Browsing by Subject "Stillen"

Now showing 1 - 3 of 3

Dietary intake, nutritional status of lactating women and their 6-23-months-old children in Genta Afeshum District, Rural Ethiopia : adaptation and validation of calculator for inadequate micronutrient intake (CIMI)
(2020) Desalegn, Beruk; Frank, Jan
Religious fasting is one of the categories of dietary or food taboos, which may affect the dietary intake and nutritional status of individuals. In Ethiopia, about half of the population are followers of Ethiopian Orthodox Tewahedo religion, and approximately 250 days per annum are fasting days. In these fasting days, lactating and pregnant women and children are exempted from fasting. However, lactating and pregnant women fast and are not also happy to prepare non-fasting foods for their children during the fasting days due to fear of contamination of family food. Early identification of micronutrient deficiencies in Ethiopia are flouted, as most often the quantitative dietary data are not available. As a result, the hidden hunger might have not been addressed properly, where it remains high and persistent. Therefore, easy to use, less costly and applicable assessment tool which can estimate the quantitative dietary intake of an individual or a community is urgently needed to achieve the national and international goals set for eradicating malnutrition. The Calculator for Inadequate Micronutrient Intake (CIM) is a simple, easy-to-use, informative, web-based application of quantitative dietary assessment method, which was first developed in Indonesia for Indonesian population. It estimates energy and nutrient intake correctly, and identifies nutrient inadequacy according to FAO/WHO recommended nutrient intake (RNI) regarding age, sex and physiological stage. Thus, the present study was conducted with the aim of assessing and comparing the nutritional status and dietary intake of lactating women and their 6-23-months-old children in fasting and non-fasting periods, and to adapt and validate the CIMI program for Ethiopian population. This study was conducted in rural Genta Afeshum district, in Tigray, Ethiopia, where almost all people in the woreda are followers of Ethiopian Orthodox Christianity. A longitudinal study was conducted using575 and 522 lactating women and their 6-23-months-old children in the lent fasting and non-fasting. In the present study it was found out that the prevalence of underweight (BMI < 18.5 kg/m2) in fasting lactating women was high (50.6%) which is associated with maternal age, maternal illness within four weeks preceding the fasting survey, fasting status during their pregnancy and lactation period of their children included in this study. Additional predictor variables for maternal underweight were grandfathers‘ as household decision maker, use of non-improved water source, household aid experience and the absence of chicken in the household. The average number of meals, diet diversity, and animal source foods consumption scores were significantly higher in non-fasting compared to fasting periods, regardless of the fasting status (p < 0.001, p < 0.05 and p < 0.001, respectively). Whereas, 31.6–33.7%, 11.7–15.7% and 4.4–4.8% of the 6-23-months-old children in the study population were stunted, underweight and wasted, respectively. In the fasting period, the weight-for-length (WLZ) and length-for-age (LAZ) values for the 6-23-months-old children of non-fasting mothers were significantly higher (p < 0.05) than the children of the fasting mothers‘ group. Similarly, the median weight-for-age (WAZ) and diet diversity score (DDS) of children of fasting mothers were also significantly lower in fasting compared to non-fasting period. The proportion of the 6-23-months-old children who met the minimum acceptable diet (MAD) was small (2.3-6.7%) in the study population; however, this proportion was significantly (p < 0.001) higher in the non-fasting than fasting period in the children of fasting mothers. Age of the child, maternal fasting status during pregnancy and lactation periods, maternal education and occupation were associated with child underweight. Likewise, age of the child, colostrum intake status, maternal fasting status during pregnancy and lactation period and toilet presence in the household were associated with child stunting. But, maternal fasting status during lactation period and maternal education predicted wasting in the children precisely. The average energy, protein and almost all micronutrients intakes of children and women were lower in fasting compared to non-fasting period. At the same time, the prevalence of inadequate intakes of energy, protein and most micronutrients were higher in both the children and lactating women during fasting than non-fasting period. The result of this study revealed that the correlation coefficients for the average dietary nutrient intake calculated by CIMI and the reference software NutriSurvey (NS) were between 0.741-0.956 for the children and between 0.779-0.920 for the lactating women groups. As a conclusion, the dietary pattern and nutritional status of lactating women and their breastfed children are affected during the fasting period. Therefore, the existing multi-sectoral nutrition intervention strategies in Ethiopia should include religious institutions in a sustainable manner. CIMI adapted for the rural Ethiopian setting estimates the average nutrient intake accurately; and identifies inadequate micronutrient intake of individuals enabling enumerators to provide feedback and suggest improvements. Thus, CIMI can be used in Ethiopia, as a simple dietary assessment tool by nutrition and related researchers, policy makers, implementers and evaluators.
