RESUMO

INTRODUCTION: The global prevalence of exclusive breastfeeding for 6 months is 48%. This analysis examined the relationship between infant and maternal morbidity symptoms and the interruption of exclusive breastfeeding. METHODS: Data from a cohort study among women living in a peri-urban community in Peru were used. Data were collected during pregnancy, birth, and the first 6 months postpartum among 179 dyads... RESULTS: After the first month, interruption of exclusive breastfeeding was almost twofold (adjusted odds ration [aOR] = 1.99, 95% confidence interval [CI]: 1.14, 3.45) more likely among infants with symptoms (e.g., diarrhea, cough) than those without. Maternal morbidity symptoms (e.g., gastrointestinal, respiratory) and breast problems were positively associated with interruption of exclusive breastfeeding throughout the first 6 months (aOR = 1.77, 95% CI: 1.11, 2.82 and aOR = 3.23, 95% CI: 1.84, 5.69, respectively). DISCUSSION: Mother-infant dyads often experience illness symptoms that are not contraindications to breastfeeding. Health professionals need to reinforce that exclusive breastfeeding should continue during illness.

Assuntos

Aleitamento Materno , Humanos , Aleitamento Materno/estatística & dados numéricos , Aleitamento Materno/psicologia , Peru/epidemiologia , Feminino , Estudos Prospectivos , Lactente , Adulto , Recém-Nascido , Gravidez , Mães/psicologia , Mães/estatística & dados numéricos , Adulto Jovem

RESUMO

BACKGROUND: Nutritional interventions targeting the critical growth and development period before two years of age can have the greatest impact on health trajectories over the life course. Compelling evidence has demonstrated that interventions investing in maternal health in the first 1000 days of life are beneficial for both mothers and their children. One such potential intervention is deworming integrated into maternal postpartum care in areas where soil-transmitted helminth (STH) infections are endemic. METHODOLOGY/PRINCIPAL FINDINGS: From February to August 2014, 1010 mother-infant pairs were recruited into a trial aimed at assessing the effectiveness of maternal postpartum deworming on infant and maternal health outcomes. Following delivery, mothers were randomly assigned to receive either single-dose 400 mg albendazole or placebo. Participants were followed-up at 1 and 6 months postpartum. There was no statistically significant difference in mean weight gain between infants in the experimental and control groups (mean difference: -0.02; 95% CI: -0.1, 0.08) at 6 months of age. Further, deworming had no effect on measured infant morbidity indicators. However, ad hoc analyses restricted to mothers who tested positive for STHs at baseline suggest that infants of mothers in the experimental group had greater mean length gain in cm (mean difference: 0.8; 95% CI: 0.1, 1.4) and length-for-age z-score (mean difference: 0.5; 95% CI: 0.2, 0.8) at 6 months of age. CONCLUSIONS/SIGNIFICANCE: In a study population composed of both STH-infected and uninfected mothers, maternal postpartum deworming was insufficient to impact infant growth and morbidity indicators up to 6 months postpartum. Among STH-infected mothers, however, important improvements in infant length gain and length-for-age were observed. The benefits of maternal postpartum deworming should be further investigated in study populations having higher overall prevalences and intensities of STH infections and, in particular, where whipworm and hookworm infections are of public health concern. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01748929).

Assuntos

Albendazol/administração & dosagem , Anti-Helmínticos/administração & dosagem , Helmintíase/tratamento farmacológico , Doenças do Recém-Nascido/tratamento farmacológico , Aumento de Peso/efeitos dos fármacos , Adulto , Método Duplo-Cego , Feminino , Seguimentos , Helmintíase/parasitologia , Helmintíase/fisiopatologia , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/parasitologia , Doenças do Recém-Nascido/fisiopatologia , Masculino , Mães , Peru , Período Pós-Parto , Adulto Jovem

