Staff competencies at health facilities implementing an outpatient therapeutic programme for severely acute malnourished children

Background: Malnutrition continues to be a major cause of disease burden, especially in low-income countries, killing millions of children. In order to reduce morbidity and mortality, the management of children with severe acute malnutrition (SAM) requires knowledgeable and skilled staff. In the study reported on in this article, we measured the level of knowledge of staff working in the outpatient therapeutic programme (OTP) in Lusaka, Zambia.Methods: The study targeted healthcare workers managing SAM from five randomly selected health facilities of the 12 health centres that have been implementing the OTP since 2005. At facility level, staff were first listed and then randomly selected for interviews. Four members of staff were selected for the self-administered questionnaire, three for the in-depth interviews and three for observations.Findings: Overall, the aggregated knowledge of the healthcare staff of integrated management of acute malnutrition procedures were slightly above 50%. Most staff could not correctly cite key knowledge segments to ensure that they would adequately manage SAM children.Conclusion: There was average knowledge to manage SAM among the healthcare staff; this suggested a need to strengthen staff's knowledge base and skills in certain areas critical to manage SAM children adequately

Set criteria in the management of severely malnourished children in Zambia: evidence from the evaluation of an 'outpatient therapeutic care program (OTP)'

Background: Severe malnutrition is still a leading cause of morbidity and mortality in sub-Saharan Africa. The Outpatient Therapeutic Care Program (OTP) is one of the interventions that seek to reduce the burden associated with severe malnutrition in children. Performance of the OTP against the Integrated Management of Acute Malnutrition (IMAM) set criteria in the selected public health facilities in Lusaka urban, Zambia was evaluated.Methods: Records of children (n=828), discharged from OTP between September 2005 and September 2007 in eleven health centres where this program was running, were evaluated for performance. The selection process adapted a multistage sampling technique using proportional to size approach in order to get the number of records for each site. Performance was determined by developing a compost indicator from weight gain, length of period of stay in the OTP, recovery rate, default rate and mortality. Logistic regression was used to assess performance and its determinants. In addition, a sampling frame of health care staff working in the OTP was made for each health facility from which twenty five of them participated in in-depth interviews assessing corroborative evidence for performance of the program (results reported elsewhere). Health facility and sex were used as indicator for completeness of data and as a measure for non-participation. Lack of completeness of records was the most important cause of non-response.Findings: Overall prevalence of good performance was 86% (n=828). However, the study showed contrasting differential performance by health facility (Ranging from 73% for N'gombe to 100% for Matero). Disaggregating the composite indicators revealed that 60% of children gained acceptable weight (above 4 g per kg body weight per day, mean weight gain of 5.7 g per day, SD 1.2); 75% stayed less than 60 days recommended (median length of stay of 48 days); Recovery rate of 59%, 31% default rate and 3.2% death rate. In multivariate logistic regression, source of admission and appetite were the main determinants of performance. Poor performance was associated with referrals from a health facility (Prevalence, 86.7%; OR=0.01, 95CI%CI 0.001-0.301) and reported lack of or inadequate breastfeeding at the time of admission to the program (OR=0.481, 95%CI 0.27-.85).Conclusion: Good overall program performance of the OTP suggests high feasibility to fight severe malnutrition in this setting. However, it was not clear how some factors such as poor appetite affected performance, suggests that there may be interplay of factors at work and further research is needed to explore them. Nonetheless, finding that breastfeeding was associated with good performance suggests how important this factor might be to child survival as a whole. Inversely, its lack could be pointing to limitations to breastfeeding interventions in the community