Food and nutrition security and associated health aspects of Syrian refugee mothers and their offspring : a mixed-method study in Greater Beirut, Lebanon
(2023) Abou-Rizk, Joana; Scherbaum, Veronika
Nutrition during the first 1000 days of life – from conception to two years of age – lays the foundation for optimal health, cognitive and social development, and well-being of children and mothers. Malnutrition and hidden hunger in mothers and their offspring during the perinatal period can have long-lasting and irreversible consequences on human capital and increase the risk to non-communicable diseases among adulthood through intergenerational effects. Since the Arab Spring in 2011, the Syrian humanitarian crisis has escalated to become the world’s largest by the end of 2018, forcing 6.7 million to flee, mainly to neighboring countries. In 2015, Lebanon was the host of more than 1.5 million refugees and displaced persons from Syria, reaching the highest per capita concentration of refugees worldwide. The protracted crisis has increasingly weakened Lebanon, in turn exposing vulnerable groups, especially women of reproductive age and children below five years, to increased risks of inadequate nutrition and health status. To date, there has been a lack of studies among refugees that examine the nutritional and health situation and investigate the underlying and immediate determinants of malnutrition among women of reproductive age and children below five years. Therefore, knowledge gaps regarding the prevalence of anemia and nutritional status of Syrian refugee mothers and children were identified as important research areas in this dissertation. Assessing the food security and mental health of Syrian refugee mothers, examining the dietary intake and infant feeding practices, and investigating their respective determinants and associated risk factors were also important areas of focus. This research project was conducted between July and October 2018 in collaboration with the American University of Beirut in primary healthcare centers in the Greater Beirut area in Lebanon using quantitative and qualitative surveys (mixed-methods survey) among Syrian refugee mothers and their child aged below five years of age. This work comprises a total of three research articles that have been published in peer-reviewed international journals. The first article (Chapter 3) describes the prevalence of anemia and the nutritional status of mothers and children below five years of age and indicates a moderate public heath significance among Syrian refugees in the Greater Beirut area, Lebanon. The existence of the so-called double burden of malnutrition and hidden hunger (micronutrient deficiencies) has been documented, as mothers and children from the same household were affected by undernutrition, overnutrition, and / or anemia. A strong association between maternal and child anemia in the same household and an association between anemia and overweight / obesity among mothers has also been demonstrated. Analysis of the 24-hr dietary recalls of pregnant, lactating, non-pregnant non-lactating mothers revealed inadequate dietary intake and nutrient deficiencies during pregnancy and lactation. The second article (Chapter 4) presents data on the prevalence of food insecurity, low dietary diversity, and poor mental health among Syrian refugee mothers in Greater Beirut, Lebanon. A significant association between food insecurity and low dietary diversity as well as poor mental health status was found. Low household monthly income and a high household crowding index were significantly associated with low dietary diversity and food insecurity. In addition, the results showed that low-income households consumed monotonous diets, characterized by a high consumption of refined starchy staples and grains. The third paper (Chapter 5) focused on the nutritional and health status of infants under six months. Overall, the public heath significance for anemia and wasting was moderate. Inadequate infant feeding practices, such as the intake of pre-lacteal feeding and liquids, were demonstrated in newborns, which in turn contributed to delayed initiation of breastfeeding and low rates of exclusive breastfeeding. Factors supporting infant feeding practices included proper knowledge on maternal nutrition and exclusive breastfeeding and support from healthcare professionals or family during breastfeeding. Identified barriers included cultural practices such as the early introduction of foods, breastmilk substitutes, and giving water or herbal tea to infants under six months of age. Maternal health issues and social factors such as misinformation from family members and violations of the Code of Marketing of Breastmilk Substitutes also affected breastfeeding. A conceptual framework was also developed in this dissertation to provide a comprehensive understanding of the linkages and pathways between the enabling, underlying, and immediate determinants and the nutritional and health outcomes in the context of humanitarian crises. Based on this conceptual framework, three principal pathways were identified to explain the following associations: (1) from the enabling determinants to anemia and nutritional status, (2) from socio-economic status and host country resources to food consumption and diets, and (3) from pre-resettlement experiences and dietary acculturation to food consumption and diets. In addition, the concluding discussion (Chapter 6) presented the role of maternal mental health status and health services and their impact on maternal nutrition and anemia status as well as infant feeding. In summary, this dissertation contributes to the knowledge about the anemia and nutritional status of Syrian refugee women and children as well as on the food security and mental health status of mothers living in an urban setting of a protracted humanitarian crisis in Lebanon. It also provides insights into the emergence of malnutrition among women and children in the context of refugees and shows the pathways between different levels of determinants of nutrition and health. Implications for practice can be drawn from this dissertation, such as the development or strengthening of evidence-based culture-specific nutritional interventions that are targeted to the refugee context. Priorities for future research were also identified, including the need to improve the effectiveness of nutritional interventions in conflict settings.
