Factors influencing feeding practices of primary caregivers of infants (0-5.9 months) in Avian Park and Zwelethemba, Western Cape, South Africa

Thesis (MNutr)--Stellenbosch University, 2013.ENGLISH ABSTRACT: Introduction Breastfeeding is a key child survival strategy. Mixed feeding (predominant and partial breastfeeding as defined by the World Health Organisation) during the first six months of life is associated with childhood morbidity and mortality, especially in resource-limited settings, and carries the highest risk of HIV transmission through breastfeeding. When compared to exclusive breastfeeding, predominant, partial or no breastfeeding increases the risk for pneumonia and diarrhoea-related mortality. National exclusive breastfeeding rates are poor and have not improved significantly over the past fourteen years, supporting investigation into the contextual factors that influence infant feeding practices. Aim The study aimed to determine the feeding practices of primary caregivers of infants (0-5.9 months) and the influencing factors in Avian Park and Zwelethemba in Worcester, in the Western Cape Province of South Africa, in order to make recommendations, where appropriate. Methods The study was conducted from April to August 2011. A cross-sectional community-based survey was performed using a structured questionnaire. Focus group discussions were held with mothers, fathers and maternal and paternal grandmothers of infants younger than six months, and health care workers (formally trained professionals and counsellors) working in child health. Results One hundred and forty primary caregivers were interviewed. All caregivers were the biological mother of the infant. Seventy-seven percent (n=108) had initiated breastfeeding. At the time of the study, 6% (n=8) breastfed exclusively. Ninety-four percent (n=132) applied suboptimal breastfeeding practices: 36% (n=51) breastfed predominantly, 27% (n=38) breastfed partially, and 31% (n=43) did not breastfeed. Ninety percent (n=126) of the mothers had introduced water, of whom 83% (n=104) had done so before their infants were one month old. Forty-four percent (n=61) of the mothers had introduced food or formula milk, of whom 75% (n=46) had done so before their infants were three months old. Knowledge of the health and economic benefits of breastfeeding supported initiation but several barriers to exclusive breastfeeding remained. The main barriers were 1) the widely-held perception that infants needed water and nonprescription medicines, 2) the concern that milk alone does not satisfy the infant, 3) inadequate infant feeding education and support by the health system, 4) the lack of community-based postnatal support, 5) convention and family influence, 6) mothers separated from their infants and 7) local beliefs about maternal behaviour and breastfeeding. HIV infection exerted a significant influence on infant feeding choice (p<0.001) and none of the HIV-infected mothers breastfed (n=19). Forty-five percent (n=19) of the formula feeding mothers over-diluted the milk, and early supplementation of formula milk with food was common. Health care workers and maternal grandmothers were the key role-players in infant feeding information and support. Conclusion Exclusive breastfeeding during the first six months of life was a rare practice in these communities. Water, formula milk and/or food were introduced at an early age. HIV-infection discouraged breastfeeding and formula feeding practices proved to be poor. Comprehensive education and support at antenatal, intrapartum and postnatal level seemed lacking and community perceptions and convention contributed to mixed feeding practices. Mothers seemed ill equipped to negotiate infant feeding practices with roleplayers at home.AFRIKAANSE OPSOMMING: Inleiding Borsvoeding is ‘n sleutelstrategie ter ondersteuning van kinderoorlewing. Gemengde voeding (hoofsaaklike en gedeeltelike borsvoeding, soos omskryf deur die Wêreldgesondheidsorganisasie) gedurende die eerste ses maande van lewe, sowel as geen borsvoeding, word geassosieer met kindersiektes and -sterftes, veral in gebiede met beperkte hulpbronne waar babas vatbaar is vir wanvoeding, gastroënteritis en longontsteking. Gemengde voeding dra ook die hoogste risiko vir MIV-oordrag deur borsvoeding. Nasionale eksklusiewe borsvoedingskoerse is swak en het nie oor die laaste veertien jaar verbeter nie. Dit dien as motivering vir die ondersoek na kontekstuele faktore wat babavoedingspraktyke beïnvloed. Doelwit Die doelwit van die navorsingsstudie is om voedingspraktyke van primêre versorgers van babas (0-5.9 maande) en die invloedryke faktore te bepaal in Avian Park en Zwelethemba in Worcester in die Wes-Kaap Provinsie van Suid-Afrika, om sodoende aanbevelings te kan maak waar gepas. Metodes Die studie is uitgevoer van April tot Augustus 2011. ‘n Gemeenskapsgebaseerde deursnee-opname is uitgevoer deur gebruik te maak van ‘n gestruktureerde vraelys. Fokusgroepbesprekings is uitgevoer met moeders, vaders, en oumas (aan moeders- en vaderskant) van babas jonger as ses maande, en gesondheidswerkers (formeel opgeleide werkers en beraders) wat in kindersorg werk. Resultate ‘n Onderhoud is met eenhonderd-en-veertig primêre versorgers gevoer. Al die versorgers was die biologiese moeder van die baba. Sewe-en-sewentig persent (n=108) het borsvoeding begin. Ten tye van die studie het 6% (n=8) eksklusief geborsvoed. Vier-en-negentig persent (n=132) het suboptimale borsvoedingspraktyke beoefen: 36% (n=51) het hoofsaaklik geborsvoed, 27% (n=38) het gedeeltelik geborsvoed en 31% (n=43) het nie geborsvoed nie. Negentig persent (n=126) van die moeders het water gegee, van wie 83% (n=104) dit gedoen het voordat hul babas een maand oud was. Vier-en-veertig persent (n=61) van die moeders het voedsel of formulemelk gegee, van wie 75% (n=46) dit gedoen het voordat hul babas drie maande oud was. Kennis van die gesondheids- en ekonomiese voordele van borvoeding het moeders ondersteun om te begin borsvoed, maar daar was steeds verskeie faktore wat eksklusiewe borsvoeding belemmer het. Die belangrikste hindernisse was 1) die algemene siening dat babas water en nie-voorskrif medisynes benodig, 2) die kommer dat alleenlik melk nie die baba bevredig nie, 3) ontoereikende babavoedingsonderrig en ondersteuning deur die gesondheidstelsel, 4) die gebrek aan gemeenskapsgebaseerde nageboorte-ondersteuning, 5) gebruike en die invloed van gesinslede, 6) moeders geskei van hul babas en 7) plaaslike sienings rakende moeders se gedrag en borsvoeding. MIV-infeksie het ‘n wesenlike invloed op voedingskeuse gehad (p<0.001) en geen van die MIV-positiewe moeders het geborsvoed nie (n=19). Vyf-en-veertig persent (n=19) van die formule voedende moeders het die melk oorverdun en vroeë supplementasie van formulemelk met kos was algemeen. Gesondheidswerkers en oumas was die kernrolspelers ten opsigte van baba-voedingsinligting en ondersteuning. Gevolgtrekking Eksklusiewe borsvoeding gedurende die eerste ses maande van lewe was ‘n seldsame praktyk in hierdie gemeenskappe. Water, formulemelk en/of voedsel is op ‘n vroeë ouderdom bekendgestel. MIV infeksie het borsvoeding ontmoedig en formulevoedingspraktyke was swak. Omvattende opvoeding en ondersteuning op voorgeboorte-, intrapartum- en nageboortevlak het ontbreek, en sienings en gebruike het bygedra tot gemengde voedingspraktyke. Dit het geblyk dat moeders nie toegerus was om oor babavoedingspraktyke met ander belanghebbendes by die huis te onderhandel nie

