The potential contribution of house crickets to the dietary zinc content and nutrient adequacy in young Kenyan children: a linear programming analysis using Optifood.

Zn deficiency arising from inadequate dietary intake of bioavailable Zn is common in children in developing countries. Because house crickets are a rich source of Zn, their consumption could be an effective public health measure to combat Zn deficiency. This study used Optifood, a tool based on linear programming analysis, to develop food-based dietary recommendations (FBR) and predict whether dietary house crickets can improve both Zn and overall nutrient adequacy of children's diets. Two quantitative, multi-pass 24-h recalls from forty-seven children aged 2 and 3 years residing in rural Kenya were collected and used to derive model parameters, including a list of commonly consumed foods, median serving sizes and frequency of consumption. Two scenarios were modelled: (i) FBR based on local available foods and (ii) FBR based on local available foods with house crickets. Results revealed that Zn would cease to be a problem nutrient when including house crickets to children's diets (population reference intake coverage for Zn increased from 89 % to 121 % in the best-case scenario). FBR based on both scenarios could ensure nutrient adequacy for all nutrients except for fat, but energy percentage (E%) for fat was higher when house crickets were included in the diet (23 E% v. 19 E%). This manoeuvre, combined with realistic changes in dietary practices, could therefore improve dietary Zn content and ensure adequacy for twelve nutrients for Kenyan children. Further research is needed to render these theoretical recommendations, practical.

Urine Se concentration poorly predicts plasma Se concentration at sub-district scales in Zimbabwe, limiting its value as a biomarker of population Se status.

Introduction: The current study investigated the value of urine selenium (Se) concentration as a biomarker of population Se status in rural sub-Saharan Africa. Method: Urine and plasma Se concentrations were measured among children aged 6-59 months (n = 608) and women of reproductive age (WRA, n = 781) living in rural Zimbabwe (Murehwa, Shamva, and Mutasa districts) and participating in a pilot national micronutrient survey. Selenium concentrations were measured by inductively coupled plasma-mass spectrometry (ICP-MS), and urine concentrations were corrected for hydration status. Results: The median (Q1, Q3) urine Se concentrations were 8.4 µg/L (5.3, 13.5) and 10.5 µg/L (6.5, 15.2) in children and WRA, respectively. There was moderate evidence for a relationship between urine Se concentration and plasma Se concentration in children (p = 0.0236) and WRA (p = < 0.0001), but the relationship had poor predictive value. Using previously defined thresholds for optimal activity of iodothyronine deiodinase (IDI), there was an association between deficiency when indicated by plasma Se concentrations and urine Se concentrations among WRA, but not among children. Discussion: Urine Se concentration poorly predicted plasma Se concentration at sub-district scales in Zimbabwe, limiting its value as a biomarker of population Se status in this context. Further research is warranted at wider spatial scales to determine the value of urine Se as a biomarker when there is greater heterogeneity in Se exposure.

The relationship between climate change induced natural disasters and selected nutrition outcomes: a case of cyclone Idai, Zimbabwe.

BACKGROUND: The increased frequency of climate induced natural disasters has exacerbated the risks of malnutrition in the already vulnerable regions. This study was aimed at exploring the effects of Cyclone Idai on nutrition outcomes of women of child-bearing age and children under 5 years. METHOD: The household-based cross-sectional study was conducted in Eastern Zimbabwe. Data were collected through face-to-face interviews to determine food consumption score (FCS) and household dietary diversity (HDDS), minimum dietary diversity for women (MDD-W) and minimum dietary diversity for children (MDD-C). Severity of Cyclone Idai was grouped into five categories based on the extent of damage to infrastructure and loss of human lives. Association between continuous and categorical variables was tested using Pearson correlation test and Chi square test, respectively. Linear and binary logistic regression was performed to investigate determinants of food security. RESULTS: A total of 535 households were interviewed. There was a significant correlation between severity of Cyclone Idai and MDD-W (p = 0.011), HDDS (p = 0.018) and FCS (p = 0.001). However, severity of Cyclone Idai was not a determinant of any nutrition outcome, but gender of household head was a negative predictor of HDDS (ß = - 0.734, p = 0.040), and marital status of household head was a positive predictor (ß = 0.093, p = 0.016) of FCS. CONCLUSION: The findings provide a good baseline to inform future programming of food aid activities during disasters. More so, our findings call for evidence-based policies regarding composition of a food aid basket and targeting of beneficiaries. The main strength of this study is that it is the first to investigate the effects of cyclones on food and nutrition security indicators and is based on a large sample size thus making our results generalisable.

Bioaccessibility of iron in pearl millet flour contaminated with different soil types.

