Meeting the food and nutrition needs of the poor: the role of fish and the opportunities and challenges emerging from the rise of aquaculture.

People who are food and nutrition insecure largely reside in Asia and Sub-Saharan Africa and for many, fish represents a rich source of protein, micronutrients and essential fatty acids. The contribution of fish to household food and nutrition security depends upon availability, access and cultural and personal preferences. Access is largely determined by location, seasonality and price but at the individual level it also depends upon a person's physiological and health status and how fish is prepared, cooked and shared among household members. The sustained and rapid expansion of aquaculture over the past 30 years has resulted in >40% of all fish now consumed being derived from farming. While aquaculture produce increasingly features in the diets of many Asians, it is much less apparent among those living in Sub-Saharan Africa. Here, per capita fish consumption has grown little and despite the apparently strong markets and adequate biophysical conditions, aquaculture has yet to develop. The contribution of aquaculture to food and nutrition security is not only just an issue of where aquaculture occurs but also of what is being produced and how and whether the produce is as accessible as that from capture fisheries. The range of fish species produced by an increasingly globalized aquaculture industry differs from that derived from capture fisheries. Farmed fishes are also different in terms of their nutrient content, a result of the species being grown and of rearing methods. Farmed fish price affects access by poor consumers while the size at which fish is harvested influences both access and use. This paper explores these issues with particular reference to Asia and Africa and the technical and policy innovations needed to ensure that fish farming is able to fulfil its potential to meet the global population's food and nutrition needs.

Snacks are important for fat and vitamin intakes among rural African women: a cross-sectional study from Malawi.

OBJECTIVE: To estimate the contribution of energy and selected nutrients from foods eaten as snacks and as meals. SUBJECTS AND METHODS: Forty-four nonpregnant women in the reproductive age, of whom 20 were lactating, participated in this study. Women from rural households were randomly selected and energy and nutrient intakes were estimated using 2 days' observed weighed food record. Snacks eaten between meals were estimated by weighed food record as well as recall, thrice per day. RESULTS: The largest proportions (mean+/-s.e.) of fat (33+/-3.6%), vitamin C (36+/-4.1%) and a large proportion of vitamin A (30+/-4.4%) intakes were from snacks. Furthermore, snacks provided 20% of the energy intakes. CONCLUSION: Snacks are important for energy and nutrient intakes and adequacies in rural African women and have the potential to combat energy and nutrient deficiencies in low-income countries.

Characteristics of antenatal care attenders in a rural population in Tamil Nadu, South India: a community-based cross-sectional study.

The objectives of the study were to identify factors associated with utilisation of antenatal care facilities in a rural population in South India. A community-based, cross-sectional questionnaire study of 30 randomly selected areas was used. A total of 1254 women (95%) had at least one antenatal care visit. The median number of visits was four. High utilisation of antenatal care facilities was associated with low parity and adverse obstetrical history, short distance to healthcare facilities and literacy. It was concluded that antenatal care coverage was high. Information about the above few aspects can be used to target women who are at risk of getting inadequate antenatal care.

Glycaemic index of parboiled rice depends on the severity of processing: study in type 2 diabetic subjects.

