WEANING

Objective: To evaluate the awareness & practices regarding weaning in lactating mothers of infants. Design: A crosssectional descriptive study. Setting: At pediatrics OPD in Ghurki Trust Teaching hospital, Lahore. Period: From Octoberto December 2007.Methodology: A non probability convenience sampling was done to collect data from 50 mothers who were attending out patient departmentalong with their infants on a pre-formed questionnaire. After gathering, data was analyzed & presented in the form of tables & graphs.Results: In the present study, 66% mothers were in the age group of 20-29 years, all were house wives, 34 % were matriculate and 72%lived in joint family system, Mean age of weaning was 4-6 months in more than 64 % of the sample. Among the women interviewed, 44%used home-made weaning diets, 30% used mixture of homemade and commercially prepared diets, while 16% used only commerciallyprepared diets. Breast feeding was continued during and after weaning, by 64% of respondents along with weaning diets. Conclusion:Mothers need to be educated about the importance of weaning, the recommended age of weaning and about the types of weaning food.This can be achieved by using lady health workers and lady health visitors and the mass media. Importance of continued breast feedingwith weaning diet should be emphasized upon.

Neutralizing Activity and SARS-CoV-2 Vaccine mRNA Persistence in Serum and Breastmilk After BNT162b2 Vaccination in Lactating Women

BackgroundThere is limited information on the functional neutralizing capabilities of breastmilk SARS-CoV-2-specific antibodies and the potential adulteration of breastmilk with vaccine mRNA after SARS-CoV-2 mRNA vaccination.MethodsWe conducted a prospective cohort study of lactating healthcare workers who received the BNT162b2 vaccine and their infants. The presence of SARS-CoV-2 neutralizing antibodies, antibody isotypes (IgG, IgA, IgM) and intact mRNA in serum and breastmilk was evaluated at multiple time points using a surrogate neutralizing assay, ELISA, and PCR, over a 6 week period of the two-dose vaccination given 21 days apart.ResultsThirty-five lactating mothers, median age 34 years (IQR 32-36), were included. All had detectable neutralizing antibodies in the serum immediately before dose 2, with significant increase in neutralizing antibody levels 7 days after this dose [median 168.4 IU/ml (IQR 100.7-288.5) compared to 2753.0 IU/ml (IQR 1627.0-4712.0), p <0.001]. Through the two vaccine doses, all mothers had detectable IgG1, IgA and IgM isotypes in their serum, with a notable increase in all three antibody isotypes after dose 2, especially IgG1 levels. Neutralizing antibodies were detected in majority of breastmilk samples a week after dose 2 [median 13.4 IU/ml (IQR 7.0-28.7)], with persistence of these antibodies up to 3 weeks after. Post the second vaccine dose, all (35/35, 100%) mothers had detectable breastmilk SARS-CoV-2 spike RBD-specific IgG1 and IgA antibody and 32/35 (88.6%) mothers with IgM. Transient, low intact vaccine mRNA levels was detected in 20/74 (27%) serum samples from 21 mothers, and 5/309 (2%) breastmilk samples from 4 mothers within 1 weeks of vaccine dose. Five infants, median age 8 months (IQR 7-16), were also recruited - none had detectable neutralizing antibodies or vaccine mRNA in their serum.ConclusionMajority of lactating mothers had detectable SARS-CoV-2 antibody isotypes and neutralizing antibodies in serum and breastmilk, especially after dose 2 of BNT162b2 vaccination. Transient, low levels of vaccine mRNA were detected in the serum of vaccinated mothers with occasional transfer to their breastmilk, but we did not detect evidence of infant sensitization. Importantly, the presence of breastmilk neutralising antibodies likely provides a foundation for passive immunisation of the breastmilk-fed infant.

Associations of Carbohydrate Intake With New-Onset Hypertension Subtypes: Results From the China Health and Nutrition Survey (2000–2011)

Background: The effects of carbohydrate intake on hypertension (HTN) subtypes are scarce. We examined the association of carbohydrate intake with new-onset HTN subtypes in Chinese adults.Methods: Chinese Health and Nutrition Survey (CHNS) 2000–2011, 22,418 individuals were recorded using a 24-h recall method over three consecutive days. We excluded those who were pregnant women, lactating mothers, age <18 years, baseline age, blood pressure, and energy intake deficiency, extreme energy intake (male > 6,000 kcal or < 800 kcal; female > 4,000 kcal or < 600 kcal), and pulse pressure difference (Systolic Blood Pressure [SBP] - Diastolic Blood Pressure [DBP]) <10 mm Hg, HTN at baseline and data from only one survey. The total number of subjects who participated in at least two surveys was 7,930. The main outcome was new-onset HTN subtypes over 6.9 person years of follow-up.Results: 2,521 participants were found to be HTN, which included 1,318 males (52.3%), 1,203 females (47.7%), 721 had systolic-diastolic hypertension (SDH, 28.6%), 655 had isolated systolic hypertension (ISH, 26.0%), and 993 had isolated diastolic hypertension (IDH, 39.4%). Compared with extreme quintiles of carbohydrate, multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for new-onset HTN, SDH, ISH and IDH associated with carbohydrate intake were 1.12 (0.97–1.30), 1.54 (1.18–2.00), 0.89 (0.67–1.19) and 1.15 (0.91–1.45), respectively. The HR of SDH compared with extreme quintiles of carbohydrates was 1.56 (95% CI, 1.08–2.25; Ptrend = 0.04) in men and 1.52 (95% CI, 1.02–2.26; Ptrend = 0.02) in women.Conclusion: Carbohydrates were related to a higher risk of SDH, which were not observed with HTN, ISH, and IDH.

