Inappropriate Feeding Behavior: One of the Important Causes of Malnutrition in 6- to 36-Month-Old Children in Myanmar.

The complementary feeding period is an important time for children's growth and development. This study was conducted to 1) determine the feeding behaviors of 6- to 36-month-old children in Myanmar, 2) explore health effects of feeding behaviors, and 3) determine factors associated with feeding behaviors. A total of 807 children and their mothers (N = 642) were recruited from nine villages in Kachin, Shan, and Kokang, Myanmar. Feeding behaviors and sociodemographic characteristics were investigated using a validated questionnaire. Hemoglobin and anthropometric indicators were measured during the fieldwork. In our sample, 18.6%, 72.7%, and 9.8% of children were introduced to complementary foods (CFs) earlier than 4 months of age, between 4 and 8 months of age, and later than 8 months of age, respectively. For different types of CFs, up to the age of 24.1-36 months, there were still 6.5% and 4.1% of the children who had never been introduced to eggs and meat. Introduction of CFs earlier than 4 months of age was a risk factor for being underweight (age-adjusted odds ratio (ORadjust-age) = 1.7, 95% confidence interval (CI) = 1.2-2.5) and for stunting (ORadjust-age = 1.6, 95% CI = 1.1-2.3), whereas introduction of CFs later than 8 months of age was a risk factor for anemia (ORadjust-age = 3.5, 95% CI = 1.7-7.2). Mothers who had anemia (OR = 3.7, 95% CI = 2.0-6.9) tended toward early introduction of CFs. Women with a lower family income tended toward later introduction of CFs (OR = 2.0, 95% CI = 1.3-3.3). This study demonstrated that inappropriate feeding behavior was one of the important causes of malnutrition.

ANEMIA AMONG LACTATING MOTHERS IN KOKANG, MYANMAR.

Anemia is an important public health problem among lactating mothers in the developing countries. The aim of the study was to determine the prevalence of anemia in lactating mothers in Kokang, Myanmar and its associated risk factors. We conducted a cross sectional study of 65 lactating mothers during June-October 2014. Each participant filled out a questionnaire asking about diet, source of drinking water, health status, socioeconomic and demographic factors. Each participant was also evaluated anthropometrically and had blood taken to determine their hemoglobin and their iron, copper, zinc, calcium, and magnesium levels. The prevalence rate of anemia (hemoglobin 81-120 g/l) in study subjects was 73.8%, and 10.8% had severe anemia (hemoglobin ≤ 80 g/l). Factors of malnutrition (mid-upper arm circumference < 23.5 cm, p = 0.013), iron deficiency (serum iron concentration < 6.6 mmol/l, p = 0.008), and source of drinking water (p = 0.031) were related to anemia. Fifty-six point three percent of women with anemia had a low serum iron level. Anemia was common among study subjects in Kokang. Since a large portion of women in our study with anemia had a low serum iron level, we conclude the major cause of anemia in our study was iron deficiency.

Potential Contribution of Iron Deficiency and Multiple Factors to Anemia Among 6- to 72-Month-Old Children in the Kokang Area of Myanmar.

The prevalence of anemia among children in Myanmar has been reported to be among the highest in the world. This study was conducted to determine 1) the prevalence of anemia in preschool children and 2) risk factors associated with anemia. A total of 138 children aged from 6 to 72 months were recruited through cluster sampling from six villages in Kokang. Hemoglobin (Hb) concentration, blood trace elements, and anthropometric indicators were measured. Feces samples were collected to examine for the presence of ascarid eggs. The overall prevalence of anemia in children was 61.6%, including 10.9% with severe anemia. Meanwhile, high prevalence of stunting (40.0%), underweight (22.4%), wasting (6.3%), and small head circumference (6.7%) was found. Children with anemia were more prone to stunting. Children with severe anemia and moderate anemia had significantly lower blood iron and zinc levels than children without anemia (P < 0.001 and P = 0.007). The prevalence of ascarid infection was 64.9%; however, it was not associated with anemia. Drinking spring water was positively associated with anemia (odds ratio [OR] = 6.368). This study demonstrated that anemia is an important public health problem among children from the Kokang area. Iron deficiency and drinking spring water may be the important causes of anemia among children.

