The use of linear programming to determine whether breastfed infants can achieve a nutritionally adequate complementary feeding diet: a case study of 6­11-month-old infants from KwaMashu, KwaZulu-Natal, South Africa

Objectives: The objectives of this study were to ascertain whether the nutrient requirements of 6­11-month-old infants can be met with a food-based approach, and to identify the nutrients of which it is difficult to achieve adequate intakes.Design, setting and subjects: A cross-sectional survey and interviews with mothers and caregivers from the KwaMashu Community Health Centre were conducted. One hundred and thirty-four interviews were completed. This information provided the food consumption input for the model using Optifood software. Results: The results revealed that with the current food pattern of infants from the study group in KwaMashu, iron, zinc and calcium are nutrients whose requirements are likely not to be met in the diet. The percentage RNI (recommended nutrient intake) for iron was 25.2%, zinc 51.3% and calcium 77%. Nutrient intakes for these nutrients of concern improved in the 'No pattern' diet but iron and zinc intakes remained below the RNI. According to the best diets modelled by Optifood, it appears that infants in KwaMashu would be able to achieve the recommended intakes of energy, protein, and 8 of the 11micronutrients, as long as breastfeeding on demand continues during the complementary feeding phase. Conclusions: This study calls into question the continued food-based focus to ensure nutrient adequacy in infants. In conjunction with efforts to improve household food security and continued support and promotion of breastfeeding for the first 2 years of life, targeted micronutrient supplementation may be needed to ensure the optimal growth and development of infants in South Africa.

Acceptance of an orange-fleshed sweet potato complementary food by infant caregivers in KwaZulu-Natal Province ­ a preliminary study

Background. Vitamin A deficiency (VAD) is a major public health problem that affects South African children and is a major contributor to the mortality of children under five years of age. VAD can result in visual impairment, diarrhoea and increased risk of severe measles and death. Orange-fleshed sweet potato (OFSP), a staple crop biofortified with provitamin A, has the potential to improve vitamin A intake in infants, especially when used as a complementary food.Objective. To assess the acceptance of an OFSP complementary food by infant caregivers.Methods. This study was conducted at the Newtown Community Health Centre, Inanda, in the eThekwini District of KwaZulu-Natal (KZN). Sixty-three infant caregivers assessed the acceptance of complementary foods made from OFSP and white-fleshed sweet potato (WFSP) (control), using a five-point hedonic rating test. In addition, ten caregivers participated in two focus group discussions, using pre-determined questions.Results. There were no statistically significant differences in the sensory attribute ratings of complementary foods made from WFSP and OFSP. The OFSP complementary food was well-accepted, especially its colour and soft texture. None of the focus group discussion participants had seen or tasted the OFSP before. Caregivers were willing to buy the OFSP, if it were available and cheaper than the WFSP.Conclusion. The complementary food made from the OFSP was highly acceptable to infant caregivers attending the Newtown Community Health Centre in KZN. It has the potential to be used in complementary feeding and to improve the vitamin A status of infants

Infant Feeding Practices during the First 6 Months of Life in a Low-Income area of the Western Cape Province

Background. Exclusive breastfeeding during the first 6 months of life protects against infant morbidity and mortality. Few studies describe the infant feeding practices of mothers living in low-income areas of the Western Cape Province of South Africa (SA).Objective. To describe the infant feeding practices of mothers of infants younger than 6 months in two low-income communities of SA. Methods. A cross-sectional community-based study using a structured questionnaire; and seven focus group discussions were conducted from February to August 2011 in Avian Park and Zwelethemba in Worcester; an urban area in the Western Cape. Results. Seventy-seven per cent of participants (n=108) had initiated breastfeeding. At the time of the study; 6 (n=8) breastfed exclusively. Ninety-four per cent (n=132) applied suboptimal breastfeeding practices: 36 (n=51) breastfed predominantly; 27 (n=38) breastfed partially and 31 (n=43) did not breastfeed. Ninety per cent (n=126) of the mothers had introduced water; of whom 83 (n=104) had done so before their infants were 1 month old. Forty-four per cent (n=61) of the mothers had introduced food or formula milk; of whom 75 (n=46) had done so before their infants were 3 months old. Qualitative findings indicated that gripe water; Lennon's Behoedmiddel and herbal medicines were also given to infants. Nutritive liquids and/or food most commonly given as supplementary feeds were formula milk and commercial infant cereal. Conclusion. Exclusive breastfeeding (EBF) during the first 6 months of life was a rare practice in these low-income communities. Water; non-prescription medicines and formula milk and/or food were introduced at an early age

