Zinc Deficiency in Low and Middle Income Countries: Prevalence and Approaches for Mitigation

This review addresses the prevalence of zinc deficiency in Low and Middle Income Countries (LMICs) and assesses the available strategies for its alleviation. The paucity of national level data on the zinc deficiency in LMICs is partially due to the lack of a reliable biomarker. Zinc deficiency appears to be a public health problem in almost all the LMICs irrespective of the recommended indicators (plasma zinc concentration, dietary zinc adequacy and stunting prevalence) used. Based on plasma/serum zinc concentration (PZC), the most appropriate indicator at present, the prevalence of zinc deficiency in LMICs are of concern. Among the 25 countries for which national PZC data were available, 23 had a zinc deficiency prevalence of >20% for at least one physiological group. Zinc supplementation is largely restricted as an adjunct therapy for diarrhoea management in children, but the best platform and the most effective way of preventive zinc supplementation delivery needs to be determined. Impact assessment for current zinc fortification programmes in LMICs and the effectiveness of zinc supplementation as part of a multi-micronutrient powder is to be ascertained. Dietary diversification, though promising for LMICs, is in nascent stages of development at present. Inclusion of meat and animal products can be an important way to improve zinc status. Programmatic experience with the promotion of home processing techniques to increase absorbable zinc in the diet is lacking. Conventional biofortification techniques are gaining recognition in LMICs, however transgenic biofortification as a strategy remains controversial

Factors impacting antiretroviral therapy adherence among human immunodeficiency virus-positive adolescents in Sub-Saharan Africa: a systematic review

© 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.Objectives: Eighty-two percent of human immunodeficiency virus (HIV)–positive adolescents live in Sub-Saharan Africa (SSA). Despite the availability of antiretroviral therapy (ART), adherence levels are suboptimal, leading to poor outcomes. This systematic review investigated factors impacting ART adherence among adolescents in SSA, including religious beliefs and intimate relationships. Methods: A systematic review was conducted between June and August 2016 using eight electronic databases, including Cochrane and PubMed. Published, ongoing and unpublished research, conducted in SSA from 2004 to 2016, was identified and thematic analysis was used to summarise findings. Results: Eleven studies from eight SSA countries, published in English between 2011 and 2016, reported on factors impacting ART adherence among adolescents living with HIV (ALHIV). Forty-four barriers and 29 facilitators to adherence were identified, representing a complex web of factors. The main barriers were stigma, ART side-effects, lack of assistance and forgetfulness. Facilitators included caregiver support, peer support groups and knowledge of HIV status. Conclusions: Stigma reflects difficult relations between ALHIV and their HIV-negative peers and adults. Most interventions target only those with HIV, suggesting a policy shift towards the wider community could be beneficial. Recommendations include engaging religious leaders and schools to change negative societal attitudes. Limitations of the review include the urban settings and recruitment of predominantly vertically infected participants in most included studies. Therefore, the findings cannot be extrapolated to ALHIV residing in rural locations or horizontally infected ALHIV, highlighting the need for further research in those areas.Peer reviewedFinal Accepted Versio

Pressure and judgement within a dichotomous landscape of infant feeding: A grounded theory study to explore why breastfeeding women do not access peer support provision

Lack of support is reported as a key reason for early breastfeeding cessation. While breastfeeding peer support (BPS) interventions are a recommended tool to increase breastfeeding rates, intervention studies identify that engagement with BPS is problematic. Due to a paucity of research in this area, this study explores why breastfeeding women do not access BPS in South-West England. Utilising Charmaz’s (2006) constructionist grounded theory approach, twenty-four semi-structured interviews were undertaken with 33 participants (13 women, six health professionals and 14 peer supporters). Analysis involved open coding, constant comparisons and focussed coding. One core category and three main themes explicating non-access were identified. The core category concerns women’s experiences of pressure and judgment around their feeding decisions within a dichotomous landscape of infant feeding language and support. Theme one, ‘place and space of support’, describes the contrast between a perceived pressure to breastfeed, and a lack of adequate and appropriate support. Theme two, ‘one way or no way’, outlines the rules based approach to breastfeeding adopted by some health professionals, and how women avoided BPS due to anticipating a similar approach. Theme three, ‘it must be me’ concerns how a lack of embodied insights could lead to ‘breastfeeding failure’ identities. A background of dichotomised language, pressure, and moral judgement, combined with the organisation of postnatal care and the model of breastfeeding adopted by health professionals, may prevent women’s access to BPS. A socio-cultural model of breastfeeding support providing clear messages regarding the value and purpose of BPS should be adopted

Ravaged landscapes and climate vulnerability: The challenge in achieving food security and nutrition in post-conflict Timor-Leste

Food insecurity and malnutrition are prevalent in post-conflict countries. Climate change poses further challenges to their food production. Timor-Leste is an agrarian society that won independence in 2002 and is struggling to achieve food security and reduce undernutrition as the country modernizes. The economy depends on fossil fuel revenues and oil reserves are dwindling. A review of climate, agricultural, and nutrition data reveals high weather vulnerability, low agricultural productivity, and slow dietary and nutritional progress. But solutions exist. Agricultural sector actions can make important contributions to poverty reduction, food security, dietary diversity, micronutrient sufficiency, and overall nutrition. Agriculture can be made to be more nutrition- and gender-sensitive with a focus on mixed farming systems, biodiversity, climate-smart practices, and access to inputs, training, and technologies for farmers to enable sustainable and healthy rural livelihoods. Ultimately, productivity levels must improve to support the availability of sufficient and nutritious foods

Discourses and critiques of breastfeeding and their implications for midwives and health professionals

This article is a discussion of the recently emerging critique of pro-breastfeeding discourses in academic literature, and what this means for midwives and other professionals who find themselves promoting breastfeeding because of professional expectations or indeed workplace policies. Various strands in the debate are explored, starting with dominant and familiar 'evidence' and descriptions of breastfeeding and breastmilk that are carried through to international policies that advocate breast over formula feeding. We then consider evidence predominantly from social science literature that has found some women's experiences of infant feeding to be at variance with the dominant pro-breastfeeding ideology. We argue that midwives and others delivering maternity care are the means to deliver the policy aspirations contained in the World Health Organization (WHO, 2018) Baby Friendly Hospital Initiative document that makes selective positive claims about breastfeeding without adequately considering its potential drawbacks. We conclude that although the benefits of breastfeeding tend to be exaggerated in promotional material, on balance the weight of evidence still favours breast over formula feeding. We challenge the charge that breastfeeding jeopardises women's financial position by arguing that it is not breastfeeding per se that impacts negatively on women's economic prospects, but rather the way in which society is socially organised