What Kigali's open-air markets reveal about achieving food and nutrition security: the role of African indigenous crops.

BACKGROUND: Household dietary diversity in Rwanda remains low and significantly contributes to the double burden of malnutrition. Rwanda has one of the highest under five stunting rates globally, and malnutrition remains one of the most pressing public health issues; therefore, factors that shape food and nutrition security are of utmost concern. Globally, the variety of foods available in open-air markets has been shown to affect dietary diversity. Furthermore, the consumption of indigenous foods can contribute to a diverse diet and improve nutrition status. At present, there are limited data on foods available for purchase in open-air markets in Africa. Therefore, this study was designed to provide data on food availability in the largest open-air markets of Rwanda's most populated city, Kigali, and to highlight which foods indigenous to Africa can be purchased. METHODS: All consumables were inventoried between October and December of 2020 in three open-air markets of Kigali, the capital city of Rwanda. Consumables were organized by the site of domestication and the nutritional contents of some African indigenous crops were compared to similar non-indigenous items. RESULTS: A variety of raw and processed consumables was available in the open-air markets inventoried; however, only 25.8% of available species are indigenous to Africa. All Rwanda's staples, including sweet potatoes, plantains, beans, maize, banana, and cassava, are endemic to other continents. Indigenous plant species, which are often drought-resistant and more nutritious, for example, Africa's pineapple fruits (Myrianthus holstii), could not be purchased in Kigali's open-air markets. Pineapple fruits are richer in iron, vitamin C, protein, and vitamin A than banana, which is the most consumed fruit in Rwanda. CONCLUSIONS: Given rapid population growth, limited arable land, and erratic climate patterns, policies to conserve and promote indigenous species, especially those already adapted to harsh environmental conditions, should be enacted in Rwanda. The cultivation of native vegetables and fruits in home gardens, and the conservation of edible wild species, can improve dietary diversity and enhance food and nutrition security across the entire country.

Healthy pregnancies and essential fats: focus group discussions with Zambian women on dietary need and acceptability of a novel RUSF containing fish oil DHA.

BACKGROUND: Nut butter-based Ready to Use Supplemental Foods (RUSF) are an effective way to add nutrients and calories to diets of malnourished and food insecure populations. The RUSF formulations have been further modified to add micronutrients including iron and folic acid needed during pregnancy and lactation. Because docosahexaenoic acid (DHA, C22:6 n-3) enhances fetal development and birth outcomes, it has been suggested that perhaps RUSF formulations for pregnancy should also include this Omega 3 fatty acid. The goal of the present study was to gain an understanding of Zambian women's knowledge of nutritional needs in pregnancy through structured focus group discussions, and to formulate and determine the acceptability of a RUSF with DHA. METHODS: Structured focus group sessions were conducted among women attending an antenatal clinic at the University Teaching Hospitals in Lusaka, Zambia. Dietary and nutrition knowledge was surveyed through structured dialogue that was recorded by audio and transcribed verbatim. An RUSF containing 400 mg DHA from fish oil in 50 g RUSF was designed and assessed for fatty acid content and product stability. Participants then sampled the RUSF-DHA, provided feedback on taste, and were surveyed about willingness to consume the novel formula using a standardized hedonic instrument. RESULTS: The participants' knowledge of foods recommended for use in pregnancy included fruits, vegetables, meat, and fish. Most women reported eating fish at least once per week, although the specific type of fish varied. Most did not have prior knowledge of the importance of consuming fish during pregnancy or that some fish types were more nutritional than others as they included omega 3 fatty acids. The participants were uniformly accepting of the RUSF-DHA for the purpose of enhancing birth and developmental outcomes, but were critical of the aroma in hedonic testing. CONCLUSIONS: Women were committed to consuming a healthy diet that would impact the outcome of pregnancy, and were receptive to advice on the importance of consuming foods such as fish as a source of DHA. The RUSF-DHA formulation was acceptable due to the potential benefits for the developing infant, however, the fishy odor may be limiting for long-term daily use.

"Are you eating healthy?" Nutrition discourse in Midwestern clinics for the underserved.

OBJECTIVE: To investigate nutrition information provided and exchanged between patients and health providers in Midwestern clinics for underserved populations. METHODS: Forty-six clinic visits were observed to determine content and direction of nutrition information. In-depth data were collected with clinicians and clinic administrators regarding nutrition education provided to patients. RESULTS: All patients were diagnosed with multiple obesity-related morbidities. Although women more often posed nutrition questions, few patients asked about dietary intake. Two-thirds of healthcare professionals initiated discussion about dietary intake; however, nutrition education was not provided regardless of clinician's profession. CONCLUSIONS: Patients did not appear to link morbidity with diet. Providers did not share comprehensive nutrition knowledge during clinic visits. Dietitians, who specialize in nutrition education, rarely had access to patients. IMPLICATIONS: Nutrition education during clinic visits is essential for reducing obesity rates. Nutrition students need clinic experience and could provide important patient education at low cost.

Relationships between the diet and dentition of Asian leaf monkeys.