Nutrition during pregnancy and early infancy in urban and rural areas of Deyang region, Southwestern China
(2022) Gao, Haoyue; Birner, Regina
In the past years, China has made remarkable progress in achieving the Millennium Development Goals. However, there are still significant urban-rural disparities and regional differences in the main indicators of child nutrition, maternal and child health. Inadequate dietary intake with regard to certain macro- and micronutrients occurs among women during the reproductive period. Despite the efforts that have been made to promote breastfeeding in China since the 1990s, there is still a very low prevalence of exclusive breastfeeding during the first six months of life. Therefore, the purpose of this observational study was to assess dietary intake and identify risk factors for nutritional inadequacy in pregnant women and to assess the current situation of infant feeding practices during the postpartum hospital stay in urban and rural settings of the study area in China. Between 2010 and 2012, cross-sectional sampling was used in two urban hospitals and five rural clinics randomly selected in the Deyang region. A total of 203 pregnant women in the third trimester and 204 pairs of mothers and newborns were recruited on the basis of informed consent during antenatal clinic sessions and in postnatal wards respectively. Semi-structured interviews on anthropometric and socio-demographic information were conducted for both the pregnant women and postpartum mothers. In addition, data on 24-h dietary recalls of pregnant women, birth outcomes and infant feeding practices of postpartum mothers were collected. Prior to pregnancy, 26.3% of the pregnant women were found to be underweight, while only 5.1% were overweight, based on self-reported pre-pregnancy weight. The women’s overall dietary energy intake during the third trimester originated excessively from fat, was low in carbohydrates, and reached the lower limits for protein. Compared to rural areas, women living in urban areas had significantly higher reference nutrient intake fulfilment levels for energy, fat, protein, vitamin A, Zn, Fe, Ca and riboflavin. The likelihood of pregnant women following certain traditional food recommendations such as avoiding beef, mutton, fish etc. was higher in rural than in urban areas. Both the short-term (e.g. gestational weight gain) and long-term nutritional status (e.g. height) of the mothers affected the birth outcomes (e.g. type of delivery). The decision for a Caesarean Section (CS) was not only related to medical/obstetrical issues but also nutritional and social demographic factors. The short stature of mothers, excessive gestational weight gain, larger-sized newborns, higher educational level or older ages of mothers were significantly positively related to the probability of CS. Although almost all of the mothers started breastfeeding after childbirth, the high prevalence of CS delayed initiation of breastfeeding. Due to the widespread use of infant formula, the prevalence of exclusive breastfeeding (EBF) was only 8.0 % one week after delivery. Regardless of prelacteal feedings, almost exclusive breastfeeding (AEBF) was 34.5%. Breastfeeding initiation within two days after birth was positively associated with AEBF, whereas smaller newborns, mothers with higher education level, mothers lack of knowledge about the importance of colostrum were negatively associated with AEBF. As most mothers lacked knowledge of the lactation physiology, higher formal education was often not related to a better knowledge of breastfeeding. In conclusion, culturally sensitive nutrition education sessions are necessary for both urban and rural women. Special attention must be given to the nutritional status, especially of rural women, before or, at the latest, during pregnancy. Personalized nutritional guidance for expectant mothers should be based on comprehensive consideration of all aspects, such as dietary intake, place of origin (rural vs. urban), body height, and gestational weight gain etc. Better guidance for the gestational weight gain of Chinese mothers needs to be established. Although disparities between urban and rural areas exist, the situation of infant feeding is inadequate in both settings. The high prevalence of CS, the mothers’ poor knowledge of the physiology of breast milk production, the mothers’ lack of breastfeeding confidence, the widespread advertising of breast milk substitutes, and the changing perception of the function of breasts, may influence the unfavorable breastfeeding behavior observed in the study area. In order to prevent CS and to promote breastfeeding, education about the complications and disadvantages of CS especially among mothers with higher education, older childbearing age, and primiparas needs to be strengthened. Supporting adequate maternal nutrition during the reproductive period and creating a good breastfeeding environment requires the efforts of the whole society.