(In)segurança da rotulagem de alimentos infantis à base de cereais em relação à legislação brasileira vigente / (In)safety of labeling of cereal-based infant foods in relation to current brazilian legislation

Introdução: Os cereais sãoamplamente utilizados na alimentação das crianças. Objetivo: avaliar a composição nutricional e a rotulagem de alimentos infantis à base de cereais, em relação à legislação vigente. Material e Métodos: Estudo transversal, analítico e descritivo que avaliou alimentos à base de cereais, bem como a conformidade da rotulagem em relação à legislação brasileira vigente. Resultados: Avaliaram-se 72 amostras de alimentos: cereal para alimentação infantil; mistura para o preparo de mingaus e farinha de cereais; 100% das amostras apresentaram alguma não conformidade em relação à legislação, incluindo a presença de falso conceito de vantagem e segurança, ilustrações não permitidas, ausência de advertências obrigatórias e ausência da idade mínima para consumo do produto. Nas análises bromatológicas e de rotulagem, o teor de carboidratos de todas as categorias ultrapassou 80% do valor energético total do produto. Os teores de proteínas, lipídios, carboidratos e energia da categoria cereal para alimentação infantil mostraram diferenças significativas, sendo, respectivamente, p=0,015, p<0,001, p=0,013 e p<0,001. A categoria "mistura para preparo de mingaus" também mostrou diferenças significativas para proteínas, lipídios, carboidratos e energia (p<0,001). Na categoria de farinhas de cereais, somente o teor de proteínas apresentou diferença (p=0,05). Conclusão: Considerando o universo amostral do estudo, é possível concluir que mesmo na vigência de legislações específicas, ainda encontramos não conformidades legais na rotulagem de alimentos à base de cereais destinados à alimentação infantil, sendo que esses alimentos apresentam composição nutricional diferente das informações apresentadas em seus rótulos, impactando negativamente a segurança alimentar de crianças.

Introduction: Cereals are widely used in children's nutrition. Objective: to evaluate the nutritional composition and labeling of cereal-based infant foods, in relation to current legislation. Material and Methods: cross-sectional, analytical and descriptive study that evaluated cereal-based foods, as well as labeling compliance with current Brazilian legislation. Results: 72 food samples were evaluated: cereal for baby food; mixture for the preparation of porridge and cereal flour. One hundred percent of the samples showed some non-compliance with the legislation, including the presence of a false concept of advantage and safety, illustrations not allowed, absence of mandatory warnings and, absence of the minimum age for consumption of the product. In bromatological and labeling analyses, the carbohydrate content of all categories exceeded 80% of the total energy value of the product. The protein, lipid, carbohydrate and energy contents of the cereal category for infant feeding showed significant differences, being, respectively, p=0.015, p<0.001, p=0.013 and p<0.001. The mix category for porridge preparation also showed significant differences for proteins, lipids, carbohydrates and energy (p<0.001). In the category of cereal flours, only the protein content showed a difference (p=0.05). Conclusion: considering the sample universe of the study, it is possible to conclude that even in the presence of specific legislation, we still find legal non-conformities in the labeling of cereal-based foods intended for infant feeding, and these foods have a nutritional composition different from the information presented on their labels, negatively impacting children's food safety.

Choking, gagging and complementary feeding methods in the first year of life: a randomized clinical trial

Abstract Objective: Compare the occurrence of choking and gagging in infants subjected to three complementary feeding (CF) methods. Methods: Randomized clinical trial with mother-infant pairs, allocated according to the following methods of CF: a) Parent-Led Weaning (PLW) — group control, b) Baby-Led Introduction to SolidS (BLISS), and c) mixed (initially BLISS and if the infant presents a lack of interest or dissatisfaction, PLW), with the last two methods guided by the infant. Mothers received nutritional intervention on CF and prevention of choking and gagging according to the method at 5.5 months of age and remained in follow-up until 12 months. Frequencies of choking and gagging were collected by questionnaire at nine and 12 months. The comparison between groups was performed using the analysis of variance test (p < 0.05). Results: 130 infants were followed, and 34 (26.2%) children presented choking between six and 12 months of age, 13 (30.2%) in PLW, 10 (22.2%) BLISS, and 11 (26.2%) mixed method, no significative difference between methods (p > 0.05). The choking was caused mainly by the semi-solid/solid consistency. Moreover, 100 (80%) infants aged from six to 12 months presented gagging and their characteristics were not statistically different among groups (p > 0.05). Conclusion: Infants following a baby-led feeding method that includes advice on minimizing choking risk do not seem more likely to choke than infants following traditional feeding practice that includes advice on minimizing choking risk.