Prevalence of picky eating behaviour in Chinese school-age children and associations with anthropometric parameters and intelligence quotient. A cross-sectional study.

Previous studies have demonstrated the importance of eating behaviour regarding dietary variety and nutrient intake of children. However, the association between picky eating and growth of children is still a topic of debate. This study sought to estimate the prevalence of picky eating and to identify possible associations with the growth of school-age children in China. In this survey, 793 healthy children aged 7-12 years were recruited from nine cities and rural areas in China using a multi-stage cluster sampling method. Data collected included socio-demographic information and parents' perceptions of picky eating using a structured questionnaire, nutrient intake using 24-hour dietary recall, weight and height using body measurements, and intelligence using the Wechsler Intelligence Scale for Children. Blood samples were collected and analysed for minerals. The prevalence of picky eating reported by parents was 59.3% in children. Compared with non-picky eaters, picky eaters had a lower dietary intake of energy, protein, carbohydrates, most vitamins and minerals, and lower levels of magnesium, iron, and copper in the blood (p < 0.05), and also had a 0.184 z-score lower in height for age (95% CI: -0.332, 0.036; p = 0.015), a 0.385 z-score lower in weight for age (95% CI: -0.533, -0.237; p < 0.001), a 0.383 z-score lower in BMI for age (95% CI: -0.563, -0.203; p < 0.001), and scored 2.726 points higher on the intelligence test (95% CI: 0.809, 4.643; p = 0.006) when adjusted for children's birth weight and food allergy, mothers' education, and family income. Picky eating behaviour towards meat, eggs and vegetables showed negative associations with growth. Picky eating behaviour is prevalent in school-age children in China and may have a negative effect on growth.

Nutritional status of breast-fed and non-exclusively breast-fed infants from birth to age 5 months in 8 Chinese cities.

This study aimed to assess the nutritional status of infants aged 0 to 5 months by different feeding approaches. A cross-sectional study on infant nutrition was performed in eight cities in China. A total of 622 infants from birth to 2 months of age and 456 infants from 3 months to 5 months of age were included in this study. Mix-fed infants received breast milk and complementary foods from birth to 2 months of age. Approximately 38.2% of mix-fed infants received excessive vitamin A, and 15.6% of infants exceeded the tolerable upper intake levels (ULs) of zinc. For artificially fed infants who received only complementary foods, approximately 20% and 12.5% infants received inadequate dietary vitamin A and zinc intakes, respectively. The vitamin A and zinc intakes of half of the infants exceeded the ULs. Results showed that the usual intake distribution of the infants from 3 months to 5 months of age were similar to that of the infants from birth to 2 months of age. The common vitamin A and zinc intakes were also severely imbalanced. In addition, higher disease prevalence and lower Z scores of length-forage, weight-for-age, and weight-for-length were found in artificially fed infants and mix-fed infants compared with those in breast-fed infants. In conclusion, the usual nutrient intakes were adequate for the majority of Chinese infants, except for an important number of infants at risk for imbalance of vitamin A and zinc intakes.

Prevalence of anemia and its risk factors among lactating mothers in Myanmar.

In Myanmar, 60% of the population consists of mothers and children, and they are the groups most vulnerable to anemia. The objectives of this study are to determine (1) the anemia prevalence among lactating women and (2) the risk factors associated with anemia. Convenience sampling was used to select three villages in two different regions (Kachin and Shan) in Myanmar. Hemoglobin and anthropometric indicators were measured for 733 lactating women. Logistic regression analyses were used to determine factors associated with anemia. The anemia prevalence rate was 60.3% in lactating women, with 20.3% of lactating women having severe anemia. Factors of malnutrition (P = 0.026), self-reported symptoms of night blindness or poor dark adaptation (P < 0.001), lack of primary education experience (P < 0.001), low family annual capita income (< 800 MMK; P < 0.001), drinking spring or river water (P < 0.001), and drinking unboiled water (P = 0.016) were associated with anemia. To promote health in lactating women, a comprehensive intervention is needed in these regions.