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Nutritional status of infants at six months of age following maternal influenza immunization: A randomized placebo-controlled trial in rural Nepal.
Katz, J, Englund, JA, Steinhoff, MC, Khatry, SK, Shrestha, L, Kuypers, J, Mullany, LC, Chu, HY, LeClerq, SC, Kozuki, N, et al
Vaccine. 2017;(48 Pt B):6743-6750
Abstract
BACKGROUND Maternal influenza vaccination has increased birth weight in two randomized trials in South Asia but the impact on infant growth is unknown. METHODS A randomized placebo-controlled trial of year round maternal influenza immunization was conducted in two annual cohorts in Sarlahi District, southern plains of Nepal, from April 2011 through April 2014. Infants born to women enrolled in the trial had weight, length, and head circumference measured at birth and 6 months of age. The study was powered for the 3 primary trial outcomes but not for stunting and wasting at 6 months of age. RESULTS 3693 women received placebo or influenza vaccine between 17 and 34 weeks gestation, resulting in 3646 live births. About 72% of infants who survived had weight and length measurements between 150 and 210 days of age. Prevalence of stunting (<-2 Z scores length-for-age) was 14.8% in the placebo and 13.6% in the vaccine groups, respectively. Stunting < -3 Z scores was 3.2% versus 2.0% in placebo versus vaccine groups (RR: 0.64 (95% CI: 0.39, 1.04)). Wasting (< -2 Z scores weight for length) was 10.3% versus 11.0% for placebo versus vaccine groups. Severe wasting (< -3 Z scores weight for length) was 3.8% for placebo versus 2.6% for vaccine (RR: 0.69 (95% CI: 0.44, 1.07)). The impact of flu vaccine on wasting was greater in cohort 2 than in cohort 1, (RR: 0.66 (0.44, 0.99) for any wasting), and RR: 0.45 (0.19, 1.09) for severe wasting. This corresponded to a larger impact on birth weight and a better vaccine match with circulating viruses in cohort 2. CONCLUSIONS Although maternal immunization reduced low birth weight by 15%, only wasting at 6 months in the 2nd cohort was statistically significantly difference. However, the study was underpowered to detect reductions of public health importance. TRIAL REGISTRATION Clinicaltrials.gov (NCT01034254).
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An in-home intervention to improve nutrition, physical activity, and knowledge among low-income teen mothers and their children: results from a pilot study.
Davis, AM, Gallagher, K, Taylor, M, Canter, K, Gillette, MD, Wambach, K, Nelson, EL
Journal of developmental and behavioral pediatrics : JDBP. 2013;(8):609-15
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OBJECTIVE Teenage pregnancy is a major public health concern in the United States. In addition to other life stressors, adolescent mothers and their children are at risk for obesity and other negative health outcomes. The current study examines the impact of a brief in-home educational intervention designed to improve health knowledge and behavior in a sample of low-income adolescent mothers. METHOD Forty-six teen mothers received 6 in-home educational sessions focused on nutrition and physical activity, with baseline and follow-up knowledge and behavior assessments. RESULTS Results indicate significant improvements in mothers' health knowledge and physical activity pertaining to themselves and to their children, and also an unexpected increase in sedentary behaviors. CONCLUSION Results from this study indicate that knowledge-focused interventions may be an effective method to facilitate positive health behavioral change for teenage mothers.
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Feasibility of integrating early stimulation into primary care for undernourished Jamaican children: cluster randomised controlled trial.