Influências sociais nas práticas alimentares da dupla mãe-filho nos primeiros seis meses de vida / Social influences on the feeding practices of the mother-child couple in the first six months of life

Resumo A dupla mãe-filho está inserida em um sistema social que gera diversas influências nas práticas alimentares, inclusive nos primeiros seis meses de vida, período em que é preconizado o aleitamento materno exclusivo pela Organização Mundial da Saúde. Objetivo: Compreender o conjunto de influências sociais que incidem nas práticas alimentares adotadas pela nutriz e para o seu filho nos primeiros seis meses de vida. Método: Estudo qualitativo, com abordagem metodológica de análise descrito por Minayo e alicerçado na fenomenologia social de Alfred Schütz. Participaram oito duplas mãe-filho recrutados de dois hospitais públicos de Salvador-BA com a Iniciativa Hospital Amigo da Criança. Realizou-se entrevista semiestruturada no domicílio das mães aos seis meses de vida da criança no período de junho a agosto de 2019. Resultados: Emergiram três tipificações: o fazer "correto" nos primeiros seis meses de vida da criança; as ações de cuidados com as práticas alimentares da mulher-mãe que amamenta; e o mundo social da dupla mãe-filho. Conclusão: para a tomada de decisão sobre as práticas alimentares da nutriz, a mãe exerceu mais influência; já para a criança, a nutriz considerou as orientações recebidas pelos profissionais de saúde.

Abstract The mother-child pair is inserted in a social system that generates different influences on eating practices, including in the first six months of life, a period in which exclusive breastfeeding is recommended by the World Health Organization. Objective: To understand the set of social influences that affect the eating habits adopted by the nursing mother and her child in the first six months of life. Method: Qualitative study, with a methodological analysis approach described by Minayo and based on the social phenomenology of Alfred Schütz. Eight mother-child pairs recruited from two public hospitals in Salvador-BA with the Amigo da Criança Hospital Initiative participated. A semi-structured interview was carried out at the mothers' homes when the child was six months old, from June to August 2019. Results: Three typifications emerged: doing "correctly" in the first six months of the child's life; care actions with the feeding practices of the woman-mother who breastfeeds; and the social world of the mother-son duo. Conclusion: For decision-making about the nursing mother's eating practices, the mother exerted more influence; for the child, the nursing mother considered the guidelines received by health professionals.

Modified Trendelenburg Procedure for Varicose Vein

Varicose veins of lower limbs is very common in clinical practice with its associated complications like venous ulcer, edema and pigmentation. Sapheno-femoral in competence and perforator incompetence are the principal cause of varicose veins. Trendlenburg operation of sapheno-femoral ligation and perforator ligation is standard procedure for its treatment. But for a beginner surgeon the procedure has some potential risks like injury to saphenous vein, injury to femoral vein and tributaries during dissection and ligation producing complications like bleeding, haematoma and long operative time. We have modified this Trendlenburg operation by a simple technique of canulating the saphenous vein from mid thigh end to easily identify the T-junction and tributaries. This Modified Trendlenburg Operation reduces the intra-operative complications and decreases the operation time.

Influences on Infant Feeding Practices: An Ecological Perspective

@#Nutrition in infancy contributes to a significant portion on the notion of the importance of nutrition during the first 1000 days of life. A vast pool of literature exists on the importance of nutrition during this phase of life with future diseases, obesity and mental health. However, despite the availability of many guidelines and policies revolving around infant feeding practices, adherence to it remains poor. This review explains factors that influence infant feeding practices from an ecological point of view. A Bronfenbrenner ecological model was used to argue the influence and interaction of various ecological factors on infant feeding practices. The review highlights that the way these factors affect infant feeding differs according to populations and settings. This review suggests the need for more robust and population sensitive interventions to improve infant feeding practices globally.

