Maternal nutrition: how is Eastern and Southern Africa faring and what needs to be done?

Background: The progress in key maternal health indicators in the Eastern and Southern Africa Region (ESAR) over the past two decades has been slow.Objective: This paper analyzed available information on nutrition programs and nutrition-specific interventions targeting maternal nutrition in the ESAR and proposes steps to improve maternal nutrition in this region.Methods: Search was conducted in relevant databases. Meta-analysis was done where there was sufficient data, while data from the nutrition programs was abstracted for objectives, settings, beneficiaries, stakeholders, impact of interventions and barriers encountered during implementation.Results: Findings from our review suggest that multiple nutrition programs are in place in the ESAR; including programs that directly address nutrition indicators and those that integrate corresponding sectors like agriculture, health, education, and water and sanitation. However, their scale and depth differ considerably. These programs have been implemented by a diverse range of players including respective government ministries, international agencies, non government organisations and the private sector in the region. Most of these programs are clustered in a few countries like Kenya, Uganda and Ethiopia while others e.g. Comoros, Somalia and Swaziland have only had a limited number of initiatives.Conclusion: These programs have been associated with some improvements in overall maternal health and nutritional indicators; however these are insufficient to significantly contribute to the progress in the region. Efforts should be prioritized in countries with the greatest burden of maternal undernutrition and associated risk factors with a focus on existing promising interventions to improve maternal nutrition.Keywords: Maternal nutrition, Eastern and Southern Africa, undernutritio

Vitamin A, carotenoid and vitamin E plasma concentrations in children from Laos in relation to sex and growth failure

BACKGROUND: Deficiencies of vitamin A and its precursors, the carotenoids are common problems in developing countries. Plasma levels of these components are used as biomarkers of their availability. The study was conducted to evaluate whether blood plasma obtained from capillaries can be compared with plasma obtained from venous blood with regard to its levels of retinol, carotenoids and α-tocopherol and secondly to apply this technique to evaluate the levels of these components in children in a region with possible deficiencies. METHODS: The survey was conducted in a region of Laos in 81 children (age 35 to 59 months). Dietary intake was assessed by a questionnaire. Retinol, carotenoids and α-tocopherol were determined by HPLC. Blood plasma was obtained either from capillary blood collected into microcapillaries and for reasons of methodological comparison in 14 adults from venous blood. RESULTS: The comparison between capillary and venous blood revealed that all components except zeaxanthin were 9 – 23 % higher in plasma obtained from capillary blood. Results in Laotian children showed that all investigated components except retinol were significantly lower (P < 0.01) compared to European children of slightly older age. Contrary to children in Europe, most components were significantly lower in boys compared to girls. In children from Laos, lutein was the dominant carotenoid, while in children in Europe, β-carotene was dominant. Within the Laotian children only a few differences were observed between stunted and non-stunted children and between children from lowland areas and high land areas. CONCLUSIONS: Results show that in consideration of slightly lower levels than in venous blood, capillary blood can be used to evaluate retinol, carotenoids and α-tocopherol as biomarkers of intake or status and to evaluate the possible effect of diet on absolute and relative carotenoid composition in children from Europe and Laos. Observed sex related differences might not be related to diet and would need further investigation