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    New Hampshire Just Food Citizen Panel Consensus Conference February 7-9, 2002: Findings and Recommendations

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    A Study Report On Infant Feeding Practices In The Context Of\ud HIV / AIDS

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    \ud \ud This report presents the findings of a study on infant feeding practices in the context of HIV/AIDS in Tanzania. The study was undertaken from 8th – 24th August 2004 in 3 regions implementing PMTCT activities namely Kagera, Mbeya and Kilimanjaro. In each region, two PMTCT and one Non-PMTCT implementing districts were involved. The study population included mothers of infants who are HIV negative, infected and those of unknown status. Others were health service providers dealing with mothers and children, men and women of reproductive age and key informants. A total of 471 and 95 mothers with their infants were interviewed in PMTCT and Non-PMTCT sites respectively. Also 211 health service providers and 16 key informants were interviewed. HIV positive and negative mothers were selected purposively whereas those of unknown status were selected randomly. The quantitative data from mothers and health workers were collected by using structured questionnaires. A checklist was used to collect qualitative data from key informants such as TBAs, CBOs, FBOs, VHWs and VGLs. Another checklist was also used for facilitation of focus group discussion which involved men and women of reproductive age. In addition, secondary data from various sources were collected. The collected data were edited manually before being captured using excel, cleaned and finally transferred into SPSS version 10 for analysis. The results show that mean age of the interviewed mothers was 25 years and 62.4% of them had more than one child. Most mothers (87.3%) were married and (76.7%) were primary school leavers. There were 40% housewives. Proportion of mothers who delivered at health facility was 76.6%. Many of health service providers interviewed were Nurse Midwives, (45.5%) and nursing officers (21.3%). As regard to knowledge about breastfeeding, 50% of mothers were able to recognize its nutritional role and 34% knew the importance of colostrums. About breastfeeding initiation, 67.5 percent of mothers reported that it is recommended to start within an hour after delivery. However, a small proportion of mothers (2.5%) and (2.7%) appreciated the advantage of exclusive breastfeeding in relation to family planning and reducing the risk of MTCT of HIV respectively. Furthermore, 34.5% of mothers mentioned appropriate age for complementation as 4-6 months, where as 32.0% mentioned at 6 months. On the other hand, 24.6% of mothers reported to complement their infants at the age below 4 months. Complementary food given were named as maize porridge (40%), Lishe porridge 2.5% and cow’s milk 24%. Findings also show that frequency of feedingfor infants aged 6-9 months as mentioned by 39.8% of mothers was 3 times. However, there were 31.3% mothers who fed their infants 1-2 times a day. With regard to infant aged 10-12 months, the data show that 29.9% and 26.3 percent are fed 3 and 4 times a day respectively. Moreover, 6.0 percent of mothers did not know feeding frequency for infants aged 6-9 months and 9.2% of them were not aware of feeding frequency of infants aged 10-12 months. As regards to knowledge of mothers on MTCT of HIV, most of the mothers (over 90%), were aware that there is a possibility of MTCT of HIV. The awareness was high (over 90%) among the HIB +ve and HIV-ve mothers within the PMTCT sites. The risk was equally known by majority of mothers even in non-PMTCT sites. The findings also show that 57% of mothers that the commonest mode of MTCT of HIV is through breastfeeding. Generally in both PMTCT and non PMTCT sites MTCT of HIV through breastfeeding was the way known by many mothers. Among the mentioned factors that increase the risk of MTCT of HIV were breastfeeding exposure (35.2%), and breast conditions (25.1%). Other factors were sharing clothes between infant and mother; mothers’ spits and sweat on the breast during breast-feeding. However, re-infection with HIV and poor breastfeeding technique were less known as they were mentioned factors by 0.3 and 3.6 percent of mothers respectively. Ways of reducing MTCT of HIV as mentioned by mothers were replacement feeding (62.3%) and avoiding the infants to suckle on a breast with some spits and sweat (16.6%). On the other hand 3.2% of mothers were not aware about any way of reducing MTCT of HIV. However, 1.7 percent and 3.6 percent knew that EBF and ARV respectively could reduce the risk. In PMTCT sites both HIV infected (69%) and non infected (89%) mothers breastfed their infants soon after delivery. HIV positive mothers who reported to give their infants replacement feed soon after delivery were only 4.8%. The proportion of infants fed on breast milk after delivery was as high 81.1% even among mothers with unknown status. On top of that the findings also show that health service providers are the important source of information on infant feeding to mothers. They are depended by almost 70% of mothers and their influence as reported by mothers is very high (60.6%). Family members were also mentioned as other source of information. The main constraints as regard to infant feeding as reported by HIV infected mothers were the refusal of infants to eat other foods, insufficient breast milk and women heavy workload. However, majority of them (71.7%) did not report way constraint. In additional, the findings revealed that infant feeding counseling was given to majority (76.1%) of HIV infected mothers and only few (24.9%) of HIV negative women. About49.6% of HIV infected women were counseled on infant feeding option during pregnancy. Those counseled during and after delivery were 21.8% and 28.6% respectively. The most preferred infant feeding option was early cessation of breast feeding, as it was used by 55.7% of HIV positive women. Other women (17.1 and 14.3%) used exclusive breastfeeding for six months and commercial infant formula respectively. Affordability of infant feeding option was the main motivation (22.9%) to choose and use the said option, as compared to HIV transmission risk reduction (11.0%). Majority of HIV infected mothers (58.7%) reported to face no constraint as regard to implementation of infant feeding option. However, some of them (12%) mentioned stigma from family and community members as a major constraint to successful implementation of infant feeding option of their choice. Some health service providers (26.5%) mentioned the 4-6 months duration of exclusive breastfeeding and 46.4% mentioned the WHO / UNICEF recommended duration of 6 months. Furthermore, 13% of HSP were unable to demonstrate proper positioning and attachment of a baby on the breast, and 0.9% were not ware of the appropriate age for complementation. The findings further show that Few HSP in PMTCT (23%) were aware that there is a possibility of MTCT of HIV during pregnancy. On top of that there were (32.9%) of HSP in PMTCT aware of the increased risk of MTCT of HIV were due to breast conditions, only (4%) of HSP recognized the risk of MTCT associated with poor positioning and attachment of baby on breast. Furthermore, 44% of HSP in PMTCT sites were trained on infant feeding in the context of HIV/AIDS. With regards to infant feeding options 21.3% of The HSP in PMTCT sites mentioned exclusive breastfeeding for 6 months 29.5% mentioned early cessation of breastfeeding. Home prepared infant formula 20.7% and commercial infant formula was given by 15%. According to HSP in PMTCT sites, the main constraints faced by HIV infected mothers when implementing IFO are stigma (51.1%), avoiding to be known by other family members that they are HIV positive (20%), and switching from one option to another without consultation (22%). Overall, the study findings show that there is limitation in terms of knowledge and skills on breastfeeding, complementation and infant feeding options among HSP and mothers. More training, sensitization and media campaigns on infant feeding are needed. Counseling services on infant feeding option need to be strengthened. Also more research need to be conducted to explore the risk of MTCT transmission of HIV through the various existing mode of infant feeding among HIV infected mothers.\u