RESUMO

The first two years of life are critical for growth and development. Little is known about infant and young child feeding (IYCF) practices in the Ecuadorian highlands and how they contribute to stunting. With the objective of understanding nutritional status and the influencing factors to design an intervention, we assessed the nutritional status of 293 infants and children between 0 and 24 months of age, living in 14 communities in the provinces of Tungurahua and Chimborazo using a cross-sectional study design. We used the WHO IYCF indicators to assess feeding practices; estimated dietary intake with 24-h recalls; and identified nutritious local foods by food frequency questionnaires. Multiple regression modelling was performed to identify correlates of nutritional status. Stunting was found in 56.2% of children. Mean protein, vitamin A and vitamin C intakes were above recommendations for all ages. Only infants 6.0 to 8.9 months of age and non-breastfed children 12-23.9 months of age consumed energy intakes below recommendations. Younger age groups had below recommended intakes for iron and calcium. While mean complementary food densities met recommendations for protein, vitamin A, vitamin C and energy, those for zinc, iron and calcium were lower than recommended. Older age, respiratory infections and being male were predictors of lower HAZ, whereas early initiation of breastfeeding, higher socioeconomic status, consumption of iron-rich foods and higher dietary protein density were protective. Interventions that promote and support optimal breastfeeding practices and enable increased consumption of nutritious local foods have potential to contribute to reducing stunting in this vulnerable population. © 2016 John Wiley & Sons Ltd.

Assuntos

Dieta , Transtornos do Crescimento/epidemiologia , Fenômenos Fisiológicos da Nutrição do Lactente , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Estudos Transversais , Equador , Feminino , Transtornos do Crescimento/sangue , Humanos , Lactente , Modelos Lineares , Modelos Logísticos , Masculino , Rememoração Mental , Micronutrientes/administração & dosagem , Micronutrientes/sangue , Estado Nutricional , Recomendações Nutricionais , População Rural , Fatores Socioeconômicos , Inquéritos e Questionários

RESUMO

OBJECTIVE: Underweight and stunting are serious problems in Ecuador that require interventions in the first 2 years of life. The researchers assessed the effectiveness of a Positive Deviance (PD)/Hearth community-based intervention using local foods to improve infant and young children's nutrition. DESIGN: A quasi-experimental nonrandomized study was conducted between March and October, 2009. SETTING: The intervention and study were implemented in the Ecuadorian highlands provinces of Chimborazo and Tungurahua. PARTICIPANTS: Eighty mother-child pairs in 6 intervention communities and 184 mother-child pairs in 9 comparison communities. INTERVENTION: Mothers met in participatory peer-led PD/Hearth cooking and nutrition education sessions for 12 days. MAIN OUTCOME MEASURES: Dietary intake and nutritional status were collected at baseline and 6-month follow-up. ANALYSIS: Multiple linear and logistic regression were used for growth outcomes, and ANCOVA for mean dietary intakes. RESULTS: Mothers in the intervention were 1.3-5.7 times more likely to feed their children the promoted foods (P < .05). Children in the intervention consumed a higher percentage of recommended intakes for iron, zinc, vitamin A, protein, and energy (P < .05) at follow-up and had improvements in weight-for-age z-score (ß = .17; 95% confidence interval, 0.01-0.31). Likelihood of underweight was reduced for children in the intervention (odds ratio = 0.36; 95% confidence interval, 0.13-0.96) CONCLUSIONS AND IMPLICATIONS: The PD/Hearth interventions support mothers to improve infant and young children's nutrition practices and reduce underweight.