The practice of Breastfeeding by Healthcare Workers in the Federal Teaching Hospital; Abakaliki; South-Eastern Nigeria

Background. Optimal breastfeeding practices include exclusive breastfeeding (EBF) for the first 6 months of life; followed by continued breastfeeding with adequate complementary foods on to at least 2 years of age. This is expected to be well known and practised by healthcare workers (HCWs) who are in the position to educate the community. Objective. To determine the actual breastfeeding practices of HCWs in a tertiary hospital in south-eastern Nigeria. Methods. We conducted a cross-sectional; descriptive study among female HCWs at the Federal Teaching Hospital; Abakaliki; southeastern Nigeria; using a self-administered; semi-structured questionnaire. Results. One hundred HCWs were recruited; including doctors; nurses; pharmacists and other HCWs. Only 3 practised EBF with all their children; their cited reasons being a busy work schedule (61.8); EBF being too stressful (18.4); ignorance of benefits of EBF (13.2) and lack of family support (3.9). Only 1 breastfed their babies up to 2 years. The reasons for failing to do so included refusal of the child to breastfeed (32.6); another pregnancy (30.4); feeling it was shameful (10.9) and feeling that the baby was too old (8.7). Conclusion. There are obvious shortcomings in breastfeeding practices among HCWs. They need to be empowered and supported to promote and support breastfeeding among their patients in particular and society in general

The practice of exclusive breastfeeding among mothers attending a postnatal clinic in Tswaing subdistrict, North West province

Objectives: The aim of this study was to determine reported infant feeding practice with reference to exclusive breastfeeding; exclusive formula feeding and mixed feeding at six weeks postpartum among women attending a postnatal clinic in the Tswaing subdistrict of North West province; and the strength of the association between maternal human immunodeficiency virus (HIV) status and exclusive breastfeeding. Design: Three hundred and eighty-six randomly selected women from seven primary healthcare clinics in Tswaing subdistrict; who were in their sixth postnatal week between November 2009 and February 2010; were enrolled in this study. Data were collected using a researcher-formulated questionnaire to ascertain demographics; including HIV status; as well as reported infant feeding practice. Secondary analysis was carried out to determine the strength of the association between the HIV status of the subjects and exclusive breastfeeding. Setting and subjects: This study was conducted among women over the age of 18 years attending their first six weeks postnatal visit in seven primary healthcare clinics that provide postnatal care in the rural Tswaing subdistrict of the North West Province. Outcome measures: The self-reported infant feeding practice at six weeks postpartum; demographic determinants of reported infant feeding practice; and the strength of the association between maternal HIV status and reported infant feeding practice; particularly exclusive breastfeeding; constituted the main outcome measures. Results: Comparatively; more HIV-negative (n = 157); than HIV-positive women (n = 43); reported that they were breastfeeding exclusively and had received infant feeding counselling (n = 258 vs. n = 65; p-value 0.05). Exposure to infant feeding counselling and a negative HIV status were associated with higher exclusive breastfeeding rates. Conclusion: HIV-positive women are still at risk of transmitting HIV to their nursing infants on account of suboptimal infant feeding methods in the prevention of mother-to-child transmission (PMTCT) context. This calls for further research in this area; and in the interim; more support to pregnant and nursing HIV-positive mothers; with a view to achieving the aims of the PMTCT programme

