26 research outputs found
A preliminary report of the food demand and intrahousehold dietary survey of the smallholder pig value chain projects in Uganda
Nutrition education to improve dietary intake and micronutrient nutriture among children in less-resourced areas: a randomised controlled intervention in Kabarole district, western Uganda
Objective: To determine whether nutrition education targeting the child-feeding practices of low-income rural caregivers will reduce anaemiaand improve vitamin A nutriture of the young children in their care.Design: A controlled intervention trial, based on experiential learning theory. Forty-six women completed a nine-session nutrition educationprogramme, while controls (n = 43) concurrently engaged in sewing classes.Setting: Two rural farming communities in the Kabarole district, western Uganda.Subjects: Less literate, low-income rural female caregivers and the children in their care (6-48 months).Outcome measures: Caregiversâ child-feeding practices and the childrenâs nutritional status were assessed at baseline, one month afterintervention (Follow-up 1) and one year from baseline (Follow-up 2).Results: Caregivers in the intervention group reported improved child snacking patterns, food-selection practices, meal adequacy, and foodvariety. Children in the intervention group recorded lower haemoglobin levels at baseline (9.86 vs. 10.70 g/dl) and caught up with controlsat Follow-up 1 (10.06 vs. 10.78 g/dl). However, changes were not sustained. Mean retinol-binding protein improved from 0.68 ĂŹmol/l (95%CI: 0.57-0.78) to 0.91 ĂŹmol/l (95% CI: 0.78-1.03) among intervention children, but remained approximately the same in controls. Vitamin Anutriture was influenced by infections.Conclusion: Nutrition education significantly improved feeding practices and childrenâs nutritional status. The effectiveness and sustainabilityof this programme can be enhanced if nutrition education is integrated into other food-production and public health programme
Contribution of forest foods to dietary intake and their association with household food insecurity: a cross-sectional study in women from rural Cameroon
To determine the contribution of forest foods to dietary intake and estimate their association with household food insecurity.
Cross-sectional survey conducted among 279 households. Using a 7 d recall questionnaire, information on household food consumption was collected from women and used to determine the household dietary diversity score, food variety score and forest food consumption score (FFCS). Household Food Insecurity Access Scale (HFIAS) score was determined and Spearman rank correlation was used to establish the relationship between consumption of forest foods and HFIAS score. Womenâs dietary intake was estimated from two 24 h recalls. The contribution of forest foods to womenâs nutrient intakes was calculated and womenâs nutrient intakes were compared with estimated average nutrient requirements.
Rural forest-dependent households in twelve villages in eastern and southern Cameroon. Household heads and their non-pregnant, non-lactating spouses.
Forty-seven unique forest foods were identified; of these, seventeen were consumed by 98 % of respondents over the course of one week and by 17 % of women during the two 24 h recall periods. Although forest foods contributed approximately half of womenâs total daily energy intake, considerably greater contributions were made to vitamin A (93 %), Na (100 %), Fe (85 %), Zn (88 %) and Ca (89 %) intakes. Despite a highly biodiverse pool of foods, most households (83 %) suffered from high food insecurity based on the HFIAS. A significant inverse correlation was observed between the HFIAS score and the FFCS (r2=â0·169, P=0·0006), demonstrating that forest foods play an important role in ensuring food security in these forest-dependent communities.