Development and evaluation of a diagnostic cytokine-release assay for Mycobacterium suricattae infection in meerkats (Suricata suricatta)

CITATION: Clarke, C., et al. 2017. Development and evaluation of a diagnostic cytokine-release assay for mycobacterium suricattae infection in meerkats (Suricata suricatta). BMC Veterinary Research, 13:2, doi:10.1186/s12917-016-0927-x.The original publication is available at http://bmcvetres.biomedcentral.comBackground: Sensitive diagnostic tools are necessary for the detection of Mycobacterium suricattae infection in meerkats (Suricata suricatta) in order to more clearly understand the epidemiology of tuberculosis and the ecological consequences of the disease in this species. We therefore aimed to develop a cytokine release assay to measure antigen-specific cell-mediated immune responses of meerkats. Results: Enzyme-linked immunosorbent assays (ELISAs) were evaluated for the detection of interferon-gamma (IFN-γ) and IFN-γ inducible protein 10 (IP-10) in meerkat plasma. An IP-10 ELISA was selected to measure the release of this cytokine in whole blood in response to Bovigam® PC-HP Stimulating Antigen, a commercial peptide pool of M. bovis antigens. Using this protocol, captive meerkats with no known M. suricattae exposure (n = 10) were tested and results were used to define a diagnostic cut off value (mean plus 2 standard deviations). This IP-10 release assay (IPRA) was then evaluated in free-living meerkats with known M. suricattae exposure, categorized as having either a low, moderate or high risk of infection with this pathogen. In each category, respectively, 24.7%, 27.3% and 82.4% of animals tested IPRA-positive. The odds of an animal testing positive was 14.0 times greater for animals with a high risk of M. suricattae infection compared to animals with a low risk. Conclusion: These results support the use of this assay as a measure of M. suricattae exposure in meerkat populations. Ongoing longitudinal studies aim to evaluate the value of the IPRA as a diagnostic test of M. suricattae infection in individual animals.http://bmcvetres.biomedcentral.com/articles/10.1186/s12917-016-0927-xPublisher's versio