Colobines have been generally described as primates that use the anterior teeth minimally, but the posterior teeth extensively, to process leaves and related food items. However, variation among leaf monkeys in both anterior and posterior dental morphology has been recognized for decades. In this study, we turn to Hylander's (Science 189 (1975) 1095-1098) analysis of anterior incisor row length and Kay's (Adaptations for foraging in nonhuman primates, 1984) examination of relative molar crest length to test hypotheses proposed by them for Asian colobines. We present findings based on data from the largest Asian colobine sample measured to date. Our findings for incisor row length and molar cresting are not amenable to broad generalizations. In those instances when our morphological findings concur with those of Hylander (Science 189 (1975) 1095-1098) and Kay and Hylander (The ecology of arboreal folivores, 1978), the ecological evidence seldom supports the morphological predictions. The disassociation between diet and dental patterns may be a consequence of differential selection by fallback foods, anthropogenic disturbance or climatic shifts limiting preferred diets, or the use of food types as opposed to food mechanical properties for dietary categorization. We also found that in the case of both incisor row length and molar crest length, the patterns for males and females differed markedly. The reasons for these differences may in part be ascribed to the metabolic challenges faced by females and subsequent niche partitioning. We propose integrated analyses of the ingestive and digestive systems of our study taxa to clarify relationships among behavior, dental morphology, and diet in extant and extinct colobines.

Oral hygiene knowledge and practice among Dinka and Nuer from Sudan to the U.S.

PURPOSE: The purpose of this study was to determine knowledge and use of oral hygiene methods for refugees from Sudan now living in the U.S. prior to conducting elective implant surgery. METHODS: The sample included 34 adults of the Dinka or Nuer tribes who participated in 1 or more phases of a project to restore 6 lower anterior teeth with implants. An English language survey was administered by an interpreter for whom Dinka or Nuer was a first language. Each interpreter underwent an elective restorative procedure prior to acting as an interpreter. The project survey covered demographics, traditional and current oral hygiene practices, perceived aesthetics and dental visits since arrival to the U.S. RESULTS: Data analyses revealed that male participants outnumbered female participants, and all were under 30 years of age. Traditional dental practices paralleled Western oral hygiene methods and current oral hygiene involved 1 brushing event per day and prevalent toothpick use. Most participants wished to have all teeth in place, bright white coloration and a maxillary diastema. Few had visited a U.S. dental facility more than once, and none were using biannual checkups to maintain dental health. All participants required detailed oral hygiene education to fill the knowledge gap between traditional and U.S. systems and to maintain their newly restored dental health status. CONCLUSION: Refugees arriving to the U.S. from a non-Western country may be in great need of Western oral hygiene training to create or maintain a high dental health status. Resettlement programs should include dental screening, treatment and oral hygiene training to prevent further decline in dental health status.

Dental restorations for dinka and nuer refugees: a confluence of culture and healing.

The Harvard Trauma Questionnaire, Hopkins Symptom Checklist-25, and the Self-reporting Questionnaire-24 were used to evaluate distress among 22 Dinka and Nuer refugees to the US before and after complete restoration of four to six lower front teeth that had been extracted during childhood in Sudan. Participants reported significant improvement in levels of distress following full restoration of missing teeth, including symptoms of PTSD. These results illustrate the value of incorporating community perspectives into the selection of health treatment options for newly arriving populations. But they also emphasize the unique situation faced by each refugee population as they embark on a wholly new cultural learning process.

Social perceptions of individuals missing upper front teeth.

Although it is assumed that there are negative social consequences for individuals missing visible front teeth, no study of the way in which edentulous individuals were perceived in a social context and the potential social repercussions could be located. This initial study concerned college students' perceptions of individuals missing visible upper front teeth. 200 volunteers, 19 to 50 years of age (M = 20.6, SD = 4.4), rated five photographs depicting tooth presence or absence, from a full dentition to missing as many as four upper front teeth, on social traits including attractiveness, health status, educational attainment, satisfaction with life, active social life, aggressiveness, intelligence, trustworthiness, amount of caring, friendship, dating, and likelihood to live as a neighbor. Analysis suggested a person missing visible teeth was more negatively perceived on all social traits than a person with full dentition. Results were strongest when students were proposed to be linked to the edentulous individual in a personal way, i.e., dating or living as neighbor. Men and women agreed on perceptions of social traits and dentition condition. These results suggest the presence of strong Western cultural values, whereby those who are missing teeth may experience significant barriers to personal and social success.

From Sudan to nebraska: Dinka and Nuer refugee diet dilemmas.

