How to strengthen an Infant and Young Child Feeding programme in Northern Nigeria

This four-page research summary brief highlights findings and recommendations from operations research into how to strengthen the implementation of an Infant and Young Child Feeding (IYCF) programme and to motivate behaviour change to improve IYCF practices in northern Nigeria. The research found that the IYCF programme was viewed positively by a range of beneficiaries and stakeholders, including family members, traditional birth attendants, IYCF programme community volunteers, health workers and state government officials, because of the perceived visibility of the health benefits, including less episodes of diarrhoea, and consequent savings on health care. Recommendations for the IYCF programme include review strategies for CV training and strengthen supportive supervision, especially in relation to counselling techniques and facilitation of support groups; reinforce and strengthen the use of examples of real healthy children who have been exclusively breastfed to enhance the acceptability of the messages and adoption of the behaviour change; and adopt multiple behaviour change techniques, including food demonstrations and professionally developed mass media

How to Strengthen the CMAM programme in Northern Nigeria and reduce rates of programme defaulting

This report presents findings from the operations research (OR) study which was conducted to identify barriers to attendance of the Maternal Neonatal and Child Health Weeks programme (MNCHW), in two states of northern Nigeria – Jigawa and Zamfara States. The work was a collaborative project between the London School of Hygiene & Tropical Medicine, Food Basket Foundation International and Oxford Policy Management. The treatment and prevention of severe acute malnutrition via the Community Management of Acute Malnutrition programme (CMAM) is one of four outputs of the DFID-funded development project “Working to Improve Nutrition in Northern Nigeria” (WINNN). This output aims to deliver, in the five WINNN supported northern states, effective treatment for severe acute malnutrition through local health systems. WINNN is implemented by UNICEF, Action Against Hunger (ACF) and Save the Children International (SCI), in partnership with the five state governments. SCI is responsible for its implementation in Zamfara, Kebbi and Katsina states, and ACF is responsible for its implementation in Jigawa and Yobe states. The CMAM services include: (1) Community outreach, for the early identification and referral of severe acute malnutrition (SAM) and later follow-up; (2) Outpatient care for children with SAM without medical complications at health facilities and at home (Outpatient Therapeutic Programme, OTP); (3) Inpatient care for children with SAM, and medical complications or no appetite (Inpatient Therapeutic Programme, ITP)

How to strengthen the Infant and Young Child Feeding (IYCF) programme in Northern Nigeria

This report presents findings from the operations research (OR) study which was conducted to strengthen the Infant and Young Child Feeding (ITCF) programme, in northern Nigeria .The work was a collaborative project between the London School of Hygiene & Tropical Medicine, Food Basket Foundation International and Oxford Policy Management. The prevention of under-nutrition via the IYCF programme is one of four outputs of the DFID-funded programme “Working to Improve Nutrition in Northern Nigeria” (WINNN). This output aims to prevent under-nutrition by promoting evidence-based IYCF feeding recommendations, including exclusive breastfeeding until an infant is 6 months of age, feeding a diverse diet of nutritious foods and breastmilk from 6-23 months of age, feeding a sick child and good hand-washing practices. WINNN is implemented by UNICEF, Action Against Hunger (ACF) and Save the Children International (SCI), in partnership with five state governments. SCI is responsible for its implementation in Zamfara, Kebbi and Katsina states, and ACF is responsible for its implementation in Jigawa and Yobe states. Each of the five WINNN states implements the IYCF programme in three Local Government Areas (LGAs). The IYCF programme includes: (1) Facility-based IYCF counselling for pregnant women and mothers with an infant less than 2 years of age, facilitated by health workers (HWs); (2) Community-based IYCF counselling for pregnant women and mothers with an infant less than 2 years of age, facilitated by community volunteers (CVs); (3) Community-based meetings with fathers of infants less than 2 years of age and grandmothers, facilitated by CVs

How to strengthen a Community-Based Management of Acute Malnutrition programme in northern Nigeria

This summary highlights findings and recommendations from operation research on a Community-Based Management of Acute Malnutrition (CMAM) programme in northern Nigeria. The study analysed the perceived benefits of CMAM; reasons for beneficiaries not defaulting from the programme; challenges of accessing CMAM services; the workloads and motivation of health workers and community volunteers; and what is required to integrate CMAM into the primary health system.UK Ai

Affinity proteomics reveals elevated muscle proteins in plasma of children with cerebral malaria

Systemic inflammation and sequestration of parasitized erythrocytes are central processes in the pathophysiology of severe Plasmodium falciparum childhood malaria. However, it is still not understood why some children are more at risks to develop malaria complications than others. To identify human proteins in plasma related to childhood malaria syndromes, multiplex antibody suspension bead arrays were employed. Out of the 1,015 proteins analyzed in plasma from more than 700 children, 41 differed between malaria infected children and community controls, whereas 13 discriminated uncomplicated malaria from severe malaria syndromes. Markers of oxidative stress were found related to severe malaria anemia while markers of endothelial activation, platelet adhesion and muscular damage were identified in relation to children with cerebral malaria. These findings suggest the presence of generalized vascular inflammation, vascular wall modulations, activation of endothelium and unbalanced glucose metabolism in severe malaria. The increased levels of specific muscle proteins in plasma implicate potential muscle damage and microvasculature lesions during the course of cerebral malaria