Infant feeding knowledge and practice among HIVpositive mothers attending HIV treatment centres in Lagos

Background: Twenty five to forty percent of children will be infected with HIV in the absence of any form of intervention which is Prevention of Mother to Child Transmission (PMTCT). Objectives: This study determined the infant feeding knowledge and practices among HIV positive mothers attending HIV treatment centers in Lagos. Methods: A descriptive crosssectional design was used for the study. A multistage sampling technique was used to select / recruit 290 HIV positive mothers with babies between the ages of 2weeks to 18months, attending PMTCT services into the study Pre-tested interviewer administered structured questionnaire was used to collect data and analysis was done using Epi-info software. Chi-square and Fischer exact tests were used to determine association between the dependent and independent variables. The pvalue was set at 0.05. Results: Majority of the respondents (58.9%) were within the age range of 31 ­ 40 years and about half had a secondary school level of education. Exclusive formula feeding (40.3%) and exclusive breast feeding (42.4%) were feeding options known by the majority of the respondents. More than half (55.5%) of the mothers had a good knowledge of infant feeding options. Exclusive breastfeeding (EBF) was practiced by majority (55.5%) of the respondents, 21.4% practiced exclusive formula feeding (EFF) while only 6% practiced mixed feeding (MF). Knowledge of infant feeding options and the attitude towards exclusive breast feeding being enough in the first 6 months of life were associated with infant feeding options practiced; those with good knowledge of infant feeding options did not practice MF (9.7%) (p = 0.013). Conclusion: knowledge of infant feeding options was good and poor knowledge was associated with exclusive formula feeding. Majority practiced EBF. Educational programmes targeted at improving the knowledge of HIV and infant feeding options as well as strengthening of counseling sessions at PMTCT clinic would help reduce the risk of HIV transmission to the child.

Follow-up to the baby friendly hospital initiative in two hospitals of the Mexican Social Security Institute / Seguimiento de la iniciativa hospital amigo del niño y la niña en dos hospitales del Instituto Mexicano del Seguro Social

Abstract Background: The Baby Friendly Hospital Initiative has proven to be effective to increase exclusive and prolonged breastfeeding. Material and methods: Longitudinal study, in two hospitals of second level, in the period from 2015 to 2018. A percentage above 85% in each step was considered acceptable. The statistical analysis was descriptive using student's t test to compare the mean between the two hospitals and ANOVA to compare the mean throughout time in SPSS v.25. Results: Steps 1 and 7 were different between the hospitals with p = 0.010 and p = 0.023, respectively. In the follow-up, General Zone Hospital No. 5 kept steps 1, 2, 3, 7, 8, and 9 above 85%, while those who did not were steps 4, 5, 6, and 10, p = 0.37. Steps of General Hospital No. 15 that remained over 85% were 1, 3, 7, and 9; those that oscillated over time with a <85% rating were steps 2, 4, 5, 6, 8, and 10, p = 0.003. Conclusion: Monitoring child-friendly hospitals allow us to observe areas of opportunity to strengthen training for both clinical and non-clinical staff, pregnant women, the general population, and to improve exclusive and prolonged breastfeeding.

Resumen Introducción: La Iniciativa Hospital Amigo del Niño y la Niña ha probado ser efectiva para mejorar la lactancia materna exclusiva y prolongada. Material y métodos: Estudio longitudinal, en dos hospitales de segundo nivel, en el periodo de 2015 a 2018. Un porcentaje superior al 85% en cada paso se consideró aceptable. El análisis estadístico fue descriptivo, utilizando la prueba t de Student para comparar las medias entre los dos hospitales y el análisis de la varianza para compararlas a lo largo del tiempo empleando el programa SPSS v.25. Resultados: Los pasos 1 y 7 variaron entre los hospitales (con p = 0.010 y p = 0.023, respectivamente). En el seguimiento, el Hospital General de Zona (HGZ) 5 mantuvo los pasos 1, 2, 3, 7, 8 y 9 por encima del 85%, y < 85% los pasos 4, 5, 6 y 10 (p = 0.37). Las medidas del HGZ 15 que se mantuvieron > 85% fueron 1, 3, 7 y 9; aquellos que oscilaron a lo largo del tiempo con una calificación < 85% fueron los pasos 2, 4, 5, 6, 8 y 10 (p = 0.003). Conclusión: Estos seguimientos permiten observar áreas de oportunidad para reforzar la capacitación al personal clínico y no clínico como a las mujeres embarazadas, a la población en general y para mejorar la lactancia materna exclusiva y prolongada.

