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Research highlights
In this section, the IYCN Project offers summaries of new and notable research related to maternal, infant, and young child nutrition. Each summary includes the findings and analysis of the study’s author(s) only. Check back periodically for new research highlights.
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Evidence supports coupling prevention with treatment of acute malnutrition
January 2009
After the Niger food crisis of 2004-2005, programs for community-based treatment of acute malnutrition found that the prevalence of acute malnutrition, although reduced from the level during the crisis, remained unacceptably high. In an anthropological study published in the January 2009 issue of Disasters, researchers investigated social factors that may predispose infants and young children to acute malnutrition and contribute to its high prevalence. The authors used a variety of qualitative research methods to elicit local understanding and coping practices, and they uncovered several harmful infant and young child feeding practices. The majority of mothers initiated breastfeeding late, failed to exclusively breastfeed, and stopped breastfeeding early. A new pregnancy was the most common reason for early breastfeeding cessation, leading mothers to wean their children abruptly. Complementary foods were dilute and contained large amounts of water, and, since children older than 1 year fed themselves from a common plate, adults had little influence over what or how much children consumed.
The authors suggested that social factors influence decision-making about resource allocation for children and aggravate the situation. For example, families were reluctant to invest extra resources for a sick or malnourished child because of their persistent poverty and livelihood insecurity. Based on the findings, the authors recommended that treatment-based nutrition programs should include long-term approaches to improve infant and young child feeding. Approaches, they suggested, should build on knowledge of local realities, constraints, beliefs, and practices, and should support sustainable improvements for children’s diets through agricultural approaches, or creation of local versions of nutritional rehabilitation foods.
The social context of childcare practices and child malnutrition in Niger’s recent food crisis
Can water safety interventions reduce diarrhea during weaning?
September 2009
After implementing the Kisumu Breastfeeding Study (KiBS) for one and a half years, the study’s safety board noted that infants had high rates of diarrhea at age 6 months—the age at which their mothers were advised to rapidly stop breastfeeding. In a study published in the Journal of Infectious Diseases in September 2009, investigators hypothesized that a main cause of infant diarrhea was waterborne pathogens. The authors implemented a set of household interventions to improve water safety for KiBS study participants, including providing sodium hypochlorite solution to treat water, providing water storage vessels, and delivering behavior change messages to improve hand washing and other hygiene practices. They hypothesized that this combination of interventions, called the safe water system (SWS), would reduce incidence of diarrhea during weaning. In comparison to infants who enrolled in KiBS before implementing the SWS, the number of clinic visits for diarrhea during the weaning period was lower during the recommended exclusive breastfeeding period (0–5 months of age) and following breastfeeding cessation (7–11 months of age). However, during the weaning period (6 months of age), the frequency of diarrhea was the same in both groups (16%), leading the authors to conclude that diarrhea during the weaning period may be attributable to factors other than waterborne pathogens. The findings, they say, suggest that additional studies are needed to help clarify the definition of “safe” replacement feeding.
Continued breastfeeding lowers the risk of serious gastroenteritis for HIV-exposed kids
January 2010
An article in the January 2010 issue of the Journal of Acquired Immune Deficiency Syndromes analyzed the risk of serious gastroenteritis in HIV-exposed infants who participated in two different trials in the same hospital in Uganda during different time periods. Each of the trials gave advice to mothers about when to stop breastfeeding their infants based on national guidance at the time the trials took place. In the HIV Network for Prevention Trial (HIVNET 012), investigators instructed mothers to exclusively breastfeed for six months and then to stop breastfeeding as soon as possible. In the HIV hyperimmune globulin/nevirapine trial (HIVGLOB/NVP), researchers encouraged mothers to exclusively breastfeed for three to six months and then to abruptly stop breastfeeding over a two-week period. The average duration of breastfeeding in the HIVNET and HIVGLOB trials was 9.3 and 4 months, respectively. In both trials, incidence of serious gastroenteritis peaked around the average time of breastfeeding cessation. However, at every age except 9–10 months, infants in the HIVGLOB trial (earlier breastfeeding cessation) had higher rates of serious gastroenteritis through 18 months, and cumulative mortality was also higher in that group. The authors found these results to be particularly worrisome since the early cessation mothers of the HIVGLOB trial had characteristics usually assumed to be associated with successful replacement feeding, including higher education and employment rates, compared to mothers in the other trial, whose children had lower rates of serious gastroenteritis. The authors call for the development of infant feeding strategies that decrease the risk of postnatal HIV transmission yet allow HIV-infected mothers longer and safer breastfeeding for optimal nutrition and reduced risk of serious gastroenteritis.
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