Severe childhood malaria syndromes defined by plasma proteome profiles

BACKGROUND Cerebral malaria (CM) and severe malarial anemia (SMA) are the most serious life-threatening clinical syndromes of Plasmodium falciparum infection in childhood. Therefore it is important to understand the pathology underlying the development of CM and SMA, as opposed to uncomplicated malaria (UM). Different host responses to infection are likely to be reflected in plasma proteome-patterns that associate with clinical status and therefore provide indicators of the pathogenesis of these syndromes. METHODS AND FINDINGS Plasma and comprehensive clinical data for discovery and validation cohorts were obtained as part of a prospective case-control study of severe childhood malaria at the main tertiary hospital of the city of Ibadan, an urban and densely populated holoendemic malaria area in Nigeria. A total of 946 children participated in this study. Plasma was subjected to high-throughput proteomic profiling. Statistical pattern-recognition methods were used to find proteome-patterns that defined disease groups. Plasma proteome-patterns accurately distinguished children with CM and with SMA from those with UM, and from healthy or severely ill malaria-negative children. CONCLUSIONS We report that an accurate definition of the major childhood malaria syndromes can be achieved using plasma proteome-patterns. Our proteomic data can be exploited to understand the pathogenesis of the different childhood severe malaria syndromes

Fatty acid profile and dietary fibre contents of some standardized soups and dishes consumed in Nigeria

Background: Dietary fat is implicated in the increasing development of chronic  diseases in developing countries while dietary fibre play major role in the  management of these diseases. Accurate nutrient  composition data for composite dishes unique to a population is essential for the development of a nutrient database and the calculation of dietary intake.Methods: Representative samples of standardized Nigerian soups and dishes were analyzed for fatty acids using gas chromatography mass spectrophotometry (GC-MS) and dietary fibre using an enzymatic-gravimetric standard method of AOAC.Results: The total Saturated Fatty acids (SFAs) ranged from 0.74+0.3g/100g to 73.82+0.07g/100g. The total monounsaturated fatty acids (MUFAs) and  polyunsaturated fatty acids (PUFAs) ranged from  2.16+1.13g/100g for Yam pottage to 22.25+0.58g/100g for Okazi soup and eba, and from 0.42+0.10g/100g for Yam pottage to 10.22+0.1g/100g for Pounded yam with egusi ball soup, respectively. Trans fat was observed in Alapafubu and Tuwo shinkafa (2.80+0.2g/100g), Yam pottage (0.20+0.15g/100g), Steamed bean pudding (1.28+0.53g/100g) and Ikokore (5.33+0.41g/100g). The Total Dietary Fibre (TDF) contents of the dishes ranged from 12.95+2.99g/100g in Jollof rice to 62.00+0.94g/100g in Melon seed and vegetable soup, the Soluble Dietary Fibre (SDF) ranged from 2.05+0.32g/100g in Steamed bean pudding to 7.81+0.74g/100g in Ikokore while the Insoluble Dietary Fibre (IDF) ranged from 8.20+0.43g/100g in Jollof rice to   57.91+4.69g/100g in melon seed and vegetable soup.Conclusions: The study has indicated that some Nigerian dishes are characterized by high SFAs, TFAs and dietary fibre, moderate MUFAs and very low levels of PUFAs. High levels of SFAs in some soups and dishes are a major public health concern.Key words: Healthy diet, dietary fibre, fatty acid profile, chronic diseases, Nigerian dishes

Circulatory hepcidin is associated with the anti-inflammatory response but not with iron or anemic status in childhood malaria

Cerebral malaria (CM) and severe malarial anemia (SMA) are the most serious life-threatening clinical syndromes of Plasmodium falciparum infection in childhood. Therefore, it is important to understand the pathology underlying the development of CM and SMA as opposed to uncomplicated malaria (UM). Increased levels of hepcidin have been associated with UM, but its level and role in severe malarial disease remains to be investigated. Plasma and clinical data were obtained as part of a prospective case-control study of severe childhood malaria at the main tertiary hospital of the city of Ibadan, Nigeria. Here, we report that hepcidin levels are lower in children with SMA or CM than in those with milder outcome (UM). While different profiles of pro- and anti-inflammatory cytokines were observed between the malaria syndromes, circulatory hepcidin levels remained associated with the levels of its regulatory cytokine interleukin-6 and of the anti-inflammatory cytokine inerleukin-10, irrespective of iron status, anemic status, and general acute-phase response. We propose a role for hepcidin in anti-inflammatory processes in childhood malaria