The use of prebiotics and probiotics in Infant Formula

Gastrointestinal flora influences health; but the composition of flora can be changed with prebiotics or probiotics. The addition of probiotics to powdered infant formula has not been demonstrated to be harmful to healthy term infants. However; evidence of clinical efficacy regarding their addition is insufficient to recommend the routine use of such formula. The administration of probiotic (single or in combination) supplementation in infant or follow-on formula; and given beyond early infancy; may be associated with some clinical benefits; such as a reduction in the risk of nonspecific gastrointestinal infections; a reduced risk of antibiotic use and a lower frequency of colic and irritability. Confirmatory well-designed clinical research studies are necessary

Implications of the new WHO guidelines on HIV and infant feeding for child survival in South Africa

The World Health Organization released revised principles and recommendations for HIV and infant feeding in November 2009. The recommendations are based on programmatic evidence and research studies that have accumulated over the past few years within African countries. This document urges national or subnational health authorities to decide whether health services should mainly counsel and support HIV-infected mothers to breastfeed and receive antiretroviral interventions; or to avoid all breastfeeding; based on estimations of which strategy is likely to give infants in those communities the greatest chance of HIV-free survival. South Africa has recently revised its clinical guidelines for prevention of mother-to-child HIV transmission; adopting many of the recommendations in the November 2009 World Health Organization's rapid advice on use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. However; one aspect of the new South African guidelines gives cause for concern: the continued provision of free formula milk to HIV-infected women through public health facilities. This paper presents the latest evidence regarding mortality and morbidity associated with feeding practices in the context of HIV and suggests a modification of current policy to prioritize child survival for all South African children

Supplementary Feeding in the Care of the Wasted HIV Infected Patient

Wasting and food insecurity are commonly seen in patients receiving antiretroviral treatment (ART) programs in sub-Saharan Africa and south Asia; and supplementary feeding is often offered in conjunction with ART. Evidence for the effectiveness of such supplementary feeding is scant. A randomised; investigatorblinded; controlled clinical trial of two types of supplementary food; corn/ soy blended flour and a ready-to-use peanut butterbased lipid paste; in wasted adults in Blantyre; Malawi is described and the results summarised. A historical control group who did not receive supplementary food is described as well. Provision of about half of the daily energy requirement as a supplementary food for 14 weeks resulted in more rapid restoration of a normal BMI; and the energy-dense; ready-to-use paste was associated with more rapid weight gain than the blended flour. Survival was similar among the 3 groups. The strong association between lower BMI and survival indirectly suggests that there may well be clinical benefit from supplementary feeding in this population. No differences were seen in ART adherence or quality of life with more rapid restoration of BMI. Further research is urgently needed concerning the widespread practice of supplementary feeding in HIV/ AIDS care to most effectively utilize this intervention

Growth pattern of exclusively breastfed infants in the first six months of life: a study of babies delivered at the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

BACKGROUND: Some authors demonstrate that exclusively breastfed infants have growth patterns comparable with the NCHS standards while others conclude that exclusively breastfed infants grow slower. These conflicting results informed the need for this study to aid the paediatricians and health workers to justify or condemn the recommendation of exclusive breastfeeding for six months. This was a prospective longitudinal study carried out to determine the growth pattern of exclusively breastfed infants in the first 6 months of life and compare them with the International, National Centre for Health Statistics (NCHS/WHO) reference and the Local, Janes' Elite Standards. METHODS:Using weight, length and occipito-frontal circumference as indices, 530 infants were recruited consecutively by convenience sampling over 17 months. Measurements were taken at birth, 2 weeks, 6 weeks, 2 months and subsequently monthly until the end of the 6th month.RESULTS: The exclusively breastfed infants doubled their birth weights at 3 months. The mean weight, OFC and length gains were maximal at 2 months, 2 weeks and 2 months respectively. The growth of exclusively breastfed infants compared favourably with the NCHS/WHO reference group and also compared favourably with the Janes' 'Elite' reference group. CONCLUSION:It is concluded that the growth in weight, length and OFC of exclusively breastfed infants appears adequate for the first 6 months of life