Free amino nitrogen improvement in sorghum malt brewing

Although sorghum malt is relatively rich in free amino nitrogen (FAN), the 150 mg FAN/L threshold recommended for brewing is difficult to obtain. The vitreous nature of the sorghum endosperm hinders proteolysis during brewing. Hence, exogenous proteolytic enzymes are often required to increase hydrolysis of sorghum malt protein to produce sufficient FAN in order to support rapid yeast growth during fermentation. Ten exogenous proteases were examined for their production of FAN in sorghum malt mashing. Mashing was done at 550C for 45 minutes. Levels of FAN, as determined by the ninhydrin method, showed great variation among the proteolytic enzymes, ranging from 96 in control to 182 mg/100 g malt with possibly of most effective proteolytic enzyme. The variation in FAN level was possibly due to different optimal mashing conditions of exogenous proteases used and perhaps due to low ratios of exopeptidase/endopeptidase in the enzyme preparations. Low temperature (400C) and long duration mashing for (7 hours) gave good FAN production during mashing to a total of 113 and 138 mg/100 g malt in control and the treatment with exogenous proteolytic enzyme Flavourzyme plus malt, respectively. The exogenous enzyme (Flavourzyme) plus potassium metabisulphite (PMB) increased FAN production during mashing in the ratio of 2 to 1 in a treatment where PMB was added compared to one without. Similarly, hot wort extract (HWE) increased by 8% during mashing with exogenous enzyme plus PMB compared to one without PMB, respectively. PMB was involved in destabilizing the disulphide bonds in the sorghum protein polypeptide chains allowing proteolytic enzymes better accessibility to proteins. The increase in HWE was possibly due to the starch being freed from the sorghum protein matrix. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) showed some oligomeric and polymeric kafirins after mashing. With transmission electron microcopy (TEM), protein bodies of varying sizes with partially degraded peripheral edges and some holes were seen after mashing. SDS-PAGE and TEM results suggest insufficient proteolysis. High protein digestibility sorghum’s potential for brewing was examined with reference to FAN production. Although during mashing FAN increased by approx. 82 and 115% for unmalted normal and high digestibility sorghums, respectively, the 150 mg FAN/L threshold, recommended for brewing was not achieved. FAN production to levels above 150 mg/L may only be realized if normal sorghum malt or high protein digestibility sorghum malt is mashed with exogenous enzymes containing sufficient exopeptidases coupled with appropriate mashing conditions. CopyrightDissertation (MSc)--University of Pretoria, 2009.Food Scienceunrestricte

Factors influencing micronutrient bioavailability in biofortified crops

Dietary and human factors have been found to be the major factors influencing the bioavailability of micronutrients, such as provitamin A carotenoid (pVAC), iron, and zinc, in biofortified crops. Dietary factors are related to food matrix structure and composition. Processing can improve pVAC bioavailability by disrupting the food matrix but can also result in carotenoid losses. By degrading antinutrients, such as phytate, processing can also enhance mineral bioavailability. In in vivo interventions, biofortified crops have been shown to be overall efficacious in reducing micronutrient deficiency, with bioconversion factors varying between 2.3:1 and 10.4:1 for trans-β-carotene and amounts of iron and zinc absorbed varying between 0.7 and 1.1 mg/day and 1.1 and 2.1 mg/day, respectively. Micronutrient bioavailability was dependent on the crop type and the presence of fat for pVACs and on antinutrients for minerals. In addition to dietary factors, human factors, such as inflammation and disease, can affect micronutrient status. Understanding the interactions between micronutrients is also essential, for example, the synergic effect of iron and pVACs or the competitive effect of iron and zinc. Future efficacy trials should consider human status and genetic polymorphisms linked to interindividual variations

“Feeding a child slowly:” a responsive feeding behavior component likely to reduce stunting: Population-based observations from rural Zambia

Zambia has a very high prevalence of stunting (40%). Child feeding behaviors such as “feeding the child slowly” are now receiving attention in addressing child undernutrition, particularly stunting. A study was undertaken in two rural areas of Zambia and mothers of 295 children 6–24 months old were questioned about their feeding behaviors including “feeding a child slowly.” The study found reduced stunting among children older than one year who were fed slowly, had been dewormed, and consumed thicker (more energy-dense) foods. It is recommended that these feeding practices should be incorporated in health promotion interventions to reduce the burden of malnutrition

Influence of high protein digestibility sorghums on free amino nitrogen (FAN) production during malting and mashing