Results of a study on breastfeeding practices / Монголын Анагаах Ухаан

Background@#Breastfeeding is the ideal food source for all newborns globally. Proper feeding of infants and young children promotes optimal growth and development, especially in the critical window from birth to 2 years of age. Exclusive breastfeeding for 6 months and continued breastfeeding for the first 2 years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe.@*Objective@#To assess the indicators of infant feeding practices among 0- 23 months old children.@*Materials and Methods@#The NNS V was implemented in 21 aimags (provinces) in 4 economic regions (Central, Eastern, Khangai, Western) and the capital city of Ulaanbaatar. Given the regional differences in lifestyle and nutrition status, target populations were stratified into 5 strata based on economic region and Ulaanbaatar with equal samples drawn from each stratum using a cluster-randomized sampling design [1]. The infant and young child feeding indicators assessed in the NNS V were based on the mother’s or caretaker’s report of breastfeeding and consumption of foods and fluids by the child during the day or night prior to being interviewed.@*Results@#83.7% of children under 2 years started breastfeeding within 1 hour of birth and though almost all children were ever breastfed (97.9%), a slightly higher percentage of girls were ever breastfed overall and within 1 hour of birth. Children 0-5 months were categorized according to whether they were exclusively breastfed or predominantly breastfed, with the former only allowing vitamins, mineral supplements, and medicine and the latter also including plain water and non-milk liquids. Among children 0-5 months of age, 58.3% were exclusively breastfed and 65.3% were predominantly breastfed, having received other liquids or foods in addition to breast milk. The prevalence of exclusive breastfeeding was lowest in the 4th wealth index quintile (46.5%) and wealthiest quintile (54.0%) households.@*Conclusions@#Exclusive breastfeeding and early initiation of breastfeeding practices are unacceptably low in Mongolia; 20% of newborns are not breastfed within 1 hour of birth and more than 40% of infants under 6 months of age are not exclusively breastfed and therefore, not receiving optimum nutritional and immunity benefits from breast milk. Strengthening IYCF counselling in all regions and wealth quintiles to support women to practice optimal breastfeeding, along with counselling and awareness of timely and adequate complementary feeding for children under 2 years of age, should be a top priority for public health and as it is a key strategy to reduce malnutrition in children.

Influências socioculturais e parentais nas práticas alimentares no primeiro ano de vida: estudo qualitativo com mães de crianças menores de dois anos / Sociocultural and parental influences on infant feeding practices: a qualitative study with mothers of children under two years of age in Rio de Janeiro, Brazil

Introdução: A prática alimentar infantil é determinada não apenas pelas necessidades biológicas e de desenvolvimento, mas também por fatores psicoafetivos, socioeconômicos e culturais, ainda pouco documentados em nosso país. Objetivo: Compreender os aspectos socioculturais e parentais que influenciam as práticas alimentares de lactentes. Método: Trata-se de estudo qualitativo conduzido por meio de entrevistas semiestruturadas realizadas com mães em duas cidades do Rio de Janeiro entre os meses de novembro e dezembro de 2017. A escolha pela técnica objetivou conhecer as reflexões individuais das mães sobre a realidade que vivenciam. Foram realizadas entrevistas até que se alcançasse o ponto de saturação necessário à identificação de sentidos recorrentes. Foi conduzida Análise de Conteúdo Temática do material empírico com apoio do software QRS Nvivo. A interpretação do material empírico foi baseada nos referenciais teórico-metodológicos de Senso Comum, Cultura Alimentar, Sentidos e Autonomia. Resultados: Foram identificadas as seguintes categorias: Cultura alimentar, Influência das relações sociais, Atributos dos alimentos ultraprocessados e Aspectos parentais. No presente estudo, dentre os aspectos socioculturais que emergiram na fala das mães, estavam a classificação dos alimentos, a influência de atores sociais e os atributos dos alimentos ultraprocessados. Quanto às práticas parentais, destacaram-se comportamentos parentais em contextos específicos e aqueles inerentes à criança. Conclusões: Tais aspectos influenciam as escolhas alimentares, devendo ser reconhecidos e compreendidos pelos profissionais de saúde de forma a potencializar seu papel promotor da alimentação saudável no aconselhamento às famílias. (AU)

Introduction: Infant feeding practices are determined not only by biological and developmental needs, by also by psycho-affective, socioeconomic, and cultural factors, which have received limited research in Brazil. Objective: Understand the sociocultural and parental aspects that influence infant feeding practices. Method: This is a qualitative study using semi-structured interviews with mothers in two cities in the state of Rio de Janeiro, Brazil, in November and December 2017. The choice of this technique aimed to elucidate the mothers´ own reflections on their infant feeding practices. Interviews were conducted until reaching the necessary saturation point for identification of recurrent meanings. Thematic content analysis was performed with the empirical material, using the QRS Nvivo software. Interpretation of the empirical material was based on the theoretical-methodological references of common sense, food culture, meanings, and autonomy. Results: The following categories were identified: food culture, influence of social relations, attributes of ultra-processed foods, and parental aspects. In the current study, the sociocultural aspects that emerged from the mothers´ discourse included classification of foods, influence of social actors, and attributes of ultra-processed foods. The parental practices featured parenting behaviors in specific contexts and those inherent to the child. Conclusions: Such aspects influenced food choices and should be acknowledged and understood by healthcare workers in order to empower their role in the promotion of healthy feeding and family counseling. (AU)