Profil nutritionnel des enfants de 6 a 59 mois dans la sous-prefecture de Danane

Nous rapportons dans ce document les resultats d'une etude transversale descriptive ayant porte sur 337 enfants dans la zone d'accueil de reference des refugies liberiens en Cote d'Ivoire. L'objectif de ce travail etait d'apprecier l'impact de la presence des refugies sur l'etat nutritionnel de la population infantile de Danane. Analyses faites; il en ressort les conclusions suivantes: parmi les facteurs communement associes a la survenue d'une MPE; la pauvrete et la mauvaise observance de la prevention contre les affections qui disposent de vaccins sont les plus incrimines dans notre etude ; les taux de MPE dans la sous-prefecture de Danane sont de 13;95 pour cent pour l'emaciation; de 19;29 pour cent pour le retard de croissance et de 27 pour cent pour l'insuffisance ponderale. Ces chiffres sont largement au dessus des moyennes nationales; etablissant ainsi une correlation entre la situation de region hote et la prevalence de la MPE ; l'aide apportee aux refugies vulnerables est d'un role indeniable car les populations non assistees font plus de MPE rejetant l'hypothese de la correlation entre la MPE et la situation de refugie. Nous proposons au vu de ces resultats que : la zone d'accueil des refugies liberiens soit l'objet d'une attention medicale curative et preventive speciale ; les populations locales soient soutenues dans leur effort d'hebergement pour une facilitation de l'integration des immigres

The Development of Nutritious Low Cost Weaning Food for Kenya Infants

The aim of this research was to develop an inexpensive weaning food of adequate dietary energy; protein and fat; for an infant of four to six months; that can be manufactured in Kenya; using readily available resources and technology. Product formulation was developed by using low cost; readily available and culturally acceptable food products. A cooked porridge was prepared using the traditional oven top method. Subsequently; the porridge was drum dried; blended with ground pumpkin seeds; heat sealed and stored at ambient temperature (22 degrees Centigrade) for eight weeks. Chemical analysis was then carried out to determine the total percentage energy; protein; fat and carbohydrate content of the dried mix. All were in accordance with the theoretical values. This analysis indicated that in order to meet the recommended daily allowances for fat and energy; the addition of oil was necessary; this value was calculated theoretically. In vitro protein digestibility was 82.5 per cent; confirming a high quality protein food. HPLC analysis detected no free floating water soluble amino acids; indicating food stability. A low peroxide value was found; confirming a rancid free food. Viscometer analysis of the reconstituted mix confirmed a nutrient and energy dense food at an acceptable consistency for infant feeding. The addition of a small amount of oil; to the reconstituted mix lowered the viscosity; allowing for the addition of an increase in the quality of dried mix; increasing both nutrient and energy density. The organoleptic qualities of the food were evaluated by a semi-trained panel. The overall appearance was highly rated; with flavour slightly less favourable

Report on the evalution of the child supplementary feeding programme

The Hon. Minister of Health; Dr S T Sekeramayi; opened the workshop by outlining the origins of the CSFP when in late 1981 some NGOs came to the aid of badly nourished children. He pointed out that since the Ministry's take-over of the programme; emphasis has been laid on Community support as the basis of this programme. Nutrition gardens have been started by the Community and Ministry has supported them so that parents can continue feeding the children when donated foods are used up. Government increased its input when drought continued; and the CSFP is now part of the National Drought Relief Programme. The programme; SIDA; UNICEF; Government and variety of NGOs. He emphasised the need for a nutrition surveillance system; the promotion of locally avialable foods and strengthening community MCH activities through this programme. He noted that the VHW had become the main cadre supporting this programme with the aid of other extension workers and NGO personnel. [abstract]