Breast-Milk Substitutes: A New Old-Threat for Breastfeeding Policy in Developing Countries. A Case Study in a Traditionally High Breastfeeding Country

Background: Developing countries with traditionally breastfeeding are now experiencing the increasing pressure of formula milk marketing. This may endanger lives and undermine the efforts of national policies in achieving the objectives of the Millennium Development Goals. We examined the use of, and factors for use, of all available breast-milk substitutes (BMS) in a country with a traditionally high rate of breastfeeding. Methods: Randomised multi-stage sampling surveys in 90 villages in 12/17 provinces in Laos. Participants: 1057 mothers with infants under 24 months of age. Tools: 50-query questionnaire and a poster of 22 BMS (8 canned or powdered milk; 6 non-dairy; 6 formulas; 2 non-formulas). Outcome measures included: prevalence of use and age of starting BMS in relation to socio-demographic characteristics and information sources, by univariate and multivariate analyses

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Main reasons for giving BMS to infants before 6 months of age among users.

£<p>The following question was asked: Why do you feed your baby this product?</p><p>*Of 207 users before 6 months, 203 users ‘responses available.</p><p>**Rich with vitamins, similar to rice, good for children.</p><p>***1.4% of 1057 mothers reported that they could not breastfeed.</p

Factors associated with the use of BMS before 6 months of age in Laos (multivariate analysis).

<p>95% Confidence Interval.</p

Map of study site.

<p>Map of study site.</p

Top five BMS used before the age of 6 months for infants in Laos.

<p>*One US$ = 8,000 kip. Mean prices reported by mothers, ^£ How long does one can or box last or box.</p><p>**Main component: Skimmed milk powder (36,5%), full cream milk powder (21,9%,) vegetable fat mix (12,6%), sucrose 7,7%, Maltodextrin 6,7%, honey 5,5%, lactose 3,2%, oligo-fructose (2,6%), butter oil (1,3%), vitamins and minerals premix (0,9%), soya lecithin (0,3%), fish oil (0,1%).</p

Main socio-economic characteristics of mothers in 12 provinces of Laos.

<p>*mean (95% confidence interval);</p><p>**This classification is used to roughly describe ethnic groups belonging to lowlands, midlands and highlands though people may have migrated since then from their original residency.</p>£<p>834 (78.9%) reported an occupation: 73 (6.9%) civil servants, 60 (5.7%) shop keepers, 18 (1.7%) workers, 16 (1.5%) other occupations.</p>££<p>At list one visit.</p>£££<p>In US dollars: US = 8000 Lao kip.</p

Main source of information on breast milk substitute (BMS).

£<p>The following questions were asked: How did you hear about these products? (many answers possible), if the answer was TV: Which channels?</p>££<p>The following question was asked: Which of the above mentioned sources of information do you trust the most for your family?</p

Knowledge of and feeding BMS to infants less than 6 months in Laos^£.

<p>*Mean age and 95% confidence interval,</p>£<p>knows at least one BMS in the category.</p><p>The following questions were asked: Did you give this product to your baby? If yes, How old was your child when you started giving this product to her/him (month).</p