OBJECTIVE: Examination of current dietary patterns of Dinka and Nuer refugees from Sudan to the United States prior to dental restoration and nutrition training. DESIGN: Thirty-one participants were interviewed regarding current intake and knowledge of US food and nutrition principles. Twenty-nine completed three 24-hour food diaries. SETTING: Refugee homes, campus offices, and classrooms in a midwestern city. PARTICIPANTS: Eight Nuer females and 9 Nuer and 14 Dinka males participating in a program to replace lower front teeth traditionally extracted in childhood. PHENOMENON OF INTEREST: Are refugees familiar with preparing and consuming US foods given that dental restoration will allow, for example, raw and/or tough food to be nipped or incised? Are diets substantively different from African ones, eg, sugar-rich, fat-rich, and dairy-poor? ANALYSIS: Interview data and diet diaries were matched, and data were compared for common themes and patterns. RESULTS: Refugees ate a monotonous diet, with few fruits, vegetables, and dairy products. All lacked familiarity with US foods and preparation techniques but ate convenience foods and sweetened beverages in large quantities. CONCLUSIONS AND IMPLICATIONS: Refugees possessed limited understanding of "healthful" US food and were overwhelmed by choices. Regardless of dental status and time in the United States, few had selection and preparation skills for US foods. Nutrient deficiency and related disease are likely without intervention.

A historical perspective on the University of Nebraska Medical Center's College of Dentistry Class of 1961.

We conducted a retrospective analysis of the University of Nebraska Medical Center (UNMC) College of Dentistry (COD) Class of 1961 to glean information that might be useful in the design of dental education programs in Nebraska and elsewhere. We scanned annual class newsletters, demographic statistics for students entering the UNMC dental program for each decade from 1961 to 2001, and UNMC COD alumni data for patterns and themes among thirty-two dental professionals. Eighty-four percent of those contacted provided responses to a survey. We found that, like current dental cohorts nationwide, the UNMC COD Class of 1961 is mostly of European ancestry (non-Hispanic) and male. But in contrast to current dental college graduates, the UNMC Class of '61 were able to rely upon self-employment and spousal and/or military support (GI Bill) to cover the costs of their dental education. They also were more likely to enter dental school before completion of an undergraduate degree and have a substantial work history before entering the UNMC dental program. Although the most common reason for attending dental school related to independence and financial security, "time with family" and "family vacations" were the next most important reasons cited for becoming dental professionals. Among '61 graduates, the average number of years spent in the dental profession is thirty-seven years. Despite the notable changes in dental technology and the continual need for updating knowledge and skill, eight members of the UNMC COD Class of 1961 continue to practice dentistry. Most maintain contact with other class members, providing support to former classmates and maintaining an identity with their alma mater, the University of Nebraska.

Health and related factors for Sudanese refugees in Nebraska.

Results of a health survey covering demographics, health risk/prevention factors, and barriers to health care among 263 refugees from Sudan, now living in Nebraska, are presented. Data are compared to Nebraska's general and minority populations. Sudanese refugees are generally young, highly mobile, uneducated, and live in poverty. Refugees are proportionally different from other Nebraskans, in terms of risk factors and rates of common U.S. conditions, but are unable to use preventive systems for maintaining high health status. Nearly 40% do not have health or dental insurance, 20% have never visited a dental or eye care professional, and 11% have never been to a doctor. Federal programs should standardize resettlement site screening so that mobile populations can begin the resettlement process healthy and prevent the spread of infectious disease. Good health at the outset will allow more time and resources for education, language, and employment acquisition, all of critical importance to the Sudanese refugee community.

Anterior dental extractions among Dinka and Nuer refugees in the United States: a case series.

Few U.S. adults today experience life without permanent anterior teeth and know little about how an incomplete anterior dentition affects adult well-being. Sudanese refugees, who had resettled in the U.S. and who had six mandibular anterior teeth ritually extracted during youth, provided an opportunity to examine the significance of the effect of this partial edentulism. The authors interviewed five adult refugees whose anterior dentition was restored using dental implants. Factors considered before and after restoration included incisal ability, food item recognition, food consumption patterns and related social factors. Before restoration of the anterior dentition, participants could not incise typical foods eaten in the U.S. and expressed embarrassment about their dental status, which limited smiling, speaking and social interaction. This case series offers insight into the bio-cultural importance of the anterior dentition for all populations living with a visible gap in the lower jaw.

Molar size and shape variations among Asian colobines.

Despite decades of research, little is known about morphometric differences within the dentition of Asian colobines. Although some differences, such as the M3 hypoconulid, are often cited as distinct among genera, no comprehensive assessment has been made. The objectives of this study were to document size and shape differences in third molars in eight Asian colobine genera, including Kasi, Nasalis, Presbytis, Pygathrix, Rhinopithecus, Semnopithecus, Simias, and Trachypithecus, and to quantify length differences for all molars in order to understand the potential impact of an occlusal surface area that includes the hypoconulid. To achieve these objectives, the most extensive survey yet published of Asian colobine dentition was conducted. Differences within and among genera for continuous and categorical variables were analyzed using descriptive statistics, chi-square, t-tests, and post hoc comparisons. Results indicate that species of Presbytis differ from all other Asian colobines in both the size and shape of the maxillary and mandibular third molars. Specifically, M3 of Presbytis is relatively shorter in length and less likely to exhibit a hypoconulid optimally positioned for occlusion with M3. Moreover, Presbytis expresses concomitant changes in the maxillary third molar such as absence of a distal shelf and/or a distal cusp with separated crests. We conclude that shape and size changes impact the molar size sequence patterns of Presbytis, setting this genus apart from all other Asian colobine taxa. These differences may reflect variation in overall body size, dietary adaptation, and phylogeny.