Anaemia among breastfeeding infants (0-6 months) and associated factors in a low income urban setting of Kenya

Controversies surrounding exclusive breastfeeding for the first six months of life and the risk of developing anaemia exist. Studies worldwide have indicated uncertainties on the way forward given the World Health Organization’s firm stand on exclusive breastfeeding as the most appropriate practice for infants less than six months old. In Kenya, research on anaemia status of infants below six months old is scanty. The main objective of the study was to determine the prevalence of anaemia and its associated factors among breastfeeding infants 0-6 months old in Kangemi Slums, Kenya. One hundred and thirty nine (139) breastfeeding infants aged 0-6 months and their respective mothers were recruited into a cross-sectional study. Infants’ blood was drawn from the heel while mothers’ blood was from a finger prick. Anaemia was assessed using HemoCue® (Hemo-control, EKF-diagnostic GmbH, Barleben/Magdeburg, Germany) and defined as haemoglobin levels <11.0 and <12.0g/dl for infants and mothers, respectively. Logistic regression was used to model the associations. Anaemia prevalence (35.3%) was of moderate public health significance and was not statistically different between exclusively (36.8%) and nonexclusively (28%) breastfed infants (χ2=0.702, 1df, p=0.402). There was no significant difference in mean haemoglobin levels between infants exclusively and those nonexclusively breastfed (t=-1.040, p=0.300). A reduced estimated relative risk of anaemia (OR=0.713, 0.95 CI: 0.34-1.50) was observed among infants <4 months versus 4-6 months old. Key factors of significant positive association with anaemia among the infants included maternal nutritional status (Body Mass Index (p=0.015), haemoglobin levels (p=0.018)) and proportion of household income spent on food (p=0.026). This study concluded that there is a likelihood of exclusively breastfed infants below 6 months to be anaemic in Kenya to the extent of moderate public health significance and special attention is warranted. The study reveals maternal nutritional status, haemoglobin levels and proportion of household income as key predictors of anaemia in infants.Keywords: anaemia, exclusive breastfeeding, infants, low income, associated factor

CHANGES IN CARBOHYDRATES ASSOCIATED WITH SENESCENCE OF CUT GLADIOLUS SPIKES UNDER PULSING AND WET COLD STORAGE DURATIONS

Several biochemical and metabolic changes are associated with senescence of cut gladioli, particularly in relation to quality characteristics, including dynamism of carbohydrates. The objective of this study was to evaluate the effect of pulsing and wet cold storage on the starch and sugar biomarkers on cut Gladiolus ( Gladiolus grandiflorus L. cv. Fado) vase quality. Pulsing treatments of 600-ppm 8-hydroxyquinoline sulphate, plus 5% sucrose solution, versus distilled water, were administered prior to wet cold storage durations of 0 - 5 days, on the cut Gladiolus grown from corms. This was done in the open field at the Horticulture Research and Teaching Field, Egerton University in Kenya, during two successive seasons. There was a significant difference (P <0.01) in total soluble sugars (TSS) and total starch of spikes pulsed with 600 ppm 8 - HQS + 5% sucrose, compared with the control, during the third day in the vase life of the cut flowers. Prolonged vase life of cut spikes was associated with a decrease in total soluble sugars and increase in total starch, as influenced by pulsing and wet storage duration up to 4 days.Plusieurs changements biochimiques et m\ue9taboliques sont associ\ue9s \ue0 la s\ue9nescence des gla\uefeuls coup\ue9s, en particulier en relation avec les caract\ue9ristiques de qualit\ue9, y compris le dynamisme des glucides. L\u2019objectif de cette \ue9tude \ue9tait d\u2019\ue9valuer l\u2019effet du stockage au froid puls\ue9 et humide sur les biomarqueurs de l\u2019amidon et du sucre sur la qualit\ue9 des vases de gla\uefeul coup\ue9 ( Gladiolus grandiflorus L. cv. Fado). Des traitements puls\ue9s de sulfate de 8-hydroxyquinol\ue9ine \ue0 600 ppm, plus une solution de saccharose \ue0 5%, contre de l\u2019eau distill\ue9e, ont \ue9t\ue9 administr\ue9s avant des dur\ue9es de stockage au froid humide de 0 \ue0 5 jours, sur le gla\uefeul coup\ue9 \ue0 partir de bulbes. Cela a \ue9t\ue9 faite dans le champ de Horticulture Research and Teaching Field, Egerton University au Kenya, pendant deux saisons successives. Il y avait une diff\ue9rence significative (P <0,01) dans les sucres solubles totaux (TSS) et l\u2019amidon total des \ue9pis puls\ue9s avec 600 ppm 8 - HQS + 5% de saccharose, par rapport au t\ue9moin, au cours du troisi\ue8me jour de la vie en vase de la coupe fleurs. La dur\ue9e de vie prolong\ue9e en vase des \ue9pis coup\ue9s a \ue9t\ue9 associ\ue9e \ue0 une diminution du des sucres solubles totaux et \ue0 une augmentation de l\u2019amidon total, sous l\u2019influence de la dur\ue9e de stockage puls\ue9 et humide jusqu\u2019\ue0 4 jours

