Malnutrition prevalence in Pakistan is high considerably and leads to susceptibility of the children to infectious diseases that are preventable, and has an association indirectly with the leading death causes of children (Perveen et al, 2006). Malnutrition can be prevented through complimentary feeding practices that are effective. Bhat et al (1992) pointed out that many strategies have been adopted to improve the complimentary practices of feeding and they include education to mothers about nutrition. These are designed to promote feeding practices that are healthy. Another strategy according to Dewey et al (1998) is complementary food provision to the children to offer extra energy. Lastly is increasing the complimentary foods energy density through simple technology. This systematic review has reviewed available studies that have content about effectiveness of complementary feeding and education in fighting malnutrition in Pakistan.
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Liaqat et al (2007) conducted a study on the “Association between Complimentary Feeding Practice and Mothers Education Status in Islamabad.” The objective of the research was to examine the relation between education of mothers, malnutrition and complimentary feeding practices amongst Islamabad mothers that attend outpatients’ clinics. 500 participant mothers who were attending Federal Government Services Hospital Pediatric Outpatient Hospital filled the questionnaires. The results indicated positive relationship between mothers’ educational status and the infants’ nutritional status. This study revealed that most of the malnourished infants belonged to the no school education mothers. In summary, education of mothers play significant role in increase knowledge receptivity and awareness related to their infants nutritional requirements (Fleisher et al, 2000).
“Malnutrition in Young Pakistani Children,” was a study done by Hirani (2012) with the main objective of reviewing the literature to analyze the politico-economical, environmental, socio-cultural, maternal and biological malnutrition determinants among young Pakistani children for recommendation of need based interventions for curbing and prevention. The study applied systematic search of all international, regional and national literature from data bases that are peer reviewed. The conclusion of the study was that malnutrition among children of Pakistan are prevalent and multiple at the community, family and even individual level. Furthermore, analysis of the politico-economical, environmental, socio-cultural, maternal and biological factors indicated that most of them are interrelated and therefore need composite interventions to tackle the issue at the level of Pakistani community, families and the malnourished children (Guldan et al, 1993).
Dewey & Adu-Afarwuah (2008) conducted a study on “Systematic Review of the Efficacy and Effectiveness of Complimentary Feeding Interventions in Developing Countries.” The study used electronic methods in the search with an objective determining effectiveness and efficacy of the developing countries complementary feeding interventions. 25 developing countries and 42 papers were used with 29 reports of efficacy trials and 13 reports on programs effectiveness. Results were varied from different countries but for the group of only education were intermediate between control groups and the food plus education. Therefore, inclusion of a food supplement in all the settings was more effective compared to education alone. Other major areas of interest of the study include morbidity, growth and child development (Malik et al, 1991).
A study, “Training In Complimentary Feeding Counseling Of Healthcare Workers And Its Influence On Maternal Behaviors And Child Growth: A Cluster-Randomized Controlled Trial In Lahore, Pakistan” by Zaman et al (2008) with an aim of reducing faltering growth in young children through proper techniques of nutrition promotion. The objective was to determine training health workers efficacy in nutritional counseling to enhance performance and communication skills, improving practices of feeding, and to reduce faltering of growth among the children aged between 6 to 24 months. The study used 40 paired health centers, where one of each paired centers was allocated intervention group randomly, and the other a control group, with 375 mothers of children aged 6 to 24 months recruited as participants. The module of Integrated Management of Childhood Illness (IMCI) was used in health workers training at the intervention centers. Results indicated that consultation and communication skills of health workers were better significantly in intervention group than control group. The recall of mothers of the health workers recommendations, and infant feeding practices reported was also better in the intervention group. Faltering of growth was also less in the intervention group. This is an indication that IMCI feeding counseling training enhances performance and communication skills of health workers. Feeding practices of the mothers counseled consequently can reduce faltering of children’s growth (Bhutta et al, 2004).
