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Effects of complementary feeding on attained height among lower primary school-aged children in Eastern Uganda: A nested prospective cohort study.

ABSTRACT: BACKGROUND:Despite the fact that Uganda has been a signatory to the global strategy for Infant and Young Children Feeding practices (IYCF) for nearly a decade, the prevalence of stunting among children under five years of age remains tragically high at 17% in Eastern Uganda and twofold higher countrywide. Only 6% of all children aged 6-23 months feed adequately. This study aimed to establish the covariates of complementary feeding (CF) and its effect on attained height among primary school-aged children in Mbale district (Eastern Uganda). METHODS:This was a community-based prospective cohort study using data from the PROMISE EBF trial. The main exposure variable was adequate complementary feeding (CF) measured in a parent questionnaire at 18-24 months of age. We defined adequate CF as having received animal food, cereals and fruit, juice and/or vegetables during the 24 hours preceding the interview. An adapted minimum acceptable diet was defined as having been given milk or milk products at least twice a day, an adapted meal frequency of two and solid or semi-solid food from at least four food groups on a 24-hour dietary recall based on modified IYCF criteria. The main outcome variable was attained height [(height-for-age Z score (HAZ)] measured between five and eight years of age using the WHO growth standards. Effects of CF on HAZ were estimated using linear regression analyses with cluster-robust standard errors. RESULTS:A total of 506 children were studied. The majority (85%) were from rural areas and the average age at the end of the study was 6.9 (standard deviation: 0.63) years. Of these, 23.9% were adequately fed and 2.3% received the adapted minimum acceptable diet. Adequate CF was not associated with HAZ (adjusted ? = -0.111; 95% CI: -0.363, 0.141; p = 0.374). Factors significantly associated with attained height were baseline HAZ (0.262; 0.152, 0.374; p<0.001) and WHZ (-0.147; -0.243, -0.051; p = 0.004), child's age (0.454; -0.592, -0.315; p<0.001) and maternal education (0.030; 95% CI: 0.003, 0.057; p = 0.034). CONCLUSION:Adequate CF at age 18-24 months was worryingly insufficient and not associated with attained HAZ at age 5-8 years. Further strategies need to be considered to improve child nutrition and linear growth in resource-constrained settings.

SUBMITTER: Bwenge Malembaka E

PROVIDER: S-EPMC6366764 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Effects of complementary feeding on attained height among lower primary school-aged children in Eastern Uganda: A nested prospective cohort study.

Bwenge Malembaka Espoir E Tumwine James K JK Ndeezi Grace G Engebretsen Ingunn Marie Stadskleiv IMS Tylleskär Thorkild T Wamani Henry H Sommerfelt Halvor H Nankabirwa Victoria V

PloS one 20190207 2

<h4>Background</h4>Despite the fact that Uganda has been a signatory to the global strategy for Infant and Young Children Feeding practices (IYCF) for nearly a decade, the prevalence of stunting among children under five years of age remains tragically high at 17% in Eastern Uganda and twofold higher countrywide. Only 6% of all children aged 6-23 months feed adequately. This study aimed to establish the covariates of complementary feeding (CF) and its effect on attained height among primary scho ...[more]

PMID: 30730915

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Project description:BackgroundDurations of exclusive breastfeeding (EBF) and predominant breastfeeding (PBF) from two different assessments, among the same mother-infant population, were investigated to determine the degree to which the assessments yielded overlapping results.MethodsThirty Ugandan mother-infant pairs were followed up weekly from birth to three months of age with weekly short-time feeding recall: the 24-hour recall asked prior to the 1-week recall. In addition, at week 6 and 12 dietary recalls since-birth were conducted. Variables for the duration of EBF and PBF were created from the short-time feeding recalls and the dietary recalls since-birth, respectively. Mean durations of EBF and PBF from the two assessments were compared with Kaplan Meier analysis at week 6 and 12. Reproducibility of dietary recall instruments was also assessed.ResultsAt six weeks postpartum the mean durations of EBF were 0.50 weeks (95% CI: 0, 1.02) according to the weekly short-time recalls and 1.51 weeks (95% CI: 0.66, 2.35) according to the recall since-birth (Mantel-Cox test, p = 0.049). The mean durations of PBF were 4.07 weeks (95% CI: 3.38, 4.77) according to the frequent short-time recalls and 4.50 weeks (95% CI: 3.93, 5.07) according to the recall since-birth, (Mantel-Cox-test, p = 0.82). At twelve weeks the mean durations of EBF were 0.5 weeks (95% CI: 0, 1.1) according to the weekly short-time recalls and 1.4 weeks (95% CI: 0.1, 2.7) according to the recall since-birth (Mantel-Cox-test, p = 0.15). The mean durations of PBF were 5.2 weeks (95% CI: 3.9, 6.5) according to the weekly short-time recalls and 6.6 weeks (95% CI: 5.4, 7.8) according to recall since-birth (Mantel-Cox-test, p = 0.20). Reports of feeding categories and early feeding practices showed high reproducibility.ConclusionComparing duration of EBF and PBF in this group of mother-infant pairs showed overlapping results from the weekly short-time assessment and the recall since-birth at twelve weeks, with the latter yielding slightly longer duration of the respective feeding modalities. The retrospective recall since-birth could be assessed as a cost-reducing tool compared to the frequent follow-up addressing duration of respective infant feeding modalities for evaluation of programmes promoting safer infant feeding practices.Trial registrationThe study was part of formative studies for the ongoing study PROMISE EBF registered at http://clinicaltrials.gov, NCT00397150.