Patterns of tobacco use in low and middle income countries by tobacco product and sociodemographic characteristics: nationally representative survey data from 82 countries.

To determine the prevalence and frequency of using any tobacco product and each of a detailed set of tobacco products, how tobacco use and frequency of use vary across countries, world regions, and World Bank country income groups, and the socioeconomic and demographic gradients of tobacco use and frequency of use within countries. Secondary analysis of nationally representative, cross-sectional, household survey data from 82 low and middle income countries collected between 1 January 2015 and 31 December 2020. Population based survey data. 1 231 068 individuals aged 15 years and older. Self-reported current smoking, current daily smoking, current smokeless tobacco use, current daily smokeless tobacco use, pack years, and current use and use frequencies of each tobacco product. Products were any type of cigarette, manufactured cigarette, hand rolled cigarette, water pipe, cigar, oral snuff, nasal snuff, chewing tobacco, and betel nut (with and without tobacco). The smoking prevalence in the study sample was 16.5% (95% confidence interval 16.1% to 16.9%) and ranged from 1.1% (0.9% to 1.3%) in Ghana to 50.6% (45.2% to 56.1%) in Kiribati. The user prevalence of smokeless tobacco was 7.7% (7.5% to 8.0%) and prevalence was highest in Papua New Guinea (daily user prevalence of 65.4% (63.3% to 67.5%)). Although variation was wide between countries and by tobacco product, for many low and middle income countries, the highest prevalence and cigarette smoking frequency was reported in men, those with lower education, less household wealth, living in rural areas, and higher age. Both smoked and smokeless tobacco use and frequency of use vary widely across tobacco products in low and middle income countries. This study can inform the design and targeting of efforts to reduce tobacco use in low and middle income countries and serve as a benchmark for monitoring progress towards national and international goals

Diabetes risk and provision of diabetes prevention activities in 44 low-income and middle-income countries: a cross-sectional analysis of nationally representative, individual-level survey data.

The global burden of diabetes is rising rapidly, yet there is little evidence on individual-level diabetes prevention activities undertaken by health systems in low-income and middle-income countries (LMICs). Here we describe the population at high risk of developing diabetes, estimate diabetes prevention activities, and explore sociodemographic variation in these activities across LMICs. We performed a pooled, cross-sectional analysis of individual-level data from nationally representative, population-based surveys conducted in 44 LMICs between October, 2009, and May, 2019. Our sample included all participants older than 25 years who did not have diabetes and were not pregnant. We defined the population at high risk of diabetes on the basis of either the presence of impaired fasting glucose (or prediabetes in countries with a haemoglobin A <sub>1c</sub> available) or overweight or obesity, consistent with the WHO Package of Essential Noncommunicable Disease Guidelines for type 2 diabetes management. We estimated the proportion of survey participants that were at high risk of developing diabetes based on this definition. We also estimated the proportion of the population at high risk that reported each of four fundamental diabetes prevention activities: physical activity counselling, weight loss counselling, dietary counselling, and blood glucose screening, overall and stratified by World Bank income group. Finally, we used multivariable Poisson regression models to evaluate associations between sociodemographic characteristics and these activities. The final pooled sample included 145 739 adults (86 269 [59·2%] of whom were female and 59 468 [40·4%] of whom were male) across 44 LMICs, of whom 59 308 (40·6% [95% CI 38·5-42·8]) were considered at high risk of diabetes (20·6% [19·8-21·5] in low-income countries, 38·0% [37·2-38·9] in lower-middle-income countries, and 57·5% [54·3-60·6] in upper-middle-income countries). Overall, the reach of diabetes prevention activities was low at 40·0% (38·6-41·4) for physical activity counselling, 37·1% (35·9-38·4) for weight loss counselling, 42·7% (41·6-43·7) for dietary counselling, and 37·1% (34·7-39·6) for blood glucose screening. Diabetes prevention varied widely by national-level wealth: 68·1% (64·6-71·4) of people at high risk of diabetes in low-income countries reported none of these activities, whereas 49·0% (47·4-50·7) at high risk in upper-middle-income countries reported at least three activities. Educational attainment was associated with diabetes prevention, with estimated increases in the predicted probability of receipt ranging between 6·5 (3·6-9·4) percentage points for dietary fruit and vegetable counselling and 21·3 (19·5-23·2) percentage points for blood glucose screening, among people with some secondary schooling compared with people with no formal education. A large proportion of individuals across LMICs are at high risk of diabetes but less than half reported receiving fundamental prevention activities overall, with the lowest receipt of these activities among people in low-income countries and with no formal education. These findings offer foundational evidence to inform future global targets for diabetes prevention and to strengthen policies and programmes to prevent continued increases in diabetes worldwide. Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program and the EU's Research and Innovation programme Horizon 2020