Powell, C, Baker-Henningham, H, Walker, S, Gernay, J, Grantham-McGregor, S
BMJ (Clinical research ed.). 2004;(7457):89
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OBJECTIVES To assess the feasibility of integrating early psychosocial stimulation into primary care for undernourished children and to determine the effect on children's development and mothers' knowledge and practices of childrearing. DESIGN Cluster randomised controlled trial. SETTING 18 clinics in three Jamaican parishes. PARTICIPANTS 139 undernourished children aged 9 to 30 months and their mothers enrolled in intervention or control clinics. INTERVENTIONS Weekly home visits by community health aides for one year in addition to usual duties. Parenting issues were discussed with the mothers and play activities were demonstrated with the children using homemade materials. MAIN OUTCOME MEASURES Children's scores on the Griffiths mental development scales and mothers' knowledge and practices of childrearing measured by questionnaires. RESULTS Children from the intervention group showed significant improvements in development: developmental quotient, 7.8 points (95% confidence interval 4.5 to 11.1); hearing and speech, 10.7 (5.9 to 15.4 points); hand and eye coordination, 6.8 (3.4 to 10.1 points); and performance subscale, 11.0 (5.6 to 16.4 points). No improvements were shown on the locomotor subscale. The mothers from the intervention group showed improved knowledge and practices of childrearing. Change in children's body mass index and height independently affected change in development. CONCLUSION Integrating parenting skills and early psychosocial stimulation for undernourished children into primary care was feasible and effective in improving the children's development and mothers' knowledge and practices of childrearing.
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Maternal compliance with nutritional recommendations in an allergy preventive programme.
Schoetzau, A, Gehring, U, Franke, K, GrĂ¼bl, A, Koletzko, S, von Berg, A, Berdel, D, Reinhardt, D, Bauer, CP, Wichmann, HE, et al
Archives of disease in childhood. 2002;(3):180-4
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AIMS: To assess maternal compliance with nutritional recommendations in an allergy preventive programme, and identify factors influencing compliance behaviour. METHODS Randomised double-blind intervention study on the effect of infant formulas with reduced allergenicity in healthy, term newborns at risk of atopy. Maternal compliance with dietary recommendations concerning milk and solid food feeding was categorised. RESULTS A total of 2252 newborns were randomised to one of four study formulas. The drop out rate during the first year of life was 13.5% (n = 304). The rates of high, medium, and low compliance to milk feeding during weeks 1-16 were 83.4%, 4.0%, and 7.5%; the corresponding rates to solid food feeding during weeks 1-24 were 60.0%, 12.1%, and 22.9%. In 5.1% of subjects no nutritional information was available. Low compliance was more frequent among non-German parents, parents with a low level of education, young mothers, smoking mothers, and those who weaned their infant before the age of 2 months. CONCLUSIONS Evaluation of allergy preventive programmes should take into account non-compliance for assessing the preventive effectiveness on study outcome.
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Birthweights and growth of infants in five Aboriginal communities.
Smith, RM, Smith, PA, McKinnon, M, Gracey, M
Australian and New Zealand journal of public health. 2000;(2):124-35
Abstract
OBJECTIVES To improve, by culturally appropriate means, birthweights and growth of children up to three years of age over 14 months in five Aboriginal communities in north-western Australia. METHODS Frequent individual nutritional assessment of infants and children with counselling of mothers and carers and of pregnant women and the introduction of the Aboriginal-controlled Strong Women, Strong Babies, Strong Culture maternal support program. Outcomes compared with those in the same communities for the five years preceding intervention. RESULTS By international standards, pre-intervention birthweights of full-term infants (37-42 weeks) were only moderately depressed and recovered to exceed standard weight-for-age within two weeks of birth. Growth of full-term infants slowed abruptly after six months. Prevalence and duration of breastfeeding were very high. Prevailing low average birthweight was chiefly attributable to a prevalence of pre-term birth approaching 20%. Intervention was not accompanied by any change in full-term birth weight but was associated with increased weight gain after six months. From 12 to 36 months growth rose by 30 g per month (p = 0.001). Average birthweights of pre-term infants were < 2,500 g and average weight-for-age did not improve during intervention. CONCLUSIONS Both low birthweight and a disproportionate part of intransigent failure to grow by Aboriginal infants were associated with pre-term birth. Depressed average growth of full-term infants appeared to respond to nutritional counselling accompanied by a community support program. IMPLICATIONS Investigation of the causes of the exceptionally high rate of Aboriginal pre-term birth in the region is urgently required.