Forest foods are widely consumed by forest-dependent communities. Given their rich nutrient content, they have potential to contribute to food and nutrition security
Raltegravir-intensified initial antiretroviral therapy in advanced HIV in Africa: a randomized controlled trial
BACKGROUND: In sub-Saharan Africa, severely immunocompromised HIV-infected individuals have high mortality (10%) shortly after starting antiretroviral therapy (ART). This group also have the greatest risk of morbidity and mortality associated with immune reconstitution inflammatory syndrome (IRIS), a paradoxical response to successful ART. Integrase inhibitors lead to significantly more rapid declines in HIV viral load (VL) than all other ART classes. We hypothesised that intensifying standard triple-drug ART with the integrase inhibitor, raltegravir, would reduce HIV VL faster, and hence reduce early mortality, although this strategy could also risk more IRIS events. METHODS AND FINDINGS: In a 2x2x2 factorial open-label parallel-group trial, treatment-naĂŻve HIV-infected adults, adolescents and children >5 years with CD4 0.7), and despite significantly greater VL suppression with raltegravir-intensified-ART at 4-weeks (343/836 (41.0%) vs 113/841 (13.4%) standard-ART, p<0.001) and 12-weeks (567/789 (71.9%) vs 415/803 (51.7%) standard-ART, p<0.001). Through 48-weeks there was no evidence of differences in mortality (aHR=0.98 (95%CI 0.76-1.28) p=0.91); serious (aHR=0.99 (0.81-1.21) p=0.88), grade-4 (aHR=0.88 (0.71-1.09) p=0.29) or ART-modifying (aHR=0.90 (0.63-1.27) p=0.54) adverse events (the latter occurring in occurring in 59 (6.5%) raltegravir-intensified-ART vs 66 (7.3%) standard-ART); in events judged compatible with IRIS (occurring in 89 (9.9%)
raltegravir-intensified-ART vs 86 (9.5%) standard-ART, p=0.79) or hospitalizations (aHR=0.94 (95%CI 0.76-1.17) p=0.59). At 12 weeks, one and two raltegravir-intensified participants had predicted intermediate-level and high-level raltegravir resistance respectively. At 48 weeks, the NRTI mutation K219E/Q (p=0.004), and the NNRTI mutations K101E/P (p=0.03) and P225H (p=0.007), were less common in raltegravir-intensified-ART, with weak evidence of less intermediate or high-level resistance to tenofovir (p=0.06), abacavir (p=0.08) and rilpivirine (p=0.07). Limitations were limited clinical, radiological and/or microbiological information for some participants, reflecting available services at the centres, and lack of baseline genotypes. CONCLUSIONS: Although 12-weeks raltegravir-intensification was well-tolerated and reduced HIV viraemia significantly faster than standard triple-drug ART during the time of greatest risk for early death, this strategy did not reduce mortality or clinical events, and is not warranted. There was no excess of IRIS-compatible events, suggesting integrase inhibitors can be used safely as part of standard triple-drug first-line therapy in severely immuno-compromised individuals
Enhanced prophylaxis with antiretroviral therapy for advanced HIV in Africa
BACKGROUND In sub-Saharan Africa, among patients with advanced human immunodeficiency virus (HIV) infection, the rate of death from infection (including tuberculosis and cryptococcus) shortly after the initiation of antiretroviral therapy (ART) is approximately 10%. METHODS In this factorial open-label trial conducted in Uganda, Zimbabwe, Malawi, and Kenya, we enrolled HIV-infected adults and children 5 years of age or older who had not received previous ART and were starting ART with a CD4+ count of fewer than 100 cells per cubic millimeter. They underwent simultaneous randomization to receive enhanced antimicrobial prophylaxis or standard prophylaxis, adjunctive raltegravir or no raltegravir, and supplementary food or no supplementary food. Here, we report on the effects of enhanced antimicrobial prophylaxis, which consisted of continuous trimethoprimâsulfamethoxazole plus at least 12 weeks of isoniazidâpyridoxine (coformulated with trimethoprimâsulfamethoxazole in a single fixed-dose combination tablet), 12 weeks of fluconazole, 5 days of azithromycin, and a single dose of albendazole, as compared with standard prophylaxis (trimethoprimâ sulfamethoxazole alone). The primary end point was 24-week mortality. RESULTS A total of 1805 patients (1733 adults and 72 children or adolescents) underwent randomization to receive either enhanced prophylaxis (906 patients) or standard prophylaxis (899 patients) and were followed for 48 weeks (loss to follow-up, 3.1%). The median baseline CD4+ count was 37 cells per cubic millimeter, but 854 patients (47.3%) were asymptomatic or mildly symptomatic. In