Severe Acute Malnutrition: The Potential of Non-Peanut, Non-Milk Ready-to-Use Therapeutic Foods.

PURPOSE OF REVIEW: This review provides information on the prospect and effectiveness of ready-to-use therapeutic foods (RUTFs) produced locally without the addition of milk and peanut. RECENT FINDINGS: The foods used in fighting malnutrition in the past decades contributed little to the success of the alleviation program due to their non-effectiveness. Hence, RUTFs are introduced to fight malnutrition. The peanut allergies, the high cost of milk, and the high production cost of peanut RUTF have made its distribution, treatment spread, and accessibility very slow, especially in areas where it is highly needed. There is a need, therefore, for a low-cost RUTF that is acceptable and effective in treating severe acute malnutrition among under-5 children. This review shows both the success and failure of reported studies on the use of non-peanut and non-milk RUTF, including their cost of production as compared to the standard milk and peanut-based RUTF. It was hypothesised that replacing the milk ingredient component with legumes like soybeans can reduce the cost of production of RUTFs while also delivering an effective product in managing and treating severe acute malnutrition (SAM). Consumers generally accept them better because of their familiarity with the raw materials.

Implication of knowledge, lifestyle and self-efficacy in the prevention of cardiovascular diseases' risk factors among the urban elderly.

Background: Cardiovascular disease (CVD) is preventable by effectively managing its risk factors. Such risk factors (smoking, unhealthy eating habits, sedentary lifestyles, etc.) are judged to reflect an individual's self-efficacy, lifestyle modification, and CVD knowledge. Objectives: To evaluate the relationship between lifestyle practices, self-efficacy, and knowledge of CVDs risk factors among the elderly. Methods: A descriptive cross-sectional study was conducted on 424 randomly individuals whose age is ≥60 years. A questionnaire-based survey was administered on the self-efficacy rate, lifestyle practices, and respondents' knowledge of CVDs risk factors. Respondents with a score of ≤50%, 51%-74.99%, and ≥75% were classified as having low, medium, or high self-efficacy. Similarly, the same score was used to classify poor, fair, or good lifestyle; and low, average, or high knowledge. Data were analysed using Statistical Package for Social Sciences, while association among variables was determined using chi-square. Results: Few respondents were involved in physical exercise (1.7%), cigarette smoking (4.5%), regular soft drinks (18.2%), and alcohol consumption (13.2%). Many respondents used excess salt during cooking (92.7%) or ate outside their homes (64.6%). 58.5%, 30.0%, and 11.6% of the respondents had fair, good, and poor lifestyle practices. 11.3%, 58.7%, and 30.0% had low, medium, and high self-efficacy scores. A total of 45.3%, 35.4%, and 19.3% had low, average, and high knowledge. Knowledge and self-efficacy scores were significantly different (P = 0.001). Conclusion: High self-efficacy and its significant relationship with knowledge could mean that CVD risk factors can be checked if the elderly have a proper lifestyle, positive attitudes, and nutrition education.

Operational Characteristics of Women Street Food Vendors in Rural South Africa.

Objective: To characterize the operations of the street food enterprise in the Vhembe district, focusing on business profile, sold foods, inputs, pricing, record-keeping practices and total running cost. Methods: A descriptive cross-sectional face-to-face study of 511 vendors was done using a structured researcher-administered questionnaire comprising demographic and operational characteristics. Convenience sampling was used to choose the vending sites. Chi-square tests were conducted between four categorical variables (gender, age, marital status and citizenship) and operational characteristics. P-values were considered significant at p < 0.05. However, a Bonferroni adjustment decreased the significant value to p < 0.013. Results: The findings highlight the dominance of single middle-aged (35-44) women (63.1%) with some high school education. About 14% migrated from Zimbabwe. Most vendors were owners (86.1%), with 70.0% in business for at least 1-10 years. Food sold included mielie pap (stiff porridge) served with beef or chicken, sometimes with vegetables. Plate prices were R40.00 (2.6 USD) for a full plate and R30.00 (2 USD) for half a plate. The typical street food consumers were government officials, middlemen, and schoolchildren. Social media such as Whatsapp were used to communicate between the street food vendors and customers. The results highlight poor managerial skills as only 15.5% kept records, most of which were sales records (59.5%). On average, street vendors made a monthly profit of R3200.00 (213 USD) while spending R1800.00 (120 USD) on daily running expenses. There were statistically significant variations in some operational characteristics of vendor variables and gender, age, marital status, and citizenship. Conclusions: There is a need for capital and management for small businesses and food training for rural street food vendors. Therefore, government officials, policymakers, and NGOs could target street vendors to offer training and microfinance to improve their business skills while promoting food safety and consumption of nutritious foods.

