Anemia and nutritional status of HIV-exposed infants and HIV-infected mothers in Busia County, Western Kenya

Background: World Health Organization recommends 6 months of exclusive breastfeeding (EBF) for HIV-exposed infants with maternal antiretroviral drugs (ARVs) to prevent mother-to-child transmission (PMTCT) of HIV. Inadequate food and breastfeeding cause malnutrition. Assessment of their nutritional status is essential.Objective: To determine the association of EBF with, maternal and infant hemoglobin and nutritional status.Design: Cross-sectional surveySetting: PMTCT of HIV clinics in Busia County, western KenyaSubjects: HIV-infected mothers and HIV-exposed infantsMethod: Data on socio-demography, food security and maternal ARVs treatment was collected from 371 mothers using a questionnaire. Mother-infant dyads’ anthropometric and hemogram measurements were obtained. Infant weight for height zee scores (WHZ) and maternal body mass index were computed.Results: Three hundred and forty-nine (94%) mothers practiced EBF; 162 (44%) were food insecure; 284 (77%) infants had normal WHZ; 298 (81%), 28 (8%) and 43(12%) mothers were normal, undernourished and overweight respectively; 261 (75%) of infants and 100 (29%) of mothers were anemic. There was no significant difference in the nutritional status of anemic and normal infants (p value 0·423). Difference in hemoglobin of mothers and infants on tenofovir disoproxil fumarate (TDF) based and zidovudine-based regimens significantly differed (p values 0.003 and 0.001 respectively).Conclusion & Recommendation: Anemia among HIV-exposed EBF infants is a public health problem in Busia. Normal nutritional status does not imply normal hematological status. Hemogram monitoring is essential for maternal and infant nutritional status assessment in this context

Maternal nutritional status in pastoral versus farming communities of West Pokot, Kenya: differences in iron and vitamin A status and body composition

BACKGROUND: Underweight and micronutrient deficiencies are sequelae of the prevailing harsh living and economic conditions of women in sub-Saharan Africa. There are few data describing maternal nutritional status in these resource-poor settings. Provision of more effective modes of intervention requires that public health and nutrition policy at both the national and the multisectoral levels be based on community-specific nutritional and behavioral practices. OBJECTIVE: This longitudinal study investigated maternal micronutrient status in two remote, semiarid, rural communities that are ethnically similar but have distinctly different pastoral and farming lifestyles. We looked at differences in iron stores, vitamin A levels, and body composition of women in the third trimester of pregnancy and again at 4 months postpartum. METHODS: Complete data were collected from 113 pastoral and 110 farming Pokot women. Anthropometric measurements were taken, and serum ferritin and retinol levels were measured. Infants were weighed within 7 days of birth. RESULTS: Women from the farming community had significantly (p < .05) lower hemoglobin concentrations than women from the pastoral community during the third trimester of pregnancy. Pastoral women had significantly higher serum ferritin concentrations than farming women during the third trimester of pregnancy (p <.05) and at 4 months postpartum. There were no significant differences between pastoral and farming women in the percentage of women with serum retinol levels < 0.70 micromol/L during the third trimester of pregnancy (27.9% [34/113] and 24.2% [31/110], respectively) and at 4 months postpartum (29.2% [33/113] and 30.9% [34/110]) In the farming community, mean infant birthweight was significantly lower (p <. 01) than in the pastoral community and a significantly higher (p < .05) proportion of newborns weighed less than 2.5 kg. At 4 months postpartum, the percentage of body fat was significantly lower in pastoral women than in farming women. CONCLUSIONS: Women from the farming community in West Pokot, Kenya, have lower iron stores during the third trimester of pregnancy than women in the pastoral community. In addition, the mean weight of their newborn infants is lower than that of infants in the pastoral community. These findings may be associated with differences in living conditions, which are usually harsher in farming than in pastoral communities. AD - Department of Epidemiology and Nutrition, School of Public Health, Moi University, Eldoret, Kenya. [email protected]

Assessment of body composition and breast milk volume in lactating mothers in pastoral communities in Pokot, Kenya, using deuterium oxide

