Journal Article > ResearchFull Text
Matern Child Nutr. 4 June 2024; Online ahead of print; DOI:10.1111/mcn.13676
Amat Camacho N, Husain F, Bahya‐Batinda D, Aung E, Chara A, et al.
Matern Child Nutr. 4 June 2024; Online ahead of print; DOI:10.1111/mcn.13676
Recommendations for the management of malnutrition among infants aged less than 6 months (<6 m) are based on limited evidence. This study aimed to describe the characteristics, treatment outcomes and outcome‐associated factors among malnourished infants <6 m admitted at Médecins Sans Frontières (MSF) inpatient and ambulatory therapeutic feeding centres (ITFC and ATFC) in North–East Nigeria, 2019–2022. We conducted a descriptive analysis of the cohorts and logistic regression to measure the association between two selected outcomes—inpatient mortality and defaulting from the ambulatory programme—and possible factors associated. In total, 940 infants <6 m were admitted at ITFC. Most of them presented severe acute malnutrition and comorbidities, with diarrhoea being the most frequent. On discharge, 13.3% (n = 125) of infants were cured, 72.9% (n = 684) stabilized (referred to ATFC), 6.5% (n = 61) left against medical advice and 4.2% (n = 39) died. The median length of hospital stay was 10 days [IQR 7–14]. A hospital stay shorter than 10 days was significantly associated with inpatient mortality (aOR = 12.51, 95% confidence interval [CI] = 3.72–42.11, p ≤ 0.01). Among 561 infants followed up at the ATFC, only 2.8% reported comorbidities. On discharge, 80.9% (n = 429) were cured, 16.2% (n = 86) defaulted and 1.1% (n = 6) died. Male sex (aOR = 1.94, 95% CI = 1.15–3.27, p = 0.01), internally displaced status (aOR = 1.70, 95% CI = 1.05–2.79, p = 0.03) and <−3 WLZ (aOR = 1.95, 95% CI = 1.05–3.63, p = 0.03) were significantly associated with programme defaulting. Stabilization and recovery rates among malnourished infants <6 m in the studied project align with acceptable standards in this humanitarian setting. Notable defaulting rates from outpatient care should be further explored.
Conference Material > Poster
Chara A, Abarquez JC, Sainna HA, Abdullahi M, Mamman S, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/XIEZLqftqK
Conference Material > Poster
Abdullah MB, Issa-Soumana A-M, Namulwana ML, Barry I, Fidelle Nyikayo L, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/iT0WOMF3Ik
Conference Material > Poster
Chara A, Abdullahi M, Ogundipe K, Briskin E, Phelan S, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/2iJ2KobBXf
Journal Article > Case Report/SeriesFull Text
Oxf Med Case Reports. 18 July 2023; Volume 2023 (Issue 7); omad053.; DOI:10.1093/omcr/omad053
Bublitz A, Manirakiza C, Whitehouse K, Chara A, Musa T, et al.
Oxf Med Case Reports. 18 July 2023; Volume 2023 (Issue 7); omad053.; DOI:10.1093/omcr/omad053
The management of kwashiorkor disease (KD) in children is challenging in resource-limited settings, especially for those cases with severe skin lesions and its complications. There are no evidenced-based management protocols specific to KD. This article describes the clinical presentation and case management of two children with different presentations of complicated kwashiorkor skin lesions and explores kwashiorkor from the perspective of the children’s caretakers in Maiduguri, Nigeria. Our experience shows that a well-structured approach and careful skin care are crucial. This includes simplified wound care guidance, training of medical staff, strict hygiene measures and the correct choice of antibiotics and antifungals, taking into the account low immunity and vulnerability to opportunistic infections amongst malnourished children. Limited knowledge of kwashiorkor amongst caretakers negatively impacts health-seeking behaviour, resulting in late presentation. Engaging caretakers in the process of care is essential to successful treatment.
Conference Material > Poster
Amat Camacho N, Hussain F, Bahya-Batinda D, Tanko M, Chara A, et al.