A controlled in-vitro experiment was conducted to determine the bioaccessibility of extrinsic soil iron in pearl millet contaminated with typical Malawian soils. Pearl millet was contaminated with soils at ratios typically encountered in real life. Iron concentrations of soil-contaminated flour increased such that soil-derived iron contributed 56, 83 and 91% of the total iron when the proportions of soil were 0.1, 0.5 and 1% (soil: grain w/w), respectively. When soils were digested alone, the concentration of bioaccessible iron differed depending on the type of soil. However, the concentration of bioaccessible iron in soil-contaminated flours did not exceed that of uncontaminated flour and there was no effect of soil type. This suggests that knowledge of the proportion of extrinsic soil iron in soil-contaminated grains would be useful for iron bioavailability estimations. Vanadium is a reliable indicator of the presence of extrinsic soil iron in grains and has potential applications in this regard.

Influence of care group participation on infant and young child feeding, dietary diversity, WASH behaviours and nutrition outcomes in rural Zimbabwe.

Background: The care group approach (CGA) is a community-based nutrition behaviour change strategy centred on 'peer-to-peer learning' through women support groups. Objective: To assess the impact of the CGA on the adoption of appropriate infant and young child feeding (IYCF), dietary diversity and water, sanitation and hygiene (WASH) practices, and associated nutrition-related outcomes. Methods: A retrospective cohort study used a mixed-method approach in selected rural districts in Zimbabwe in June 2022. A structured questionnaire was used to collect data on IYCF, diet quality, WASH and child morbidity. Binary logistic regression was used to evaluate the association between exposure and outcome. Significance was at p<0.05. Results: A total of 127 exposed and 234 controls were enrolled. There was no significant difference between exposed and controls on the prevalence of; diarrhoea (p=0.659), cough (p=0.191) and fever (p=0.916). No significant difference was observed in the proportion ever breastfed (p=0.609), Children with Adequate Dietary Diversity Score (p=0.606) across the two groups. However, the proportion of families with adequate Household Dietary Diversity Score (HDDS) (p=0.005) and Minimum Dietary Diversity for Women (MDD-W) (p=0.009) were significantly higher in exposed than controls. Knowledge on all promoted behaviours was significantly higher in the exposed than in controls with the exception of exclusive breast feeding. While the practices were significantly higher in exposed compared with controls for: 'Appropriate complementary feeding for children aged 6-24 months' (p=0.001), 'good nutrition for women of reproductive age' (p=0.001), 'production and consumption of diverse nutritious food' (p=0.001) and 'production and consumption of biofortified crops' (p=0.001). Conclusions: The results showed that CGA potential to increase knowledge and achieve nutrition and health-related behaviour change in low-income settings if integrated into existing community programmes. Interestingly, HDDS and MDD-W were significantly higher in exposed than controls. However, more research is required to obtain conclusive results.

A pilot survey of selenium status and its geospatial variation among children and women in three rural districts of Zimbabwe.

Introduction: Selenium (Se) deficiency is increasingly recognized as a public health problem in sub-Saharan Africa. Methods: The current cross-sectional study assessed the prevalence and geospatial patterns of Se deficiency among children aged 6-59 months (n = 741) and women of 15-49 years old (n = 831) selected by simple random sampling in rural Zimbabwe (Murewa, Shamva, and Mutasa districts). Venous blood samples were collected and stored according to World Health Organization guidelines. Plasma Se concentration was determined by inductively coupled plasma-mass spectrometry. Results: Median, Q1, and Q3 plasma Se concentrations were 61.2, 48.7, and 73.3 µg/L for women and 40.5, 31.3, and 49.5 µg/L for children, respectively. Low plasma Se concentrations (9.41 µg/L in children and 10.20 µg/L in women) indicative of severe Se deficiency risk was observed. Overall, 94.6% of children and 69.8% of women had sub-optimal Se status defined by plasma Se concentrations of <64.8 µg/L and <70 µg/L, respectively. Discussion: High and widespread Se deficiency among women and children in the three districts is of public health concern and might be prevalent in other rural districts in Zimbabwe. Geostatistical analysis by conditional kriging showed a high risk of Se deficiency and that the Se status in women and children in Murewa, Shamva, and Mutasa districts was driven by short-range variations of up to ⁓12 km. Selenium status was homogenous within each district. However, there was substantial inter-district variation, indicative of marked spatial patterns if the sampling area is scaled up. A nationwide survey that explores the extent and spatial distribution of Se deficiency is warranted.

Anemia in children aged 6-59 months was significantly associated with maternal anemia status in rural Zimbabwe.