In sorghum brewing, obtaining sufficient Free Amino Nitrogen (FAN) for rapid and complete fermentation remains a problem due to the high proportions of unmalted sorghum used and the poor digestibility of wet-heat treated sorghum protein. Sorghum mutant lines with high protein digestibility have been developed through breeding. These high protein digestibility sorghums (HPDS) have protein bodies with villi-like borders that apparently facilitate protease access. This work investigated FAN production from HPDS when malted and mashed, to assess their potential for use in sorghum brewing to improve wort FAN levels. When malted, HPDS contained substantially higher levels of FAN than normal protein digestibility sorghums (NPDS), 32 mg/100 g malt more. However, when the HPDS were mashed either as malt, or as grain or malt plus exogenous proteases, FAN production during mashing was not substantially higher than with NPDS subjected to the same treatments, only 6, 6–18 and 9–13 mg/100 g grain or malt, respectively. This is probably due to wet-heat induced cross-linking of the kafirin proteins reducing their susceptibility to proteolysis. Notwithstanding this, HPDS could be very useful for improving FAN levels in sorghum brewing if they are malted. sorghum this is a particular issue as the grists often comprise a low proportion of malt relative to unmalted adjunct or even 100% unmalted sorghum. Recent work on improving FAN production in sorghum brewing has focused on the use of exogenous proteases7,10,12. However, it appears that to achieve sufficient proteolysis of the sorghum proteins, excessively high levels of exogenous proteases may be required. This can be attributed to the poor digestibility of the sorghum kafirin storage protein3, when it has been subjected to wet-heat treatment, as occurs in the brewing process. Weaver and co-workers at Purdue University identified mutant sorghum lines with improved protein digestibility23. These high protein digestibility sorghums (HPDS) were developed by crossing normal sorghum lines with a high-lysine sorghum mutant. More recently, research at Texas A&M University has focused on breeding to improve the agronomic and end-use quality of the HPDS, and determination of quantitative trait loci (QTLs) for the HPD trait24. This work therefore investigated FAN production from HPDS when malted and mashed, with the objective of assessing their potential for use in sorghum brewing to improve wort FAN levels.The International Sorghum, Millet and Other Grains Collaborative Research Support Program (INTSORMIL), Sun Grant Program, US Department of Transportation, Project No. DTOS59-07-G-00056 to D.B. Hays, Novozymes SA, Mr J. van Aswegen, Mr I. Kennedy and Mr B. Higgins.http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)2050-041

Sorghum Malting

Malting is defined as the germination of grain in moist air under controlled conditions. Malting occurs in three stages: steeping (soaking), germination, and drying or kilning, then milling can take place. Malting changes the chemistry of the grain

Investigating physiological and quality response of pomegranate fruit to controlled atmosphere storage