Hanif (2011) conducted a study “Trends in Breastfeeding and Complimentary Feeding Practices in Pakistan, 1990-2007” with an objective of evaluating these programs effectiveness. Estimates on the different proposed WHO indicators for young child and infant feeding were analyzed in light to Health Survey and Pakistani Demographic (2006-2007 and 1990 to 1991). The results indicated that almost half the optimal and core indicators over the years have modestly improved. Out of the five required indicators in the assessment tool of WHO of child feeding, duration and exclusive breastfeeding fall in fair category (Morisky et al, 2002). However, bottle feeding, introduction of complementary food and early breastfeeding initiation was in poor category (David, 1995).
References
Bhat, I.A., Shah, G.N., Dhar, G.M. & Mehnaz, S.A. (1992) Study on the impact of maternal knowledge and practice on the nutritional status of infants. Indian J. Matern. Child Health 3, 12–15
Bhutta ZA, Thaver D, Akram DS, Khan M. (2004)Situation and Program analysis of malnutrition among women and children in Pakistan. In: Bhutta ZA, editor. Maternal and Child Health in Pakistan Challenges and Opportunities. Pakistan: Oxford University Press
David S, ML.(1995). Childhood Diarrhea and Malnutrition in Pakistan, Part I: Incidence and Prevalence. J Pediatr Nurs;10(2):131–7.
Dewey, K. G., & Adu-Afarwuah, S. (April 01, 2008). Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Maternal & Child Nutrition, 4, 24-85.
Dewey, K.G., Cohen, R.J., Rivera, L.L. & Brown, K.H. (1998) Age of introduction of complementary foods and growth of term, low- birth-weight, breast-fed infants: a randomised intervention study in Honduras. Am. J. Clin. Nutr. 67, 878–884.
Fleisher Michaelson, K., Weaver, L. & Branca, F. (2000) Feeding and Nutrition of Infants and Young Children Copenhagon: WHO Regional Publications, European Series, 87.
Guldan, G.S., Zeitlin, M.F., Beiser, A.S., Super, C.M.,Gershoff, S.N. & Datta, S. (1993) Maternal education child feeding practices in rural Bangladesh. Soc. Sci. Med. 36, 925–935.
Hanif, H. M. (January 01, 2011). Trends in breastfeeding and complementary feeding practices in Pakistan, 1990-2007. International Breastfeeding Journal, 6.
Hirani, S. A. (January 01, 2012). Malnutrition in young Pakistani children. Journal of Ayub Medical College, Abbottabad : Jamc, 24, 2.)
Liaqat, P., Rizvi, M. A., Qayyum, A., & Ahmed, H. (August 01, 2007). Association between complementary feeding practice and mothers education status in Islamabad. Journal of Human Nutrition and Dietetics, 20, 4, 340-344.
Malik, I. A., Azim, S., Good, M. J., Iqbal, M., Nawaz, M., Ashraf, L., & Bukhtiari, N. (January 01, 1991). Feeding practices for young Pakistani children: usual diet and diet during diarrhoea. Journal of Diarrhoeal Diseases Research, 9, 3, 213-8.
Morisky DE, Kar SB, Chaudry AA, Chen KR, Shaheen M, Chickering K. (2002).Breastfeeding practices in Pakistan. Pak J Nutr;1:137–42
Perveen Liaqat, Mazhar Abbas Rizvi, Abdul Qayyum, Hajra Ahmed, & Nadia Ishtiaq. (2006). Maternal Education and Complementary Feeding. Asian Network for Scientific Information.
Zaman, Shakila, Ashraf, Rifat N., & Martines, José. (2008). Training in Complementary Feeding Counselling of Healthcare Workers and Its Influence on Maternal Behaviours and Child Growth: A Clusterrandomized Controlled Trial in Lahore, Pakistan. (The Journal of Health, Population and Nutrition (ISSN: 1606-0997) Vo
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