Moringa oleifera : Nutritional and Medicinal Properties for preventive health care

Moringa oleifera, commonly known as ―drum stick‖ or the ―horse radish‖ is cultivated all over the country as it can withstand both severe drought and mild frost conditions. It is a good source of protein, vitamins, fatty acids, micro-macro minerals and other essential phytochemicals. Due to its high nutritional content, the extract of leaves of Moringa oleifera is used to treat malnutrition and supplement breast milk in lactating mothers. Because of its medicinal value, it is also used as anti-inflammatory, anticancer, antioxidant, antidiabetic, cardiovascular hepatoprotective, anti-ulcer, antimicrobial agent. The pharmaceutical effects of Moringa oleifera makes it useful in therapeutic remedy in traditional medicinal system. Each part of the tree is useful in one form or another due to high nutritional and medicinal value. This paper reports the results of the study made on how these can help boosting the immunity level in individuals.

Safe Medicine Administration Counseling for Pregnant and Breastfeeding Mothers

The use of drugs for pregnancy and breastfeeding needs to be self-medication and the importance of counselling to increase the mother's knowledge about the correct use of drugs so that pregnant and lactating women's level of health and knowledge increases. The counselling purpose was to determine the mother's level of knowledge and whether there was a difference in the knowledge level of the use of drugs during pregnancy and lactation. The method used is pre and post-media analysis (flipchart). Data analysis obtain by scoring questionnaires, univariate analysis, and statistical analysis. Mann-Whitney test results showed that in the post-test or after giving counselling using flipchart media, there was a change in respondents' knowledge from before being given a flipchart and after being given a flipchart. The hypothesis from this counselling is accepted, which means that giving flipcharts affects the level of knowledge. The calculations using the spearman test obtained p-value pretest 0.732 and p-value post-test 0.253 for pregnant women and obtained p-value pretest and post-test of 0.033 (p <0.05) for breastfeeding mothers, then there is a relationship between the education level pregnant and lactating mothers with knowledge. The Wilcoxon test data pretest and post-test knowledge of pregnant and lactating mothers had a p-value of 0.003 (p 0.05), the effect of counselling concluded with flipchart media on the knowledge of pregnant and lactating mothers about the use of drugs.

Maternal dietary diversity during lactation and associated factors in Palghar district, Maharashtra, India

Dietary adequacy and diversity during the lactation period are necessary to ensure good health and nutrition among women and children. Behavioral interventions pertaining to health and nutrition counselling during pregnancy and lactation are critical for awareness about dietary diversity. The issue assumes salience for marginalized communities because of the Covid-19 pandemic and associated economic and societal disruptions. This paper assesses the dietary patterns among 400 lactating mothers in the tribal-dominated district of Palghar in Maharashtra, India in 2020. The study is based on primary data regarding consumption of 10 food groups among women across 10 food groups based on 24-hour recall period. The primary outcome variable was binary information regarding Minimum Dietary Diversity defined as consumption from at least 5 food groups. Econometric analysis based on multilevel models and item-response theory is applied to identify food groups that were most difficult to be received by mothers during the early and late lactation period. We find that the daily diet of lactating mothers in Palghar primarily consists of grains, white roots, tubers, and pulses. In contrast, the intake of dairy, eggs, and non-vegetarian food items is much lower. Only Half of the lactating women (56.5 percent; 95% CI: 37.4; 73.8) have a minimum diversified diet (MDD). The prevalence of lactating women with MDD was higher among households with higher income (73.1 percent; 95% CI: 45.2; 89.9) than those in lower income group (50.7 percent; 95% CI: 42.3; 58.9). Lactating Women (in early phase) who received health and nutrition counseling services are more likely (OR: 2.37; 95% CI: 0.90; 6.26) to consume a diversified diet. Food groups such as fruits, meat, poultry, fish, nuts, and seeds were among the rare food items in daily diet. The dietary pattern lacking in fruits, nuts, and heme (iron) sources indicates more significant risks of micronutrient deficiencies. The findings call for improving dietary diversity among lactating mothers, particularly from the marginalized communities, and are driven by low consumption of dairy products or various fruits and vegetables. Among the different food items, the consumption of micronutrient-rich seeds and nuts is most difficult to be accessed by lactating mothers. Also, diet-centric counseling and informing lactating mothers of its benefits are necessary to increase dietary diversity for improving maternal and child nutrition.