OBJECTIVE: To study the influence of parboiling and the severity of the process on glycaemic and insulinaemic responses to rice in type 2 diabetes. Moreover, to examine changes in starch structure related to parboiling, which may affect the metabolic responses and digestibility. DESIGN: Nine type 2 diabetic subjects ingested four test meals: white bread (WB) and three meals of cooked polished rice of the same variety being non-parboiled (NP), mildly traditionally parboiled (TP) and severely pressure parboiled (PP). The participants ingested the test meals (50 g available carbohydrates) on separate occasions after an overnight fast. SETTING: Outpatient clinic, Dept. Endocrinology and Metabolism, Aarhus University Hospital, Denmark. RESULTS: All three rice samples elicited lower postprandial plasma glucose response (NP: 335+/-43; TP: 274+/-53; PP: 231+/-37 mmol/1*180 min.; means+/-s.e.m.) than white bread (626+/-80; P<0.001), within rice samples PP tended to be lower than NP (P=0.07). The glycaemic indices were: NP: 55+/-5, TP: 46+/-8 and PP: 39+/-6, and lower for PP than NP (P<0.05). The insulin responses were similar for the three rice meals, which were all lower than that to white bread (P<0.001). Differential scanning calorimetry showed the presence of amylose-lipid complexes in all rice samples and of retrograded amylopectin in PP. Amylose retrogradation was not detected in any of the rice samples. CONCLUSIONS: All rice test meals were low-glycaemic in type 2 diabetic subjects. There was no effect of TP on glycaemic index, whereas PP reduced the glycaemic index by almost 30% compared to NP. SPONSORSHIP: The Royal Veterinary and Agricultural University, Aarhus University Hospital, Danish International Development Assistance (DANIDA), Ministry of Foreign Affairs and the 'Konsul Johannes Fogh-Nielsens og Fru Ella Fogh-Nielsens Legat' foundation.

Whole small fish as a rich calcium source.

The present rat balance study investigated Ca availability from the whole indigenous small fish species, mola (Amblypharyngodon mola) from Bangladesh and from skimmed milk. Four groups of six young male rats each were fed ad libitum with diets containing either small fish or milk, at 100 or 160 g crude protein/kg diet dry matter. The study was conducted for 28 d and faeces and urine samples were collected in two balance periods: day 8-14 and 22-28. The Ca and N contents of the diets, faeces and urine were analysed. Ca intake, fractional Ca absorption and Ca retention in relation to N retention were measured. Digestibility and protein utilization of the experimental diets, weight gain of the rats, femur bone weight and mineral composition as well as bone alkaline phosphatase activity were also determined. It was concluded from the values of these variables that Ca from small fish with bones was available and appeared to be a useful Ca source in rats, though perhaps not as available as Ca from milk. This study suggests that small fish with bones may be an important source of Ca in human diets. Promotion of the production and consumption of small fish in population groups with low intakes of milk and milk products should therefore be encouraged.

Calcium absorption from small soft-boned fish.

The prevalence of osteoporosis in developing countries is low compared to most industrialised countries despite an apparent low Ca intake. It is possible, however, that food surveys have overlooked important Ca sources in developing countries. Small fish eaten with the bones can be a rich source of Ca, even though Ca from bone may be considered unavailable for absorption. In the present study, absorption of Ca from indigenous Bengali small fish was compared with the Ca absorption from milk. Ca absorption from single meals was determined in 19 healthy men and women (21-28 y). Each subject received two meal types on two separate occasions. Both meals consisted of white wheat bread, butter and ultra pure water with the main Ca source being either small Bengali fish (397 mg Ca in total) or skimmed milk (377 mg Ca in total). The meals were extrinsically labelled with 47Ca, and whole-body retention was measured on day 8, 12, 15 and 19 after intake of each meal. The labelling procedure was evaluated by an in vitro method. The calculated absorption of Ca as measured with 47Ca whole-body retention was 23.8 +/- 5.6% from the fish meal and 21.8 +/- 6.1% from the milk meal (mean +/- SD), which was not significantly different (p = 0.52). Even after correction for an incomplete isotope exchange, as indicated by the in vitro study, Ca absorption was similar from the two meal types. It was concluded that Ca absorption from small Bengali fish was comparable that from skimmed milk, and that these fish may represent a good source of Ca.

Does antenatal care influence postpartum health behaviour? Evidence from a community based cross-sectional study in rural Tamil Nadu, South India.