BACKGROUND: In sub-Saharan Africa, the practice of breast-feeding infants is common. Records documenting the intake of breast milk amongst infants are limited. This study evaluated the association between maternal body composition and the intake of breast milk in infants from the pastoral communities within Pokot, Kenya. METHODS: The study was conducted in 10 lactating mothers who were participating in a longitudinal study aimed at determining maternal body composition, iron stores and vitamin A status during the third trimester pregnancy and four months after they had given birth. Maternal and infant anthropometric measurements were made, and maternal blood samples were taken to determine serum retinol and ferritin levels. Infant milk intake and maternal fat-free mass (FFM) and percent body fat (% BF) were measured using 'the dose to the mother method'. A measured deuterium oxide ((2)H(2)O) dose was given to the mother. Urine and breast milk from the mother, and saliva samples from the infant, were collected on days 1, 8 and 14 after dosing. RESULTS: The mean (+/- SD) maternal mid upper arm circumference (MUAC) and body mass index (BMI) were 21.8 (0.9) cm and 18.6 (1.0) kg/height (m(2)), respectively. Infant weight and weight/age Z score were 4.956 (0.874) kg and -1.750 (0.77), respectively. Throughout the study, the infants gained 20 (4) g/day in body weight and had a milk intake of 555 (22) ml/day. The energy intake of the infant was 1,602 (148) kJ/day and was lower (p < 0.05) than the 2,404 (423) kJ/day estimated requirement by the FAO/WHO/UNU. The maternal FFM, %BF, Hb, Hct, ferritin and retinol were 32.8 (3.1) kg, 17.24 (7.0), 11.5 (1.3) g/dl, 33.9 (4.9), 16.2 (0.1) microg/l and 0.894 (0.16) micromol/l, respectively. Infant milk intake was significantly and positively correlated to maternal pregnancy triceps (r = 0.679) p < 0.05) and pregnancy MUAC (r = 0.725) p < 0.05). Maternal pregnancy MUAC was an important predictor of infant breast milk intake. CONCLUSION: Data on volume of breast milk consumed by the infants suggests, at least for this group of infants, that adequate growth may not be achieved. There is a possibility that lactating mothers practicing exclusive breast-feeding and living under harsh conditions may experience periods of low breast milk volume. Body composition and biochemical findings among this group of Pokot mothers indicate dietary inadequacies that require nutritional intervention

Growth monitoring in rural Kenya : experiences from a pilot project

In IDL-979

Assessment of body composition in lactating mothers in a rural African community using deuterium oxide dilution

Background and objective. The deuterium oxide (do) dilution method for measuring body composition was validated against the widely used skinfold (sf) measurement-based equation of durnin and womersley. The study involved 10 lactating women living in a rural community in nandi, kenya and participating in a cross-sectional study aimed at determining their iron and vitamin a status.methods. The selection criteria were exclusive breast-feeding, infants between 2 and 4 months of age, maternal parity <4, birth weight more than 2 500 g and no congenital abnormalities. Maternal and infant anthropometric measurements were taken. Do (approximately 0.1 g 2h2o/kg body water) was given orally to each mother accordingly to the maastricht protocol (do) for total body water (tbw) determination. The 2h enrichment of the urine was measured using gas-isotope-ratio mass spectrometry. Blood samples were collected. Serum retinol and ferritin were determined using high- performance liquid chromatography (hplc) and enzyme-linked immunosorbent assay (elisa) respectively. Body mass index (bmi) was determined as weight/height (m2). The bland-altman pair-wise comparison was used to compare maternal fat-free mass (ffm), body fat (bf) and percentage body fat (% bf) that were determined based on the do and sf techniques.results. Maternal mean (± standard deviation (sd)) for parity, age, bmi, haemoglobin (hb), serum ferritin and serum retinol were 3 (2), 26 (4) years, 23.4 (4), 12.1 (1.8) g/dl, 10.3 (4.0) µg/l and 0.696 (0.300) µmol/l respectively. The ffm, bf and % bf accordingly to the do and sf methods respectively were 44.0 (4.7) kg v. 42.9 (5.9) kg, 16.7 (8.8) kg v. 17.8 (7.5) kg and 26.2 (8.1)% v. 28.4 (6.4)%. Limits of agreement for underestimation of ffm and % bf were 4.4 kg (see 3.4) and 11.6% (see 5.8) respectively. Bias in the measurement of ffm and % bf was 1.1 kg (see 1.9), and —2.2% (see 3.3) respectively.conclusion. The variability (5.8 - 17.5%) observed in the sf technique may result in lower prediction of % bf. This may be an important factor for community-based nutritional interventions that aim at improving the body composition of vulnerable groups such as pregnant and lactating women or subjectswith severe undernutrition