A summary index of feeding practices is positively associated with height-for-age, but only marginally with linear growth, in rural Senegalese infants and toddlers

Several studies have shown an association between an infant and young child feeding index (ICH) and height-for-age Z-score (HAZ) in Latin America and Africa. A previous study was unable to reproduce these findings in 500 rural Senegalese 12-42-mo-old children. The relationship of ICFI, dietary diversity index (DDI), food variety index (FVI), meal frequency index (MFI), and breastfeeding (BF) to HAZ and growth in height/length over 6 mo was studied in 1060 6-36-mo-old Senegalese children during 2 visits. List-based food frequencies were recalled for the past 24 h, and height/length and weight measurements were taken. Indicators were transformed into tertiles in age-specific subgroups. DDI, FVI, MFI, and ICFI were poorly concordant across visits at all ages (weighted kappa: 0.02-0.25). In cross-sectional analyses that pooled children from the 2 visits, HAZ was positively associated with DDI and FVI at 6-12, 12-18, and 18-24 mo and with ICFI at 6-12 and 18-24 mo (P < 0.001 and P < 0.05, respectively) but was negatively associated with BF at 12-18, 18-24, and 24-30 mo. The length increment between visits was positively associated with MFI and ICFI, measured during the first visit in 18-24-mo-olds (P < 0.001 and P < 0.05, respectively) but not with DDI, FVI, or BF at any age. In conclusion, ICFI, DDI, and FVI were associated with HAZ, particularly during infancy, whereas no indicator was associated with linear growth in this age group. Therefore, the strong association between HAZ and ICFI during infancy may be partly due to maternal adaptation to infant clues, i.e., greater appetite for and interest in non-breast-milk foods among taller infants. J. Nutr. 142: 1116-1122, 2012

Reduced Quantitative Ultrasound Bone Mineral Density in HIV-Infected Patients on Antiretroviral Therapy in Senegal

Background: Bone status in HIV-infected patients on antiretroviral treatment (ART) is poorly documented in resource-limited settings. We compared bone mineral density between HIV-infected patients and control subjects from Dakar, Senegal. Methods: A total of 207 (134 women and 73 men) HIV-infected patients from an observational cohort in Dakar (ANRS 1215) and 207 age-and sex-matched controls from the general population were enrolled. Bone mineral density was assessed by quantitative ultrasound (QUS) at the calcaneus, an alternative to the reference method (i.e. dual X-absorptiometry), often not available in resource-limited countries. Results: Mean age was 47.0 (+/- 8.5) years. Patients had received ART for a median duration of 8.8 years; 45% received a protease inhibitor and 27% tenofovir; 84% had undetectable viral load. Patients had lower body mass index (BMI) than controls (23 versus 26 kg/m(2), P<0.001). In unadjusted analysis, QUS bone mineral density was lower in HIV-infected patients than in controls (difference: -0.36 standard deviation, 95% confidence interval (CI): -0.59;-0.12, P = 0.003). Adjusting for BMI, physical activity, smoking and calcium intake attenuated the difference (-0.27, CI: -0.53; -0.002, P = 0.05). Differences in BMI between patients and controls explained a third of the difference in QUS bone mineral density. Among patients, BMI was independently associated with QUS bone mineral density (P<0.001). An association between undetectable viral load and QUS bone density was also suggested (beta = 0.48, CI: 0.02; 0.93; P = 0.04). No association between protease inhibitor or tenofovir use and QUS bone mineral density was found. Conclusion: Senegalese HIV-infected patients had reduced QUS bone mineral density in comparison with control subjects, in part related to their lower BMI. Further investigation is needed to clarify the clinical significance of these observations

Acceptabilité et faisabilité des recommandations de l'OMS pour l'alimentation des enfants nés de mères infectées par le VIH au cours de la première année de postpartum, au Burkina Faso

