Abstract
Background Children with chronic cholestatic liver diseases have a high risk of malnutrition. However, nutritional management does not receive attention with limited evidence to improve these practices. This study aimed to evaluate feeding status of children with chronic cholestatic liver disease, aged 6-24 months, and to explore the experiences of parents’ feeding behaviors. Methods A mixed-method study was conducted among parents of 74 children with chronic cholestatic liver diseases. The Infant and young Child Feeding Index (ICFI) was used to collect quantitative data of feeding behaviors. In-depth interviews with parents were performed to generate qualitative information. Multivariate analysis was conducted to identify predictors of feeding practice. Qualitative data were analyzed using thematic analysis. Results Only 16.2% children had qualified feeding practice. In terms of dairy products, the rate of breast-feeding, medium-chain-triglyceride formula-feeding, and regular formula-feeding was 25.7%, 39.2% and 44.6% respectively. The complementary feeding rate was 68.8%, and the time of adding complementary food was 6.9±1.7 months. Consumption of food from animal sources is sub-optimal, 66.7% of children aged 6-8 months and 45.5% of children aged 9-11 months had carbohydrate as single source of complementary food and had no intake of flesh foods, eggs or bean products, while in the age group 12-24 months, 52% of children had eggs less than 2 days/week, 60% had flesh foods less than 2 days/week, and 60% had no intake of bean products. Literacy of primary care provider was significantly related with inappropriate feeding practice (Adjusted OR 5.52; 95% CI 1.29, 23.66). The result of the interviews indicated that parents generally had limited feeding knowledge and thought that the intake of animal source products such as flesh foods, eggs and oil would be a burden to the liver, and cause damage to the liver function. Conclusion Parents had limited feeding knowledge and the feeding practices in 6-24-month-old children diagnosed with chronic cholestatic liver diseases did not follow current nutritional guidelines. Appropriate intervention targeting social and cultural family circumstances should therefore be included in the disease management in order to improve children’s clinical outcomes.
Feeding practices and association of fasting and low or hypo glycaemia in severe paediatric illnesses in Malawi – a mixed method study
