Breastfeeding versus formula feeding in HIV infection.
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Africa↗
Biomedical subjects
M C Latham
Publications and source records attributed to M C Latham.
Grandma ahead of her time: traditional ways of diarrhoea management in Lesotho.
The study was aimed at learning about home management of infant and young child diarrhoea in Lesotho. Focus groups and individual interviews were conducted with mothers, grandmothers and nurses during two phases of field work in three geographically different locations. It was found that home management of diarrhoea traditionally had emphasised feeding. While medical advice in the past recommended that, except for breast feeding, food should be withheld during diarrhoea, mothers, grandmothers and even nurses had been reluctant to follow this advice. Mothers and grandmothers saw feeding during diarrhoea as so essential that they would make special efforts to feed a child with diarrhoea. Since most foods contain protein and carbohydrates which stimulate intestinal fluid absorption, feeding during diarrhoea, besides maintaining nutrition, will help maintain hydration. When such beneficial feeding practices are protected and supported there is less need to promote new practices and less risk of producing harmful effects.
Breast Feeding↗
Rational home management of diarrhoea.
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Dehydration↗
Vitamin A supplementation and morbidity among preschool children in south India.
A randomized, double-blind, placebo-controlled trial was conducted in an ongoing Growth Monitoring Research project in TamilNadu, India, to assess the impact of high-dose vitamin A supplementation on morbidity among mildly to moderately malnourished children aged < 3 y. Every 4 mo, the treatment group received 60 mg vitamin A (200,000 IU) whereas the control group received a placebo. Cases of xerophthalmia and severe malnutrition were excluded. Anthropometric measurements and serum retinol determinations were made at baseline and at the end of 1 y. Morbidity data were collected by trained village-level workers throughout the study period by using the weekly recall method. The two groups had similar nutritional status, serum retinol concentrations, age-sex composition, and other sociodemographic indicators at baseline. The mean number of episodes per child-year was 2.62 +/- 2.95 and 2.56 +/- 2.5 for respiratory illness and 1.9 +/- 2.2 and 1.77 +/- 1.77 for diarrhea for the vitamin A (n = 309) and placebo (n = 274) groups, respectively. The differences in respiratory and diarrheal morbidity between the two groups were not statistically significant and these findings remained unaltered after multivariate analysis in which the effects of age, sex, socioeconomic status, sanitation, etc, were considered. These findings are similar to other recent findings and indicate that vitamin A supplementation does not reduce common morbidity in children with mild-to-moderate vitamin A deficiency in areas where access to health care and immunization are good.
Analysis of Variance↗
Vitamin A supplementation does not improve growth of preschool children: a randomized, double-blind field trial in south India.
A randomized, double-blind, placebo-controlled trial was conducted in an ongoing growth monitoring research project in TamilNadu, India, to assess the role of high dose vitamin A supplementation on the growth of mild to moderately malnourished children < 3 y old. The treatment group received 60 mg of vitamin A and the control group received a placebo every 4 mo. Infants 6-11 mo of age received only 30 mg of vitamin A Cases of xerophthalmia and severe malnutrition were excluded. Anthropometric measurements and serum retinol determinations were made at baseline and at the end of 1 y. The two groups were similar at baseline in nutritional status, serum retinol, age-sex composition and other socio-demographic indicators. The mean height increments were 9.20 +/- 3.51 and 9.01 +/- 3.41 cm/y for the vitamin A-treated (n = 310) and placebo (n = 282) groups, respectively, and the mean weight increments were 2.02 +/- 0.83 and 1.99 +/- 0.81 kg/y, respectively. The differences in growth increments between the two groups were not statistically significant. These findings remain unaltered following multivariate analysis and suggest the lack of an effect of vitamin A supplementation on growth in young children where access to health care and immunization are good.
Aging↗
Prolonged breastfeeding without the introduction of supplementary feeding.
A study on the determinants of nutritional marasmus (NM) and kwashiorkor (K) was conducted using Sudanese children aged 6-36 months. The hypotheses tested were related to the specific circumstances leading to the development of NM and K. Subjects consisted of 55 children with NM and 55 with K, admitted to the Children's Emergency Hospital in Khartoum. This paper presents the results of the association between NM and prolonged breastfeeding without introduction of supplementary feeding between the ages of 6 and 24 months. Mothers were interviewed in hospital, and information on duration of breastfeeding, age at introduction of supplementary foods, and weaning foods was obtained. Observations were made in 20 per cent of homes of study children. The results suggest a positive association between prolonged breastfeeding without introduction of supplementary feeding between the ages of 6 and 24 months, and NM. Using multivariate analysis the data show that late introduction of supplementary foods produces an increase of 1.4-fold the odds of developing nutritional marasmus, rather than kwashiorkor. In contrast the odds ratio is 1.9 for the two conditions in terms of age of cessation of breastfeeding, the kwashiorkor children breastfeeding for fewer months. Results suggest strategies to reduce the prevalence of NM and K, plus mild and moderate PEM.
