Critical Appraisal of an Article in Nutrition Strategies - Essay Example

Topic: Critical Appraisal of Journal Articles Name: Professor: Institution: Course: Date of Submission: Title: “The effect of nutrition research/ intervention strategies on the nutritional status of women of childbearing age, infants or children”: A critical Appraisal Abstract: This study seeks to establish whether there are any potential benefits of exclusive breastfeeding for six months to the health status of the mother and the child or infant. This is in done in comparison with mixed breastfeeding. Mixed breastfeeding involves exclusively breastfeeding a child for three to four months after which complementary liquid and solid foods are introduced alongside breastfeeding. Previous studies have shown that these two practices have distinctive effects on child health, growth, and development, and on maternal health. In this paper we critically review this study with an aim of evaluating and reporting on the study’s methods, results and recommendations. Objectives: From the analysis of this article, the objectives are clear and precise since they revolve around the variables relating to breastfeeding period, growth and development of children. The objectives have been met as the analysis in this case indicates that there is a correlation between the breastfeeding period and the growth, development and the general health of the child. The two variables of concern in this study are exclusive breastfeeding for six months and mixed breastfeeding which involves introduction of complementary liquid and solid foods as from the third or fourth month of the child. While some studies favor mixed breastfeeding, others are of the opinion that exclusive breastfeeding s the best health practice for both the mother and the child. The objectives test hypotheses raised in the introductory part of the article and are clearly stated and achieved. Study Design, Methods of Research: The approach used in this article is a contextual analysis as one of the methods of data collection. This involved the researcher digging into various databases that contain information concerning breastfeeding. The researcher then narrowed on those topics that are most relevant to the objective of the study. Some of the databases sought include MEDLINE (as of 1966), Index Medicus (before 1966). This approach was appropriate as it could reasonably enhance attainment of the study’s goals since it involves methods that ascertain inferences from clearly defined population samples representative of the group from which it is drawn. Methods: The researcher contacted experts in the field who also provided useful information on the topic. These experts were interviewed so as to get their opinion on the subject of the study. Some experts had already published information on this study that was useful in providing more evidence of the propositions of the study while others were only able to provide verbal responses to the questions being posed by the research. Accordingly published records provided more reliable information than that obtained from verbal interviews. This is because information sourced from verbal interviews is prone to distortion as opposed to written records. However, verbal information may be deemed to be up to date as opposed to written records which could have outdated information (Liamputtong, 2010, p.273). Data was also collected through the use internally-controlled clinical trials and observational studies. Internally-controlled clinical trials involved the selection of a given sample of breastfeeding mothers and their children, instructing them to either exclusively breastfeed their children for six months or to use mixed breastfeeding method (Bouwstra, et al, 2003, p.4243). These mothers are then monitored together with their children to identify any differences in their health status growth and development. The results are measured in terms the risk of gastrointestinal infection in children, maternal weight loss after birth, and delayed return of menstrual periods for mothers. Depending on the nature of the results, conclusions are then made and recommendations offered in favor of one practice over the other. Observational studies on the other hand were a source of data on breastfeeding which was based on previous studies on the same topic. Information collected was based on the observed trend in growth and development of children over the years (Brown, J et al, 2010, p.165). According to this method, there was no constructive effort to alter the method of breastfeeding so as to gauge the outcome. Instead, the researcher only made observations of the trend in the children health and drew conclusions as to whether exclusive breastfeeding or mixed breastfeeding is the best for both the mother and child’s health. It is this assumption makes observational studies less reliable than clinically-controlled studies. Bias and other distortions: A potential bias associated with these observational studies is the fact that infants who continue to be exclusively breastfed tend to be those who remain healthy and on an acceptable growth trajectory (Liamputtong, 2010, p.277). On