Maternal micronutrient status as a risk factor for perinatal mortality in a Tanzanian randomized controlled trial

The objective of this study was to determine if maternal micronutrient status (specifically iron) during pregnancy is a risk factor for perinatal mortality among women in Tanzania. Secondary analysis of data from a randomized, double-blind, placebo-controlled vitamin A supplementation trial conducted between August 2010-March 2013 was used to assess iron intake among women who experienced a stillbirth or early neonatal death. The mean dietary iron intake (measured using a quantitative Food Frequency Questionnaire) for this population was 12.64 mg/day (SD = 6.32). There were 206 cases of perinatal mortality. Three classifications of dietary iron intake were devised and risk ratios were calculated using the Log Binomial Regression Model: <18 mg/day (RR: 2.13), 18-27 mg/day (RR: 2.63), & >27 mg/day (the reference group to which the first two classification groups were compared).There was neither a significant relationship found among women who consumed iron levels <18 mg/day or between 18-27 mg/day of iron compared to women who consumed more than 27 mg/day of iron, but on average there was twice the risk for perinatalmortality. The current study is consistent with previous literature findings and supports the need for more efficacious nutrition strategies. (Afr J Reprod Health 2022; 26[7]: 38-48).

Assessing infant and young child feeding priorities to inform the development of a nutrition social and behaviour change communication (SBCC) strategy during a pandemic threat

Objectives: This study was undertaken to identify stakeholder needs and wants in relation to an Infant and Young Child Feeding, Social and Behaviour Change Communication (SBCC) strategy for the 16 Southern African Development Community (SADC) member states during Covid-19 lockdowns and travel restrictions.Design: A rapid-assessment mixed-methods approach using qualitative and quantitative studies was adopted. Secondary data sources supported in-field findings. Setting/Subjects: Qualitative approaches included 17 key informant interviews from 7 SADC member states. Quantitative methods of an online survey elicited feedback from 61 participants from 11 SADC member states.Outcome measures: More strategic, best practice, infant and young child feeding SBCC programmes are recommended in SADC.Results: Programme challenges included increased demands on health systems from Covid-19, poor attitudes and beliefs toward IYCF behaviours, the dual burden of undernutrition and overnutrition, and financial and human resource capacity challenges to implement and evaluate SBCC campaigns at scale. Opportunities were also identified for improved detection,better meeting IYCF nutritional needs from locally sourced foods, training and capacity building for greater engagement of front-line field staff, effective policy development to support parent-friendly hospitals and workplaces, and improved regional integration. Conclusions: The needs assessment demonstrated that priority programme planning can continue while the health sector deals with a pandemic threat. The adaptation to virtual support provided a variety of learnings for research designs, data collection and analysis, albeit over an extended timeframe of six months. A number of innovative approaches were identified in the resultant SBCC strategy for SADC along with opportunities for regional efficiencies in adapting existing, best practice SBCC creative and programming approaches.