Assuntos

Dieta/métodos , Dieta/estatística & dados numéricos , Educação em Saúde/métodos , Promoção da Saúde/métodos , Estado Nutricional , Adulto , Serviços de Saúde Comunitária/métodos , Equador , Feminino , Humanos , Lactente , Masculino , Mães , Valor Nutritivo , Adulto Jovem

RESUMO

BACKGROUND: Appropriate health and nutrition interventions to prevent long-term adverse effects in children are necessary before two years of age. One such intervention may include population-based deworming, recommended as of 12 months of age by the World Health Organization in soil-transmitted helminth (STH)-endemic areas; however, the benefit of deworming has been understudied in early preschool-age children. METHODOLOGY/PRINCIPAL FINDINGS: A randomized, double-blind, placebo-controlled trial was conducted to determine the effect of deworming (500 mg single-dose crushed mebendazole tablet) on growth in one-year-old children in Iquitos, Peru. Children were enrolled during their routine 12-month growth and development clinic visit and followed up at their 18 and 24-month visits. Children were randomly allocated to: Group 1: deworming at 12 months and placebo at 18 months; Group 2: placebo at 12 months and deworming at 18 months; Group 3: deworming at both 12 and 18 months; or Group 4: placebo at both 12 and 18 months (i.e. control group). The primary outcome was weight gain at the 24-month visit. An intention-to-treat approach was used. A total of 1760 children were enrolled between September 2011 and June 2012. Follow-up of 1563 children (88.8%) was completed by July 2013. STH infection was of low prevalence and predominantly light intensity in the study population. All groups gained between 1.93 and 2.05 kg on average over 12 months; the average difference in weight gain (kg) compared to placebo was: 0.05 (95% CI: -0.05, 0.17) in Group 1; -0.07 (95%CI: -0.17, 0.04) in Group 2; and 0.04 (95%CI: -0.06, 0.14) in Group 3. There was no statistically significant difference in weight gain in any of the deworming intervention groups compared to the control group. CONCLUSIONS: Overall, with one year of follow-up, no effect of deworming on growth could be detected in this population of preschool-age children. Low baseline STH prevalence and intensity and/or access to deworming drugs outside of the trial may have diluted the potential effect of the intervention. Additional research is required to overcome these challenges and to contribute to strengthening the evidence base on deworming. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01314937).

Assuntos

Doenças Endêmicas , Helmintíase/tratamento farmacológico , Solo/parasitologia , Estatura , Peso Corporal , Método Duplo-Cego , Fezes/parasitologia , Feminino , Helmintíase/epidemiologia , Helmintíase/fisiopatologia , Humanos , Lactente , Masculino , Cooperação do Paciente , Fatores de Tempo

RESUMO

INTRODUCTION: Soil-transmitted helminth infections are endemic in 114 countries worldwide, and cause the highest burden of disease among all neglected tropical diseases. The WHO includes women of reproductive age as a high-risk group for infection. The primary consequence of infection in this population is anaemia. During lactation, anaemia may contribute to reduced quality and quantity of milk, decreasing the duration of exclusive breastfeeding and lowering the age at weaning. To date, no study has investigated the effects of maternal postpartum deworming on infant or maternal health outcomes. METHODS AND ANALYSIS: A single-centre, parallel, double-blind, randomised, placebo-controlled trial will be carried out in Iquitos, Peru, to assess the effectiveness of integrating single-dose 400 mg albendazole into routine maternal postpartum care. A total of 1010 mother-infant pairs will be randomised to either the intervention or control arm, following inhospital delivery and prior to discharge. Participants will be visited in their homes at 1, 6, 12 and 24 months following delivery for outcome ascertainment. The primary outcome is infant mean weight gain between birth and 6 months of age. Secondary outcomes include other infant growth indicators and morbidity, maternal soil-transmitted helminth infection and intensity, anaemia, fatigue, and breastfeeding practices. All statistical analyses will be performed on an intention-to-treat basis. ETHICS AND DISSEMINATION: Research ethics board approval has been obtained from the McGill University Health Centre (Canada), the Asociación Civil Impacta Salud y Educación (Peru) and the Instituto Nacional de Salud (Peru). A data safety and monitoring committee is in place to oversee study progression and evaluate adverse events. The results of the analyses will be published in peer-reviewed journals, and presented at national and international conferences. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov: NCT01748929.

