Educating caregivers to recognise the clinical signs of pneumonia in children younger than 6 months

Background. Pneumonia remains the foremost cause of death in young children in sub-Saharan Africa. This phenomenon is largely driven by poor access to healthcare and delay in seeking medical care for childhood pneumonia. Objective. To assess the effectiveness of training caregivers to recognise the early clinical signs of pneumonia. Methods. The study involved a cohort of women presenting to the Child Welfare Clinic at the Komfo Anokye Teaching Hospital in Kumasi, Ghana, between 7 July and 8 September 2016. A total of 90 women with children younger than 10 weeks were recruited. Participants were trained on identifying early signs of pneumonia using low-cost equipment. Follow-up training and assessment sessions formed part of the programme.Results. At pre-training assessment, the majority of the participants (n=83/90; 92.2%) recognised lower chest indrawing as a sign of respiratory disease requiring immediate hospital intervention. Participants' performance in determining rhythms of 50 breaths per minute (bpm) and 60 bpm improved significantly across sessions (p=0.011 and p≤0.001, respectively). After training, 87 participants (96.7%) were able to determine rapid breathing accurately compared with 73 participants (81.1%) before training (p=0.001).Conclusion. The results suggest that caregivers can be effectively trained to identify clinical signs of pneumonia in young children, even in low-resource settings. A training initiative as described in this study could be an effective public health intervention to help address the burden of pneumonia in low-resource settings

Short-term, Daily Supplementation with Vitamin A, But Not Beta-carotene, Increases Plasma and Breast Milk Retinol Concentration in Lactating Filipino Women.

Objective: To assess the usefulness of breast milk vitamin A (BMVA) for evaluating the impact of food-based vitamin A (VA) interventions. Methods: We assessed the effect of daily supplementation with 600 ug VA activity as either retinyl palmitate or β-carotene (BC) or 0 ug VA activity as corn oil (CO) on BMVA and BC concentrations in lactating women (n=83) who were randomly assigned to receive one of the three treatments, 6 d/wk for 3 wk. Treatments were administered as capsules (containing either 300 ug or 0 ug VA ), 2 times/d, with morning and noon meals consisting of low VA foods. Plasma and milk concentrations of VA and BC were measured before and after the intervention. Results: Initial mean plasma retinol concentration was 1.29±0.41 umol/L, and the mean change in plasma retinol was greater in the VA group than in the BC and CO groups (0.13, 0.03, -0.04 umol/L, respectively, P<0.01). Initial mean BMVA was 28.0±14.6 nmol/g fat, and the mean change in BMVA was greater in the VA group than in the BC and CO groups (4.6, 0.5, -3.6 nmol/g fat, respectively, P<0.001). Initial plasma BC concentration was 0.33±0.22 umol/L, and the mean change in plasma BC was greater in the BC group than in the VA and CO groups (0.74, 0.02, 0.07 umol/L, respectively, P<0.0001). Conclusions: Both BMVA and plasma retinol concentrations increased in response to supplementation with retinyl palmitate, but bioconversion of BC to VA is limited in this population.

Two contact Moments to Supply Micronutrient Powder (MNP) Yielded Similar Benefit on Anemia Reduction Compared to One Contact Moment in Misamis Oriental, the Philippines.

Objectives: This operational research study compared MNP distribution approaches, Group 1: one time delivery of 60 sachets/six months; and Group 2: twice a delivery of 30 sachets/three months, to assess differences in coverage and adherence among children aged 6-23 months in Misamis Oriental province, the Philippines. Both groups received similar education on IYCF. Methods: Cross-sectional data from baseline and six months were compared. Results: All 5704 children in the intervention communities received MNP (100% coverage). The median (range) number of MNP consumed by children was significantly higher in group 1 (n=680) than group 2 (n=680), as assessed using compliance cards [58 (1-60) vs. 42 (1-60)] and empty sachets count [56 (1-60) vs. 35 (1-60)]. More mothers in group 1 than group 2 reported changes in food attributes after adding MNP (85.5% vs. 67.5%) and side-effects (18.3% vs. 13.3%), P<0.05. Anemia was significantly lower at endline (15.1%) than baseline (44.9%) in both groups. Health workers had different opinions about integrating MNP into other child health programs. Some felt such integration will make their work easier, save time and provide a comprehensive approach to preventing anemia. However, others suggested such integration may pose problems for mothers and health workers, including difficulty to provide multiple services to families at the same time. Conclusions: Supplying 30 dosages of MNP twice did not increase MNP intake, but yielded similar benefit on anemia compared to supplying 60 dosages once. Programs should emphasize good introduction of MNP, strong IYCF education and anticipate changes in food attributes and side-effects.