Kenya nutrition monitoring and evaluation

Kenya is facing a triple burden of malnutrition in the form of under nutrition, micronutrient deficiencies and over-nutrition. The Ministry of Health in collaboration with stakeholders developed the Kenya Nutrition Action Plan (KNAP) 2018-2022. The overarching objective of the plan is accelerating and scaling up efforts towards the elimination of malnutrition in Kenya in line with Kenya's Vision 2030 and Sustainable Development Goals (SDGs) with focus on specific achievements by 2022. The action plan is organized into three category focus areas namely; Nutrition-specific and Nutrition-sensitive Interventions and, Enabling Environment. The Kenya Nutrition Monitoring and Evaluation Framework 2018-2022 has been developed to align with the needs of the Kenya Nutrition Action Plan 2018-2022. A review of the Nutrition Monitoring and Evaluation Framework 2013 and other relevant documents was conducted to inform the development of this framework. The development was conducted through a consultative process involving deliberations by task teams, stakeholder consultations, and online survey and review and validation workshops. The rationale of this framework is to ensure continuous tracking of progress, document lessons learned and replicate best practices of nutrition interventions as outlined in the KNAP 2018-2022. It highlights the goal and the objectives and the guiding principles which are expected to ensure a systematic implementation of the monitoring and evaluation framework. The framework describes the basic principles of Monitoring, Evaluation, Accountability and Learning (MEAL) the sources of nutrition information and data analysis and reporting. In addition, the Nutrition Information System monitoring toolkit repository comprising of a variety of guidelines, training packages, tools for data collection and guidance on data analysis and reporting for different sources of information has been developed to provide ease of accessibility to these tools and documents. The framework also covers the Common Results and Accountability Framework (CRAF) for the 19 Key Result Areas (KRAs) and elaborates the process of Monitoring, Evaluation, Accountability and Learning. The key result areas are categorized into nutrition specific, nutrition sensitive and enabling environment with their indicators, definitions, thresholds, means of verification, frequency of reporting and operational research to be conducted. The indicators will be measured and reported through existing systems such as Kenya Health Information System (KHIS), the National Drought Management Authority (NDMA) early warning system, program reports and population-based surveys. Reporting and communication of results will adhere to standard guidelines and use effective communication channels to ensure improved uptake of findings. Evaluation and operational research will be implemented to provide evidence for informing programme decisions that lead to effective coverage of interventions. Finally, accountability will be mainstreamed to ensure service providers or duty bearers are accountable for resources and results. Learning and application of best practices will contribute to adaptation of approaches that are known to produce results. The actualization of the M&E Framework will help build a chain of evidence that will provide the metrics of change. The burden of proof lies with the various stakeholders whose responsibility is to demonstrate that the commitment made in the KNAP 2018-2022 shall indeed be realized and that there is evidence to back up the claim of progress. The implementation strategy therefore shall be driven by human resource development and system readiness and funding mechanisms that will boost M&E human resource and systems at National and County levels

Review of current concept in the management of pressure ulcers

Pressure ulcers are quite distressing, and they cut across all age groups. Aside from increasingmortality, it results in protracted hospital stay and an upsurge in the consumption of healthcare resourcesPressure ulcers are considered to be essentially preventable, but in order to prevent them it is important to identify the people most at risk and deliver timely preventative care. In case of severe acute respiratory distress syndrome (ARDS), as in coronavirus dis­ease 2019 (COVID-19) affected patients, prone position and invasive ventilation improve the clinical status of this group of patients. This form of therapy is associated with an increased risk of facial pressure ulcers. When pressure ulcer occurs, appropriate documentation of each ulcer and staging of the ulcer are essential for good wound assessment.Treatment involves, assessing the nutritional needs of the patient, management of infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery

Nutrition knowledge, attitudes and practices of primary school children in Tshwane Metropole, South Africa

Background: The increasing prevalence of being overweight and obesity in South African school children requires interventions that are evidence based. Nutrition knowledge, attitudes and practices (KAP) studies are thus needed to provide evidence for the planning of interventions that address and prevent nutrition problems in school children. Aim: The aim of the study on which this article is based was to assess nutrition knowledge, attitudes and practices of grade 4­6 learners from three primary schools in a South African township. The article seeks to highlight the key results of this quantitative study. Setting: The study took place in three primary schools in Mamelodi township, Pretoria, South Africa. Methods: Data were collected from grade 4­6 learners using self-administered questionnaires. After coding and collating data using Epi info TM, STATA was then used for analysis. A description of KAP results was carried out using simple descriptive statistics, while the associations were tested using a chi-square test. Results: Learners displayed inadequate knowledge of a balanced diet (23%) as well as low knowledge of food groups. With regard to attitudes, the most liked food group was the drinks and snacks (72.9%), while the least liked food group was the fruits and vegetables (8.11%). With regard to practices, the most frequently consumed food group was the drinks and snacks (72.6%), while fruits and vegetables were the least consumed. However, 78.91% of the learners displayed very good nutrition-related practices, such as making their own breakfast and eating breakfast. Conclusion: The inadequate knowledge displayed by learners indicates a gap with nutrition education in the curriculum. There is a need to explore innovative and novel approaches to improve nutrition knowledge of school children. Parents also need to be targeted to ensure better outcomes

Predictors of time to sputum culture conversion in multi-drug-resistant tuberculosis and extensively drug-resistant tuberculosis in patients at Tshepong-Klerksdorp Hospital