the other hand significant illness or growth faltering can lead to interruption of breastfeeding or supplementation with infant formula or solid foods. When a study is then conducted on such people, the researcher will be quick to conclude that the interruption of breastfeeding is what caused the slow growth of the child when in essence it is the latter that forced the introduction of the former. This is a bias associated with these observational studies. Another bias associated with these observational studies is the fact that infants who develop a clinically important infection are likely to become anorectic and to reduce their breast milk intake, which can in turn lead to reduction in milk production and even weaning. Since the early signs of infection and weaning may not be adequately appreciated; infection may be blamed on the weaning, rather than the reverse. As a result of this, the researcher will not have the correct, accurate and reliable information when drawing conclusions if his or her source of data is basically observational studies. This is the reason as to why in this study, internally-controlled clinical studies were conducted alongside observational studies so as give more accurate information. Controls: Two clinically-controlled trials were carried out in Honduras. In these trials, exclusively breastfed infants were allocated to either continue exclusive breastfeeding for four to six months or to receive solid foods along with continued breastfeeding as of four months. The results did not show any significant benefit for growth or any disadvantage for morbidity with the earlier introduction of complementary foods (Kandiah, Burian & Amend, 2011, p.262). These results however were not widely accepted majorly due to the small sample size used and the fact that the weanling foods used were those commonly found in developed countries, rather than those traditionally used in Honduras or other developing countries. Results: The results of this study were presented in the form of comparison reports. The first comparison was made between controlled trials of exclusive versus mixed breastfeeding for four to six months in developing countries (Michaleson & WHO, 2000, p.133). It was found that monthly weight gain from four to six months was non-significantly slightly higher among infants whose mothers were assigned to continued exclusive breastfeeding than those who practiced mixed breastfeeding. Mothers in the exclusively breastfed group had a statistically significantly larger weight loss from four to six months. These mothers were also non-significantly less likely to have resumed menses by six months postpartum. The second set of results concerns observational studies of exclusive versus mixed breastfeeding for three to seven months in developing countries. This study given the weaknesses associated with these observational studies gives results that can be interpreted differently. However, what remains outstanding is the fact that infants that are exclusively breastfed begin walking at a slightly earlier age than those who undergo mixed breastfeeding. Mothers in this observational study also reported a significantly larger weight loss from four to six months than those who engaged in mixed breastfeeding (Bouwstra, et al, 2003, p.4244). The overall results of this study point to the fact that infants that breastfed exclusively for six or more months had no observable deficits in growth, and their mothers were more likely to remain amenorrheic for six months postpartum. Similarly, there are no benefits associated with the introduction of complementary foods between four and six months with the exception of improved iron status in one developing-country setting (Honduras). However this can best be achieved by use of medicinal iron supplementation. From this findings, recommendations were made to the effect that exclusive breastfeeding should be done for the first six months of life in both developing and developed-country settings. The two major studies included in this review are those carried out by Cohen and Dewey. These studies sought to find out the impact that breastfeeding period has on the mother’s and infant’s health. The studies were actually clinically-controlled trials whose results provided a vital basis for drawing conclusion on this topic (Bouwstra, et al, 2003, p.4245). The importance of these studies came as a result of the accuracy and reliability of this approach to study. This approach was more reliable than the observational studies because the there are no assumptions being made as pertains the study sample and the methodology. Discussion and Conclusions: Human milk is the best meal for babies and provides all the nutrients needed for about six months (26 weeks) of life. It contains certain nutrients that serve unique needs of the human infant such essential fatty acids, certain milk proteins and iron in a readily absorbable form. Human milk also contains immunological and bioactive substances which protect the infant from bacterial and viral infections besides aiding in gut adaptation and development of the newborn. These very important components lack in commercial infant