عنوان

Effect of Pre- and Post-Natal Nutrient Supplements on Common Childhood Illnesses, Newborn Physical Condition and Early Infant Feeding Behaviors:

TLpq2411055841

انگلیسی

Effect of Pre- and Post-Natal Nutrient Supplements on Common Childhood Illnesses, Newborn Physical Condition and Early Infant Feeding Behaviors:

[Thesis]

Ullah, Md Barkat

A Cluster Randomized Effectiveness Trial

Dewey, Kathryn G.

University of California, Davis

2020

123

Ph.D.

University of California, Davis

2020

Background: There are several strategies for reducing child undernutrition in low and middle income countries, including pre- and postnatal nutritional supplements. Although there is evidence that such interventions can have positive effects on pregnancy outcomes and maternal and child nutrition, there is less information on how they impact child morbidity, newborn condition and feeding behaviors. My dissertation examines these questions in a population in rural Bangladesh. In addition, I examine risk factors associated with diarrhea and acute respiratory infection (ARI) among 6 to 23 months old children in the study population. These two types of infections are still major causes of child mortality globally, even though there has been improvement in reduction of child mortality from these illnesses. Methods: For this research I used data from a longitudinal, cluster randomized effectiveness trial, the Rang-Din Nutrition Study in rural northern Bangladesh. Pregnant women were enrolled at ≤20 wk gestation (n=4011) and received either: a) Lipid-based nutrient supplement (LNS) during pregnancy and the first 6 months postpartum, and LNS for the offspring from 6-24 months (LNS-LNS); b) Iron and folic acid (IFA) during pregnancy and the first 3 months postpartum, and LNS for the offspring as described above (IFA-LNS); c) IFA as described above and micronutrient powder (MNP) for the offspring from 6-24 months (IFA-MNP); or d) IFA as described above and no supplement for the offspring (IFA-Control). All supplements were intended for daily consumption. Women and their children were followed up until two years postpartum. Data on household socioeconomic status, type of toilet facility and garbage disposal system, indoor air quality, household food insecurity, and maternal and child characteristics were collected during early pregnancy and/or at 6, 12, 18 and 24 months postpartum. Data on delivery and newborn characteristics including health and feeding behaviors were collected within 72 hours of delivery. Information on acute lower and upper respiratory infection (ALRI/AURI), diarrhea and fever in the previous fourteen days and the previous six months was collected at 6, 12, 18 and 24 months of age. Effects of the intervention were analyzed using negative binomial regression for continuous outcomes and mixed model logistic regression for dichotomous outcomes. Associations between potential risk factors and morbidity outcomes were assessed using logistic regression controlling for potentially confounding variables. Results: A total of 3664 live births occurred among the women not lost to follow-up before delivery. Information was collected from 3333, 3331, 3364 and 3379 children at 6, 12, 18 and 24 months, respectively. In the first set of analyses, prevalence of ALRI, fever and diarrhea at 6 months of age did not differ between infants of women who received LNS vs IFA, but infants in the LNS-LNS group had lower prevalence of AURI compared to the other three groups combined. At 12, 18 and 24 months, there were no significant differences among the 4 intervention groups in prevalence of fever or ALRI, but compared to IFA-Control infants, IFA-LNS infants had lower prevalence of AURI at 12 months after covariate adjustment. No other pairwise group differences were significant. In the second set of analyses, no significant differences were found between intervention groups in newborn response, mother's rating of the general condition of her newborn, early initiation of breastfeeding (EIBF), suckling ability, or frequency and exclusivity of breastfeeding in the first 24 hours after birth. Strong associations were found between mother's rating of the overall condition of her newborn and newborn response and early feeding practices. If the mother perceived her infant to be healthy, EIBF was more likely and frequency of breastfeeding in the first 24 hours was greater. In the third set of analyses, diarrhea and ALRI were more likely among children of mothers with higher maternal depression score and among children in households with food insecurity. In addition, diarrhea was less likely among the children in joint families, ALRI was less likely in female children, and AURI was more likely among children in households with food insecurity. Cough or common cold in the previous six months was associated with maternal depression score, type of toilet and garbage disposal, household food insecurity, child sex and perceived overall physical condition of the infant after birth. Conclusions: Providing LNS to women or LNS or MNP to children generally did not increase or decrease common childhood illnesses. However, LNS provided pre- or post-natally may reduce AURI among infants, though results were inconsistent. We found no association between prenatal nutritional supplementation and maternal perception of the general condition of her newborn or early breastfeeding practices. However, early breastfeeding practices were related to maternal perception of the general condition of her newborn. Thus, interventions to support recommended breastfeeding practices for newborns with poorer perceived health status may be useful. Maternal depression score and food insecurity appear to be important risk factors for diarrhea and respiratory infection among children under two years of age in this setting. Policies and programs that include strategies to address maternal mental health and household food insecurity may contribute to improved child health.

Epidemiology

Nutrition

Statistics

Dewey, Kathryn G.

Ullah, Md Barkat

p

[Thesis]

276903

a

Y