Setting: Klerksdorp-Tshepong Hospital Complex MDR-TB Unit, North-West Province, South Africa.Background: To determine the time to sputum culture conversion (TTSCC) and factors predictive of TTSCC in patients with multi-drug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in the North-West Province.Methods: A retrospective cohort study, abstracting patient demographic and clinical data, laboratory results, dates of sputum testing and sputum culture conversion results, from medical records of 526 MDR-TB and 47 XDR-TB patients started on TB treatment between 01 January 2012 and 31 December 2014. Predictors of TTSCC were determined by Cox proportional hazards regression.Results: The median age was 38 years (interquartile range 31­47) with 64% being male. Overall, 79% (449) were Human Immunodeficiency Virus (HIV)-infected. The median TTSCC was 56.5 days and 162.5 days for MDR-TB and XDR-TB patients, respectively. In the multivariate analysis, age [hazard ratio (HR): 0.89, 95% confidence interval (CI): 0.96­0.99], being underweight (HR: 0.631.61, 95% CI: 0.451.03­0.882.51), Acid Fast Bacilli (AFB) positivity (HR: 0.72, 95% CI: 0.51­1.01) and having XDR-TB (HR: 0.36. 95% CI: 0.19­0.69) were predictive of longer TTSCC.Conclusion: Predictors of TTSC allow for MDR-TB- and XDR-TB-diagnosed patients to be identified early for effective management. Those with risk factors for delayed sputum culture conversion which are being underweight and having XDR-TB should be monitored carefully during treatment so that they can achieve sputum culture conversion early

Needs and Preferences for Nutrition Education of Type 2 Diabetic Adults in a Resource-Limited Setting in South Africa

Diabetes self-management education is crucial in diabetes care. Education that is tailored to the needs of the patient is considered the most effective in improving health outcomes. Diet; a critical element of diabetes treatment; is reported as the most difficult to adhere to by both patients and health professionals. Tailored nutrition education (NE) could benefit diabetic individuals with low socio-economic status; who are amongst those noted to have poor health outcomes. This qualitative interpretive phenomenological study aimed to explore and describe the NE needs of adults with type 2 diabetes mellitus to guide development of a tailored NE programme for resource-poor settings. Participants were 31 non-insulin-dependent type 2 diabetic patients (convenience sample) and 10 health professionals. Focus group discussions using semi-structured questions were held with the diabetics; and open-ended self-administered questionnaires were used with the health professionals. Data analysis was done using Krueger's framework approach. Disease-related knowledge deficits and inappropriate self-reported dietary practices; including intake of unbalanced meals; problems with food portion control and unsatisfactory intake of fruits and vegetables; were observed. Recommendations for the NE programme included topics related to the disease and others related to diet. Group education at the clinic; a competent educator and comprehensive education were indicated by the patients. Participation of family and provision of pamphlets were aspects recommended by patients and health professionals. Barriers that could impact the NE included financial constraints; food insecurity; conflict in family meal arrangements and access to appropriate foods. Support from family and health professionals and empowerment through education were identified as facilitators to following dietary recommendations by both groups of participants. Knowledge deficits; inappropriate dietary practices and barriers are issues that need addressing in an NE programme; whilst the suggestions for an NE programme and facilitators to dietary compliance need to be incorporated

Elements of Effective Nutrition Education for Adults with Diabetes Mellitus in Resource-Poor Settings: a Review

This review article highlights the key factors that need consideration in planning an effective nutrition education programme for adults with type 2 diabetes mellitus in resource-poor settings. Type 2 diabetes is increasing to epidemic levels globally. Low socio-economic status is associated with poorer health outcomes and a higher economic burden. Individuals with diabetes cite dietary adherence as the most difficult self-care area. Effective nutrition education achieves the desired goals and outcomes; which include appropriate change in dietary behaviour; improved glycaemic control; plasma lipid levels; blood pressure and body weight; as well as improved potential mediators (knowledge; skills and attitudes). Elements that contribute to a successful nutrition education programme include interventions tailored to the needs; abilities and socio-cultural context of the target group; the active involvement of the patient; a behaviour-focused approach based on appropriate theory; suitable delivery methods and individual/group approaches. Adequate contact time with an educator ( 10 hours); the educator's competence; provision of social support and follow-up intervention are also crucial. Effectively educating diabetic individuals from resource-poor settings in nutrition is a challenging task. It needs innovative and skilled educators who are sensitive to the unique needs of the target group and who use appropriate approaches to address these needs

Factors Influencing the Health Behaviors of International Students at a University

