- Title
- Early childhood nutrition and growth in an Indigenous Australian population
- Creator
- Onifade, Oyepeju
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Adequate nutrition in the first 1,000 days of life, which mainly encompasses breastfeeding and complementary feeding, positively influences physical growth and development. It is thus necessary that children can access nutritionally adequate foods to reduce the risk of non-communicable diseases (NCDs), such as type 2 diabetes, obesity and cardiovascular diseases. Indigenous Australian populations are vulnerable population groups with an increased risk of developing NCDs, and ensuring optimal nutrition among infants and young children in these populations is essential for improved health outcomes. However, little is currently known about these populations’ nutrition and growth patterns in the first 1,000 days of life. The overall aim of this thesis is thus to understand the nutrition and growth patterns of a cohort of Indigenous Australian children and to identify opportunities for future interventions. Specifically, this thesis focuses on breastfeeding, complementary feeding and the anthropometric status of Indigenous infants and young children in the Gomeroi Gaaynggal cohort. It aims to identify the knowledge and data gaps in this subject area and to provide several beneficial propositions for the Indigenous community. This thesis is presented in the format of published and non-published research articles. Its specific research aims and results obtained from subsequent studies derived from the thesis are summarised below. Breastfeeding has both short and long-term benefits, and it improves health outcomes in early childhood. Adequate breastfeeding reduces the risk of infections and development of NCDs. Traditional breastfeeding patterns among Indigenous Australian populations indicate an extensive duration of breastfeeding that often lasts for four years or until the arrival of another sibling. The first study in this thesis describes the breastfeeding patterns of the Gomeroi Gaaynggal cohort—a longitudinal cohort of Indigenous mothers and their children—and it followed the women and their children from pregnancy until the age of 10 years. This study aimed to describe the intention to breastfeed and breastfeeding trends of Indigenous infants in the Gomeroi Gaaynggal cohort. Pregnancy and postpartum data were obtained from mothers (n = 250) and children aged three to 24 months (n = 133). The study found that most mothers indicated an intention to breastfeed and a high breastfeeding initiation rate (82.5%). However, the breastfeeding rate declined by 50 days in approximately half of the population. Although consistent with findings relating to the larger Australian population, and to meet World Health Organization (WHO) recommendations and improve both short and long-term outcomes for mothers and babies, Indigenous women may benefit from adequate community support during breastfeeding. It is recommended that complementary feeding be introduced to infants by six months of age, after which breastmilk alone can no longer meet the infants’ nutritional requirements. Nutritionally adequate complementary foods (in both quantity and quality) are crucial for child growth and developmental outcomes in the first 1,000 days of life. The second study in this thesis focuses on the complementary food intake of Indigenous children in the Gomeroi Gaaynggal cohort and compares the results to recommended standards. Dietary data were obtained from 95 individual children aged 7.6–24.7 months and resulted in 130 dietary recalls collected. Most of the children aged 7–12 months did not meet the requirements for omega-3 fatty acids, while all children exceeded the recommended intake for sodium. Less than half the children aged 1–3 years met recommendations for iron intake, while the median intake for sodium for this age group was fourfold higher than the national recommended intake. Most of the children met daily recommendations for fruit and dairy serves. This study’s findings suggest that the diet of Indigenous children was adequate regarding most nutrients, and that optimising nutrient intakes through community-led strategies could improve nutrition outcomes. Adequate nutrition in early childhood is a critical component of human growth and development. Further, improving the nutritional status of children and preventing malnutrition during this critical growth is essential to overall childhood health outcomes (e.g., to avoid undernutrition and obesity). The third study in this thesis assessed the growth of Indigenous children in the Gomeroi Gaaynggal cohort and compared the results to WHO growth standards. Demographic data were obtained from 115 mothers during their pregnancy visits, while anthropometric measurements were obtained from 125 children during postnatal visits at three, six, nine, 12 and 24 months. The mean z-scores for height for age (HFA) and body mass index (BMI) for age were –0.15 ± 1.16 and 0.39 ± 1.28, respectively, indicating that the average z-scores of the study’s infants and young children were within two standard deviations (SDs) of the WHO median. The weight for age (WFA) and weight for height (WFH) z-scores compared to the WHO references were below the median in infants aged 0–5 months; however, a gradual increase in the z-scores was observed over the next two time points. This study’s findings that most of the infants and young children in the Gomeroi Gaaynggal cohort had anthropometric z-scores within two SDs of the norm meant they had normal nutritional status. The fourth study in this thesis systematically reviewed the effectiveness of interventions designed to optimise the dietary intake and nutrition-related behaviours of Indigenous children worldwide in the first 1,000 days of life. A participatory approach and adequate community engagement are required to ensure effective interventions. This study also aimed to identify whether Indigenous populations were involved in co-designing the interventions and, if so, how they were involved. This study comprised three studies from Indigenous populations in the United States (US) and Guatemala, in which all aimed to improve child health outcomes through a nutrition intervention. However, only one study reported community participation in the intervention design. This study’s findings indicate that engaging Indigenous communities throughout the entire process of nutrition interventions could beneficially influence improved outcomes in the first 1,000 days of life. This thesis holistically investigates the existing state of nutrition and growth among a cohort of Indigenous Australian children. It highlights key components of nutrition in early childhood among this cohort, including breastfeeding practices, complementary feeding practices and anthropometric status. It provides useful insights into existing knowledge gaps regarding the diet of Indigenous children, and it contributes to the limited available nutrition data for children aged 0–2 years. It also identifies potential areas that might require community-led interventions. Improving the nutrition and health outcomes of Indigenous infants in the first 1,000 days of life would be effective if Indigenous communities were involved in every stage of intervention—from design to implementation. This would ensure that Indigenous ways of knowing are incorporated into the intervention, thus rendering it culturally appropriate and acceptable to the community.
- Subject
- Indigenous health; infant nutrition; child growth; complementary feeding; first 1000 days; breastfeeding; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1508260
- Identifier
- uon:56109
- Rights
- Copyright 2023 Oyepeju Onifade
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 6 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 403 KB | Adobe Acrobat PDF | View Details Download |