the KaplanâMeier analysis at 24 weeks, the rate of death with enhanced prophylaxis was lower than that with standard prophylaxis (80 patients [8.9% vs. 108 [12.2%]; hazard ratio, 0.73; 95% confidence interval [CI], 0.55 to 0.98; P=0.03); 98 patients (11.0%) and 127 (14.4%), respectively, had died by 48 weeks (hazard ratio, 0.76; 95% CI, 0.58 to 0.99; P=0.04). Patients in the enhanced-prophylaxis group had significantly lower rates of tuberculosis (P=0.02), cryptococcal infection (P=0.01), oral or esophageal candidiasis (P=0.02), death of unknown cause (P=0.03), and new hospitalization (P=0.03). However, there was no significant between-group difference in the rate of severe bacterial infection (P=0.32). There were nonsignificantly lower rates of serious adverse events and grade 4 adverse events in the enhanced-prophylaxis group (P=0.08 and P=0.09, respectively). Rates of HIV viral suppression and adherence to ART were similar in the two groups. CONCLUSIONS Among HIV-infected patients with advanced immunosuppression, enhanced antimicrobial prophylaxis combined with ART resulted in reduced rates of death at both 24 weeks and 48 weeks without compromising viral suppression or increasing toxic effects
The costâeffectiveness of prophylaxis strategies for individuals with advanced HIV starting treatment in Africa
Introduction Many HIVâpositive individuals in Africa have advanced disease when initiating antiretroviral therapy (ART) so have high risks of opportunistic infections and death. The REALITY trial found that an enhancedâprophylaxis package including fluconazole reduced mortality by 27% in individuals starting ART with CD4 <100 cells/mm3. We investigated the costâeffectiveness of this enhancedâprophylaxis package versus other strategies, including using cryptococcal antigen (CrAg) testing, in individuals with CD4 <200 cells/mm3 or <100 cells/mm3 at ART initiation and all individuals regardless of CD4 count. Methods The REALITY trial enrolled from June 2013 to April 2015. A decisionâanalytic model was developed to estimate the costâeffectiveness of six management strategies in individuals initiating ART in the REALITY trial countries. Strategies included standardâprophylaxis, enhancedâprophylaxis, standardâprophylaxis with fluconazole; and three CrAg testing strategies, the first stratifying individuals to enhancedâprophylaxis (CrAgâpositive) or standardâprophylaxis (CrAgânegative), the second to enhancedâprophylaxis (CrAgâpositive) or enhancedâprophylaxis without fluconazole (CrAgânegative) and the third to standardâprophylaxis with fluconazole (CrAgâpositive) or without fluconazole (CrAgânegative). The model estimated costs, lifeâyears and qualityâadjusted lifeâyears (QALY) over 48 weeks using three competing mortality risks: cryptococcal meningitis; tuberculosis, serious bacterial infection or other known cause; and unknown cause. Results Enhancedâprophylaxis was costâeffective at costâeffectiveness thresholds of US500 per QALY with an incremental costâeffectiveness ratio (ICER) of US113 per QALY in the CD4 <100 cells/mm3 population) and increased in all individuals regardless of CD4 count (US2.30. Conclusions The REALITY enhancedâprophylaxis package in individuals with advanced HIV starting ART reduces morbidity and mortality, is practical to administer and is costâeffective. Efforts should continue to ensure that components are accessed at lowest available prices
Legislative Documents
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Measuring fish catch and consumption: Practical methods for smallâscale fisheries based on length as an alternative to weightâbased approaches
Small-scale fisheries are recognised as making important contributions to nutrition and economic development despite a lack of accurate quantitative information on catches and consumption. While direct measurement remains the most appropriate way of collecting such data, it is impractical at large scales. Instead, household surveys based upon informant recall of fish caught and/or consumed are frequently used. However, the accuracy of weight recall by informants (even over short recall periods) has not been established. Using data from household surveys, the accuracy and precision of catch and consumption estimates derived from: (a) asking informants to recall weights of fish caught and (b) asking respondents to recall lengths of fish caught and converting to weight were tested. Length-based methods, using visual aids to assist recall, were more accurate, precise and correctable. These methods could be useful for catch estimation, especially where fish are processed, sold or consumed shortly after capture