Diagnostic testing for hypertension, diabetes, and hypercholesterolaemia in low-income and middle-income countries: a cross-sectional study of data for 994 185 individuals from 57 nationally representative surveys.

Testing for the risk factors of cardiovascular disease, which include hypertension, diabetes, and hypercholesterolaemia, is important for timely and effective risk management. Yet few studies have quantified and analysed testing of cardiovascular risk factors in low-income and middle-income countries (LMICs) with respect to sociodemographic inequalities. We aimed to address this knowledge gap. In this cross-sectional analysis, we pooled individual-level data for non-pregnant adults aged 18 years or older from nationally representative surveys done between Jan 1, 2010, and Dec 31, 2019 in LMICs that included a question about whether respondents had ever had their blood pressure, glucose, or cholesterol measured. We analysed diagnostic testing performance by quantifying the overall proportion of people who had ever been tested for these cardiovascular risk factors and the proportion of individuals who met the diagnostic testing criteria in the WHO package of essential noncommunicable disease interventions for primary care (PEN) guidelines (ie, a BMI >30 kg/m <sup>2</sup> or a BMI >25 kg/m <sup>2</sup> among people aged 40 years or older). We disaggregated and compared diagnostic testing performance by sex, wealth quintile, and education using two-sided t tests and multivariable logistic regression models. Our sample included data for 994 185 people from 57 surveys. 19·1% (95% CI 18·5-19·8) of the 943 259 people in the hypertension sample met the WHO PEN criteria for diagnostic testing, of whom 78·6% (77·8-79·2) were tested. 23·8% (23·4-24·3) of the 225 707 people in the diabetes sample met the WHO PEN criteria for diagnostic testing, of whom 44·9% (43·7-46·2) were tested. Finally, 27·4% (26·3-28·6) of the 250 573 people in the hypercholesterolaemia sample met the WHO PEN criteria for diagnostic testing, of whom 39·7% (37·1-2·4) were tested. Women were more likely than men to be tested for hypertension and diabetes, and people in higher wealth quintiles compared with those in the lowest wealth quintile were more likely to be tested for all three risk factors, as were people with at least secondary education compared with those with less than primary education. Our study shows opportunities for health systems in LMICs to improve the targeting of diagnostic testing for cardiovascular risk factors and adherence to diagnostic testing guidelines. Risk-factor-based testing recommendations rather than sociodemographic characteristics should determine which individuals are tested. Harvard McLennan Family Fund, the Alexander von Humboldt Foundation, and the National Heart, Lung, and Blood Institute of the US National Institutes of Health

Data Resource Profile: The Global Health and Population Project on Access to Care for Cardiometabolic Diseases (HPACC).

[No abstract available]ach STEPS survey is co-funded by the country’s government and the WHO. DHS are co-funded by the United States Agency for International Development (USAID) and the respective country’s government. The funding of the other surveys are mostly co-funded by a country’s government, universities and international organizations, and sometimes supported by local sponsors. The creation of the final collated data set has been funded by the Harvard McLennan Family Fund and the Alexander von Humboldt Foundation as well as institutional funds from the Universities of Heidelberg and Göttingen