COVID-19’s impact on food environment in the Indian states of Telangana, Maharashtra, West Bengal, Tamil Nadu and Punjab: a descriptive qualitative study to build further research in India’s food environment resilience building

Background and aim Globally, COVID-19 has had a profound impact on food and nutrition security. This paper aims to gather the perspective from Transforming India’s Green Revolution by Research and Empowerment for Sustainable food Supplies (TIGR2ESS) Flagship Project 6 (FP-6) team on the impact of COVID-19 on the food systems in India. The responses collected will be used for further research projects after TIGR2ESS ends in March 2022. Method Members of the TIGR2ESS FP-6 team in India were invited to complete an online open-ended questionnaire with 21 questions exploring the impact of the COVID-19 pandemic on food systems and environments in India. The questionnaire and data analysis were guided by the food environment framework developed by Turner et al and the adaptations proposed by the United Nations System Standing Committee on Nutrition. Discussions and organisation of codes under the respective themes and subthemes were held online using the virtual platform Miro. 35 individual codes and 65 subcodes were agreed on. Responses were collated and analysed using the template with support from NVivo software and synthesised the relevant themes under Turner et al’s framework. Results The organisation representatives from TIGR2ESS FP-6 (n=16) captured the perceived impact of the COVID-19 on food systems and the environment from the Indian states of Maharashtra, Punjab, Tamil Nadu, Telangana and West Bengal. Negative disruptions were caused by the COVID-19 restrictions across all the themes affecting food actors and consumers. Myths and misconception on dietary intake were reported across the state affecting especially the consumption of poultry. Positive aspects such as home cooking and awareness around healthy food emerged. Conclusion Potential research areas were identified and involve the effects of supply chain resilience building, farmers selling their produce directly to consumer and the revival of local and traditional food’s impact on diets, understanding the harm for consumers by implementing restrictions, how indigenous and local food may impact peoples’ diets, how to build on the encouragement of healthy home cooking during the pandemic, investigate the negative and positive effects of digital environments during the pandemic and dispelling myths and misconception while advocating for healthy diets

Finding the place for nutrition in healthcare education and practice

Background: Malnutrition continues to impact healthcare outcomes, quality of life and costs to healthcare systems. The implementation of nutrition care in healthcare practice may improve health outcomes for patients and the community. This paper describes the iterative development and implementation of nutrition medical education resources for doctors and healthcare professionals in England. These resources are part of the Nutrition Education Policy for Healthcare Practice initiative. Method: Action research methodology was employed to develop and implement nutrition education workshops for medical students and doctors. The workshop was developed iteratively by an interdisciplinary project team, and the content was initially based on the General Medical Council outcomes for graduates. It was evaluated using quantitative evaluation tools and informal qualitative feedback captured from attendees using tools provided by the host organisations and developed by the roadshow team. Results: A total of 6 nutrition education workshops were delivered to 169 participants. This simple educational package demonstrated potential for delivery in different healthcare settings; however, formal feedback was difficult to obtain. Evaluation results indicate that workshops were better received when delivered by doctors known to the participants and included local context and examples. Reported barriers to the workshops included difficulty for participants in finding the time to attend, beliefs that peers gave a low priority to nutrition and uncertainty about professional roles in the delivery of nutrition care. Conclusion: A key outcome of this project was the development of resources for nutrition training of doctors, adapted to local needs. However, relatively low attendance and multiple barriers faced in the delivery of these workshops highlight that there is no ideal ‘place’ for nutrition training in current healthcare teaching. Interprofessional education, through relevant clinical scenarios may increase awareness of the importance of nutrition in healthcare, support the alignment of health professional roles and improve subsequent knowledge and skills

Addressing nutritional gaps and suggesting a practical framework to reduce the risk of malnutrition and improve nutrition security in santhal tribal communities in India