Breast Feeding↗
Iron supplementation improves appetite and growth in anemic Kenyan primary school children.
A randomized, double-blind, placebo-controlled iron supplementation trial was conducted in Kenya to examine the effect of iron supplements on appetite and growth in 87 primary school children. Sustained-release ferrous sulfate (150 mg) or placebo tablets were provided daily at school for 14 wk. Prior to tablet administration, baseline anthropometry, iron nutritional status (hemoglobin and serum ferritin), parasitic infections and clinical indicators of morbidity were measured. A baseline appetite test was conducted twice on each child by quantitatively measuring the ad libitum consumption of a midmorning snack. In addition, each child was asked for a subjective assessment of his or her appetite. Follow-up exams and appetite tests were identical to those at baseline. Findings indicated that provision of iron supplements resulted in improved growth and improved appetite (in terms of both energy intake of the snack and child report of appetite) as compared with children receiving the placebo. The increased energy intake from the snack was 10% of the daily estimated energy intake for children of this same age group living elsewhere in Kenya. Further research into the underlying physiological mechanisms may shed light on the relationship between iron nutritional status and appetite.
Anemia, Hypochromic↗
Physical activity and growth of Kenyan school children with hookworm, Trichuris trichiura and Ascaris lumbricoides infections are improved after treatment with albendazole.
Growth, activity, appetite and intestinal helminth infections were compared for 55 Kenyan primary school children with hookworm (93% prevalence), T. trichiura (84% prevalence) and A. lumbricoides (29% prevalence) before and 9 wk after treatment with three 400-mg doses of albendazole (Zentel) or placebo. Fecal samples were examined for helminth eggs using a modified Kato technique. Activity was measured during free-play with motion recorders on the dominant thigh. Children rated their appetites on a 5-point scale. After baseline measurements, children were randomly allocated to the albendazole-treated (n = 28) and placebo (n = 27) groups, treated, and re-examined 9 wk later. At follow-up, egg counts were significantly lower than at baseline in the albendazole-treated group (P < or = 0.002), and gains in activity, reported appetite and most indices of growth were significantly greater for the albendazole-treated group than for the placebo group. We conclude that treatment of undernourished school children for intestinal helminth infections with albendazole may improve growth and appetite and increase spontaneous physical activity.
Albendazole↗
Symposium: clinical nutrition in developing countries: toward the application of contemporary concepts and technology.
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Developing Countries↗
Vitamin A and childhood mortality.
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Cause of Death↗
Vitamin A and childhood mortality.
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Cause of Death↗
Evaluation of effectiveness of good growth monitoring in south Indian villages.
We conducted a community intervention trial in 12 villages in Tamil Nadu, India to evaluate the benefits of growth monitoring. The villages were divided into 6 "growth-monitoring package" of intervention villages (GMP) and 6 "non-growth-monitoring package" of intervention villages (NGM). A functioning primary health care system was in place in all 12 villages implemented a set of interventions including health and nutritional education. About 550 children under the age of 60 months were studied over 4 years in GMP villages and a similar number of children in NGM villages. The interventions were identical in the two sets of villages except for the use of growth charts in education in the 6 GMP villages. The nutrition worker in the NGM villages had the same contact time as in the GMP villages but advised mothers without the benefit of growth charts. The research team, independently of the nutrition worker, did anthropometric studies on children in all villages every 4 to 5 months. Comparisons were done by calculating monthly gains in stature, and weight, and the significance of differences observed was adjusted for age and sex. After 30 months of interventions, similar improvements in growth were seen in GMP and NGM children. The interventions seemed to have improved the nutritional status of young children in both groups of villages. In view of the lack of additional benefit from growth monitoring over other educational interventions, we question its use as part of child survival programmes in India.
Anthropometry↗
Weight gain of Kenyan school children infected with hookworm, Trichuris trichiura and Ascaris lumbricoides is improved following once- or twice-yearly treatment with albendazole.
We studied growth in infected children given one dose (600 mg) or two doses of albendazole per school year. Children were examined and allocated at random within sex by descending hookworm egg count to one of three groups: placebo (n = 93), one dose (1x, n = 96) or two doses (2x, n = 95). Each child was treated and then re-examined and treated 3.6 and 8.2 mo later (Exams 2 and 3). The 1x and 2x groups gained significantly more by Exam 3 than the placebo group in weight (1.1 and 0.9 kg more, respectively), percent weight-for-age (3.3 and 2.7 percentage points more), percent weight-for-height (3.1 and 2.9 percentage points more), percent arm circumference-for-age (2.3 and 2.0 percentage points more) and triceps and subscapular skinfolds but did not differ significantly from each other. The placebo group showed significant decreases between exams (P < 0.0002) in percent weight-for-age and percent arm circumference-for-age and no change in percent weight-for-height, whereas the 1x and 2x groups exhibited significant increases (P < 0.005). At Exam 3, arithmetic mean egg reduction rates for the 1x and 2x groups were 84 and 95% for hookworm, 42 and 32% for Trichuris and 55 and 87% for Ascaris, respectively. We conclude that one or two doses of albendazole per year resulted in similar growth improvements, despite reinfection, in school-age children in an area where these helminths and poor growth are prevalent.