Deficiencias en la labor clínica relacionada con la alimentación infantil / Clinical deficiencies in infant feeding

Resumen Se analiza la forma como se llevan a cabo dos procesos clínicos relacionados con la alimentación infantil en las consultas médicas de niños menores de seis meses atendidos en un centro de salud de la Ciudad de México. El primero se refiere a la medición antropométrica de los infantes y el segundo, a la identificación de las modalidades alimentarias. Se requieren acciones correctivas en función de la calidad en la atención a la salud infantil en el sector público.

Abstract The way in which two clinical procedures related to infant feeding are carried out in medical consultations for children younger than six months in a health center in Mexico City is analyzed. The first one refers to infants' anthropometric measurement, and the second, to feeding modalities' identification. Corrective actions are required based on the quality of children's health care in the public sector.

Maternal knowledge on infant feeding in São Luís, Maranhão, Brazil / Conhecimento materno sobre alimentação infantil em São Luís, Maranhão, Brasil

Abtract Objectives: to describe the knowledge of infant feeding on breastfeeding and the introduction of complementary feeding among mothers of children under one-year-old in São Luís, MA. Methods: a cross-sectional descriptive study using a single questionnaire, standardized by trained interviewers, who visited all the residents in 20 communities chosen by convenience. This questionnaire searched for socioeconomic, demographic information, care received during pregnancy, and the knowledge about infant feeding. The analysis was performed through the creation of knowledge scores, frequency listing, central tendency and dispersion measurements. Results: among the 709 interviewees, 53.5% presented satisfactory knowledge. The score on the percentage mean of knowledge on infant feeding was 66.7%. The specific score on the introduction of complementary feeding was 60.7% and breastfeeding was71.4%. The benefits of breastfeeding for the babies were better known than the advantages it confers on mothers. The worst result was related to porridge preparation,(13.5%). Conclusion: the proportion of mothers who did not know about the basic teachings of infant feeding is high. This can lead to reduce exclusive breastfeeding time, increase rates of improper introduction of food and drink, and in favor early weaning.

Resumo Objetivos: descrever o conhecimento em alimentação infantil sobre aleitamento materno e introdução da alimentação complementar entre mães de menores de um ano em São Luís, MA. Métodos: estudo descritivo transversal com aplicação de questionário único, padronizado por entrevistadoras treinadas, que visitaram todos os domicílios de 20 comunidades escolhidas por conveniência. Este questionário buscava informações socioe-conômicas, demográficas, assistência recebida durante a gestação e sobre conhecimento em alimentação infantil. A análise consistiu da montagem de escores do conhecimento, listagem de frequências e medidas de tendência central e de dispersão. Resultados: dentre as 709 entrevistadas, 53,5% apresentaram conhecimento satisfatório. A média em percentual de acertos do escore do conhecimento em alimentação infantil foi de 66,7%. O escore específico da introdução alimentar obteve 60,7% e o do aleitamento materno 71,4%. Os benefícios da amamentação para os bebês foram mais conhecidos do que as vantagens que esta confere às mães. O pior resultado esteve relacionado ao preparo de papas (13,5%). Conclusões: é elevada a proporção de mães que desconhece ensinamentos básicos sobre alimentação infantil. Isto pode levar à redução do tempo de aleitamento exclusivo, aumentar as taxas de introdução inadequada de alimentos e bebidas e favorecer o desmame precoce.

Introdução de frutas e verduras na alimentação complementar de lactentes em Montes Claros, Minas Gerais / Introduction of fruits and vegetables in the complementary feeding of infants in Montes Claros, Minas Gerais

Esse trabalho teve como objetivo avaliar a introdução de frutas e verduras na alimentação complementar de lactentes. Trata-se de um estudo de corte transversal, realizado em 2015, envolvendo crianças com idade entre 0 a 24 meses de idade, que frequentam a Estratégia da Saúde da Família de Montes Claros, Minas Gerais. Avaliaram-se as características sociodemográficas e o consumo alimentar de frutas e verduras entre as crianças. Foi aplicado o questionário de frequência de consumo alimentar onde se perguntava em que idade se deu início a ingestão de frutas e verduras, além de aplicar também o recordatório alimentar para avaliar a presença ou ausência do consumo desses alimentos no dia anterior. Participaram deste estudo 545 crianças, sendo 53,9% do sexo masculino. Quanto à introdução de frutas e verduras, observou-se que 52,0% e 24,0% consumiram antes dos seis meses de idade, respectivamente. Neste estudo foi alta a prevalência da introdução precoce de frutas e verduras entre as crianças(AU)

