Nutritional needs in the first years of life | Political economics

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Pakistan, one of the most populous countries in the world; currently ranks 26th in the world for under-five mortality. Poor nutrition and maternal education are major factors affecting mortality rates. Demographic and health surveys have shown that the mortality of children under five born to uneducated mothers is twice that of children born to mothers with secondary education and three times higher than that of children of mothers with higher education. (BMC Health Research Policy and Systems 2015).

Pakistan is one of the countries in the world with the highest child malnutrition rates (stunting 38%, wasting 15% and underweight 31%) and its progress in child nutrition and health has remained slower than other South Asian countries.

Malnutrition in children under five is a significant problem worldwide, but particularly in low- and middle-income countries. Key factors include: maternal education, knowledge, perception and misconceptions about breast milk and various other food products. If mothers are unaware of a healthy and balanced diet or if they perceive healthy foods as harmful, they will not incorporate these foods into their child’s regular diet, even if they are readily available.

Colostrum, a protein-rich yellowish-white or bluish-white milk, is the first secretion of the mammary gland, which begins to be expressed in the third trimester. Studies have shown that the negative attitude towards colostrum feeding contributes to its lack of use.

So what information do we have on feeding practices among mothers of children under five? A local study comparing mothers’ education levels with the use of colostrum or “first milk” showed that 42% of mothers who had no schooling/education perceived it as “unclean”, compared to 9, 5% of those with higher education. Interestingly, however, the percentage of more educated mothers who did not use colostrum due to parental/family elder advice against its use was higher than that of uneducated mothers (28.5%). vs. 15.8 percent).

In another study, 81% of mothers with a college or university degree said that their overall food choices for their children were influenced by the elders in the family. When specific foods were examined, it appeared that the use of bananas and eggs was generally avoided due to certain misconceptions.

Community-based interventions to promote maternal health education can be cost-effective and can be used over the long term. Even in disadvantaged areas, with a high rate of poverty and malnutrition, structured community intervention in the areas of food economy, healthy eating and food security can have positive results..

The consumption of bananas, eggs, rice and butter throughout the year was noted among children belonging to more educated mothers compared to their less educated counterparts. It was noted that bananas and dates were included in a child’s diet all year round when the mother’s choice was influenced by older family members.

One of the main reasons for the use of complementary foods, also called supplementary or superior food (which is food given to the child in addition to breast milk) was the maternal belief that she was not producing enough milk. mother to properly feed her child. Depending on affordability, either diluted cow/buffalo milk or infant formula was used as the superior food. About 80% of mothers were unaware that cow’s milk can cause iron deficiency anemia in children under 12 months.

There is a need to educate mothers and families on the importance of breastfeeding, especially the benefits of colostrum.

Information about the benefits of colostrum and exclusive breastfeeding in the media rather than the promotion of breastmilk substitutes can help primary care providers address the current knowledge gap.

Information on the nutritional benefits of foods like banana, eggs, rice, dates, ghee and butter should be presented to mothers. This will promote the inclusion of these elements in the diets of infants and toddlers.

For a successful transition to healthy eating, myths and misconceptions must be systematically challenged. Nutritionists, healthcare professionals need to be aware of common misconceptions and address them promptly during consultations.

Higher maternal education leads to a better understanding of pediatric anemia, which affects more than half of preschool children in developing countries.

Community-based interventions to promote maternal health education can be cost-effective and can be used over the long term. Even in disadvantaged areas, with a high rate of poverty and malnutrition, structured community intervention in the areas of food saving, healthy eating and food security can have positive results.

I would like to acknowledge the work of two family physicians: Drs Khudija Amna Arif and Dr Marriam Sheraz in the studies mentioned above.


The author is Assistant Professor of Family Medicine at Lahore University of Health Sciences


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