Purpose: Each year; college campuses in America welcome an increasing and diverse population of international students. While the health status of these students is as diverse as the countries they come from; the shared experience of coming from different cultures; different backgrounds and different systems could lead to differences in health behavior. This study aimed to identify key patterns in nutrition; exercise and use of health care services and make recommendations for health promotion interventions. Methods: Online questionnaires were distributed to all international students enrolled in classes for the Spring 2007. Results: The majority of international students believed healthy behaviors were important: good nutrition habits (91); regular exercise (74); and use of health care services (60). Forty-four percent of the students reported they never exercise and 56reported not to have used any health care services within the past year. Conclusion: Although international students of Western Kentucky University; USA believe in healthy behaviours; majority often do not use the health care services. University wellness programs should be designed to identify target areas for health promotion interventions among international students. In addition; orientation programs provided to these students should be comprehensive and must include perceived academic; health; social and cultural issues and how to overcome them

The Nutritional Intake of Undergraduates at the University of Zimbabwe College of Health Sciences

In developing countries the cost of treating disease is much more than prevention and so there is now a lot of interest in understanding nutrition. In this pilot study we selected a cohort of pre-clinical students studying at the College of Health Sciences in the University of Zimbabwe. This study was carried to investigate the gender-based weekly consumption of different food categories amongst University of Zimbabwe students. Semi-structured questionnaires distributed to 100 undergraduate students (male= 47; female= 52). The proportion of male and female respondents; age and body weight did not differ significantly. Principal foods consumed by males included sadza and cerevita; naartjies; bananas and avocado pears; tomatoes; onions; covo and spinach; beef; and condensed milk and powdered milk occupied the larger proportions. Females frequently ate a lot of bread; cerevita; sadza and cereal; lemons and avocado pears; onions; tomatoes; rape and covo; beef and soya meat; creamer; powdered milk and milk. This study suggests that females consumed a greater variety of food; including the infrequent types by comparison with men

HPLC analysis of nicotinamide, pyridoxine,riboflavin and thiamin in some selected food products in Nigeria

Food fortification is an important tool for improving the health of the population. Motivated by this; the National Agency for Food and Drug Administration and Control (NAFDAC) has in the past few years embarked on a campaign to create this awareness. There has been varying degree of compliance to this; and so it is of utmost importance to know the food products that contribute significantly to the dietary vitamin B intake. This study investigates the amount of four Vitamin B compounds; namely nicotinamide; pyridoxine; riboflavin and thiamin; present in different packaged food items available in Lagos metropolis of Nigeria. The food items analyzed include dairy products; fruit juices and cereal products. These foods were chosen because of their widespread consumption in the area. The analysis was done using a high performance liquid chromatographic technique with a UV detector. The separation was carried out on a C18 column; using a mobile phase made up of 70buffer (a solution of sodium salt of hexane sulphonic acid) and 30HPLC grade methanol. The identification was based on retention time match against a standard while the quantitation was based on the peak area match against those of a standard. The calibration curves for the standards were linear with a linear regression coefficient close to unity

How can we improve the management of stroke in Nigeria; Africa?

Stroke is a significant economic; social and medical problem all over the world. This article discusses recent developments in stroke management worldwide. We reviewed and highlighted published clinical guidelines from several countries. The current thoughts on stroke care are discussed and summarized in concise and unambiguous terms. Limitation to optimal management in developing countries as well as areas requiring development and research are highlighted. It should be possible to utilize this in stimulating the development of management strategies for stroke; customized to the unique health structure in Nigeria. The management of stroke in Nigeria is suboptimal as there are significant deficiencies in the provision of diagnostic; treatment; rehabilitation and support services. The limited resources; manpower shortage; lack of organized stroke unit; neuro-imaging facilities; ambulance services; education of patients and general practitioners as well as impracticable use of thrombolytics are contributory. Training of stroke experts in collaboration with experts in the developed world with provision of neuro-imaging facilities would improve the outlook of stroke management in Nigeria. The focus in Nigeria must be on preventive strategies and ways to harness local resources in the acute treatment of stroke patients. Health education of the community with emphasis on control of the predisposing factors would reduce the burden of stroke in the country. Risk factor management should begin in childhood; with emphasis on exercise; nutrition; weight and blood sugar control; avoidance of tobacco and excessive alcohol; as well as effective treatment of hypertension and hyperlipidaemia