Assuntos

Albendazol/administração & dosagem , Anti-Helmínticos/administração & dosagem , Helmintíase/prevenção & controle , Transtornos da Nutrição do Lactente/prevenção & controle , Mães , Adulto , Aleitamento Materno , Análise Custo-Benefício , Método Duplo-Cego , Feminino , Helmintíase/complicações , Helmintíase/tratamento farmacológico , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Lactação , Masculino , Fenômenos Fisiológicos da Nutrição Materna , Peru/epidemiologia , Período Pós-Parto , Gravidez , Solo/parasitologia , Resultado do Tratamento

RESUMO

Excessive demands on maternal nutritional status may be a risk factor for poor birth outcomes. This study examined the association between breastfeeding during late pregnancy (≥ 28 weeks) and the risk of having a small-for-gestational-age (SGA) newborn, using a matched case-control design (78 SGA cases: birthweight <10th percentile for gestational age; 150 non-SGA controls: 50th percentile

Assuntos

Aleitamento Materno , Recém-Nascido Pequeno para a Idade Gestacional , Adulto , Estudos de Casos e Controles , Ingestão de Energia , Feminino , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Modelos Logísticos , Fenômenos Fisiológicos da Nutrição Materna , Avaliação Nutricional , Peru , Gravidez , Terceiro Trimestre da Gravidez , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem

RESUMO

An overlap of breast-feeding and late pregnancy is associated with decreased intake of human milk and reduced infant growth. We evaluated the association of an overlap with macronutrient and immunological components of milk, infant urinary IgA, and infant and maternal morbidity. On d 2 and 1 mo postpartum, staff measured 24-h intake of breast milk and collected samples from 133 Peruvian women; 68 had breast-fed during the last trimester of pregnancy (BFP) and 65 had not breast-fed during pregnancy (NBFP). Data on maternal and infant anthropometry and health were collected for 1 mo. On d 2, lactose and lysozyme concentrations were higher, total lysozyme intake was higher and concentration and total intake of lactoferrin were lower in the BFP than the NBFP group (P < 0.05). The total 1-mo IgA intake was lower among BFP than NBFP infants (P = 0.01). Urinary IgA concentration was correlated with breast milk IgA concentration (r = 0.29; P = 0.01) but not with breast-feeding during pregnancy. An overlap was not associated with diarrhea but BFP infants were 5 times as likely to have a cough for at least 7 d than NBFP infants (P < 0.05). Reported mastitis was rare and occurred only in the NBFP group (P = 0.05). An overlap of breast-feeding and late pregnancy was associated with changes in milk composition, an increased frequency in symptoms of infant respiratory illness but decreased reported mastitis. Further in-depth studies are warranted to determine the cumulative effects associated with a breast-feeding/pregnancy overlap on infant and maternal outcomes.

Assuntos

Aleitamento Materno , Colostro/química , Adulto , Antropometria , Estudos de Casos e Controles , Tosse/epidemiologia , Diarreia/epidemiologia , Feminino , Humanos , Fatores Imunológicos/análise , Fatores Imunológicos/urina , Incidência , Fenômenos Fisiológicos da Nutrição do Lactente , Bem-Estar do Lactente , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Mastite/epidemiologia , Fenômenos Fisiológicos da Nutrição Materna , Bem-Estar Materno , Leite Humano/química , Morbidade , Peru , Período Pós-Parto , Gravidez , Terceiro Trimestre da Gravidez , Transtornos Respiratórios/epidemiologia

RESUMO

La importancia de la lactacia materna durante la infancia es un echo bastante reconocido. Tanto los niños que crecen en un ambiente marginal como los niños de familias más priviligiadas se benefician a través de la lactancia materna. La leche materna es importante por sus propiedades inmunológicas y por que ayuda a reducir el riesgo de enfermedades generadas por la ingesta de liquidos contaminados

Assuntos

Humanos , Pré-Escolar , Lactente , Lactação , Ciências da Nutrição