formulas (Michaelsen, 2000). From this book, we can confidently advocate for exclusive breastfeeding of children for at least six months. There has been evidence that exclusive breastfeeding for 3 months or more provides protection against otitis media and that breastfeeding for at least 3 months has shown to be associated with lower rates of chest infection among the Aboriginal children (Liamputtong, 2010, p.273). Apart from this, there are a number of reviews conducted which have demonstrated a small protective effect of breastfeeding on obesity, blood pressure, total serum cholesterol and Type 2 diabetes. This means that exclusive breastfeeding of children especially for the first six months of life is very crucial to the child’s development and overall health status. Various studies and reviews have been conducted to establish the benefits that breastfeeding has on the health of the mother. According to (Brown, J et al, 2010, p.168), breastfeeding has physical, hormonal and psychosocial benefits to the mother. Exclusive breastfeeding increases the level of oxytocin, a hormone that stimulates uterine contractions, minimizes material postpartum blood loss and helps the uterus regain its non-pregnant size. More research also shows that after birth the return of fertility in most women can be delayed by exclusive breastfeeding. This therefore allows women to use it as a birth control mechanism although it should not be used in solely. Research conducted by medical practitioners suggests that breastfeeding should be done exclusively for the first six months followed by continued breastfeeding while adding age appropriate foods for at least the first year of life. This study further suggests that breastfeeding is important in that the milk contains antibodies that can help protect infants from infections and even Sudden Infant Death Syndrome (SIDS). Breastfeeding is also beneficial to the mother in that there are no bottles or nipples to sterilize, there are no formulas to purchase which saves money. The energy needed to make breast milk can help a mother lose the weight gained during pregnancy, helping her to quickly get back to her pre-pregnancy weight (Dunn, 2012, p.258). This review is therefore a focus on breastfeeding as a very vital element in the growth and development of infants. Breastfeeding can be done exclusively or alongside other sources of nutrients in the form of supplementary solid or liquid foods. While it is true that many people use these supplements, it is worth mentioning that the best way to care for a child is by exclusively breastfeeding it until the age of six months before introducing any supplementary foods. Exclusive breastfeeding according to the fore discussed studies is very important both to the mother and the child in many ways: financially, physically, hormonally and in terms of health (Dunn, 2012, p.264). The fact that exclusive breastfeeding for at least six months has not been popular among many mothers can be attributed to the belief that this practice had a deterrent effect on the growth and development of the child. Consequently, a number of studies have been conducted to prove that exclusive breastfeeding does not have this negative effect (Kandiah, Burian & Amend, 2011, p.259) This in effect led to the conclusion that breastfeeding especially if done exclusively leads to increased rate of growth and development among children. This was noticed in one of the studies where it was found that exclusively breastfed children began walking earlier than those who underwent mixed breastfeeding. In conclusion, the review carried out by (Kramer MS, Kakuma R, 2002) is indeed very informative and its results conclusions and recommendations are of adequate accuracy and therefore very crucial to the society if correctly adhered to. Their recommendation that exclusive breastfeeding should be encouraged among mothers for the first six months of their children is very valid. This is because we have other studies whose results and recommendations are similar to this despite the fact that they were conducted in a completely different setting. Exclusive breastfeeding should be conducted for the first six months after which breastfeeding can be done alongside the use of supplementary liquid and solid foods. References Michaleson, K & WHO, 2000, Feeding and Nutrition of Infants and Young Children: Guidelines for the WHO European Region, with Emphasis on the Former Soviet Countries Volume 87 of WHO Regional Publications: European Series. WHO Regional Office Europe. Liamputtong, P, 2010, Infant Feeding Practices: A Cross-Cultural Perspective. Springer. Brown, J et al, 2010, Nutrition Through the Life Cycle. Edition4. Cengage Learning. Dunn, C, 2012, Nutrition Decisions: Eat Smart, Move More - Book Only. Jones & Bartlett Publishers. Bouwstra, H et al, 2003, Exclusive Breastfeeding of Healthy Term Infants for at Least 6 Weeks Improves Neurological Condition1. The Journal of Nutrition133. 12 (Dec 2003): 4243- 5. Kandiah, J, Burian, C & Amend, V, 2011, Teaching New Mothers about Infant Feeding Cues May Increase Breastfeeding Duration. Food and Nutrition Sciences2. 4 (Jun 2011): 259- 264. Read More