Development of the South African renal exchange lists

Objective: The objective of this developmental study was the development of renal exchange lists for the South African population with renal failure.Subjects and design: A questionnaire was circulated to South African renal dietitians to establish the format and composition of the proposed exchange lists. Foodfinder 3 was used for assessment of nutrient composition of foods; and the NRIND Food Quantities Manual was used for assessment of portion sizes. Results from the Food Consumption Study were used to identify food items frequently consumed by the South African population; and dietitians with knowledge of the eating habits of Moslem; Indian; white; black and coloured groups were consulted regarding the inclusion of cultural foods. Portion sizes were determined by protein content of foods. The preliminary exchange lists were circulated for comment and tested for a period of 1 year. Results: Many new food items were added during revision of the exchange lists. Portion sizes were adapted to be more realistic; and in some cases additional sub-groups were added. Foodfinder 3 and renal exchange list values for all food items included in the exchange lists were then compared; and this showed highly significant correlations for all nutrients concerned. There was no significant difference between mean nutrient values for the two methods; with the exception of protein; the content of which was consistently and significantly underestimated by a mean of 0.1 g per food item. This underestimation is not considered to be of clinical importance. Conclusion: In this study renal exchange lists were developed for use in South African persons with renal failure. Despite the small but significant underestimation of protein content; the lists appear to be of sufficient precision for use in clinical practice

Analyse biochimique et nutritionnelle de quelques mets traditionnels de Cote d'Ivoire

"Les mets traditionnels a base de cereales; racines; tubercules et banane a cuire sont analyses en vue d'une meilleure exploitation. Les resultats d'analyse revelent que les teneurs en eau de la plupart de ces mets traditionnels; a l'exception du "" gwonmi "" et du "" bachi "" prepares a partir des grains de cereales; excedent les 50pour cent. Le "" bachi "" se caracterise par une forte teneur en glucides (80;93pour cent). Les beignets a base de farine de mil sont plus riches en lipides (20;32pour cent). D'une maniere generale; ces mets traditionnels se revelent pauvres en proteines (8;12pour cent a 8;31pour cent). Les taux de cendres se situent entre 0;83pour cent et 4;62pour cent. Le "" bachi "" avec 371;34 kcal semble plus energetique contre 56;01 kcal pour la bouillie des grains de mil. Les valeurs de pH de ces mets traditionnels varient de 3;80 a 6;75."

Food consumption patterns in the Seychelles between 1983 and 1993

In the absence of dietary survey; information from two Household Expenditure Surveys of 1983/84 and 1992/93 was used to estimate the amount of nutrients available to an average person and to identify shifts in food consumption patterns in the Seychelles. The data shows heavy dependence on refined foods and low purchase of fruits and vegetables. There is an increase in consumption of most foods and the greatest increase is seen in the consumption of milk (395 per cent) and meat products. The amount of nutrients provided by purchased foods has improved between 1983 and 1993. In 1992/93 purchased foods provided marginal amounts of energy but protein intake remains above recommended requirements. Purchased foods provide a high carbohydrate; moderate protein and low fat intake which is not commensurate with a high prevalence of cardiovascular disease risk factors in the local population. With the exception of Niacin; all other nutrients are provided in amounts below recommended intakes. Iron intake is adequate for male but not for female household members. The data suggest the need to improve the availability of wholesome foods; promote the consumption of local foods and obtain better data in order to elucidate the link between diet and disease in Seychelles

Le centre de recuperation et d'education nutritionnelles : une structure a vulgariser

Le probleme de la malnutrition s'accentue au fil des annees au Senegal malgre la mise sur pied de centres visant a promouvoir l'education sanitaire de base et a prendre en charge les enfants malnutris. En se fondant sur le bilan des cinq annees d'activites des CREN de Dakar et de Thies qui prennent en charge en moyenne 600 a 700 malnutirs par an avec des resultats satisfaisants (80 pour cent de succes); l'utilisation de tels centres s'est imposee. En consequence; leur implantation dans les differentes structures de sante publique aiderait a juguler ce fleau

Low birth weight assessment in Chatinkha maternity wing

The aims of this study were to assess the incidence of LBW in the Gogo Chatinkha Banda Maternity wing of Queen Elizabeth Central Hospital(Chatinkha Martenity Wing) in Blantyre; to subdivide the LBW infants into preterm and TSGA groups; and to use the results to make suggestions for optimal management of LBW at Chatinkha Maternity Wing

Nutrition rehabilitation at Katema Health Centre

This study was undertaken to evaluate the effectiveness of a supplementary feeding programme at Katema Health Centre in Mangochi District. Katema Health Centre is a missionary Health Centre situated 43 kms west of Mangochi Town Centre