Background The double burden of malnutrition is a growing problem, which is disproportionately represented across the Indian population, with undernutrition dominating rural areas. This study aimed to identify nutritional gaps in traditional recipes of Santhal tribes, create a recipe book to address deficiencies and support diet diversity. Methods Food Frequency Questionnaires (FFQ) were conducted to analyse dietary patterns of Santhal communities. Recipes were collected from five villages and shortlisted into 37 dishes based on availability, acceptability and popularity. Commonly consumed templates were based on FFQ findings and individual dishes. Nutritics software was used to identify nutritional gaps. In total, 24 recommended templates, were created to satisfy adequate intake of nutrients. Mann-Whitney and unpaired t-test were performed and findings were presented as mean (standard deviation(SD)) and median (25th–75th percentile). Results Less than one-fifth of consumed templates met energy requirements, 27% met protein recommendations, and 4% met requirements for fibre, total fat, monounsaturated and polyunsaturated fat. Other nutrients of concern included vitamins B12, B9, iodine, calcium and iron. Recommended templates significantly increased energy (Consumed (C): 996.0kcal(930-1090); Recommended (R): 1183.0kcal(1094-1341); p<0.0001), protein (C: 25.0g(8.4); R: 40.5g(33.2-52.3); p<0.0001), total fat (C: 7.4g(6.1-8.8); R: 17.2g(14.1-22.9); p<0.0001) and fibre (C: 5.0g(4.0-6.5); R: 8.2g(5.8-11.7); p=0.0013) compared to consumed templates. Additionally, calcium (C: 108.5mg(36.0-302.5); R: 245.5mg(152.3-528.3); p=0.0121), iron (C: 5.3mg(2.1-8.2); R: 10.7mg(8.2-13.2); p=0.0002), vitamin B6 (C: 0.4mg(0.3-0.7); R: 1.1mg(0.6-1.6); p=0.0001), B9 (C: 54.5ug(36.3-172.8); R: 252ug(179.4); p=0.0026) and B12 (C: 0ug(0-0); R: 1.0ug(0-2.1); p=0.0001) were also significantly increased. Conclusion This study provides a novel insight on the nutritional adequacy of indigenous Santhal recipes and highlights the need to enhance the nutrition status of these communities. Concerted efforts should be made to increase communication for nutritional advocacy, both nationally and internationally. Future research should evaluate the acceptability, practicality, and uptake of this recipe book in addressing malnutrition in rural communities

Finding the place for nutrition in healthcare education and practice

Peer reviewed: TrueAcknowledgements: NEPHELP Team & NNEdPro Organisational Support.BackgroundMalnutrition continues to impact healthcare outcomes, quality of life and costs to healthcare systems. The implementation of nutrition care in healthcare practice may improve health outcomes for patients and the community. This paper describes the iterative development and implementation of nutrition medical education resources for doctors and healthcare professionals in England. These resources are part of the Nutrition Education Policy for Healthcare Practice initiative.MethodAction research methodology was employed to develop and implement nutrition education workshops for medical students and doctors. The workshop was developed iteratively by an interdisciplinary project team, and the content was initially based on the General Medical Council outcomes for graduates. It was evaluated using quantitative evaluation tools and informal qualitative feedback captured from attendees using tools provided by the host organisations and developed by the roadshow team.ResultsA total of 6 nutrition education workshops were delivered to 169 participants. This simple educational package demonstrated potential for delivery in different healthcare settings; however, formal feedback was difficult to obtain. Evaluation results indicate that workshops were better received when delivered by doctors known to the participants and included local context and examples. Reported barriers to the workshops included difficulty for participants in finding the time to attend, beliefs that peers gave a low priority to nutrition and uncertainty about professional roles in the delivery of nutrition care.ConclusionA key outcome of this project was the development of resources for nutrition training of doctors, adapted to local needs. However, relatively low attendance and multiple barriers faced in the delivery of these workshops highlight that there is no ideal ‘place’ for nutrition training in current healthcare teaching. Interprofessional education, through relevant clinical scenarios may increase awareness of the importance of nutrition in healthcare, support the alignment of health professional roles and improve subsequent knowledge and skills.</jats:sec

Antibiotic and Disinfectant Susceptibility Patterns of Bacteria Isolated from Farmed Fish in Kirinyaga County, Kenya

Fish bacterial pathogens cause diseases which result in a considerable economic impact on the aquaculture industry, necessitating the use of antimicrobials for their control. However, intensive and indiscriminate use of antimicrobials has led to increased occurrence of drug resistance in pathogenic bacteria, as well as normal flora. The aim of the current study was to determine the susceptibility patterns of bacteria isolated from fish, with respect to some commonly used antibiotics and disinfectants. Bacteria were isolated between December 2017 and April 2018 from farmed Nile tilapia, African catfish, goldfish, and koi carp in Kirinyaga County, Kenya. Antibiotic and disinfectant susceptibility patterns of 48 isolates belonging to the genera Aeromonas, Proteus, Klebsiella, Citrobacter, Salmonella, Streptococcus, Pseudomonas, Escherichia, Serratia, and Micrococcus were established using the Kirby–Bauer disc diffusion method and agar well diffusion technique, respectively. The antibiotics evaluated included ampicillin, tetracycline, co-trimoxazole, streptomycin, kanamycin, gentamicin, co-trimoxazole, and chloramphenicol, while the disinfectants tested were quaternary ammonium compound, formalin, hydrogen peroxide, sodium hypochlorite, and iodine. All the bacteria except Micrococcus, Escherichia, and Salmonella species showed multiple drug resistance patterns. Streptococcus showed resistance to six antibiotics, while Proteus, Pseudomonas, and Serratia were resistant to five antibiotics. The multiple antibiotic resistance index ranged from 0.1 to 0.8, with Streptococcus spp. having the highest score value. All the organisms were sensitive to gentamicin, while co-trimoxazole and ampicillin showed the highest resistance at 73% (n = 34) and 62% (n = 31), respectively. Most of the disinfectants showed antibacterial activity with varying magnitudes. The isolates were 100% sensitive to hydrogen peroxide and formalin, but were resistant to sodium hypochlorite at recommended user-dilution. The study has shown that some of the bacterial isolates were resistant to common antibiotics and disinfectants; thus, it is recommended to include an antibiogram whenever making any therapeutic decision. The resistant bacteria may transmit resistance genes to other fish bacteria and also to human bacteria, thus making it difficult to treat the resultant disease(s); thus, there is a possibility that these resistant bacteria may be transmitted to humans who consume or handle the carrier fish. It is, therefore, advisable that fish are cooked properly before consumption, so as to kill bacteria that may be present

