to determine the relationship between social-economic status and place of residence indicators and the nutritional status of the children. Significance was set at p <0.05.Results: Among all participating (n=7578), 22.7% were stunted (HAZ < -2), 6.2% were wasted (WHZ < -2), and 6.1% were either overweight or obese (BAZ > 2). Wasting and stunting were significantly higher in children from rural areas, poorer wealth index, and mothers with no education. In contrast, children from urban areas, the richest wealth index category, and mothers with secondary or higher education were significantly more likely to be overweight or obese. Conclusion: Current and future policies and programs to curb malnutrition in Kenya need to target specific needs of children based on their social-economic status, area of residence, and other demographic characteristics that were identified as determinants of child malnutrition instead of using a general approach

105-115

Authors: Beyhan Özge Yersel, Lugen Ceren Gunes, Ender Durualp

The aim of this descriptive study was to examine the views of parents with children between the ages of 3-6 on their children's daily life activities during the pandemic. The study sample was composed of 65 parents, among whom 60 were mothers, and five were fathers, who were selected with the snowball method and who had children between the ages of 3-6 and voluntarily participated in the study. The data were collected through the General Information Form and the Family Interview Form, which were developed in line with expert opinions. The collected data were analyzed using percentage and frequency values. The findings suggested that, during the pandemic, the children's family relationships were positively affected; the duration of using technological tools increased; the children started to wash their hands more carefully; and duration of activities, such as drawing and chores, and plays increased. It was also found that the children mostly preferred piece assembly games; their physical movement needs were not fully satisfied; and there was no change in their health conditions, self-care skills, diet, sleep patterns, interactive book reading, and purposes of using technology. In line with the findings, parents, experts were given specific recommendations.

121-129

Authors: Yenefenta Wube Bayleyegne

Background: Stunting is a well-established child health indicator of chronic malnutrition related to environmental and socio-economic circumstances. In Ethiopia, childhood stunting is the most widely prevalent among children under the age of five years. Objective: To estimate the prevalence of stunting and model the determinants of stunting prevalence among children under age five in Ethiopia. Methods: Data were extracted from 2016 EDHS, and samples of 8487 children under age five were used in this study. The sample was selected using a two-stage stratified sampling process, and a multilevel logistic regression model was used to determine the factors associated with childhood stunting in Ethiopia. Results: This study revealed that the prevalence of stunting among children under age five years in Ethiopia was around 39.39%. The multilevel binary logistic regression analysis was performed to investigate the variation of predictor variables of stunting prevalence among children under age five. Accordingly, it has been identified that the ages of the child above 12 months, male gender, children from poor households, and no mother education significantly affect the prevalence of stunting in Ethiopia. It is found that variances related to the random term were statistically significant, implying a variation in the prevalence of stunting across Ethiopia's regional states. Conclusion: The current study confirmed that the prevalence of stunting among children under aged five years in Ethiopia was a severe public health problem. Therefore, governmental or stakeholders should pay attention to all the significant factors mentioned in this study's analysis.

44-50

Authors: Nigus Bililign Yimer, Misgan Legesse Liben

Background: A skilled birth attendance for every pregnant woman during childbirth is the most crucial intervention for improving maternal health. This study aimed to assess institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Raya Kobo district, Ethiopia. Methods: A community-based cross-sectional study was carried out in the Raya Kobo district of Amhara Regional State during March 2016. Logistic regression analysis was performed to assess the association between each independent variable and the outcome variable. Variables with a p-value <0.05 were considered significant. Results: A total of 493 mothers were included in the study, with a response rate of 95.4%. The mean (+SD) age of the study participants was 29.13 (±6.93) years. About 73% of the study participants had attended at least one antenatal care follow up for their last pregnancy, and 56.6% (95% CI: 52.0, 61.0%) gave birth at health institutions. Travelling for 30 minutes and less [AOR=2.95(1.89, 4.58)], attending antenatal care [AOR=6.0(3.55, 10.13)], having knowledge about intrapartum danger signs [AOR=2.48(1.44, 4.24)] and getting information from health extension workers (HEWs) regarding maternal health services were positively associated. Conclusion: The district health office should strengthen its effort to provide free ambulance accessibility and provide information on danger signs of intrapartum complications and the importance of using institutional delivery service to every mother who came to the antenatal clinic. Furthermore, the district health officials should focus on strengthening the capacity of HEWs in relation to maternal health services.