This work aimed to evaluate the introduction of fruits and vegetables in the complementary feeding of infants. This is a cross-sectional study, carried out in 2015, involving children aged 0 to 24 months, who attend the Family Health Strategy of Montes Claros, Minas Gerais. Sociodemographic characteristics and food consumption of fruits and vegetables among children were evaluated. The food consumption frequency questionnaire was applied, asking at what age fruit and vegetable intake started, in addition to applying the food record to assess the presence or absence of consumption of these foods on the previous day. 545 children participated in this study, being 53.9% male. As for the introduction of fruits and vegetables, it was observed that 52.0% and 24.0% consumed before the age of six months, respectively. In this study, the prevalence of early introduction of fruits and vegetables was high among children(AU)

Optimal feeding practices in Tamilnadu, breast feeding and complementary feeding: the reality

Background: Optimal feeding of infants under two years of age has the greatest potential impact on child survival of all preventive interventions. This study was done to evaluate feeding practices of infants in first two years of life.Methods: In this cross sectional study, 161 mothers with infants 6 mo to 24 mo of age, attending the well-baby clinic of this hospital were selected for study from April 2014 to March 2015 and interviewed using a structured questionnaire.Results: The prevalence of exclusive breastfeeding for 6 mo was 44% with a median duration of 4.9'1.8 mo. The proportion of infants who received continued breast feeding at 1 year of age (12-15 mo) was 67%. The median duration of any breast feeding was 13.6 mo by survival analysis. Early introduction of cow's milk and bottle feeding were associated with nonexclusive breast feeding under 6 mo and early termination of breast feeding.Conclusions: While rate of exclusive breast feeding was comparable to the state average (48%), there was a higher rate of introduction of cow's milk and bottle feeding which contributed to early termination of breastfeeding before one year of age. This study emphasis the fact that bottle feeding and inappropriate complementary feeding should be tackled to improve IYCF indicators in Tamilnadu.

Development of a new questionnaire to assess childcare providers’ KAP regarding infant and young child feeding

@#Introduction: The integration of infant and young child feeding into childcare settings is important to the overall wellbeing of a community. To our knowledge, there is no questionnaire at the national context specifically on the knowledge, attitude and practice (KAP) of infant and young child feeding among childcare providers. Preexisting questionnaires are unsatisfactory due to different target populations and validation approaches. This study aims to develop a new questionnaire for assessing the KAP regarding infant and young child feeding among childcare providers in Malaysia. Methods: A new questionnaire on childcare providers’ KAP was developed using literature review, expert opinions, and a theoretical framework. It was developed using a modified Delphi technique in five phases: 1. Identification of the domains, 2. Verification of the identified domains, 3. Definition of the domains, 4. Identification of relevant and representative items for each domain, and 5. Final verification of the domains and items, followed by a pre-survey evaluation. Results: The final items were verified by experts with references to relevant literatures, other questionnaires, and experts’ experiences. A total of 236 items were selected after consideration of their relevancy and representativeness: 104, 90, 42 items addressing knowledge, attitude, and practice, respectively. The questionnaire was named Borang Kaji Selidik Pemakanan Bayi dan Kanak-kanak dalam kalangan Pengasuh, or IYCFCCPQ. Conclusion: The IYCF-CCPQ is a newly developed questionnaire to measure childcare providers’ KAP regarding infant and young child feeding.

Does faulty feeding practices act as a driver to undernutrition? A comparative study on rural and urban preschool children in Western Uttar Pradesh

Background: India is home to the largest number of underweight and stunted children in the world. While several studies have focused on the determinants of child’s nutrition status in India, little attention has been given to the aspect of rural-urban variation in child’s nutritional status. Bearing in mind that around 70% of India’s population resides in the rural area, the study of rural-urban divergence in nutritional status as indicator can be appreciated naturally. Objective: The objective of the study is to compare the feeding practices of children in the initial six months of life in rural and urban setting and to find out any relation between early feeding practices and nutritional status of young children. Materials and Methods: A community-based study was conducted for 2 months in the field practice areas of a tertiary care hospital. Multistage random sampling technique was used for the selection of study subjects. A total of 117 under-five children were studied equally from rural and urban area. A pre-designed pre-tested proforma was used to assess the feeding practices. Stunting and underweight were used to proxy the child nutrition status. Data were evaluated on SPSS version 17. Chi-square test was used to compare the feeding practices and to find out their association with nutritional status in the two areas. Results: Undernutrition was found in children who initiated early artificial feeds, i.e., in the first 6 months of life, were given over diluted milk, were bottle fed, and had inappropriate weaning practices in both the areas. Conclusions: Faulty feeding practices were found in both areas, but some of the parameters were still better in urban areas. Faulty feeding practices were found to be a significant predictor for undernutrition.