MSF Scientific Day International 2023. 7 June 2023; DOI:10.57740/fzn8-qb40
Journal Article > ResearchFull Text
Front Public Health. 2 June 2023; Volume 11; 1077068.; DOI:10.3389/fpubh.2023.1077068
Amat Camacho N, Chara A, Briskin E, Pellecchia U, Kyi HA, et al.
Front Public Health. 2 June 2023; Volume 11; 1077068.; DOI:10.3389/fpubh.2023.1077068
BACKGROUND
Breastfeeding (BF) should be protected, promoted, and supported for all infants in humanitarian settings. The re-establishment of exclusive BF is also a central part of the management of acutely malnourished infants under 6 months (<6 m). Médecins Sans Frontières (MSF) runs a nutrition project in Maiduguri, a protracted emergency setting in North-East Nigeria. This study aimed to explore caregivers' (CGs) and health workers' (HWs) perceptions of BF practice, promotion, and support among CGs with infants <6 m in this setting.
METHODS
We conducted a qualitative study using in-depth interviews and focus group discussions combined with non-participant observations. Participants included CGs of young infants enrolled in MSF nutritional programs or who attended health promotion activities in a displacement camp. MSF HWs were involved at different levels in BF promotion and support. Data were collected involving a local translator and analyzed using reflexive thematic analysis directly from audio recordings.
RESULTS
Participants described how feeding practices are shaped by family, community, and traditional beliefs. The perception of breastmilk insufficiency was common and led to early supplementary feeding with inexpensive but unsuitable products. Participants often linked insufficient breastmilk production with poor maternal nutrition and stress, in a context shaped by conflict and food insecurity. BF promotion was generally well received but could be improved if tailored to address specific barriers to exclusive BF. Interviewed CGs positively valued BF support received as part of the comprehensive treatment for infant malnutrition. One of the main challenges identified was the length of stay at the facility. Some participants perceived that improvements in BF were at risk of being lost after discharge if CGs lacked an enabling environment for BF.
CONCLUSION
This study corroborates the strong influence of household and contextual factors on the practice, promotion, and support of BF. Despite identified challenges, the provision of BF support contributes to improvements in BF practice and was positively perceived by CGs in the studied setting. Greater attention should be directed toward providing support and follow-up for infants <6 m and their CGs in the community.
Breastfeeding (BF) should be protected, promoted, and supported for all infants in humanitarian settings. The re-establishment of exclusive BF is also a central part of the management of acutely malnourished infants under 6 months (<6 m). Médecins Sans Frontières (MSF) runs a nutrition project in Maiduguri, a protracted emergency setting in North-East Nigeria. This study aimed to explore caregivers' (CGs) and health workers' (HWs) perceptions of BF practice, promotion, and support among CGs with infants <6 m in this setting.
METHODS
We conducted a qualitative study using in-depth interviews and focus group discussions combined with non-participant observations. Participants included CGs of young infants enrolled in MSF nutritional programs or who attended health promotion activities in a displacement camp. MSF HWs were involved at different levels in BF promotion and support. Data were collected involving a local translator and analyzed using reflexive thematic analysis directly from audio recordings.
RESULTS
Participants described how feeding practices are shaped by family, community, and traditional beliefs. The perception of breastmilk insufficiency was common and led to early supplementary feeding with inexpensive but unsuitable products. Participants often linked insufficient breastmilk production with poor maternal nutrition and stress, in a context shaped by conflict and food insecurity. BF promotion was generally well received but could be improved if tailored to address specific barriers to exclusive BF. Interviewed CGs positively valued BF support received as part of the comprehensive treatment for infant malnutrition. One of the main challenges identified was the length of stay at the facility. Some participants perceived that improvements in BF were at risk of being lost after discharge if CGs lacked an enabling environment for BF.
CONCLUSION
This study corroborates the strong influence of household and contextual factors on the practice, promotion, and support of BF. Despite identified challenges, the provision of BF support contributes to improvements in BF practice and was positively perceived by CGs in the studied setting. Greater attention should be directed toward providing support and follow-up for infants <6 m and their CGs in the community.
