Determinants of Stunting and Severe Stunting Among Under-Fives in Tanzania: Evidence from the 2010 Cross-Sectional Household Survey.

Stunting is one of the main public health problems in Tanzania. It is caused mainly by malnutrition among children aged less than 5 years. Identifying the determinants of stunting and severe stunting among such children would help public health planners to reshape and redesign new interventions to reduce this health hazard. This study aimed to identify factors associated with stunting and severe stunting among children aged less than five years in Tanzania. The sample is made up of 7324 children aged 0-59 months, from the Tanzania Demographic and Health Surveys 2010. Analysis in this study was restricted to children who lived with the respondent (women aged 15-49 years). Stunting and severe stunting were examined against a set of individual-, household- and community-level factors using simple and multiple logistic regression analyses. The prevalence of stunting and severe stunting were 35.5 % [95 % Confidence interval (CI): 33.3-37.7] and 14.4 % (95 % CI: 12.9-16.1) for children aged 0-23 months and 41.6 % (95 % CI: 39.8-43.3) and 16.1 % (95 % CI: 14.8-17.5) for children aged 0-59 months, respectively. Multivariable analyses showed that the most consistent significant risk factors for stunted and severely-stunted children aged 0-23 and 0-59 months were: mothers with no schooling, male children, babies perceived to be of small or average size at birth by their mothers and unsafe sources of drinking water [adjusted odds ratio (AOR) for stunted children aged 0-23 months = 1.37; 95 % CI: (1.07, 1.75)]; [AOR for severely stunted children aged 0-23 months = 1.50; 95 % CI: (1.05, 2.14)], [AOR for stunted children aged 0-59 months = 1.42; 95 % CI: (1.13, 1.79)] and [AOR for severely stunted children aged 0-59 months = 1.26; 95 % CI: (1.09, 1.46)]. Community-based interventions are needed to reduce the occurrence of stunting and severe stunting in Tanzania. These interventions should target mothers with low levels of education, male children, small- or average-size babies and households with unsafe drinking water

Association between eating frequency, weight, and health

There is speculation amongst health professionals, the media, and the public regarding eating frequency (EF) and its impact on weight and health. Nutritional weight-loss and -maintenance interventions of longer than 1 week's duration were reviewed for associations between EF and weight and health. Of the 176 studies identified, 25 relevant studies matched the criteria and only 10 of these were weight-loss interventions. Generally, sample sizes were small, interventions were short-term, and a wide array of definitions was used to define an eating occasion. Several key outcomes such as physical activity, adherence to assigned EF, and hunger were often not measured. The limited evidence available suggests there is no association between EF and weight or health in either weight-loss or -maintenance interventions, with a possible inverse association between EF and lipids in weight-maintenance interventions. Longer term, larger studies that include important weight and health outcomes are needed

To snack or not to snack: What should we advise for weight management?

Aims

Protein and vegetarian diets

A vegetarian diet can easily meet human dietary protein requirements as long as energy needs are met and a variety of foods are eaten. Vegetarians should obtain protein from a variety of plant sources, including legumes, soy products, grains, nuts and seeds. Eggs and dairy products also provide protein for those following a lacto-ovo-vegetarian diet. There is no need to consciously combine different plant proteins at each meal as long as a variety of foods are eaten from day to day, because the human body maintains a pool of amino acids which can be used to complement dietary protein. The consumption of plant proteins rather than animal proteins by vegetarians may contribute to their reduced risk of chronic diseases such as diabetes and heart disease

Zinc and Vegetarian Diets

© 2012 Australasian Medical Publishing Co. Ltd. All rights reserved. • Well planned vegetarian diets can provide adequate amounts of zinc from plant sources.• Vegetarians appear to adapt to lower zinc intakes by increased absorption and retention of zinc.• Good sources of zinc for vegetarians include whole grains, tofu, tempeh, legumes, nuts and seeds, fortified breakfast cereals and dairy products.• The inhibitory effects of phytate on absorption of zinc can be minimised by modern food-processing methodssuch as soaking, heating, sprouting, fermenting and leavening.• Absorption of zinc can be improved by using yeastbased breads and sourdough breads, sprouts, and presoaked legumes.• Studies show vegetarians have similar serum zinc concentrations to, and no greater risk of zinc deficiency than, non-vegetarians (despite differences in zinc intake)

Factors associated with inappropriate complementary feeding practices among children aged 6-23 months in Tanzania

Inappropriate complementary feeding is one of the major causes of under nutrition among young children in Tanzania. Prevalence of newly developed World Health Organization complementary feeding indicators and their associated factors were determined among 2402 children aged 6–23 months in Tanzania using data from the 2010 Tanzania Demographic and Health Survey. The survey used a multistage cluster sample of 10 300 households from the eight geographical zones in the country. The prevalence of the introduction of soft, semi-solid or solid foods among infants aged 6–8 months was 92.3%. Of all the children aged 6–23 months, the prevalence of minimum dietary diversity, meal frequency and acceptable diet were 38.2%, 38.6% and 15.9%, respectively. Results from multivariate analyses indicated that the main risk factors for inappropriate complementary feeding practices in Tanzania include young child's age (6–11 months), lower level of paternal/maternal education, limited access to mass media, lack of post-natal check-ups, and poor economic status. Overall, complementary feeding practices in Tanzania, as measured by dietary diversity, meal frequency and acceptable diet, are not adequately met, and there is a need for interventions to improve the nutritional status of young children in Tanzania