Ultra-processed food consumption among infants in primary health care in a city of the metropolitan region of São Paulo, Brazil, / Consumo de alimentos ultraprocessados entre crianças com menos de um ano na atenção primária à saúde em uma cidade da região metropolitana de São Paulo, Brasil,

Abstract Objective: To analyze the prevalence of ultra-processed food intake among children under one year of age and to identify associated factors. Methods: A cross-sectional design was employed. We interviewed 198 mothers of children aged between 6 and 12 months in primary healthcare units located in a city of the metropolitan region of São Paulo, Brazil. Specific foods consumed in the previous 24 h of the interview were considered to evaluate the consumption of ultra-processed foods. Variables related to mothers' and children's characteristics as well as primary healthcare units were grouped into three blocks of increasingly proximal influence on the outcome. A Poisson regression analysis was performed following a statistical hierarchical modeling to determine factors associated with ultra-processed food intake. Results: The prevalence of ultra-processed food intake was 43.1%. Infants that were not being breastfed had a higher prevalence of ultra-processed food intake but no statistical significance was found. Lower maternal education (prevalence ratio 1.55 [1.08-2.24]) and the child's first appointment at the primary healthcare unit having happened after the first week of life (prevalence ratio 1.51 [1.01-2.27]) were factors associated with the consumption of ultra-processed foods. Conclusions: High consumption of ultra-processed foods among children under 1 year of age was found. Both maternal socioeconomic status and time until the child's first appointment at the primary healthcare unit were associated with the prevalence of ultra-processed food intake.

Resumo: Objetivo: Analisar a prevalência do consumo de alimentos ultraprocessados entre crianças com menos de um ano e identificar os fatores associados. Métodos: Foi realizado um estudo transversal. Entrevistamos 198 mães de crianças com idades entre 6 e 12 meses em unidades de atenção primária à saúde localizadas em Embu das Artes, uma cidade da região metropolitana de São Paulo, Brasil. Alimentos específicos consumidos nas 24 horas anteriores à entrevista foram considerados para avaliar o consumo de alimentos ultraprocessados. As variáveis relacionadas às características das mães e crianças e as unidades de atenção primária à saúde foram agrupadas em três blocos de influência cada vez mais proximal com o resultado. Foi realizada uma análise de regressão de Poisson de acordo com um modelo estatístico hierárquico para determinar os fatores associados ao consumo de alimentos ultraprocessados. Resultados: A prevalência de consumo de alimentos ultraprocessados foi 43,1%. As crianças que não eram amamentadas apresentaram maior prevalência de consumo de alimentos ultraprocessados, porém não foi encontrada diferença estatística. Menor nível de escolaridade materna (RP 1,55 [1,08-2,24]) e o fato de a primeira consulta da criança na unidade de atenção primária à saúde acontecer na primeira semana de vida (RP 1,51 [1,01-2,27]) foram fatores associados ao consumo de alimentos ultraprocessados. Conclusões: Foi encontrado consumo elevado de alimentos ultraprocessados entre crianças com menos de um ano. A situação socioeconômica materna e o tempo da primeira consulta da criança na unidade de atenção primária à saúde foram associados à prevalência de consumo de alimentos ultraprocessados.

Infant feeding practices among parturient women in rural communities of Anambra State, Nigeria

Background: Infant feeding is an integral part of the reproductive process with important implications for the health of mothers and their babies. However, various practices exist in different communities. It is therefore pertinent to know the infant feeding practices among rural dwellers, as well as the factors that influence them.Methods: This study was a cross sectional survey. A total of 372 volunteering parturient women were recruited using a multi-stage stratified sampling technique. Ethical approval and respondents’ informed consent was obtained. A self-developed and validated questionnaire was used to collect data. Descriptive and inferential statistics was used to analyse data.Results: Findings revealed that majority (84.4%) of the respondents were aware of exclusive breastfeeding (EBF), but only about half (50.5%) ever practiced exclusive breastfeeding. Also, a significant percentage of the respondents introduced complimentary feeding to the baby immediately after birth while 29.3% of participants reported drinking palm wine which is mainly alcoholic to stimulate breast milk secretion. Occupation of parturient women was associated with the practice of EBF (p=0.002).Conclusions: Almost half of our studied parturient women do not engage in EBF. There is need for health care workers to strategically educate parturient women and their significant others on the numerous benefits of exclusive breast feeding.