Thesis (PhD (Food Sc ))--Stellenbosch University, 2017.ENGLISH ABSTRACT: Pomegranate (Punica granatum) is a highly valued crop with a huge economic potential. It is very nutritious with numerous bioactive compounds with the potential to prevent a certain type of cancers and other health conditions. The fruit can also be processed into various industrial products. In South Africa, the pomegranate industry is growing rapidly due to the rising demand from local and international markets. However, owing to its high perishability, the shelf life is limited to less than eight weeks under cold storage conditions. In light of this, a study of ‘CA’ storage as a supplementary postharvest treatment was investigated. The ‘CA’ storage is a system that involves altering and maintaining an atmospheric gas composition different from that of room air (79% N2, 20% O2, and 0.03% CO2) to levels generally, with O2 below 8% and CO2 above 1% supplemented with low temperature and relative humidity above 90%. The primary objective of this study was to investigate the physiological and quality response of pomegranate (weight loss, shrivel, decay, colour, texture, incidences of disorders and decay) to different ‘CA’ treatments and storage temperatures. In addition, to assess the overall quality (total soluble solids, pH, acidity, antioxidant properties, aroma volatility compounds and sensory analysis) including respiration and development of a model for predicting the transpiration rate with the view to optimise the ‘CA’ storage requirements for ‘Wonderful’ and ‘Bhagwa’ pomegranates. The results showed that the selected pomegranate cultivars responded differently to ‘CA’ storage conditions. More importantly, it was observed that by increasing CO2 and/or decreasing O2 concentrations under ‘CA’ resulted in opposite effects on quality attributes. Despite the variation in response, the shelf life of the whole pomegranate fruit was extended by five months more after harvest with a minimal loss of physiological properties (weight loss, physiological disorders, colour, and texture) and quality. Furthermore, the notable fluctuation of quality attributes (TSS, aroma volatility compounds and antioxidants) under ‘CA’ conditions depended highly on cultivar, storage temperature, gas composition and storage duration. In addition, a mathematical model developed based on respiratory heat energy reliably predicted the transpiration rate, with an accuracy of R2 = 0.97. In conclusion, the study proposes a goal-oriented optimisation strategy focussing on the market-driven quality expectation with a negligible compromise on some attributes. The concept was validated using a general linear model (statistical tool) which showed that atmosphere under CAs minimised the weight loss with minimal physiological and quality loss of attributes in addition to extending the shelf life for than two-fold compared to room air. These findings highlight both importance and challenges in finding optimal ‘CA’ for the storage of fresh horticultural produce.AFRIKAANSE OPSOMMING: Granate (Punica granatum) is ’n waardevolle vrug met baie ekonomiese potensiaal. Dit is baie voedsaam en daar is baie bioaktiewe samestellings wat die potensiaal besit om sekere tipes kanker en ander ongesteldhede te verhoed. Die vrug kan ook in sekere industriële produkte gebruik word. Die granaatindustrie in Suid-Afrika groei tans vinnig as gevolg van die groeiende vraag na granate in plaaslike en internasionale markte. Maar omdat granate baie onderhewig is aan bederf, is die raklewe daarvan beperk tot minder as agt weke as dit onder koel toestande geberg word. Daarom is berging onder beheerde atmosfeeer toestande ‘CA’ ondersoek. Die ‘CA’ -berging behels verandering endie behoud van ’n atmosferiese gas samestelling wat verskil van dié van normale lug (79% N2, 20% O2, and 0.03% CO2) tot vlakke waar die O2 onder 8% en die CO2 bokant 1%, die temperature laag en die lugvoggehalte bo 90% is. Die hoofdoel met hierdie studie was om die fisiologiese en gehalte respons van granate (verlies aan gewig inkrimping, aftakeling, kleur, tekstuur, en siektetoestande) tot verskillende ‘CA’ behandeling en bergingtemperature te ondersoek. Verder is daar gepoog om die algehele gehalte (oplosbare vastestowwe, pH, suurinhoud, antioksidantkenmerke geur en sensoriese ontleding) insluitende respirasie te assesseer en om ’n model vir die voorspelling van die uitwasemingkoers te bou om sodoende die ‘CA’ berging van die kultivars, ‘Wonderful’ en ‘Bhagwa te verbeter. Die resultate het bewys dat die verskillende tipes granate verskillend op ‘CA’ berging reageer. Meer belangrik is die feit dat die verhoging van CO2 en/of die vermindering van O2 konsentrasies teenoorgestelde uitwerkings op die gehalte van die vrug het. Ten spyte van die verskillende reaksies is die raklewe in die geheel met vyf maande na die oes verleng en met minimale verlies aan fisiologiese kenmerke (verlies aan gewig, fisiologiese probleme, kleur en tekstuur) en gehalte. Verder is daar bevind dat die fluktuasies in gehalte (TSS, geur, vlugtigheidsamestellings en antioksidante) onder bergingstoestande tot ’n groot mate afhang van die kultivar, bergingstemperatuur, komposisie van die gas en die duur van die berging. Verder is ’n wiskundige model ontwikkel wat baseer is op respiratoriese hitte energie wat die uitwasemingskoers koers met ’n akkuraatheid van R2 = 0.97. voorspel. Daar is tot die slotsom gekom dat daar van ’n doelgerigte optimasie strategie gebruik gemaak moet word met die fokus op markverwagtings en met toegewens in sommige onbelangrike opsigte. ’n Lineêre model (statistiese instrument) is gebruik om die konsep te valideer. Daar is bevind dat berging onder beheerde atmosfeer tieatande lei tot minimale verlies aan gewig, kenmerke en gehalte en dat dit die raklewe twee keer meer as normale lug. Hierdie bevindinge beklemtoon die belangrikheid sowel as die uitdagings na die soeke van ‘n optimale ‘CA’ vir vars hortologie produkte

Common Complementary Feeding Practices Among Under-Five Children: The Case of Zambia

Introduction In the past several decades, Zambia has suffered high levels of under nutrition particularly stunting among children below 5 years of age. Although appropriate complementary feeding practices are reported to reduce child deaths by 6%, they have not received the adequate attention from programme officers and caregivers in terms of implementation. Objectives The objective was to investigate issues surrounding the common complementary feeding practices practised by caregivers of children below five years in health facilities and areas where high rates of malnutrition admission come from. Design A cross sectional research using both qualitative and quantitative methods. The study used mostly proportions based mostly on global indicators on complementary feeding. Qualitative data was also analysed according to themes of global complementary feeding indicators Setting The study was conducted in five hospitals, namely Arthur Davison, Solwezi Central, Kabwe and Livingstone General, and University Teaching Hospital. Subjects The target populations were mothers whose children were admitted for malnutrition and those with children 0-59 months living in communities with the highest number of malnourished cases admitted to selected hospitals Results About45.2% (190) of caregivers introduced liquids before six months of age and 7.6% (32) after 6 months attributing child thirst, medication and advice from health worker as the main reasons. Slightly above half (54.2% of 224) of mothers/caregivers used cups to feed their babies. The use of feeding bottles was still common (8.2% of 34). Responsibility to feed the child is mostly left to the mother (86.4%, 362). In addition, children were being feed about 2.67 (SD 0-72) per day. Conclusions Child feeding practices were still poor. This contributes to poor child growth and health. More interventions should be planned to improve child care behaviour.</jats:p