Determinants of breastfeeding indicators among children less than 24 months of age in Tanzania: a secondary analysis of the 2010 Tanzania Demographic and Health Survey

Objective: To examine the prevalence of key WHO breastfeeding indicators and identify determinants of suboptimal breastfeeding practices among children aged less than 24 months in Tanzania. Design, setting and participants: Secondary analyses of cross-sectional data from the 2010 Tanzania Demographic and Health Survey. The survey used a stratified two-stage cluster sample of 10 312 households from eight geographical zones of Tanzania. The sample consisted of 3112 children aged 0–23 months. Main outcome measures: Outcome measures were factors significantly associated with delayed initiation of breastfeeding, non-exclusive breastfeeding and predominant breastfeeding in the first 6 months. Results: Breastfeeding was initiated within the first hour of birth in 46.1% of mothers. In infants aged less than 6 months, the prevalence of exclusive breastfeeding was 49.9% but only 22.9% were exclusively breastfed at 4–5 months. Seventeen per cent of infants, less than 6 months of age, were ‘predominantly breastfed’. At 12–15 months, 94.0% of infants were still breastfed but the proportion decreased to 51.1% at 20–23 months of age. Multivariate analysis revealed that the risk of delayed initiation of breastfeeding within 1 h after birth was significantly higher among young mothers aged <24 years, uneducated and employed mothers from rural areas who delivered by caesarean section and those who delivered at home and were assisted by traditional birth attendants or relatives. The risk factors associated with non-exclusive breastfeeding, during the first 6 months, were lack of professional assistance at birth and residence in urban areas. The risk of predominant breastfeeding was significantly higher among infants from the Zanzibar geographical zone. Conclusions: Early initiation of breastfeeding and exclusive breastfeeding indicators were unsatisfactory and are below the national targets for Tanzania. To improve breastfeeding practices, national level programmes will be required, but with a focus on the target groups with suboptimal breastfeeding practices

Microencapsulation of Lactobacillus acidophilus LA-5, Bifidobacterium animalis subsp. lactis BB-12 and Propionibacterium jensenii 702 by spray drying in goat's milk

A mixture of probiotic <i>Lactobacillus acidophilus</i> LA-5, <i>Bifidobacterium animalis</i> subsp. <i>lactis</i> BB-12 and novel potential probiotic <i>Propionibacterium jensenii</i> 702 was resuspended in reconstituted (20% w/v) goat's milk, spray dried in a mini spray dryer (inlet temperature=195°C and outlet temperature=85°C) and the spray dried powder was stored in air tight glass jars at 4°C and 30°C for 24 weeks. Powder quality and probiotic viability after spray drying and subsequent storage were measured. Spray drying probiotics in reconstituted goat's milk resulted in a significant reduction in the viability of all three probiotics. However, all three probiotics were able to maintain satisfactory viability levels (10⁶-10⁸cfu/g) after spray drying. While storage temperature did not appear to have a significant effect on moisture content, the viability of all three strains declined dramatically when stored at 30°C but lactobacilli and propionibacteria remained virtually unaffected under storage at 4°C, satisfying recommendations regarding the level of viable cells in probiotic foods

Iron and Vegetarian Diets

© 2014, Australasian Medical Publishing Co. Ltd. All rights reserved. Vegetarians who eat a varied and well balanced diet are not at any greater risk of iron deficiency anaemia than non-vegetarians. A diet rich in wholegrains, legumes, nuts, seeds, dried fruits, iron-fortified cereals and green leafy vegetables provides an adequate iron intake. Vitamin C and other organic acids enhance non-haem iron absorption, a process that is carefully regulated by the gut. People with low iron stores or higher physiological need for iron will tend to absorb more iron and excrete less. Research to date on iron absorption has not been designed to accurately measure absorption rates in typical Western vegetarians with low ferritin levels

Patient Perspectives of Living with Coeliac Disease and Accessing Dietetic Services in Rural Australia: A Qualitative Study

Adapting to living with coeliac disease requires individuals to learn about and follow a strict gluten-free diet. Utilising a qualitative inductive approach, this study aimed to explore the perspectives of adults diagnosed with coeliac disease who have accessed dietetic services in a rural outpatient setting. A purposive sample of adults with coeliac disease who had accessed dietetic services from two rural dietetic outpatient clinics were recruited. Semi-structured interviews were conducted by telephone. Data were thematically analysed. Six participants were recruited and interviewed. Three key themes emerged: (i) optimising individualised support and services, (ii) adapting to a gluten-free diet in a rural context, and (iii) managing a gluten-free diet within the context of interpersonal relationships. Key issues identified in the rural context were access to specialist services and the increased cost of gluten-free food in more remote areas. The findings of this study have highlighted the difficulties associated with coeliac disease management and how dietetic consultation has the potential to influence confidence in management and improve lifestyle outcomes. Further qualitative research is required to expand on the findings of this study and inform future dietetic practice that meets the expectations and individual needs of people with coeliac disease in rural settings