Conference Material > Slide Presentation
Camacho A, Chara A, Htet Aung K, Hussein F, Nzala JC, et al.
MSF Paediatric Days 2022. 1 December 2022; DOI:10.57740/73y2-af86
Conference Material > Abstract
Camacho A, Chara A, Htet Aung K, Hussein F, Nzala JC, et al.
MSF Paediatric Days 2022. 26 November 2022; DOI:10.57740/2s5d-th30
BACKGROUND AND AIMS
International guidelines on infant feeding in emergencies advise protecting, promoting, and supporting breastfeeding (BF) for all infants in these settings. The re-establishment of exclusive BF (EBF) is also a central part of the management of acutely malnourished infants under six months old. More evidence on the feasibility, acceptance, and impact of BF promotion and support during emergencies is needed. Médecins Sans Frontières (MSF) runs a nutrition project in Maiduguri, a protracted emergency setting in North-East Nigeria. This study aimed to explore caregivers' (CGs) and health workers' (HWs) experiences and perceptions of BF practice, promotion, and support.
METHODS
We conducted a qualitative study using in-depth interviews, focus group discussions and non-participant observations. Participants included CGs of young infants enrolled in MSF nutritional programmes or reached during health promotion activities in a displacement camp. MSF HWs were involved at different levels in BF promotion and support. Data was collected involving a local translator and analysed using reflexive thematic analysis directly from audio recordings. [Download full PDF for more information on participants.]
RESULTS
Data shows how BF practices are strongly influenced by family and community. BF is common, although EBF for the first six months remains suboptimal. Frequent perception of breastmilk insufficiency, leading to early supplementary feeding, is associated with poor maternal nutrition, stress, and inadequate BF practice, in a context shaped by displacement and food insecurity. Yet, EBF seems to increase over time, due to growing access to BF promotion. The provision of comprehensive in-patient care generally leads to acceptance and positive outcomes of BF support. The achievement of EBF may be reversed after discharge if CGs lack an enabling environment for BF.
CONCLUSIONS
When designing promotion and support strategies, BF should be understood as an embodied experience shaped by socio-cultural and contextual factors. More emphasis should be placed on the follow-up and management of nutritionally at-risk mothers and infants in the community.
International guidelines on infant feeding in emergencies advise protecting, promoting, and supporting breastfeeding (BF) for all infants in these settings. The re-establishment of exclusive BF (EBF) is also a central part of the management of acutely malnourished infants under six months old. More evidence on the feasibility, acceptance, and impact of BF promotion and support during emergencies is needed. Médecins Sans Frontières (MSF) runs a nutrition project in Maiduguri, a protracted emergency setting in North-East Nigeria. This study aimed to explore caregivers' (CGs) and health workers' (HWs) experiences and perceptions of BF practice, promotion, and support.
METHODS
We conducted a qualitative study using in-depth interviews, focus group discussions and non-participant observations. Participants included CGs of young infants enrolled in MSF nutritional programmes or reached during health promotion activities in a displacement camp. MSF HWs were involved at different levels in BF promotion and support. Data was collected involving a local translator and analysed using reflexive thematic analysis directly from audio recordings. [Download full PDF for more information on participants.]
RESULTS
Data shows how BF practices are strongly influenced by family and community. BF is common, although EBF for the first six months remains suboptimal. Frequent perception of breastmilk insufficiency, leading to early supplementary feeding, is associated with poor maternal nutrition, stress, and inadequate BF practice, in a context shaped by displacement and food insecurity. Yet, EBF seems to increase over time, due to growing access to BF promotion. The provision of comprehensive in-patient care generally leads to acceptance and positive outcomes of BF support. The achievement of EBF may be reversed after discharge if CGs lack an enabling environment for BF.
CONCLUSIONS
When designing promotion and support strategies, BF should be understood as an embodied experience shaped by socio-cultural and contextual factors. More emphasis should be placed on the follow-up and management of nutritionally at-risk mothers and infants in the community.