Globally, anemia is a public health problem affecting mostly women of reproductive age (WRA, n = 452) and children aged 6-59 months (n = 452) from low- and lower-middle-income countries. This cross-sectional study assessed the prevalence and determinants of anemia in WRA and children aged 6-59 months in rural Zimbabwe. The venous blood sample was measured for hemoglobin utilizing a HemoCue machine. Anthropometric indices were assessed and classified based on World Health Organization standards. Socioeconomic characteristics were assessed. The median (±inter quartile range (IQR)) age of WRA was 29 ± 12 years and that for children was 29 ± 14 months. The prevalence of anemia was 29.6% and 17.9% in children and WRA, respectively, while the median (±IQR) hemoglobin levels were 13.4 ± 1.8 and 11.7 ± 1.5 g/dl among women and children, respectively. Multiple logistic regression analysis was used to assess determinants of anemia. Anemia in children was significantly associated with maternal anemia (odds ratio (OR) = 2.02; 95% CI 1.21-3.37; p = .007) and being a boy (OR = 0.63; 95% CI 0.41-0.95; p = .029), while anemia in WRA was significantly associated with the use of unimproved dug wells as a source of drinking water (OR = 0.36; 95% CI 0.20-0.66; p = .001) and lack of agricultural land ownership (OR = 0.51; 95% CI 0.31-0.85; p = .009). Anemia is a public health problem in the study setting. The positive association between maternal and child anemia reflects the possibility of cross-generational anemia. Therefore, interventions that focus on improving preconceptual and maternal nutritional status may help to reduce anemia in low-income settings.

Linking Climate Change Adaptation Strategies and Nutrition Outcomes: A Conceptual Framework.

BACKGROUND: The relationship between climate adaptation strategies and nutrition security is poorly understood and often unclear. Although several adaptation strategies have been implemented to mitigate the impact of climate change, there is still a lack of conclusive evidence or studies on the interrelationships between adopted climate change adaptation strategies and nutrition outcomes. OBJECTIVE: This study aimed to develop a conceptual framework that links climate change, adaptation strategies and nutrition and to show the indicators that can be used to assess the impact of climate adaptation strategies on nutrition. METHODOLOGY: The proposed conceptual framework was developed through a literature review. RESULTS: A generic conceptual framework that could be used to assess the impact of adopted climate change adaptation strategies on nutrition outcomes was developed. The framework consists of 5 key elements: agro-food system, context characteristics, adaptation strategies, climatic shocks and stress, and system output. The principles used in designing the conceptual framework include systems approach, contingency theory, and system output. CONCLUSION: The developed framework offers a channel to evaluate adopted climate change adaptation strategies and their impact on nutrition outcomes. Such a conceptual framework can also be used in selecting and identifying more suitable climate adaptation strategies given specific contextual environments.

Linkages between soil, crop, livestock, and human selenium status in Sub-Saharan Africa: a scoping review.

Selenium (Se) is essential for human health, however, data on population Se status and agriculture-nutrition-health linkages are limited in sub-Saharan Africa (SSA). The scoping review aims to identify linkages between Se in soils/crops, dietary Se intakes, and livestock and human Se status in SSA. Online databases, organisational websites and grey literature were used to identify articles. Articles were screened at title, abstract and full text levels using eligibility criteria. The search yielded 166 articles from which 112 were excluded during abstract screening and 54 full text articles were assessed for eligibility. The scoping review included 34 primary studies published between 1984 and 2021. The studies covered Se concentrations in soils (n = 7), crops (n = 9), animal tissues (n = 2), livestock (n = 3), and human Se status (n = 15). The evidence showed that soil/crop Se concentrations affected Se concentration in dietary sources, dietary Se intake and biomarkers of Se status. Soil types are a primary driver of human Se status and crop Se concentration correlates positively with biomarkers of Se dietary status. Although data sets of Se concentrations exist across the food system in SSA, there is limited evidence on linkages across the agriculture-nutrition nexus. Extensive research on Se linkages across the food chain is warranted.

Mopane worm value chain in Zimbabwe: Evidence on knowledge, practices, and processes in Gwanda District.

Consumption of edible insects is a potential solution to the growing need for protein. However, the wild harvested edible insects' value chain faces several challenges including limited knowledge on indigenous practices in the harvesting and processing and lack of information on roles of the different actors in the chain. A case study of Gonimbrasia belina, colloquially referred to as the 'mopane worm', was conducted to understand and identify determinants of participation in the value chain of the edible caterpillar. A cross sectional study was conducted in Gwanda (a rural district in Zimbabwe) to (a) understand the indigenous knowledge on harvesting and processing methods, (b) explore value addition and the traditional beliefs surrounding the utilisation of the mopane worm. Results showed that consumers (81.7%), and harvesters (76.6%) were the main actors in the mopane worm value chain. Using the Ordinary Least Squares (OLS) model, the following were shown to be determinants of participation in the mopane worm value chain: (a) gender (b) household size (c) marital status (d) religion and (e) household assets. Two primary processing methods of harvested mopane worm were distinguished i.e., boiling and roasting on ambers. Results showed lack of diversity in mopane worm-based products. Current culturally acceptable processing techniques need improvement and standardization to support sustainable mopane worm processing while optimising nutrient bio-accessibility.