Depuis 2001, pour prévenir la transmission mère-enfant (TME) du VIH, l OMS recommande aux mères infectées d éviter l allaitement si l alimentation artificielle est acceptable, faisable, accessible financièrement, durable et sûre, sinon, l allaitement exclusif suivi d un sevrage rapide à 6 mois est recommandé. Cette recherche qui combine les approches qualitatives et quantitatives a montré la faible acceptabilité de ces deux options au sein d une cohorte de mères participant à une étude sur la prévention de la TME du VIH au Burkina Faso. L alimentation artificielle n était pratiquée que par 10% des femmes mais dans des conditions de faisabilité et de sécurité satisfaisantes. Les autres mères ont rencontré de grandes difficultés à allaiter exclusivement, pratique contraire à la norme culturelle et mal acceptée par l entourage. Leur perception d un risque élevé de transmission par le lait maternel était une source d angoisse supplémentaire. Malgré la fourniture d un aliment de complément fortifié après 6 mois, 50% des enfants non allaités ne couvraient pas leur besoin en énergie, conséquence d une consommation trop faible d aliment fortifié et de lait, associée à de mauvaises pratiques d alimentation. Cependant, la croissance pondérale jusqu à 24 mois était relativement satisfaisante. La nouvelle stratégie de l OMS qui recommande depuis 2010 l allaitement prolongé jusqu à 12 mois postpartum sous couverture antirétrovirale est une avancée majeure pour les nombreuses femmes au sud qui ne peuvent renoncer à l allaitement faute d alternative acceptable. Il est cependant crucial que le soutien à l alimentation artificielle soit maintenu pour les femmes qui le souhaitentPARIS-BIUSJ-Biologie recherche (751052107) / SudocSudocFranceF

Growth and maturation of Sereer adolescent girls (Senegal) in relation to seasonal migration for labor

This study compares the growth and maturity status of Sereer girls (Senegal) temporarily migrating to an urban setting during the dry season to work as maids in the capital city, Dakar, with girls remaining in rural communities. A total of 343 girls, aged 12.5-14.5 were surveyed : 222 lived year-round in several villages (sedentes) and 121 girls worked in Dakar for 8 months of the year (migrants). All girls were born and reared under the same conditions and in the same rural communities in Senegal. Growth and nutritional status were assessed with anthropometry, and the body mass index (BMI) was calculated. Sexual maturation was assessed by stage of breast development and occurrence of menarche. A questionnaire on housing conditions, food consumption patterns, nature of work, health status, and reasons for leaving the villages was administered to 57 urban girls. Overall, the girls were small relative to NCHS/WHO reference values : 30-40% were lower than -2 z-scores of age-specific medians. They also had less subcutaneous fat. Only nine girls had attained menarche and 30% were prepubertal in breast development. The migrants had a significantly higher body mass and BMI and thicker skinfolds than sedentes, but there was no difference in stature. The migrants were also more sexually mature than the sedentes. Comparison of anthropometric status 2 years before migration, in 1995, showed no differences between migrant and sedentes girls. Within migrant girls, those with two or more stays in Dakar were taller and heavier than newcomers. These results suggest that seasonal movement to the city results in improved nutritional status, as reflected larger body mass and increased fatness. These factors appear to be associated with better living conditions in the city. (Résumé d'auteur

Acceptability and feasibility of infant-feeding options : experiences of HIV-infected mothers in the World Health Organization Kesho Bora mother-to-child transmission prevention (PMTCT) trial in Burkina Faso

In Burkina Faso, prolonged breastfeeding with introduction of ritual fluids from birth is a deep-seated norm. We explored HIV-infected mothers' views and experiences of the acceptability and feasibility of the World Health Organization's recommended infant-feeding options within a mother-to-child-transmission prevention trial. A qualitative study was conducted on 17 formula-feeding and 19 breastfeeding mothers, from a larger cohort of 51 eligible HIV-infected women, consenting to participate in separate focus group discussions in early post-partum. Mothers opted for breastfeeding essentially out of fear of family rejection. Most of them were afraid of denigration for disrespecting tradition if they formula-fed or being suspected of HIV infection. Achieving exclusive breastfeeding remained a difficult challenge as they engaged in a continuous struggle with close elders to avoid fluid feeding. Additional stress and fatigue were fed by their perception of a high transmission risk through breast milk. Exclusive formula-feeding seemed easier to implement, especially as formula was provided free of charge. Formula-feeding mothers more frequently had a supportive partner, a strong personality and lived in better socio-economic conditions than breastfeeding mothers (76% had education and electricity supply vs. 42%, respectively). Exclusive breastfeeding for the first 6 months remains the most appropriate option for many HIV-infected mothers in sub-Saharan Africa. Its acceptability and feasibility urgently need to be improved by promoting it as the best feeding option for all infants. Other crucial interventions are the promotion of voluntary counselling and testing for couples, and greater partner involvement in infant-feeding counselling

Impact of Highly Active Antiretroviral Therapy on Chronic Hepatitis B Serological Markers among Senegalese HIV Co-infected Children