Nutrition Knowledge of Caregivers Influences Feeding Practices and Nutritional Status of Children 2 to 5 Years Old in Sekhukhune District, South Africa.

BACKGROUND: The aim of this study was to determine caregivers' nutrition knowledge and its influence on feeding practices and nutritional status on young children. METHODS: A cross-sectional survey was conducted in 120 caregiver-child pairs. A validated questionnaire was used to collect caregivers' nutrition knowledge and feeding practices. Nutritional status was estimated using anthropometric measurements. Z-scores were computed using WHO Antro software. Chi-square test was used to determine the association between caregivers' nutrition knowledge and feeding practices. Significance was set at p <0.05. RESULTS: Forty three percent of caregivers reported health professionals as their source of nutrition information. Almost all children (94.2%) were breastfed at one stage in their lives, with 62.5% introduced to solid foods before six months. Maize meal porridge (87.5%) and bread (54.2%) were consumed daily by most of the children, while 48.3% consumed meat and meat products three to four times per week. One in eight children consumed fruits daily and 5.8% vegetables daily. Forty one percent of children were stunted. Family income showed positive correlation with the nutritional status of children (weight-for-age R = 0.207, p < .05; height-for-age R°=°0.203*, p°= .026). An association was observed between the duration of breastfeeding and alternative food, to milk (R = 0.302**, p = .001), amount of fruit consumed daily (R = 0.197*, p = .031) and number of meals consumed daily (R = 0.284**, p = .048). Conclusion: Nutrition knowledge and feeding practices of the caregivers were not satisfactory.

Recommendations for Infant Feeding Policy and Programs in Dzimauli Region, South Africa: Results From the MAL-ED Birth Cohort.

BACKGROUND: There is strong evidence that exclusive breastfeeding (EBF) in the first 6 months of life reduces the risk of diseases in infancy and in later life. OBJECTIVE: To understand the maternal reasoning that influences optimum infant feeding practices of caregivers in semirural communities of Limpopo province. METHODS: Nested qualitative study among mothers in an ongoing birth cohort study was conducted; structured and semi-structured interviews were used to collect data. Data from 234 infants after 6 months of follow-up was included for quantitative analysis. Four focus discussion groups comprising 7 to 10 caregivers were used to obtain perception of mothers on breastfeeding. A semi-structured interview guide was used to stimulate discussions. Thematic content analyses were conducted to identify the main themes that influence breastfeeding practices of caregivers. RESULTS: Over 90% of the caregivers initiated breastfeeding after delivery. However, less than 1% of mothers practiced EBF by 3 months, and none of the children were exclusively breastfed for up to 6 months. All caregivers introduced non-breast milk liquids and solids by the second month of child's life. Common reasons for introducing non-breast milk foods included insufficiency of breast milk production, going back to work or school, and influence by elderly women (mothers/mothers-in-law) and church members. CONCLUSION: Exclusive breastfeeding was not practiced in this community due to cultural and religious beliefs and misinformation. The involvement of elderly women and church members in infant feeding education and promotion programs and the dissemination of breastfeeding information through mobile phones to younger mothers are recommended.

Early interruption of exclusive breastfeeding: results from the eight-country MAL-ED study.