OBJECTIVE: To study the association between attendance to antenatal care and postpartum health behaviour among women in rural Tamil Nadu, South India. DESIGN: Community based, cross-sectional questionnaire study of 30 randomly selected areas served by health subcentres. SETTING: Rural parts of Salem District, Tamil Nadu, South India. POPULATION: 1321 women who were delivered in the six months before the questionnaire-based interview. MAIN OUTCOME MEASURES: Feeding of colostrum, time of initiation of breastfeeding and maternal dietary habits during the first month postpartum. RESULTS: The median number of antenatal visits was four (range 0-51; lower quartile 3, upper quartile 7)., The fifth month of pregnancy was the median time for the initiation of antenatal care. Pregnant women 1. who had a large number of antenatal care visits, 2. who initiated antenatal care in the first trimester or 3. who reported having received information about breastfeeding were more likely to feed colostrum (odds ratio 1.48; 95% CI 1.06 to 2.07), (odds ratio 1.40; 95% CI 1.06 to 1.85), (odds ratio 1.66; 95% CI 1.29 to 2.14, respectively). Only women who reported having received information about breastfeeding were more likely to initiate early breastfeeding (odds ratio 1.81; 95% CI 1.34 to 2.43). Use of antenatal care facilities was not associated with maternal postpartum dietary habits. CONCLUSIONS: A large number of women attended antenatal care in the study area, but antenatal care had a limited effect on postpartum health behaviour. As antenatal care is considered an essential part of primary health care and takes up considerable resources, we recommend further research to explain the gap between the intentions of antenatal care and the actual outcome of such care.

Reproductive pattern, perinatal mortality, and sex preference in rural Tamil Nadu, south India: community based, cross sectional study.

OBJECTIVES: To study reproductive pattern and perinatal mortality in rural Tamil Nadu, South India. DESIGN: Community based, cross sectional questionnaire study of 30 randomly selected areas served by health subcentres. SETTING: Rural parts of Salem District, Tamil Nadu, South India. SUBJECTS: 1321 women and their offspring delivered in the 6 months before the interview. MAIN OUTCOME MEASURES: Number of pregnancies, pregnancy outcome, spacing of pregnancies, sex of offspring, perinatal and neonatal mortality rates. RESULTS: 41% of the women (535) were primiparous; 7 women (0.5%) were grand multiparous (> 6 births). The women had a mean age of 22 years and a mean of 2.3 pregnancies and 1.8 live children. The sex ratio at birth of the index children was 107 boys per 100 girls. The stillbirth rate was 13.5/1000 births, the neonatal mortality rate was 35.3/1000, and the perinatal mortality rate was 42.0/1000. Girls had an excess neonatal mortality (rate ratio 3.42%; 95% confidence interval 1.68 to 6.98; this was most pronounced among girls born to multiparous women with no living sons (rate ratio 15.48 (2.04 to 177.73) v 1.87 (0.63 to 5.58) in multiparous women with at least one son alive). CONCLUSIONS: In this rural part of Tamil Nadu, women had a controlled reproductive pattern. The excess neonatal mortality among girls constitutes about one third of the perinatal mortality rate. It seems to be linked to a preference for sons and should therefore be addressed through a holistic societal approach rather than through specific healthcare measures.

PIP: This study examines patterns of neonatal mortality among rural mothers in Salem district, Tamil Nadu state, India. Data were collected during August-September 1995 in a catchment area of 30 health subcenters. The sample includes 1321 women who had delivered within the preceding 6 months. The aim was to determine the extent of excess female neonatal mortality. The instrument was pretested, and other reliability checks were made. Findings indicate that 20% (261) of the mothers had experienced the death of one or more children. The mean age of the women was 22 years, the average number of pregnancies was 2.3, and the average number of live-born children was 1.8. The mean age of first-time mothers was 20.2 years. The mean age of multiparous women was 23.9 years. There were 268 live-born babies, 68 stillbirths, 275 postnatal deaths, 280 spontaneous abortions, and 60 induced abortions. The stillbirth rate was 13.5/1000 births. The perinatal mortality rate was 42.0/1000. The early neonatal mortality rate was 28.9/1000. The late neonatal mortality rate was 6.6/1000. Of the 1321 deliveries in the prior 6 months, 99% were singleton births. 51.7% were boys, and 48.3% were girls. 98.6% were live-born, and 1.4% were stillbirths. 4.0% of live-born infants died postnatally, of which 64% died in the first 7 days and 13% died between 8 and 28 days. 23% died 1 month or more following birth. There were 11 sets of twins, of which one each died in the early and late neonatal period. In the one set of quadruplets, all infants died in the early neonatal period. The relative risk of death among daughters was 4.36 compared to sons. Primiparous women did not experience excess female neonatal mortality. Risk of female neonatal death was higher among multiparous women with no living sons compared to women with at least one son. This study did not find a shorter birth interval after the birth of a girl. The preference for sons should be addressed through a holistic societal approach.