International audienceBackground: Coinfection with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) causes complex interactions. The aim of this study was to evaluate the seroprevalence and HBV evolution among HIV coinfected children receiving highly active antiretroviral therapy (HAART).Methods: A descriptive cross-sectional study was carried out among 252 HIV infected children enrolled in the Hôpital d'enfants Albert Royer, Dakar, Senegal, from April 2013 to March 2015. Clinical characteristics, immuno-virological status, alanine aminotransferase (ALT) levels, and HBV serological marker were taken from the patients' medical records.Results: Overall, 7 children were HBsAg positive with a determinate prevalence rate of 2.8%. Median age at HIV diagnosis was 3.5 years (1.3-14.4 years). According to World Health Organization (WHO) staging, 40.1% of children were stage 4 and 25.8% were stage 3. Of the 7 HIV/HBV-co-infected children, 6 (86%) received lamivudine alone at initiation of treatment, and only one child received tenofovir associated with emtricitabine. Overall median HAART duration treatment including lamivudine alone or tenofovir+lamivudine (or emtricitabine) was 7.7 years (3.3-11.3). Only the two children (29%) receiving lamivudine during follow-up had high HBV DNA load despite having good immuno-virological status. Suppression of HBV DNA replication was achieved in 5 (71.4%) of 7 children.Conclusion and Global Health Implication: HIV/HBV coinfection prevalence was low in our study. HBsAg and HBeAg loss were low while suppression of HBV DNA replication was still higher on tenofovir. Screening and monitoring HBV infection among all HIV infected children are required to direct treatment in order to improve children HBV/HIV coinfected outcome

A sustainable food support for non-breastfed infants : implementation and acceptability within a WHO mother-to-child HIV transmission prevention trial in Burkina Faso

Objective: To provide HIV-positive mothers who opted for exclusive breastfeeding or formula feeding from birth to 6 months postpartum as a means of prevention of mother-to-child transmission (PMTCT) of HIV with a sustainable infant food support programme (FSP) from 6 to 12 months postpartum. We describe the implementation and assessment of this pilot initiative. Design: The FSP included a 6-month provision of locally produced infant fortified mix (IFM; 418 kJ/100 g of gruel) for non-breastfed infants coupled with infant-feeding and psychosocial counselling and support. Acceptability and feasibility were assessed in a subsample of sixty-eight mother-infant pairs. Setting: The FSP was developed in collaboration with local partners to support. participants in a PMTCT prevention study. Formula WAS provided for free from 0 to 6 months postpartum. Cessation by 6 months was recommended for breast feeding mothers. Results: The FSP was positively received and greatly encouraged breastfeeding mothers to cease by 6 months. As recommended, most infants were given milk as an additional replacement food, mainly formula subsidised by safety networks. Among daily IFM consumers, feeding practices were satisfactory overall; however, the IFM was shared within the family by more than one-third of the mothers. Cessation of IFM consumption was observed among twenty-two infants, seventeen of whom were fed milk and five neither of these. Conclusions: Without any food support most mothers would have been unable to provide appropriate replacement feeding. The food security of non-breastfed infants urgently needs to be addressed in HIV PMTCT programmes. Our findings on a simple cost-effective pioneer intervention provide an important foundation for this process

Anthropometric characteristics and cardiometabolic risk factors in a sample of urban-dwelling adults in Senegal

Aim. - The aim of this study was to analyze the relationship between anthropometric characteristics and cardiometabolic risk factors in urban-dwelling adults in Senegal to evaluate future threats to the public health in terms of chronic diseases. Methods. - Age- and gender-matched control subjects for a study on the prevalence of lipodystrophy in HIV+ patients were selected between June and September 2006 from the general population through systematic home visits guided by area of residence of cases. After consenting to participate, these subjects underwent anthropometric, clinical and biological examinations in their homes. Results. - The sample included 60 men and 106 women, mean age of 43.2 +/- 9.4 years. Although the prevalence of overweight and obesity was much higher in women (30.2 and 29.2%, respectively) vs. 23.3 and 3.4%, respectively, in men (P < 0.001), the women had lower waist-to-hip ratios (mean [95% CI]: 0.78 [0.77-0.80] vs. 0.86 [0.84-0.88] in men; P < 10(-4)) and better systolic blood pressure, triglyceride and high-density lipoprotein (HDL)-cholesterol levels. However, their insulin levels were significantly higher (32.1 [28.2-36.5] pmol/l vs. 25.5 [21.0-30.8] in men; P < 0.04). Principal component analysis showed that glucose and insulin correlated with subcutaneous fat, whereas blood pressure correlated with central fat distribution. Lipids were distributed between these two factors. Conclusion. - Obesity still appears to be rare in Senegalese urban-dwelling men, whereas women, despite their overweight, have no untoward cardiometabolic profiles. However, the observed correlations between cardiometabolic risk factors and the amount and/or distribution of body fat suggest that obesity prevention should not be overlooked in the public health agenda for sub-Saharan Africa