Suzanne Filteau

Feeding difficulties in disabled children leads to malnutrition: experience in an Indian slum

The aim of the present study was to explore the nature, extent and probable causes of nutritional deficiencies among children with disabilities living in Dharavi, a slum in Mumbai, India. A cross-sectional study was conducted to investigate whether the nutritional status of children with disabilities, aged 2-6 years (n 141), was worse than that of non-disabled sibling controls (n 122) and neighbour controls (n 162). Data on food patterns, anthropometry, micronutrient status and feeding difficulties reported by parents were collected. The mean weight for age of the children with disabilities (-2.44 (SD 1.39) Z scores; n 120) was significantly lower (P<0.05) compared with the sibling (-1.70 (SD 1.20) Z scores; n 109) and neighbour (-1.83 (SD 1.290) Z scores; n 162) control groups. The children with disabilities had significantly lower (P<0.05) mean haemoglobin levels (92 (SD 23) g/l; n 134) compared with siblings (102 (SD 18) g/l; n 103) and neighbours (99 (SD 18) g/l; n 153). Relative risk (RR) analysis indicated that the disabled children with feeding difficulties were significantly more likely (P<0.05) to be malnourished, by the indicator of weight for age (RR 1.1; 95 % CI 1.08, 1.20) compared with the disabled children without a feeding difficulty. They were also significantly more likely to be malnourished using the indicators of height for age (RR 1.3; 95 % CI 1.19, 1.43) and weight for height (RR 2.4; 95 % CI 1.78, 3.23) compared with the disabled children without a feeding difficulty. Feeding difficulties were identified as a risk factor for vulnerability to inadequate nutritional status among children with disabilities.

Comparison of armspan, arm length and tibia length as predictors of actual height of disabled and nondisabled children in Dharavi, Mumbai, India

Objectives: To investigate appropriate measurements to predict height in children with physical impairments to facilitate the accurate assessment of nutritional status in field studies.Design: Case–control cross-sectional study.Setting: Dharavi, a large slum in Mumbai, India.Subjects: In total, 141 children with mixed disabilities and 162 nondisabled control children, aged 2–6 y.Methods: Height/length, armspan, arm length and tibia length were measured to the nearest 0.1 cm using standard procedures. The relations between armspan, arm length and tibia length with height in controls were investigated using linear regression.Results: Armspan (R 2=0.93, P<0.001, n=158), arm length (R 2=0.81, P<0.001, n=162) and tibia length (R 2=0.72, P<0.001, n=161) were found to be strong predictors of height based on data from nondisabled control children. These measurements could be used to determine a more accurate height for children with physical impairments where the nature of the impairment may interfere with height measurements.Conclusions: Armspan, arm length and tibia length can be used to determine accurate height for children with physical impairments, for example, children with a nonambulatory status or those with kyphosis or scoliosis of the spine.Sponsorship: Department for International Development (DFID), UK.

The nutritional status of disabled children in Nigeria: a cross-sectional survey.

Objective: To compare the nutritional status of disabled children in Nigeria with their non-disabled siblings and neighbours. A second aim was to investigate anthropometric techniques appropriate for disabled children in this situation.Design: A cross-sectional survey.Setting: Nasarawa and Plateau States and the Federal Capital Territory in Central Nigeria.Subjects: 311 children under 10 years of age were studied: 112 with various disabilities, 87 siblings and 112 neighbours.Methods: Selected anthropometric measurements, (height, weight, mid-upper arm circumference (MUAC), demispan and halfspan), and blood haemoglobin levels were assessed by trained personnel. All measurements of disabled subjects were compared to the non-disabled controls.Results: The disabled subjects had mean height for age (ht/age) and weight for age (wt/age) significantly lower than the control group (P<0.05). These differences were due largely to the very low Z scores in children with neurological impairments, (ht/age= 3.07 (s.d.=1.6); wt/age= 2.0 (s.d.=1.2)). Measurement difficulties contributed to low height values in disabled children and halfspan was found to be a useful proxy for height in these children. MUAC results were higher for the children with disabilities due to polio than for controls. The mean haemoglobin levels were slightly but significantly higher (P<0.05) in the disabled and sibling groups compared to the neighbourhood group.Conclusion: Disabled children with neurological impairments and consequent feeding difficulties are nutritionally at risk, but others are no worse off than their non-disabled peers in this area. Halfspans may serve as a useful proxy indicator for estimating height in some children with physical impairments.Sponsorship: The study was funded by a TEAR fund grant to JT for her MSc studies.