Infant feeding practices among mothers in rural Rajamahendravaram, Andhra Pradesh

Background: Maternal and child under nutrition remain extensive in low and middle-income population groups. Safe delivery practices and adequate nutrition during infancy is essential to ensure health, growth, and development of a child. Early under nutrition has a long-lasting effect on physical and cognitive growth. So it is essential to assess and promote the healthy child feeding & caring practices in the vulnerable groups. Methods: Community-based cross-sectional study was conducted to enrol 160 mothers of infants by probability proportional to size (PPS) sampling procedure for 5 months in the field practicing areas of GSL Medical College. Primary data was collected through a validated questionnaire with variables of socio-demography, intra-natal, and infant feeding practices. Secondary data was obtained from MCP cards. The analysis was done using SPSS trial version 18, results were expressed as percentages and proportions and Chi-square test was used to assess the association. Results: Majorities (90%) of the deliveries are institutional and the proportion of low birth weight was found to be 12.5%. Breastfeeding was initiated within 1st hour after delivery among 75.6% infants and 79.1% of the infants of 6-11m were reportedly exclusively breast fed. Working status and literacy status of mother are significantly associated with infant feeding practices. Conclusions: In spite of many programmes targeted for promoting safe intra natal and infant feeding practices this study finds a relatively high proportion of faulty practices prevalent in rural areas.

Skilled Counseling in Enhancing Early and Exclusive Breastfeeding Rates: An Experimental Study in an Urban Population in India

Objectives: The study was conducted to evaluate the effect ofbreastfeeding counseling and breastfeeding support by trainedcounselors during the ante-natal period at health facility and post-natal period at home on breastfeeding practices during the first sixmonths of life.Design: This was a randomized controlled study that comparedthe effect of counseling on breastfeeding during the first 6 monthsof life.Setting: study was done in a government medical college innorthern India, which is situated in an urban area.Participants: 300 healthy pregnant women from an urbanpopulation attending the antenatal clinic at Jawaharlal NehruMedical College, Aligarh Muslim University were recruited for thestudy.Intervention: Subjects were equally assigned randomly to theintervention (2 antenatal and 8 postpartum home counseling visitsby the counselors) and control (non-counseling) group.Main Outcome Measures: Infant feeding practices includingrates of initiation of the breastfeeding within one hour of birth;exclusive breastfeeding and bottle-feeding during the first 6months of life.Results: Initiation of breastfeeding within one hour of birth was73.4% in intervention group as compared to 33.6% in controlgroup (P=0.001). More mothers in the intervention group (88.1%)were able to sustain exclusive breastfeeding rates at 6 months ofage in comparison to the control group (50%) (OR 7.44, 95% CI3.98-13.92).Conclusions: This study substantiates positive role of skilledcounseling by a trained dedicated breastfeeding counselorduring the antenatal and post-natal periods on breastfeedingpractices during the first six months of life.

A perspective on partially hydrolyzed protein infant formula in nonexclusively breastfed infants / 소아과

The World Health Organization recommends that infants should be exclusively breastfed for the first 6 months of life to provide optimal nutrition in this critical period of life. After this, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond. For nonbreastfed infants, infant formula is an available option to provide the nutrition needed. Infant formula is usually prepared from industrially modified cow's milk and processed to adjust for the nutritional needs of infants. However, cow's milk is one of the most common causes of food allergy, affecting 2%–5% of all formula-fed infants during their first year of life. One strategy to prevent cow's milk allergy in nonbreastfed infants is the use of partially hydrolyzed formula (pHF) in high-risk infants, which are infants born in families with atopic disease. However, based on an epidemiological study, approximately half of the infants who develop allergy are not part of the at-risk group. This is because the non-at-risk group is significantly larger than the at-risk group and the non-at-risk infants have approximately 15% risk of developing allergies. This study aimed to evaluate the effects of partially hydrolyzed whey formula (pHF-W) in nonbreastfed infants and determine whether pHF-W can prevent atopic disease in high-risk infants and can be used as routine starter formula regardless of the allergy risk status.