Project description:In resource-poor settings, HIV positive mothers are recommended to choose between 'Exclusive breastfeeding' (EBF) or 'Exclusive replacement feeding' (ERF). Acceptability, Feasibility, Affordability, Sustainability and Safety (AFASS) has been the World Health Organization (WHO)'s a priori criteria for ERF the last ten years. 'AFASS' has become a mere acronym among many workers in the field of prevention of mother-to-child transmission of HIV, PMTCT. Thereby, non-breastfeeding has been suggested irrespective of social norms. EBF for the first half of infancy is associated with huge health benefits for children in areas where infant mortality is high. But, even if EBF has been recommended for a decade, few mothers are practicing it. We set out to understand fathers' and mothers' infant feeding perceptions and the degree to which EBF and ERF were 'AFASS.'Eight focus groups with 81 informants provided information for inductive content analysis. Four groups were held by men among men and four groups by women among women in Mbale District, Eastern Uganda.Two study questions emerged: How are the different feeding options understood and accepted? And, what are men's and women's responsibilities related to infant feeding? A mother's commitment to breastfeed and the husband's commitment to provide for the family came out strongly. Not breastfeeding a newborn was seen as dangerous and as unacceptable, except in cases of maternal illness. Men argued that not breastfeeding could entail sanctions by kin or in court. But, in general, both men and women regarded EBF as 'not enough' or even 'harmful.' Among men, not giving supplements to breast milk was associated with poverty and men's failure as providers. Women emphasised lack of time, exhaustion, poverty and hunger as factors for limited breast milk production. Although women had attended antenatal teaching they expressed a need to know more. Most men felt left out from health education.Breastfeeding was the expected way to feed the baby, but even with existing knowledge among mothers, EBF was generally perceived as impossible. ERF was overall negatively sanctioned. Greater culture-sensitivity in programs promoting safer infant feeding in general and in HIV-contexts in particular is urgently needed, and male involvement is imperative.The study was part of formative studies for the ongoing study PROMISE EBF registered at http://clinicaltrials.gov (NCT00397150).

Project description:BACKGROUND: The choice of infant feeding method is important for HIV-positive mothers in order to optimise the chance of survival of their infants and to minimise the risk of HIV transmission. The aim of this study was to investigate feeding practices, including breastfeeding, in the context of PMTCT for infants and children under two years of age born to HIV-positive mothers in Uganda. METHODS: In collaboration with The Aids Support Organisation Mbale, we conducted a cross-sectional survey involving 235 HIV-positive mothers in Uganda. Infant feeding practices, reasons for stopping breastfeeding, and breast health problems were studied. Breastfeeding duration was analysed using the Kaplan-Meier method based on retrospective recall. RESULTS: Breastfeeding was initiated by most of the mothers, but 20 of them (8.5%) opted exclusively for replacement feeding. Pre-lacteal feeding was given to 150 (64%) infants and 65 (28%) practised exclusive breastfeeding during the first three days. One-fifth of the infants less than 6 months old were exclusively breastfed, the majority being complementary fed including breast milk. The median duration of breastfeeding was 12 months (95% confidence interval [CI] 11.5 to 12.5). Adjusted Cox regression analysis indicated that a mother's education, socio-economic status, participation in the PMTCT-program and her positive attitude to breastfeeding exclusively, were all associated with a reduction in breastfeeding duration. Median duration was 3 months (95% CI 0-10.2) among the most educated mothers, and 18 months (95% CI 15.0-21.0) among uneducated mothers. Participation in the PMTCT program and being socio-economically better-off were also associated with earlier cessation of breastfeeding (9 months [95% CI 7.2-10.8] vs. 14 months [95% CI 10.8-17.2] and 8 months [95% CI 5.9-10.1] vs. 17 months [95% CI 15.2-18.8], respectively). The main reasons for stopping breastfeeding were reported as: advice from health workers, maternal illness, and the HIV-positive status of the mother. CONCLUSION: Exclusive breastfeeding was uncommon. Exclusive replacement feeding was practised by few HIV-positive mothers. Well-educated mothers, mothers who were socio-economically better-off and PMTCT-attendees had the shortest durations of breastfeeding. Further efforts are needed to optimise infant feeding counselling and to increase the feasibility of the recommendations.

Dataset Information

Effects of complementary feeding on attained height among lower primary school-aged children in Eastern Uganda: A nested prospective cohort study.

Publications

Effects of complementary feeding on attained height among lower primary school-aged children in Eastern Uganda: A nested prospective cohort study.

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