Traditional nutritional and surgical practices and their effects on the growth of infants in south-west Ethiopia

Abstract

A 1-year birth cohort of 1563 infants was seen bi-monthly for the first year of life. They comprised all identified infants born in Jimma town, south-west Ethiopia, in the year starting 1 Meskren 1985 in the Ethiopian calendar (11 September 1992). Growth in infancy is poor in this town, as it is in Ethiopia more generally: mean z-scores for both weight and length were more than 1.5 SD below the median of the NCHS/WHO reference population by 1 year of age, and infant mortality was 115/1000. In this paper we examine the weight gain of singletons in relation to background variables and to traditional nutritional and surgical practices in the families. Confirming work in other areas, sanitation, water supply, the income of the family and the mother's literacy were important determinants of weight gain. Almost all the infants were initially breast fed, and about 80% were still breast fed at 1 year. Many were also given cows' milk from 4 months onwards. Breast feeding had beneficial effects up to 8 months of age, and cows' milk had beneficial effects after 6 months of age. Supplementary feeds of solids and semi-solids were given at appropriate ages, but had no detectable benefit. Water was given inappropriately early, but did no detectable harm. Episodes of diarrhoea, fever or persistent cough each reduced weight gain. Catch-up in weight then took up to 8 months, probably because of the poor nutritional quality of supplementary feeds. The incidences of local traditional operations in the first year were: circumcision 63% in males and 4% in females, uvulectomy 35% and the extraction of milk teeth 38%. Although circumcision had no detectable adverse effect on weight, uvulectomy and milk teeth extraction both reduced weight gain.

PIP: The effect of family-level activities on growth in infancy was examined by looking into traditional nutritional and surgical practices in Ethiopia. The subjects were 1563 infants born in Jimma, southwest Ethiopia between 11 September 1992 and 10 September 1993. Prior to birth, pregnant women were identified through a network of traditional birth attendants (TBAs). The TBAs worked closely with the project interviewer in gathering information from pregnancy until birth. Details of the sample size at different ages, of the actual ages at which infants were weighed and of known deaths are presented. It was found that the level of infants' weight gain over the first year was related to environmental and familial background. Environmental factors cited include sanitation and water supply. Family income and the level of the mother's literacy were important determinants of weight gain. A big majority of the infants were initially breast-fed, and about 80% were still breast-fed at 1 year. Infant nutrition was supplemented by cow's milk from 4 months onward. In addition, supplementary feedings of solid and semisolid foods were given at appropriate ages, but had no evident benefit. Ailments such as diarrhea, fever and persistent cough slowed down growth, but eventually weight increased at age 8 months. Local traditional operations such as uvulectomy and extraction of milk teeth in the first year also contributed to the reduction of weight gain, but circumcision in either males or females had no detectable adverse effect on weight.