Influence of parboiling and physico-chemical characteristics of rice on the glycaemic index in non-insulin-dependent diabetic subjects.

OBJECTIVE: To study the influence of parboiling, amylose content and gelatinisation temperature of rice on the postprandial blood glucose and insulin responses in non-insulin-dependent diabetic (NIDDM) subjects. DESIGN AND SUBJECTS: Twelve NIDDM subjects ingested high (27%) and low amylose content five test meals of 50 g available carbohydrates as white bread, cooked polished rice with high (27%) and low amylose content (12%) with different gelatinisation temperature and as nonparboiled and parboiled. The meals were taken in random order after a 12h fast with approximately 7 days interval. RESULTS: The glycaemic indices (GI) of all rice varieties were lower than that of white bread (P <0.001). Furthermore, GI of parboiled rice with a high amylose content was lower than that of parboiled rice with a low amylose content (50 +/- 7 vs 73 +/- 7, P <0.01). No differences were 47 +/- 4, n.s.), nor between non-parboiled and parboiled rice (50 +/- 7 vs 53 +/- 7, n.s.). Insulin responses to the five test meals were not significantly different in the NIDDM subjects. CONCLUSIONS: In NIDDM subjects the investigated rices were all low glycaemic as compared to white bread,independent of parboiling and physico-chemical characteristics. The mildparboiling process used did not influence GI. The study showed that the amylose content, but not the gelatinisation temperature, may be an useful criterion in selection of low GI rices also after parboiling.

Evaluation of preventive health services for hospitalised children under a child health programme.

In the hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, the Child Health Programme (CHP) has been offering preventive health care services to about 60,000 patients per year. The patient populations are mostly children who stay with their mothers or other relatives. In this programme, health education, immunisation and nutrition rehabilitation services are offered. Health education is offered as group discussion and face-to-face interaction between the educator and the mother. Immunisation is offered daily from 0700h to 1900h to all children and women attending the hospital. Nutrition rehabilitation services, both inpatient and outpatient, are offered to severely undernourished children. These preventive services are implemented by health workers and health assistants. All attendants and adult patients participate in health education sessions. More than 80% of unimmunized children and 50% of unimmunized women receive immunisation. The experience of the CHP shows that it is possible to offer different preventive health care services to all attendants and patients attending a busy hospital.

Why do some families become defaulters in a hospital based nutrition rehabilitation follow-up programme?

Since 1989, a nutrition rehabilitation follow-up (NFU) service is being offered in the Dhaka hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh. Parents bring their children for treatment of diarrhoea and those with additional diagnosis of moderate to severe protein energy malnutrition (PEM) are referred to NFU. Families with severely undernourished children are encouraged to attend NFU. Some of them do not come back to NFU after the first or subsequent visits and are considered as 'defaulters'. This paper focuses on the reasons why some families become defaulters. Thirty-two defaulter families were matched with an equal number of non-defaulter families for age and gender of the child and follow-up visit number. All families were interviewed. Children from both groups had similar nutritional, socio-economic status and parental education level. The main reason stated by defaulter mothers for not coming to NFU was 'follow-up was not needed since the child was okay'. The main reason for coming to NFU stated by non-defaulter mothers was for 'the child's improvement', indicating that parental perception of the child's nutritional status differ in the two groups. A greater proportion (75%) of defaulter mothers as compared to non-defaulter mothers (41%) came to NFU accompanied by another adult. It was not possible to identify potential defaulters. Thus all families accepting NFU must be given equal attention. The poor nutritional status of the child and associated risks must be explained to the mother and other family members. The benefits of NFU to the child and family must be stressed.(ABSTRACT TRUNCATED AT 250 WORDS)