Fish Husbandry Practices and Water Quality in Central Kenya: Potential Risk Factors for Fish Mortality and Infectious Diseases

Fish mortality has an enormous impact on the aquaculture industry by reducing fish production and slowing industrial growth. A cross-sectional study was carried out in Kirinyaga County, Central Kenya, to evaluate potential risks of fish mortality and disease transmission and suitability of pond water for rearing fish. A semistructured questionnaire that focused on general information, management practices, and disease history was administered to 92 small-scale fish farmers. Parasitological examination of fish sampled from selected farms (farms that were reporting mortality at the time of sampling) was done by following the standard procedure. Water quality parameters for 33 ponds were evaluated in situ (recorded on pond site) and ex situ (analysed at the laboratory) following the standard methods. The risks were assessed by adjusted odds ratio based on univariate regression analysis. Prevalent fish husbandry practices that were found to be associated with fish mortality and acquisition of pathogens in the study area were the use of raw livestock manure (0R = 1.500), high fish stocking density (0R = 1.168), and feeding fish on homemade rations (0R = 1.128). Parasitological investigation found infestation with Diplostomum spp., Dactylogyrus spp., Clinostomum spp., and Piscicola leeches. Water temperature and pH were found fit for rearing fish. Of the 33 fishpond water samples tested, 1 (3%) and 6 (18%) exceeded the recommended limits of <100 mg/L and <0.2 mg/L of nitrate and nitrite, respectively. Of the 29 fishpond water tested, 15 (59%) exceeded the recommended limits of <100 mg/L of total ammonia. The findings show that the use of raw livestock manure, high fish stocking density, high nitrates and nitrites, and high ammonia levels in fishponds are potential risk factors for fish mortality and acquisition of infectious pathogens in a pond environment in a rural setup, in Central Kenya. There is a need to address the above factors in small-scale farming practices to minimize fish loss and also to prevent the occurrence and spread of infectious pathogens

2 Addressing nutritional gaps and suggesting a practical framework to reduce the risk of malnutrition and improve nutrition security in santhal tribal communities in India

Background The double burden of malnutrition is a growing problem, which is disproportionately represented across the Indian population, with undernutrition dominating rural areas. This study aimed to identify nutritional gaps in traditional recipes of Santhal tribes, create a recipe book to address deficiencies and support diet diversity. Methods Food Frequency Questionnaires (FFQ) were conducted to analyse dietary patterns of Santhal communities. Recipes were collected from five villages and shortlisted into 37 dishes based on availability, acceptability and popularity. Commonly consumed templates were based on FFQ findings and individual dishes. Nutritics software was used to identify nutritional gaps. In total, 24 recommended templates, were created to satisfy adequate intake of nutrients. Mann-Whitney and unpaired t-test were performed and findings were presented as mean (standard deviation(SD)) and median (25th–75th percentile). Results Less than one-fifth of consumed templates met energy requirements, 27% met protein recommendations, and 4% met requirements for fibre, total fat, monounsaturated and polyunsaturated fat. Other nutrients of concern included vitamins B12, B9, iodine, calcium and iron. Recommended templates significantly increased energy (Consumed (C): 996.0kcal(930-1090); Recommended (R): 1183.0kcal(1094-1341); p<0.0001), protein (C: 25.0g(8.4); R: 40.5g(33.2-52.3); p<0.0001), total fat (C: 7.4g(6.1-8.8); R: 17.2g(14.1-22.9); p<0.0001) and fibre (C: 5.0g(4.0-6.5); R: 8.2g(5.8-11.7); p=0.0013) compared to consumed templates. Additionally, calcium (C: 108.5mg(36.0-302.5); R: 245.5mg(152.3-528.3); p=0.0121), iron (C: 5.3mg(2.1-8.2); R: 10.7mg(8.2-13.2); p=0.0002), vitamin B6 (C: 0.4mg(0.3-0.7); R: 1.1mg(0.6-1.6); p=0.0001), B9 (C: 54.5ug(36.3-172.8); R: 252ug(179.4); p=0.0026) and B12 (C: 0ug(0-0); R: 1.0ug(0-2.1); p=0.0001) were also significantly increased. Conclusion This study provides a novel insight on the nutritional adequacy of indigenous Santhal recipes and highlights the need to enhance the nutrition status of these communities. Concerted efforts should be made to increase communication for nutritional advocacy, both nationally and internationally. Future research should evaluate the acceptability, practicality, and uptake of this recipe book in addressing malnutrition in rural communities