Health and Nutritional Status of Certain Lactating Mothers of Bahawalpur, Pakistan

Diet is the vital part to survive, and balanced diet is the key to better and healthy living. Our daily needs of the body depend upon food to intake for better and proper functioning of vital organs and all organs. These include carbohydrates, proteins, fats, vitamins, and minerals. The amount required for living is much lowers then required for the nourishing an offspring. Lactation is an astonishing procedure in which the mother's body makes a secretion that has no immediate advantage to them but may completely support the baby. It was descriptive hospital-based study conducted among lactating mothers visiting Bahawal Victoria Hospital, Bahawalpur Pakistan. Sample size comprised of 200 lactating mothers. The Chi-square statistical test was used to analyze the difference between the groups by SPSS of latest version. The results revealed that groups of Body mass index (BMI), age groups, breast feeding status, working status, health status, family income, family member, mode of delivery, infant age status, parity, energy intake, protein intake, fat intake and carbohydrate intake had statistically significant differences while the educational status had no significant differences. In this study dietary intake pattern of lactating mother was normal because mostly mothers were educated, they have good knowledge of balanced diet

The Effect of Breastfeeding Calendar Training on Knowledge and Attitudes of Mothers in Exclusive Breastfeeding

Background: Lactating mothers were successful in giving exclusive breastfeeding as much as 42% based on SDKI (Survei Demografi Kesehatan Indonesia) in 2012. This is depend on the support of husbands and families as well as health workers. Thus, the husband or family should remind and motivate mothers as well as monitor the breastfeeding activity every day for 6 months using breastfeeding calendar.Objectives: This study aimed to determine the increase in knowledge and attitudes of mothers in providing exclusive breastfeeding after the exclusive breastfeeding calendar training.Materials and Methods: The research design used a quasi-experimental one group pre-test post-test design. This research was conducted on mothers who had babies (age 0-12 months) in Pasawahan Village and Pasawahan Kidul Village, Pasawahan District, Purwakarta Regency in April to November 2018, with 96 respondents. The sampling technique was conducted by purposive sampling. Data were collected by giving questionnaires to respondents, before and after the breastfeeding calendar training were given. The Wilcoxon test was used for the analysis of the data in this study.Results: The results showed that there were differences in the knowledge of mothers before and after training on breastfeeding calendar (p <0,000) and there were differences in the attitudes of mothers before and after the training on breastfeeding calendar (p <0,000).Conclusions: There was an increase in knowledge and changes in the attitude of mothers towards exclusive breastfeeding after being given the breastfeeding Calendar training. Therefore, suggestions for health workers, especially midwives and nutrition workers, can use the breastfeeding calendar as an educational medium to increase husband and family support in exclusive breastfeeding.

Child nutritional status as screening tool for identifying undernourished mothers: an observational study of mother–child dyads in Mogadishu, Somalia, from November 2019 to March 2020

BackgroundActive screening of only pregnant and lactating mothers (PLMs) excludes other mothers of reproductive age susceptible to undernutrition. Our analysis evaluated if mothers presenting with wasted children were more likely to be undernourished themselves.MethodsThe observational study enrolled mother and child dyads presenting to an outpatient facility in Mogadishu, Somalia, between November 2019 and March 2020. Trained nurses recorded lower extremity oedema for children aged 6–59 months, parity and gestational status for women aged 19–50 years and age, access to care, height/length, mid-upper arm circumference (MUAC) and weight for both. Weight-for-height z-score (WHZ) for children and body mass index (BMI) for mothers were calculated using standard procedures. Wasting was defined as WHZ <−2, MUAC <12.5 cm and/or presence of oedema for children. Undernutrition was defined as MUAC <23 cm for PLMs and BMI <18.5 kg/m2 for neither pregnant nor lactating mothers (non-PLMs). Four multivariable linear regression models were fit to evaluate maternal anthropometric indicators (BMI or MUAC) given child anthropometric indicators (MUAC or WHZ), adjusting for maternal age, parity and gestational status.ResultsA total of 93.6% (2142/2288) of enrolled dyads met inclusion criteria. Wasting was observed among 57.5% of children; 20.2% of pregnant mothers, 20.0% of lactating mothers and 7.95% of non-PLMs were undernourished. Models suggest significant, positive associations between child and maternal anthropometrics; a one-unit increase in WHZ and a 1 cm increase in child MUAC were associated with 0.22 kg/m2 (95% CI 0.22 to 0.24) and 0.19 kg/m2 (95% CI 0.16 to 0.21) increases in maternal BMI, respectively, and 0.20 cm (95% CI 0.18 to 0.22) and 0.24 cm (95% CI 0.23 to 0.25) increases in maternal MUAC, respectively. Adjusted R2 values were low (range 0.06–0.10).ConclusionsUndernutrition among non-PLMs illustrates the importance of expanding screening. However, while significant, the strength of association between mother and child anthropometrics does not support child nutritional status as a screening tool for identifying at-risk mothers.