Are lhws equipped enough to detect malnutrition in under-5 children? a kap survey of district Rawalpindi

Background: Malnutrition remains one of the major problems in developing countries including Pakistan. Despite raised awareness, there is little improvement in nutrition indicators in Pakistan, which calls for identification of the causes of stagnant rates

Objectives: To assess the proficiency of lady health workers [LHWs] to detect malnourishment in under-5 children using Salter scales and growth charts

Study design, settings and duration: Cross sectional study done in district Rawalpindi from May to August 2013

Subjects and Methods: Knowledge and skills of 59 LHWs related to growth charts were determined by cross-sectional method; and availability of tools were assessed by a short survey in district Rawalpindi

Results: None of the LHWs had growth chart while Salter-weighing scale was available with 34 [57.6%]. In knowledge assessment 78.8% LHWs scored good marks [above 80%] while 19.2% scored average [60-79% marks]. Skills of LHWs related to child weighing were satisfactory but major deficiencies were noted regarding hanging the Salter-scale to stable support and tarring the scale-needle to zero reading

Conclusion: For timely identification of malnutrition in children, availability of Salter-weighing scales and growth charts must be ensured with the LHWs

Policy message: LHWs trainings should be updated with frequent trainings and refresher courses. They should be provided with updated materials like charts for Weight-for-Height and Mid-Upper Arm Circumference [MUAC] measuring tapes

Association of maternal anthropometry with the neonatal birth weight in 3rd trimester of normal pregnancy

There is scarcity of data from Pakistan, which looks at the relationship of maternal nutritional status with the neonatal birth weight The objective of study was to investigate association of increase in the neonatal birth weight with maternal height and weight, in 3rd trimester in normal pregnancy. The study was conducted between the months of April-November 2007 at Gynecology and Obstetrics Unit of Pakistan Institute of Medical Sciences, Islamabad. This Descriptive case series included a total of 118 patients who were selected by consecutive sampling. Dietary history was taken by a semi structured Food Frequency questionnaire at the time of registration and 24 hours dietary recall was conducted at least three times from time of registration until the last visit before pregnancy and mean dietary intake for third trimester was calculated. Differences between group means were calculated by Student's t-test. Regression analysis was used to examine the trends between neonatal birth weight and the maternal dietary intake including energy, protein, carbohydrates and lipids. Energy consumption of the pregnant women was 2168.89 Kcal/day during the third trimester of pregnancy. Maternal energy intake showed a highly significant [P = 0.007] increase in the birth weight of the neonates. Neonatal birth weight was positively associated with increasing maternal height [p=0.02] as well as increasing maternal weight gain [P=0.008]. No significant difference was observed between the mean maternal energy consumption [kcal/day], maternal weight gain in the last trimester [g/wk], and neonatal birth weight [g] between the pregnant women belonging to the different categories of Body Mass Index and mean upper arm circumference. Maternal nutritional status is positively associated with the neonatal birth weight. Expecting mothers and young girls nutritions must be given special attention to ensure delivery of a healthy and a normal child

Low birth weight and relationship with maternal dietary habits during third trimester of low risk pregnancies in a hospital based study in Pakistan

The study is conducted to observe the relationship of maternal diet in third trimester of pregnancy with the neonatal birth weight, in the women at a low risk of delivering low birth-weight neonates. This hospital based follow up study was conducted during the months of April-November 2007 at the Gynaecology and Obstetrics Unit of Pakistan Institute of Medical Sciences, Islamabad. Pregnant women with low risk of delivering low birth weight neonates were registered at 26 weeks of pregnancy, by employing consecutive [non-probability] sampling technique. Dietary history was taken by a semi structured Food Frequency questionnaire and 24 hours dietary recall at the time of registration. Written informed consent was obtained. Thirteen percent of women with normal pregnancies delivered low birth weight neonates weighing <2500 grams [including preterm and full term neonates]. The women delivering low birth weight neonates had significantly lower consumption of calories [P= 0.0002], carbohydrate [P=0.008], and lipid [P=0.00005] during the third trimester. In addition the mean maternal weekly weight gain and maternal hemoglobin concentration was also significantly lower in the women who delivered LBW neonates. The frequency of total protein, meat, carbohydrates and fruits consumption per week, calculated from food frequency questionnaire conducted at the start of third trimester was also lower in the women who delivered LBW neonates. The consumption of soft drinks and tea per week was higher in the women who delivered LBW neonates, although this finding was not statistically significant. This study suggests the importance of good maternal nutrition during pregnancy for the optimal newborn weight

Prevalence of goiter in school-going children in a union council near Islamabad

To assess the prevalence of goiter in school Children [6-12 years], and determine the pattern of salt consumption b the children; and see if there is any association between the prevalence of goiter and the source of drinking water. The study was conducted in a Union Council located in the outskirts of Islamabad. A convenience non-random sampling technique was adopted. Three hundred and ninety six students [6-12 years of age] were enrolled for the study. Interview was recorded in a structured pre-tested questionnaire. Children were asked to bring a teaspoon of salt which was being consumed at their houses and the salt was tested by Rapid Test Kit for iodine concentration. Clinical examination of the subjects was conducted for the presence or absence of goiter. Goiter was classified according to the WHO grading system. About 71.6% children had goiter which was equally distributed between both genders [p=0.34]. There was no association between the advancement of age and the prevalence in goiter [P<0.05]. Non-iodized salt was commonly used in the households [89.8%] and only 7% iodized salt samples contained the optimum iodine concentration [50-75 ppm]. No relationship was found between use of iodized salt and the goiter prevalence [P<0.09]. Use of spring and well water were significantly associated wit goiter [p<0.001] and villages which has spring and well water as their main source of water were endemic for goiter. High prevalence of goiter was found in the local population as compared to the immigrants [p<0.0069]. This study shows that goiter is prevalent in the areas around Islamabad and that simple and appropriate intervention like iodized salt are needed to reduce and control iodine deficiency