59-73

Authors: Vladyslav Deputatov, Mariana Velykodna

The body image is to be reconstructed during adolescence, which is more difficult in the case of somatic illness and social stigma. This research aimed to study adolescents' body image with scoliosis, students of a special educational institution in Ukraine socially identified with stigma as 'a school for scoliotics'.The participants (n=104) of the research were adolescents (13-15 years old) with scoliosis from the institution mentioned above (n=52, 24 males, 28 females) and adolescents without scoliosis from the same city (n=52, 24 males, 28 females). Two methods were used to collect the data: (1) Self-portraits; (2) Dembo-Rubinstein Self-Assessment Scale. The adolescents with scoliosis and labeled as 'scoliotics' face additional obstructions in their psychic body development compared to their peers. For instance, they tend to overinvest in the desired image of a healthy body and do not feel able to get it. We found the markers of four different ways to cope with the situation by the adolescents with scoliosis: (a) identification as 'a scoliotic' instead of hope to be cured soon; (b) psychological distancing from the others to preserv e the desire of a more attractive body image; (c) repression or denial of the body parts which could relate to scoliosis; (d) infantilization, aimed to slow down the discovery of their maturing corporeality. Consequently, adolescents with scoliosis affected by stigma experience the gap or conflict between their current, desired and perceived realistic body image

1-8

Authors: Aminata Ndene Ndiaye, Isabelle Galibois, Sonia Blaney

Intake of iron-rich foods was investigated in Senegalese adolescent girls. A cross-sectional survey was conducted among 136 girls aged 13 to 18, attending two colleges in Dakar. Data on the consumption of iron-rich foods over the previous week were collected through a food frequency questionnaire. Results show that 12% of the girls had consumed dishes made with iron-rich foods 3 times or less in the past seven days, 34%, 4 to 6 times, and 54%, 7 times and above. However, 83% of the girls had an intake of iron-rich foods below the 84 g per day recommended for animal protein sources by the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems. The diet of Senegalese adolescent girls seems conducive to iron deficiency. To define effective interventions to improve the situation, investigating underlying factors to the low consumption of iron-rich foods is warranted

17-23

Authors: Maryam Mirmotalebi, Behshid Garrusi* and Mina Danaei

Background and Objective: Evaluation of the severity of pain in children can help the medical team diagnose the type of disease. In this study, anxiety and pain intensity in children were examined based on self-report. Materials and Methods: This cross-sectional study was performed in 2018 on 300 children aged 3 to 12 years, referring to outpatient treatment centres in Kerman. To measure the severity of pain felt by children, FPS-R was used. The level declared by children was evaluated by the pain intensity estimated by parents and doctors using a visual analogue scale (VAS) and the standard FLACC (Face, Legs, Activity, Cry, Consolability scale) for correlation. The data were analysed using SPSS software version 25. Results: The pain reported by children was obtained by VAS (4.16 ± 3.49), and the estimated pain by the doctor was obtained by FPS-R (2.87±1.68). The pain severity estimated by the doctor using FLACC had the highest correlation with the pain estimated by the doctor using VAS and the lowest correlation with the pain estimated by the mother using VAS. Conclusion: The results of this study showed that FPS-R could be used as a suitable self-report tool in children and, along with the standard FLACC, can help the medical team recognize the severity of children's pain

34-43

Authors: Fassikaw Kebede, Nemera Eticha, Belete Negese, Mastewal Giza, Tadesse Tolossa, Bizuneh Wakuma

Malnutrition (over and undernutrition) is a major public health problem across the globe, especially undernutrition is responsible for one-third of the death of children in underprivileged populations. Each year more than 25 to 35 million under-five children have suffered from Severe Acute Malnutrition (SAM). The sub-Saharan African countries account for the lion's share of this case fatality rate. The case in Ethiopia is not different from other countries. This study's main aim is to assess predictors for the cure rate of Severe Acute Malnutrition in 6-59 month Children in stabilizing center at Pawe General Hospital, Northwest Ethiopia. A retrospective cohort study. Methods: Hospital-based retrospective cohort study was employed among 454 admitted under-five SAM children from Januarys1st 2015-to December 30, 2019. Data were cleaned, coded, and entered into Epi-Data 3.1; then exported to STATA/SE- 14/R for analysis. Survival analysis was used to check each variable's proportional hazard assumption and no variable Schoenfield test <0.05. Variable with AHR at 95 % CI at P-value less than 0.05 considered as significant. Final model adequacy was checked by Nelson Alana and Cox Snell residual plot test. Result: Totally 454 (90.4%) individual data were included for final analysis; Sixty-five percent of 65.4% (95%CI: 50.1- 69.2) admitted children declared as cured, 16.52 % of them defaulted and 11.5% of children reported as dead. The median age and median cure time of SAM children were found at 2.2 years and 13 days (±7), respectively. Children diagnosed marasmus (AHR=1.56: 95% CI 1.08--2.2, p<0.018), with No nasal-gastric intubation (NGT) during admission (AHR= 1.31: 95%CI (1.04 --1.67, P<0.029) and taking F-100 milk (AHR=5.42 95% CI (2.92--9.85, p<0.001) were associated with treatment cure rate. The conclusions: The overall treatment cure rate of this study was remaining low at 65.4% compared to the sphere standard sets reference (i.e., >75-77.9 %). Concerning associated factors addressing F-100 milk, making SAM underfive children with no NGT and increased treatment cure rate was independently associated with treatment cure rate