We report the infant feeding experiences in the first month of life for 2,053 infants participating in "Malnutrition and Enteric Infections: Consequences for Child Health and Development" (MAL-ED). Eight sites (in Bangladesh, India, Nepal, Pakistan, Brazil, Peru, South Africa, Tanzania), each followed a cohort of children from birth (by day 17), collecting detailed information on infant feeding practices, diet and illness episodes. Mothers were queried twice weekly regarding health status, breastfeeding and the introduction (or no) of non-breast milk liquids and foods. Here, our goal is to describe the early infant feeding practices in the cohort and evaluate factors associated with termination of exclusive breastfeeding in the first month of life. With data from enrollment to a visit at 28-33 days of life, we characterized exclusive, predominant or partial breastfeeding (using a median of 6-9 visits per child across the sites). Only 6 of 2,053 infants were never breastfed. By one month, the prevalences of exclusive breastfeeding were < 60% in 6 of 8 sites, and of partial breastfeeding (or no) were > 20% in 6 of 8 sites. Logistic regression revealed that prelacteal feeding (given to 4-63% of infants) increased the likelihood of partial breastfeeding (Odds Ratio (OR): 1.48 (95% confidence interval (CI): 1.04, 2.10), as did the withholding of colostrum (2-16% of infants) (OR: 1.63:1.01, 2.62), and being a first-time mother (OR: 1.38:1.10, 1.75). Our results reveal diversity across these sites, but an overall trend of early transition away from exclusive breastfeeding in the first month of life. Interventions which introduce or reinforce the WHO/UNICEF Ten Steps for Successful Breastfeeding are needed in these sites to improve breastfeeding initiation, to reinforce exclusive breastfeeding and delay introduction of non-breast milk foods and/or liquids.

Infant feeding practices, dietary adequacy, and micronutrient status measures in the MAL-ED study.

The overall goal of The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study is to evaluate the roles of repeated enteric infection and poor dietary intakes on the development of malnutrition, poor cognitive development, and diminished immune response. The use of 8 distinct sites for data collection from Latin America, sub-Saharan Africa, and South Asia allow for an examination of these relationships across different environmental contexts. Key to testing study hypotheses is the collection of appropriate data to characterize the dietary intakes and nutritional status of study children from birth through 24 months of age. The focus of the current article is on the collection of data to describe the nature and adequacy of infant feeding, energy and nutrient intakes, and the chosen indicators to capture micronutrient status in children over time.

Household food access and child malnutrition: results from the eight-country MAL-ED study.

BACKGROUND: Stunting results from decreased food intake, poor diet quality, and a high burden of early childhood infections, and contributes to significant morbidity and mortality worldwide. Although food insecurity is an important determinant of child nutrition, including stunting, development of universal measures has been challenging due to cumbersome nutritional questionnaires and concerns about lack of comparability across populations. We investigate the relationship between household food access, one component of food security, and indicators of nutritional status in early childhood across eight country sites. METHODS: We administered a socioeconomic survey to 800 households in research sites in eight countries, including a recently validated nine-item food access insecurity questionnaire, and obtained anthropometric measurements from children aged 24 to 60 months. We used multivariable regression models to assess the relationship between household food access insecurity and anthropometry in children, and we assessed the invariance of that relationship across country sites. RESULTS: Average age of study children was 41 months. Mean food access insecurity score (range: 0-27) was 5.8, and varied from 2.4 in Nepal to 8.3 in Pakistan. Across sites, the prevalence of stunting (42%) was much higher than the prevalence of wasting (6%). In pooled regression analyses, a 10-point increase in food access insecurity score was associated with a 0.20 SD decrease in height-for-age Z score (95% CI 0.05 to 0.34 SD; p = 0.008). A likelihood ratio test for heterogeneity revealed that this relationship was consistent across countries (p = 0.17). CONCLUSIONS: Our study provides evidence of the validity of using a simple household food access insecurity score to investigate the etiology of childhood growth faltering across diverse geographic settings. Such a measure could be used to direct interventions by identifying children at risk of illness and death related to malnutrition.