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Food fortification and biofortification as potential strategies for prevention of vitamin D deficiency
Hypovitaminosis D (vitamin D deficiency) is widespread throughout the world.
The cutaneous production of vitamin D through sunlight can be limited by
several factors (e.g. skin pigmentation, sunscreen usage and, increasingly, indoor
lifestyle). Thus, diet has become an important strategy to increase vitamin D
intake and status {blood 25-hydroxyvitamin D [25(OH)D]}. However, there are a
limited number of foods that naturally contain vitamin D, and concentrations
can vary significantly between and within species. The need for vitamin Dfortified
foods (including via direct fortification and biofortification) to support
the adequacy of vitamin D status is a corollary of several limitations to
synthesise vitamin D from sunlight. Ergocalciferol (vitamin D2) and
cholecalciferol (vitamin D3) can be found in some mushrooms and animalderived
foods, respectively. Evidence has shown vitamin D3 is more effective than
vitamin D2 at raising 25(OH)D blood concentrations. The vitamin D metabolite,
25(OH)D3, is present in animal-derived foods (e.g. meat, eggs and fish), and
several intervention trials have shown 25(OH)D3 to be more effective at raising
blood 25(OH)D concentrations than vitamin D3. In addition, 25(OH)D3
supplements may prove to be preferable to vitamin D3 for patients with certain
clinical conditions. However, there is limited evidence on the effects of 25(OH)
D3-fortified foods on human vitamin D status and health, both in the general
population and patients with certain conditions, and long-term randomised
controlled trials are needed in this area
Couple experiences of provider-initiated couple HIV testing in an antenatal clinic in Lusaka, Zambia: lessons for policy and practice.
BACKGROUND: Couple HIV testing has been recognized as critical to increase uptake of HIV testing, facilitate disclosure of HIV status to marital partner, improve access to treatment, care and support, and promote safe sex. The Zambia national protocol on integrated prevention of mother-to-child transmission of HIV (PMTCT) allows for the provision of couple testing in antenatal clinics. This paper examines couple experiences of provider-initiated couple HIV testing at a public antenatal clinic and discusses policy and practical lessons. METHODS: Using a narrative approach, open-ended in-depth interviews were held with couples (n = 10) who underwent couple HIV testing; women (n = 5) and men (n = 2) who had undergone couple HIV testing but were later abandoned by their spouses; and key informant interviews with lay counsellors (n = 5) and nurses (n = 2). On-site observations were also conducted at the antenatal clinic and HIV support group meetings. Data collection was conducted between March 2010 and September 2011. Data was organised and managed using Atlas ti, and analysed and interpreted thematically using content analysis approach. RESULTS: Health workers sometimes used coercive and subtle strategies to enlist women's spouses for couple HIV testing resulting in some men feeling 'trapped' or 'forced' to test as part of their paternal responsibility. Couple testing had some positive outcomes, notably disclosure of HIV status to marital partner, renewed commitment to marital relationship, uptake of and adherence to treatment and formation of new social networks. However, there were also negative repercussions including abandonment, verbal abuse and cessation of sexual relations. Its promotion also did not always lead to safe sex as this was undermined by gendered power relationships and the desires for procreation and sexual intimacy. CONCLUSIONS: Couple HIV testing provides enormous bio-medical and social benefits and should be encouraged. However, testing strategies need to be non-coercive. Providers of couple HIV testing also need to be mindful of the intimate context of partner relationships including couples' childbearing aspirations and lived experiences. There is also need to make antenatal clinics more male-friendly and responsive to men's health needs, as well as being attentive and responsive to gender inequality during couselling sessions
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