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

\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

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

A Review of Dietary Zinc Recommendations

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

New spaces of food justice

‘Food is fundamental to life’ (Sbicca 2012, 456) and this shared need establishes food as a site of potential for connective and convivial practices and relations. Yet, when we realise that more than one billion people are undernourished worldwide (Food Ethics Council 2010), despite the fact that the world produces enough food to feed billions more than the current global population of seven billion (Holt-Gimenez et al. 2012), the social, political, economic and environmental challenges posed by contemporary food systems start to become apparent. Given current global production levels – whether we agree with the social and environmental implications of these or not – it is clear that malnutrition rates worldwide are not simply an indicator of agricultural praxis but demonstrate the continued, broader social and structural issues of access, equity and justice. Recognising that many feel increasingly disenfranchised from formal political representation, marginalised by a hegemonic neoliberal capitalism or disconnected from ‘healthy’ social or environmental relations, food offers an opportunity to re-engage individuals and society with critical questions and practices of justice because, as Allen (2008, 159) notes, ‘no other public issue is as accessible to people in their daily lives as that of food justice. Everyone – regardless of age, gender, ethnicity, or social class – eats. We are all involved and we are all implicated’. The multiplicity of ways in which we can engage with food – including growing, buying, eating, cooking, writing, processing, marketing, selling and watching – enacts its radical potential as a set of dynamic socio-material relations (Alkon 2013; Alkon et al. 2013) that can both conform to and subvert existing practices and understandings, enabling food to ‘speak’ to many different people in a range of different contexts. Although this multiplicity has its dangers (Heynen, Kurtz, and Trauger 2012), it also means that food matters and matters in complex and diverse ways: ‘It rallies people and it often induces unexpected changes in society’ (Van der Ploeg 2013, 999)

Risks for public health related to the presence of tetrodotoxin (TTX) and TTX analogues in marine bivalves and gastropods

Peer reviewedPublisher PD

Scientific Opinion on the re-evaluation of Quinoline Yellow (E 104) as a food additive:Question No EFSA-Q-2008-223

The Panel on Food Additives and Nutrient Sources added to Food provides a scientific opinion re-evaluating the safety of Quinoline Yellow (E 104). Quinoline Yellow has been previously evaluated by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) in 1975, 1978 and 1984, and the EU Scientific Committee for Food (SCF) in 1984. Both committees established an Acceptable Daily Intake (ADI) of 0-10 mg/kg body weight (bw). Studies not evaluated by JECFA and the SCF included a chronic toxicity and carcinogenicity study with a reproductive toxicity phase in rats and a study on behaviour in children by McCann et al. from 2007. The latter study concluded that exposure to a mixture of colours including Quinoline Yellow resulted in increased hyperactivity in 8- to 9-years old children. The Panel concurs with the conclusion from a previous EFSA opinion on the McCann et al. study that the findings of the study cannot be used as a basis for altering the ADI. The Panel notes that Quinoline Yellow was negative in in vitro genotoxicity as well as in long term carcinogenicity studies. The Panel concludes that the currently available database on semi-chronic, reproductive, developmental and long-term toxicity of Quinoline Yellow, including a study in rats not apparently taken into consideration by JECFA or the SCF, provides a rationale for re-definition of the ADI. Using the NOAEL of 50 mg/kg bw/day provided by the chronic toxicity and carcinogenicity study with a reproductive toxicity phase carried out in rats and applying an uncertainty factor of 100 to this NOAEL, the Panel establishes an ADI of 0.5 mg/kg bw/day. The Panel notes that at the maximum levels of use of Quinoline Yellow, refined intake estimates are generally well over the ADI of 0.5 mg/kg bw/day

Risks to human and animal health related to the presence of deoxynivalenol and its acetylated and modified forms in food and feed

Peer reviewedPublisher PD

Improving Food Security in Africa: Highlights of 25 Years of Research, Capacity-Building, and Outreach.

Decades of research have led to substantially improved understanding of the nature of food insecurity. A combination of economic growth and targeted programs resulted in a steady fall (until the food crisis of 2007/08) in the percentage of the world’s population suffering from undernutrition (from 20% in 1990/92 to 16% in 2006). Yet over a billion people still face both chronic and/or transitory food insecurity due to long-standing problems of inadequate income, low-productivity in agricultural production and marketing, and related problems of poor health and absence of clean water. Assuring adequate food security for such a large share of the world’s population is increasingly challenging due to continuing resource degradation driven by a combination of population pressure and outdated agricultural practices, poorly functioning input markets, rapid urbanization, increased concerns about food safety, and climate change. This document contains an overview of the past 25 years of research, capacity-building, and outreach by MSU’s Food Security Group. The paper describes key elements of the FSG approach and draws lessons regarding the value of that model. Insights gained from research and outreach and their value in addressing the major current challenges facing food and agricultural systems in Africa are summarized in FSG (2009).Africa, Food Security, research, capacity building, outreach, Agricultural and Food Policy, Community/Rural/Urban Development, Consumer/Household Economics, Demand and Price Analysis, Food Security and Poverty, International Development, Land Economics/Use, Research and Development/Tech Change/Emerging Technologies, Research Methods/ Statistical Methods, q10, q18, q12, q13,