Detection of Mycobacterium bovis in nasal swabs from communal goats (Capra hircus) in rural KwaZulu-Natal, South Africa

Animal tuberculosis, caused by Mycobacterium bovis, presents a significant threat to both livestock industries and public health. Mycobacterium bovis tests rely on detecting antigen specific immune responses, which can be influenced by exposure to non-tuberculous mycobacteria, test technique, and duration and severity of infection. Despite advancements in direct M. bovis detection, mycobacterial culture remains the primary diagnostic standard. Recent efforts have explored culture-independent PCR-based methods for identifying mycobacterial DNA in respiratory samples. This study aimed to detect M. bovis in nasal swabs from goats (Capra hircus) cohabiting with M. bovis-infected cattle in KwaZulu-Natal, South Africa. Nasal swabs were collected from 137 communal goats exposed to M. bovis-positive cattle and 20 goats from a commercial dairy herd without M. bovis history. Swabs were divided into three aliquots for analysis. The first underwent GeneXpert® MTB/RIF Ultra assay (Ultra) screening. DNA from the second underwent mycobacterial genus-specific PCR and Sanger sequencing, while the third underwent mycobacterial culture followed by PCR and sequencing. Deep sequencing identified M. bovis DNA in selected Ultra-positive swabs, confirmed by region-of-difference (RD) PCR. Despite no other evidence of M. bovis infection, viable M. bovis was cultured from three communal goat swabs, confirmed by PCR and sequencing. Deep sequencing of DNA directly from swabs identified M. bovis in the same culture-positive swabs and eight additional communal goats. No M. bovis was found in commercial dairy goats, but various NTM species were detected. This highlights the risk of M. bovis exposure or infection in goats sharing pastures with infected cattle. Rapid Ultra screening shows promise for selecting goats for further M. bovis testing. These techniques may enhance M. bovis detection in paucibacillary samples and serve as valuable research tools

Infant feeding practices during the first 6 months of life in a low-income area of the Western Cape Province

CITATION: Goosen, C., McLachlan, M. & Schubl, C. 2014. Infant feeding practices during the first 6 months of life in a low-income area of the Western Cape Province. South African Journal of Child Health, 8(2):50-54, doi:10.7196/SAJCH.675.The original publication is available at http://www.sajch.org.za/index.php/SAJCHBackground. Exclusive breastfeeding during the first 6 months of life protects against infant morbidity and mortality. Few studies describe the infant feeding practices of mothers living in low-income areas of the Western Cape Province of South Africa (SA). Objective. To describe the infant feeding practices of mothers of infants younger than 6 months in two low-income communities of SA. Methods. A cross-sectional community-based study using a structured questionnaire, and seven focus group discussions were conducted from February to August 2011 in Avian Park and Zwelethemba in Worcester, an urban area in the Western Cape. Results. Seventy-seven per cent of participants (n=108) had initiated breastfeeding. At the time of the study, 6% (n=8) breastfed exclusively. Ninety-four per cent (n=132) applied suboptimal breastfeeding practices: 36% (n=51) breastfed predominantly, 27% (n=38) breastfed partially and 31% (n=43) did not breastfeed. Ninety per cent (n=126) of the mothers had introduced water, of whom 83% (n=104) had done so before their infants were 1 month old. Forty-four per cent (n=61) of the mothers had introduced food or formula milk, of whom 75% (n=46) had done so before their infants were 3 months old. Qualitative findings indicated that gripe water, Lennon’s Behoedmiddel and herbal medicines were also given to infants. Nutritive liquids and/or food most commonly given as supplementary feeds were formula milk and commercial infant cereal. Conclusion. Exclusive breastfeeding (EBF) during the first 6 months of life was a rare practice in these low-income communities. Water, non-prescription medicines and formula milk and/or food were introduced at an early age.http://www.sajch.org.za/index.php/SAJCH/article/view/675Publisher's versio