Longitudinal Changes in Milk Sodium/Potassium Ratio in Women with Serious Infection in the Postpartum Period

Subclinical mastitis, as defined by raised milk sodium/potassium (Na/K) ratio (>0.6), is common among several populations and is associated with poor infant growth (Filteau et al. in press) and, in HIV-infected women with high milk HIV viral load, a risk factor for mother to child transmission.1, 2

Serum leptin in disabled and non-disabled children in an Indian slum population

Objective: To assess the concentration of serum leptin in a population of malnourished children and to compare the leptin levels of disabled and non-disabled children in this population.Design: Case–control study.Subjects: Eighty-one children, comprising 41 children with mixed disabilities and 40 non-disabled controls, were selected from 425 children involved in a case–control study assessing the nutritional status of children with disabilities in an Indian slum population.Methods: Leptin was measured in the serum samples and was compared with anthropometry (weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ), weight-for-height Z-scores (WHZ), body mass index (BMI), mid-upper-arm circumference (MUAC), sub-scapular skinfold thickness and triceps skinfold thickness) and serum acute phase proteins.Results: The children were very malnourished with WAZ=−2.07 (s.d. 1.15), HAZ=−2.15 (s.d. 1.85) and WHZ=−1.07 (s.d. 0.83). Leptin was extremely low in both the disabled (1.44 ng/ml; 95% confidence interval, CI, 1.23–1.69) and the non-disabled (1.19 ng/ml; 95% CI 1.04–1.35) children. There were no differences between the disabled and non-disabled groups as a whole but 15 children with neurological disabilities had significantly higher (P<0.05) serum leptin (1.65 ng/ml; 95% CI 1.29–2.06) than the non-disabled children. Girls (1.55 ng/ml; 95% CI 1.29–1.87) had significantly higher concentrations of leptin than boys (1.11 ng/ml; 95% CI 1.02–1.22; P=0.002). Leptin did not correlate with any biochemical or anthropometric measures.Conclusions: In this population, where malnutrition was common, serum leptin levels were very low and did not correlate with anthropometry.Sponsorship: UK Department for International Development; Virgin Airways through the Great Ormond Street Hospital Trustees.

Infant feeding and infectious disease

Infectious diseases take the lives of many infants and young children in developing countries. Furthermore, the adverse effects of infection linger even among the survivors who may suffer growth faltering and its associated risks, including, in the short term, increased susceptibility to infection (Tomkins and Watson, 1989) and, in the long term, decreased life-long productivity (Gopalan, 1988). Because of the devastating effects of infectious disease, much research has dealt with possible means of prevention of infection, including immunization and improved sanitation, water supplies and personal hygiene. One factor which appears to have an important influence on an infant’s risk of and response to an infection is the infant’s diet. Infant feeding practices and their relation to infectious disease are the subject of this review, with particular emphasis on the role of breast feeding but also with some discussion of weaning foods.

Determinants of Milk Sodium/Potassium Ratio and Viral Load Among HIV-Infected South African Women

Although HIV can be transmitted from mother to infant through breastmilk,1 breastfeeding remains a key component of maternal and child health policy. Therefore, it is crucial to understand factors contributing to breastmilk HIV transmission, especially in Africa where HIV is most prevalent. In South Africa, exclusive breastfeeding was associated with a lower rate of transmission than was mixed breastfeeding with other foods.2