    Facilitating Effective Food Security Policy Reform

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    Food Security and Poverty, Downloads December 2008 - July 2009: 10,

    "Canned Goods" Thanksgiving Food Drive posters

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    These posters were created to promote a community food drive

    Gender relations and couple negotiations of British men's food practice changes after prostate cancer.

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    Nutrition plays an important role in the health of men diagnosed with prostate cancer and dietary interventions can therefore be a significant part of prostate cancer survivorship supportive care. Family food provision, however, involves complex social interactions, which shape how men engage with their diets and dietary interventions. The role that gender plays in shaping prostate cancer couples' food practices and men's diets after a prostate cancer diagnosis is thought to be important but is little understood. This study explored couples' accounts of nutrition information seeking and diet change to gain a better understanding of how gender relations shaped men's food practices after prostate cancer diagnosis. Qualitative health interviews with men and their partners were conducted and analysed using interpretive descriptive methods. Findings demonstrated how couples navigated food change journeys that involved seeking information, deciding what changes were warranted and implementing and regulating diet changes. Two overarching themes that illustrated couples' food negotiations were called 'Seeking information and deciding on food changes' and 'Monitoring food changes'. Additional sub-themes described who led food changes, women's filtering of information, and moderation or 'treats'. Throughout these food change journeys interactions between men and women were at play, demonstrating how gender relations and dynamics acted to shape couples food negotiations and men's food practices. Findings reveal that attention to gender relations and the men's family food dynamics should inform diet interventions for men with prostate cancer in order to improve uptake

    A Review of Dietary Zinc Recommendations

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    Background. Large discrepancies exist among the dietary zinc recommendations set by expert groups. Objective. To understand the basis for the differences in the dietary zinc recommendations set by the World Health Organization, the U.S. Institute of Medicine, the International Zinc Nutrition Consultative Group, and the European Food Safety Agency. Methods. We compared the sources of the data, the concepts, and methods used by the four expert groups to set the physiological requirements for absorbed zinc, the dietary zinc requirements (termed estimated and/or average requirements), recommended dietary allowances (or recommended nutrient intakes or population reference intakes), and tolerable upper intake levels for selected age, sex, and life-stage groups. Results. All four expert groups used the factorial approach to estimate the physiological requirements for zinc. These are based on the estimates of absorbed zinc required to offset all obligatory zinc losses plus any additional requirements for absorbed zinc for growth, pregnancy, or lactation. However, discrepancies exist in the reference body weights used, studies selected, approaches to estimate endogenous zinc losses, the adjustments applied to derive dietary zinc requirements that take into account zinc bioavailability in the habitual diets, number of dietary zinc recommendations set, and the nomenclature used to describe them. Conclusions. Estimates for the physiological and dietary requirements varied across the four expert groups. The European Food Safety Agency was the only expert group that set dietary zinc recommendations at four different levels of dietary phytate for adults (but not for children) and as yet no tolerable upper intake level for any life-stage group

    Food Surpluses and Food Insecurity

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    Provides a historical overview of Israeli agricultural policy and examines the paradox of the creation and destruction of agricultural surpluses. Includes long-term recommendations aimed at overhauling the current system of agricultural subsidies
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