High-Specificity Test Algorithm for Bovine Tuberculosis Diagnosis in African Buffalo (Syncerus caffer) Herds

Ante-mortem bovine tuberculosis (bTB) tests for buffaloes include the single comparative intradermal tuberculin test (SCITT), interferon-gamma (IFN-&gamma;) release assay (IGRA) and IFN-&gamma;-inducible protein 10 release assay (IPRA). Although parallel test interpretation increases the detection of Mycobacterium bovis (M. bovis)-infected buffaloes, these algorithms may not be suitable for screening buffaloes in historically bTB-free herds. In this study, the specificities of three assays were determined using M. bovis-unexposed herds, historically negative, and a high-specificity diagnostic algorithm was developed. Serial test interpretation (positive on both) using the IGRA and IPRA showed significantly greater specificity (98.3%) than individual (90.4% and 80.9%, respectively) tests or parallel testing (73%). When the SCITT was added, the algorithm had 100% specificity. Since the cytokine assays had imperfect specificity, potential cross-reactivity with nontuberculous mycobacteria (NTM) was investigated. No association was found between NTM presence (in oronasal swab cultures) and positive cytokine assay results. As a proof-of-principle, serial testing was applied to buffaloes (n = 153) in a historically bTB-free herd. Buffaloes positive on a single test (n = 28) were regarded as test-negative. Four buffaloes were positive on IGRA and IPRA, and M. bovis infection was confirmed by culture. These results demonstrate the value of using IGRA and IPRA in series to screen buffalo herds with no previous history of M. bovis infection

Anaemia, iron and vitamin A status among South African school-aged children living with and without HIV

Background. Data on iron and vitamin A deficiency are scarce in school-aged children living with HIV (HIV+) compared with children without HIV (HIV-). Both deficiencies can contribute to anaemia.Objective. To assess anaemia, iron and vitamin A status in a sample of HIV+ and HIV- school-aged children in South Africa.Methods. In this comparative cross-sectional study, biomarkers for anaemia (haemoglobin), iron (plasma ferritin (PF), soluble transferrin receptor), vitamin A (retinol-binding protein (RBP)) and inflammatory status (C-reactive protein, alpha-1-acid glycoprotein) were measured in 8 - 13-year-old children from Cape Town living with (n=143) and without HIV (n=148). Measurements of PF and RBP were adjusted for inflammation using a regression-correction approach.Results. HIV+ children had higher prevalences of anaemia (29% v. 14%; odds ratio (OR) = 2.6; 95% confidence interval (CI) 1.4 - 4.9; p=0.002), iron-deficient erythropoiesis (20% v. 9%; OR=2.5; 95% CI 1.2 - 5.0; p=0.013) and iron deficiency anaemia (11% v. 4%; OR=2.9; 95% CI 1.1 - 7.7; p=0.035) than HIV- children. Marginal vitamin A deficiency was noted in 52% of HIV+ and 57% of HIV- children (p=0.711). Subclinical inflammation was more prevalent in HIV+ than HIV- children (p=0.012).Conclusion. Anaemia, iron-deficient erythropoiesis and iron deficiency anaemia were more prevalent in HIV+ than HIV- children. Prevalence of marginal vitamin A deficiency was high in both groups. Efforts to improve micronutrient status and mitigate nutritional determinants of anaemia in HIV+ children from resource-limited settings should be prioritised

Culture-Independent PCR Detection and Differentiation of <i>Mycobacteria</i> spp. in Antemortem Respiratory Samples from African Elephants (<i>Loxodonta Africana</i>) and Rhinoceros (<i>Ceratotherium Simum</i>, <i>Diceros Bicornis</i>) in South Africa