Relationships of depression and anxiety to readmission rates among patients with diabetes from Harare and Parirenyatwa referral hospitals in Zimbabwe.

BACKGROUND: The knowledge of determinants of readmission among individuals with diabetes minimises relapse and decreases diabetes associated morbidity and mortality. OBJECTIVES: To explore the prevalence of depression and anxiety as well as determinants of readmission in individuals with diabetes from Harare, Zimbabwe. METHODS: A cross sectional study was carried out at Parirenyatwa and Harare group of hospitals. Participants were recruited through purposive sampling and interviewed at the diabetic clinics. Depression and anxiety were measured using the Hospital Anxiety and Depression Scale. Binary logistic regression was used to determine predictors of readmission. RESULTS: In total 65 participants took part, 36.9% were males. The mean age ±SD was 44.89±14.2 years. Anxiety affected 40% and 20% were at risk of anxiety, while depression was reported in 27.7% and 30.8% were at risk of depression. Depression [OR=0.64, 95%CI: 0.42-0.97 (p=0.037)] and checking of blood glucose [OR=0.06, 95%CI: 0.01-0.71 (p=0.025)] were significant negative predictors of readmission among diabetic patients while anxiety was a significant positive predictor OR=1.55, 95%CI: 1.09-2.21 (p=0.015). CONCLUSIONS: Mental health conditions in people living with diabetes are factors contributing to increased re admissions and are more prevalent with aging. Psychotherapy and education interventions are recommended for the elderly diabetic population.

Sensitivity of Food-Based Recommendations Developed Using Linear Programming to Model Input Data in Young Kenyan Children.

Food-based recommendations (FBR) developed using linear programming generally use dietary intake and energy and nutrient requirement data. It is still unknown to what extent the availability and selection of these data affect the developed FBR and identified problem nutrients. We used 24 h dietary recalls of 62 Kenyan children (4-6 years of age) to analyse the sensitivity of the FBR and problem nutrients to (1) dietary intake data, (2) selection criteria applied to these data and (3) energy and nutrient requirement data, using linear programming (Optifood©), by comparing a reference scenario with eight alternative scenarios. Replacing reported by estimated consumption frequencies increased the recommended frequencies in the FBR for most food groups while folate was no longer identified as a problem nutrient. Using the 10-90th instead of the 5-95th percentile of distribution to define minimum and maximum frequencies/week decreased the recommended frequencies in the FBR and doubled the number of problem nutrients. Other alternative scenarios negligibly affected the FBR and identified problem nutrients. Our study shows the importance of consumption frequencies for developing FBR and identifying problem nutrients by linear programming. We recommend that reported consumption frequencies and the 5-95th percentiles of distribution of reported frequencies be used to define the minimum and maximum frequencies.

Effect of the COVID-19-induced lockdown on nutrition, health and lifestyle patterns among adults in Zimbabwe.

BACKGROUND: The COVID-19 is a global public health emergency resulting in lockdowns, associated diet and lifestyle changes and constrained public health delivery. OBJECTIVE: To investigate the impacts of the COVID-19-induced lockdown in Zimbabwe on nutrition, physical activity, alcohol consumption and smoking among Zimbabwean population aged ≥18 years. METHODS: A cross-sectional online survey was conducted using a structured questionnaire to collect information on demographics (age, gender, place of residence, current employment), food system dimensions, diet and physical activity patterns, stress and anxiety, body image perceptions, lifestyle behaviours like smoking, alcohol intake, screen time and ease of access to health services. Results The participants (n=507) were mostly women (63.0%) between the ages of 31 and 40 years (48.1%) and had tertiary education (91.3%). The lockdown resulted in increase in food prices (94.8%) and decrease in availability of nutritious foods (64%). Most (62.5%) of the participants reported a reduction in their physical activity levels. The prevalence of generalised anxiety disorder (GAD) was 40.4% and mostly affecting woman (63.5%, p=0.909), 31-40 years age group (49.6%, p=0.886). Based on the Body Mass Index-based Silhouette Matching Test (BMI-SMT) 44.5% gained weight, 24.3% lost weight and 31.2% did not have weight change. The paired samples t-test showed that there was a significant increase in perceived body weight (p<0.001). More than half (59.6%) reported having difficulties accessing medicinal drugs and 37.8% growth monitoring services. CONCLUSIONS: The lockdown period was associated with increase in food prices, decrease in dietary diversification, elevated GAD symptoms, disrupted diet and consumption patterns. There were low levels of physical activity and perceived weight gained during the lockdown period, thus increasing the risk of overweight and obesity. Further studies incorporating participants of different socioeconomic status are warranted to get more conclusive results.