Albendazole↗
Physical fitness, growth and appetite of Kenyan school boys with hookworm, Trichuris trichiura and Ascaris lumbricoides infections are improved four months after a single dose of albendazole.
We studied physical fitness with the Harvard Step Test, growth, and appetite in primary school boys infected with hookworm (96% baseline prevalence), Trichuris trichiura (98% prevalence) and Ascaris lumbricoides (41% prevalence) who received a single 600-mg dose of albendazole or an identical placebo. Boys were examined, allocated at random within pairs by descending hookworm egg count to placebo (n = 26) or albendazole (n = 27) groups, treated, and re-examined 4 mo later. Four months after treatment, the albendazole group showed highly significant improvements in fitness score, resting heart rate, and heart rates at 1, 2, 3 and 4 min after the Harvard Step Test, whereas the placebo group had not changed significantly. The albendazole group also exhibited significantly more rapid growth judged by weight gain (1.0 kg greater than the placebo group, P < 0.0002), height increment (0.6 cm more, P < 0.003), arm circumference (0.3 cm more, P < 0.0002), and triceps and subscapular skinfolds (1.0 mm more, P < 0.0002), and showed improved appetite with objective and subjective measures. We conclude that single-dose treatment with albendazole can allow improved physical fitness, growth, and appetite in school-age children in areas where these helminths and poor growth are highly prevalent.
Adolescent↗
Use of positive-negative deviant analyses to improve programme targeting and services: example from the TamilNadu Integrated Nutrition Project.
This paper describes the characteristics of southern rural Indian children who grow best (positive deviants) and worst (negative deviants) as compared to median growers. A 100 each of positive and negative deviants and 120 median growers were selected after analysing the 12-month growth patterns (weight-for-age) of 2954 children enrolled in the TamilNadu Integrated Nutrition Project (TINP), a major health and nutrition intervention project covering nearly one million children in rural south India. The determinants of poor growth that have been left unaddressed by 6 years of TINP exposure are delineated to address the question of what more needs to be done. Further, the rationale for differential targeting of services to negative deviants and to median growers is discussed, as are the implications for programme evaluation. Data indicate that the next generation of projects targeted at the most needy (negative deviants) should address the issues of gender discrimination in childcare, of breastfeeding, of diarrhoeal disease, and of maternal empowerment. Such interventions will, however, not improve the growth of median growers in the direction of positive deviance. Instead, programmes targeted at the median growers need to support the hygienic use of nonbreast milk supplements. Improving family wealth will also improve the nutritional status of the median growers, but less so than for the negative deviants.
Case-Control Studies↗
The dermatosis of kwashiorkor in young children.
A characteristic dermatosis is often seen in young children suffering from kwashiorkor, one of the severe forms of protein-energy malnutrition (PEM). The skin lesions usually first occur in areas subject to friction or pressure, for example the groin, behind the knees, on the buttocks, and at the elbows; in advanced cases, the dermatosis may be almost anywhere on the body--trunk, limbs, or head. Darkly pigmented patches form, and these may peel or desquamate, rather like old, sun-baked blistered paint. This has led to the terms "peeling paint" or "flaky paint" dermatosis. Underneath these flakes are atrophic depigmented areas that may resemble a healing burn. This dermatosis does not occur in children with nutritional marasmus, the other life-threatening form of PEM. Kwashiorkor may be diagnosed and the condition be serious without any dermatosis being present. However, when "flaky paint" dermatosis is seen in a malnourished child with edema, it is pathognomonic of the disease kwashiorkor.
Child↗
Metrifonate or praziquantel treatment improves physical fitness and appetite of Kenyan schoolboys with Schistosoma haematobium and hookworm infections.
We studied physical fitness, as determined by the Harvard Step Test (HST), and appetite, as measured by the consumption of a morning snack (maize meal porridge), in primary school boys infected with Schistosoma haematobium (100% baseline prevalence) and hookworm (94-100% prevalence) who received a single dose of metrifonate (MT, 10 mg/kg body weight) or praziquantel (PR, 40 mg/kg body weight), or a placebo (PL). Five weeks after treatment, HST scores and porridge intake increased significantly in the MT and PR groups, but the PL group did not change. At the second examination, the MT group showed a significant decrease in S. haematobium egg counts (mean = 180 vs. 14 eggs/10 ml adj, P less than 0.0002, 82% egg reduction in arithmetic means) as did the PR group (mean = 198 vs. 0.1 eggs/10 ml adj, P less than 0.0002, 99.9% reduction); the egg counts in the PL group did not change. The MT group also exhibited a significant decrease in hookworm egg counts (mean = 1,550 vs. 75 eggs per gram feces [epg], P less than 0.0005, 80% reduction). Treatment with either drug may allow improved physical fitness and appetite in areas where S. haematobium and protein-energy malnutrition are highly prevalent.
Adolescent↗