Infant and Young Child Feeding Practices among Mothers in Lahore, Pakistan: A Cross-Sectional Study

Background: Inadequate child feeding practices lead to malnutrition, higher under-five mortality rates and adverse effects on quality of life. This study aimed to assess the breastfeeding and complementary feeding practices of mothers as well as the influence of various sociodemographic factors on them in local families of Lahore. Methods: This is a cross-sectional, descriptive study. It was conducted in CMH (Combined Military Hospital), Lahore in 2018. It comprises a sample of 203 mothers with children of at least two years of age, from various urban areas of Lahore. The subjects were selected on the basis of the inclusion criteria. Mothers with psychiatric illnesses and children with congenital anomalies were excluded from the study. Mothers were approached in the paediatric outpatient departments of four tertiary care hospitals of Lahore. Responses were recorded using a modified version of the Action Contre La Faim (ACF) questionnaire. Independent sample t-test and chi-square test were applied for analysis of the data. Results: Early initiation of breastfeeding within one hour from birth was observed in 83.3% children. Most children were administered colostrum (69.5%). The rate of exclusive breastfeeding for the first six months was 45.3%.  A child was being breastfed 8.21 ± 6.67 (mean ± SD) times a day. Maternal educational status, total number of adults in a household, and access to free healthcare were identified as important factors influencing the practice of breastfeeding. Porridge, khichdi, eggs, fruit and yoghurt were the most frequently used complementary foods. Conclusions: A high rate of an early start of breastfeeding and a low rate of exclusive breastfeeding for at least six months were predominant in our population. Administration of colostrum was observed in approximately two-thirds of the study participants. Education of the mother, type of the family system (nuclear or combined), and access to free healthcare strongly influence the breastfeeding practices.

Oral Health Conditions, Head and Neck Cancer Risks in Patients Visiting Cancer Hospitals in Peshawar

HNC comprises tumors in the oral cavity, pharynx and larynx. Pakistan falls into a high risk of HNC geographical zone. Oral cancer is one of the most prevalent malignancy worldwide, it is the second most prevalent cancer in Pakistan after lung carcinoma in men and breast carcinoma in women. Epidemiological studies have reported that various factors render increased risk for HNC which include smoking, alcohol consumption, intake of betel quid, chewing of tobacco, naswar, ingestion of fruit and vegetables in very low quantity, hereditary factors and family history, exposure to carcinogens, poor oral hygiene and Epstein–Barr virus. This study was aimed to investigate the association of HNC with demographic variables, oral health indicators and 7 SNPs of 5 interleukin gene in a case-control study design. This study was conducted in two phases. In phase I, epidemiological study was carried out and in phase II SNPs study was carried out. There were 276 cases which were pathologically confirmed patients with HNC, and among those 231 were selected for SNPs analysis, prospectively recruited from the IRNUM, Peshawar, Pakistan, from Nov. 2015 to Aug. 2016. The controls (n=275) were ethnically and linguistically matched subjects without any oral pathology. The clinical and pathological detail and data regarding demographic variables, risk factors, and oral health indicators were obtained and blood was also collected for SNPs analysis. Descriptive statistics and logistic regression modeling were employed to analyze the data. There were 276 cases and 275 controls. Majority of participants (cases and controls) belonged to Pashto ethnicity (90%), poor socioeconomic background (85%), rural origin (68%), and were illiterate (54%). There were statistically no differences among the cases and xi controls with respect to demographic attributes. In the present study patients were mostly presented with cancer of oral cavity (61%) or larynx (13%). Results shows that a high proportion of patients had poor oral hygiene (88%). The other oral health indicators were: no toothbrushing (65%), no use of dental floss (45%) and mouthwash (98%), periodontal diseases (65%), certain missing teeth (79%), and use of denture (13%). Smoking was more prevalent among the patients compared to the controls (25% vs. 12%; OR=2.53; 95%CI:1.60-4.00; p<0.0001). Similarly, a significantly higher number of patients used naswar (41% vs. 18%; OR=3.15; 95%CI:2.13-4.66; p<0.0001). A stepwise logistic regression was used to assess combined effect of independent variables which revealed that poor oral hygiene (OR=9.45, 95%CI: 5.95-15.01), material used of toothbrush (OR=5.01, 95%CI:2.20-11.37), no use of mouthwash (OR=4.76, 95%CI:1.46-15.48), and periodontal diseases (OR=5.04, 95%CI:3.18-8.01), were the significant predictors of oral cancer. It is pertinent to mention that demographic variables appeared not significant in multivariable analyses. It was further assessed that in absence of smoking and naswar use, the aforementioned four variables and no toothbrush use were significant risk factors for oral cancer. In the present study 231 cases (newly registered patients) and 219 controls were recruited for SNPs analysis in the selected genes. A significantly high number of cases had poor oral hygiene compared to controls (90.5% vs 23.7%) (p<0.01). Majority of cases never brush the teeth compared to controls (89.6% vs 49.3%). Furthermore, the frequency of missing teeth and the use of naswar were significantly high among cases compared to control (p<0.001). However, very less proportion of xii subjects were found to be smokers (p=0.58). Only 1.7% of cases contrasting to 0.9% controls used to chew paan (p=0.69). Similarly, 1.3% of used to drink alcohol compared to 0.5% of controls (p=0.62). The polymorphisms data showed that out of seven SNPs, oneSNP (IL10 rs1800896 T/C) was found to significantly associated with oral cancer. This study suggests that oral health indicators and polymorphism in IL10 rs1800896 T/C in combination with smoking confer an increased risk of oral cancer in Pakistani patients.