Since certain Mycobacterium tuberculosis complex (MTBC) members, such as M. bovis, are endemic in specific South African wildlife reserves and zoos, cases of clinically important nontuberculous mycobacteria (NTM) in wildlife may be neglected. Additionally, due to the inability of tests to differentiate between the host responses to MTBC and NTM, the diagnosis of MTBC may be confounded by the presence of NTMs. This may hinder control efforts. These constraints highlight the need for enhanced rapid detection and differentiation methods for MTBC and NTM, especially in high MTBC burden areas. We evaluated the use of the GeneXpert MTB/RIF Ultra, the Hain CMdirect V1.0 line probe assay, and novel amplicon sequencing PCRs targeting the mycobacterial rpoB and ku gene targets, directly on antemortem African elephant (n = 26) bronchoalveolar lavage fluid (BALF) (n = 22) and trunk washes (n = 21) and rhinoceros (n = 23) BALF (n = 23), with known MTBC culture-positive and NTM culture-positive results. Our findings suggest that the Ultra is the most sensitive diagnostic test for MTBC DNA detection directly in raw antemortem respiratory specimens and that the rpoB PCR is ideal for Mycobacterium genus DNA detection and species identification through amplicon sequencing

Identification and Characterisation of Nontuberculous Mycobacteria in African Buffaloes (<i>Syncerus caffer</i>), South Africa

Diagnosis of bovine tuberculosis (bTB) may be confounded by immunological cross-reactivity to Mycobacterium bovis antigens when animals are sensitised by certain nontuberculous mycobacteria (NTMs). Therefore, this study aimed to investigate NTM species diversity in African buffalo (Syncerus caffer) respiratory secretions and tissue samples, using a combination of novel molecular tools. Oronasal swabs were collected opportunistically from 120 immobilised buffaloes in historically bTB-free herds. In addition, bronchoalveolar lavage fluid (BALF; n = 10) and tissue samples (n = 19) were obtained during post-mortem examination. Mycobacterial species were identified directly from oronasal swab samples using the Xpert MTB/RIF Ultra qPCR (14/120 positive) and GenoType CMdirect (104/120 positive). In addition, all samples underwent mycobacterial culture, and PCRs targeting hsp65 and rpoB were performed. Overall, 55 NTM species were identified in 36 mycobacterial culture-positive swab samples with presence of esat-6 or cfp-10 detected in 20 of 36 isolates. The predominant species were M. avium complex and M. komanii. Nontuberculous mycobacteria were also isolated from 6 of 10 culture-positive BALF and 4 of 19 culture-positive tissue samples. Our findings demonstrate that there is a high diversity of NTMs present in buffaloes, and further investigation should determine their role in confounding bTB diagnosis in this species

Examining Associations of HIV and Iron Status with Nutritional and Inflammatory Status, Anemia, and Dietary Intake in South African Schoolchildren

The etiology of multifactorial morbidities such as undernutrition and anemia in children living with the human immunodeficiency virus (HIV) (HIV+) on antiretroviral therapy (ART) is poorly understood. Our objective was to examine associations of HIV and iron status with nutritional and inflammatory status, anemia, and dietary intake in school-aged South African children. Using a two-way factorial case-control design, we compared four groups of 8 to 13-year-old South African schoolchildren: (1) HIV+ and low iron stores (inflammation-unadjusted serum ferritin ≤ 40 µg/L), n = 43; (2) HIV+ and iron sufficient non-anemic (inflammation-unadjusted serum ferritin > 40 µg/L, hemoglobin ≥ 115 g/L), n = 41; (3) children without HIV (HIV-ve) and low iron stores, n = 45; and (4) HIV-ve and iron sufficient non-anemic, n = 45. We assessed height, weight, plasma ferritin (PF), soluble transferrin receptor (sTfR), plasma retinol-binding protein, plasma zinc, C-reactive protein (CRP), α-1-acid glycoprotein (AGP), hemoglobin, mean corpuscular volume, and selected nutrient intakes. Both HIV and low iron stores were associated with lower height-for-age Z-scores (HAZ, p 8.3 mg/L) (95% CI: 1.03–5.8, p = 0.04), 2.7-fold higher odds of subclinical inflammation (95% CI: 1.4–5.3, p = 0.004), and 12-fold higher odds of macrocytosis (95% CI: 6–27, p < 0.001). Compared to HIV-ve counterparts, HIV+ children reported significantly lower daily intake of animal protein, muscle protein, heme iron, calcium, riboflavin, and vitamin B12, and significantly higher proportions of HIV+ children did not meet vitamin A and fiber requirements. Compared to iron sufficient non-anemic counterparts, children with low iron stores reported significantly higher daily intake of plant protein, lower daily intake of vitamin A, and lower proportions of inadequate fiber intake. Along with best treatment practices for HIV, optimizing dietary intake in HIV+ children could improve nutritional status and anemia in this vulnerable population. This study was registered at clinicaltrials.gov as NCT03572010