Infant Weight Faltering and Feeding Patterns at 6 Weeks Post-Delivery in a Rural East African Community:Comparing Incremental Versus Static Weight Assessments

Abstract

AbstractBackgroundEarly stages of infant weight faltering is difficult to detect in the first 6 months of life. Major reason for this might be the method of assessing infant growth. Incremental growth assessment, which is rarely performed in developing countries, is more useful than static growth assessment in infants. In a remote, understudied village in East Africa, this study examined the prevalence and determinants of infant weight faltering and compared incremental with static weight assessments among 6 weeks old infants.Subject and methodsThis was a secondary analysis of a prospective cohort data. Data of 512 out of the 529 mother-newborn pairs recruited from birth were obtained and analysed at 6 weeks post-delivery in the postnatal clinic. Records of infant feeding patterns and anthropometry were documented. Infant weight at birth and at 6 weeks were compared using the NICE criteria for both incremental/interval and static weight growth. Mothers were interviewed using the Edinburgh postpartum depression score to assess emotional status. Chi test and binary logistic regression model was used to examine the relationship between maternal/infant characteristics and infant weight growth. The results were presented in p-values, Odds ratio and 95% confidence interval. The similarity and dissimilarity between infant static and incremental weight assessments were measured using Kappa and McNemar tests respectively.ResultsOverall, the incidences of static and incremental weight faltering at 6 weeks post-delivery were 3.1% (16 out of 512) and 1.4% (7 out of 512), respectively. The Cohen Kappa measure of agreement between the 2 methods of weight assessment, was moderate at 0.424 (p<0.001). 3 out of the 512 infants were not exclusively breastfed; 2 of whom were offered water and 1 was fed with fresh cow milk.A higher percentage of the SGA-born (compared to AGA and LGA) infants, 11 out of 107 (10.3%) were weight faltering according to static assessment. This was contrary to increment weight assessment, where a lower percentage of SGA-born [only 2 out 107 (1.9%), compared to LGA] infants, were faltering. The LGA-born infant, according to incremental weight assessment, was the least likely to weight accelerate, compared to the SGA-born and AGA-born infants; OR 0.04; 95% CI 0.01, 0.10. High maternal depression score was associated with infant weight acceleration, p<0.001; OR 1.13; 95% CI 1.06, 1.21. Boys were less likely to weight accelerate compared to girls, p<0.001; OR 0.45; 95% CI 0.29, 0.70. Infants, who were adequately fed were more likely to weight accelerate compared to those who were poorly fed, p<0.001; OR 2.80; 95% CI 1.55, 5.05. Infants, who did not fall ill since birth were more likely to weight accelerate compared to those who had fallen ill, p=0.004; OR 2.73; 95% CI 1.37, 5.43.Conclusion and RecommendationsThis study emphasizes the importance of assessing infant growth using both static and incremental measures. Health workers need to be trained to carry out incremental growth assessment in infants. Lactational and mental support programs should be strengthened in the rural MCH systems, to assist mothers to achieve pleasant experiences with breastfeeding and newborn care. Exclusive breastfeeding should be encouraged and this will in turn reduce the incidence of infant ill health. Home visits should be carried out for infants lost to follow up.