Suchergebnisse

Fortification with micronutrient powders (MNPs) is recommended as a strategy for increasing the micronutrient content in complementary foods. However, plant-based diets commonly consumed in developing countries are rich in phytates and tannins, which decrease the micronutrient bioavailability. The present work analysed the relationship between the antinutrient content, and also iron and zinc bioaccessibility, in home-made MNP-fortified complementary feeding porridges refined with white rice, maize, white sorghum, finger millet, pearl millet, Irish potato, and banana samples, which were obtained from the local market and milled into flour. Porridges were prepared using the flour, cooled to 50°C, fortified with MNPs, and subjected to in vitro digestion. Total and bioaccessible zinc and iron were quantified using atomic absorption spectrometry. Tannins and phytates were analysed using Folin-Denis and high-performance liquid chromatography methods, respectively. Porridges were classified as having poor bioavailability if their phytate-zinc and phytate-iron molar ratios were > 15 and > 0.4, respectively. Only pearl millet and soybeans showed tannin levels higher than the recommended values. The lowest phytate level was observed in refined white rice (0.11 ± 0.04 g/100 g), and the highest was in pearl millet (2.83 ± 0.10 g/100 g). Zinc bioaccessibility ranged from 7.31% (finger millet) to 26.05% (corn-soy blend). Only pearl millet porridge was classified as having poor zinc bioavailability. Iron bioaccessibility ranged from 20.73% (refined white rice) to 0.62% (pearl millet). Refined white rice and Irish potato were the only foods with the phytate-iron ratio within the recommended range. Iron bioaccessibility decreased significantly with an increase in both tannin (r = -0.31, p = 0.045) and phytate (r = -0.39, p = 0.01) contents. Zinc bioaccessibility showed a significant positive relationship with tannin levels (r = 0.41, p = 0.008), but an insignificant inverse relationship with phytate levels (r = -0.072, p = 0.700). Iron bioaccessibility was adversely affected by phytate and tannin levels. To improve iron and zinc bioavailability in complementary foods, strategies for lowering the phytate and tannin contents at the household level are recommended.

Positive results from clinical trials of the anti-retroviral medications zidovudine and nevirapine created the possibility of offering an affordable and feasible intervention worldwide to reduce HIV transmission from an infected pregnant woman to her infant. Governmental and nongovernmental health services in many highly affected areas of Africa, Asia, Latin America, and Eastern Europe have responded by piloting and rapidly expanding programs for the prevention of mother-to-child HIV transmission (PMTCT). Since their inception in 1999, programs have offered voluntary HIV counseling and testing (VCT) to more than 800,000 pregnant women around the world. An important objective of VCT is to identify which pregnant women are HIV-positive so they can receive antiretroviral drugs to prevent transmitting HIV to their infants. HIV counseling and testing also offer an opportunity to promote HIV prevention, encourage serostatus disclosure, and foster couple communication on HIV and PMTCT. This brief focuses on VCT in the antenatal care setting, examining service utilization by pregnant women, their perceptions of services, client outcomes as a result of undergoing HIV counseling and testing, and strategies for improving quality and coverage of VCT as a key component of PMTCT programs.

BackgroundWe set out to determine the relative roles of stigma versus health systems in non‐uptake of prevention of mother to child transmission (PMTCT) of HIV‐1 interventions: we conducted cross‐sectional assessment of all consenting mothers accompanying infants for six‐week immunizations.MethodsBetween September 2008 and March 2009, mothers at six maternal and child health clinics in Kenya's Nairobi and Nyanza provinces were interviewed regarding PMTCT intervention uptake during recent pregnancy. Stigma was ascertained using a previously published standardized questionnaire and infant HIV‐1 status determined by HIV‐1 polymerase chain reaction.ResultsAmong 2663 mothers, 2453 (92.1%) reported antenatal HIV‐1 testing. Untested mothers were more likely to have less than secondary education (85.2% vs. 74.9%, p = 0.001), be from Nyanza (47.1% vs. 32.2%, p < 0.001) and have lower socio‐economic status. Among 318 HIV‐1‐infected mothers, 90% reported use of maternal or infant antiretrovirals. Facility delivery was less common among HIV‐1‐infected mothers (69% vs. 76%, p = 0.009) and was associated with antiretroviral use (p < 0.001). Although internal or external stigma indicators were reported by between 12% and 59% of women, stigma was not associated with lower HIV‐1 testing or infant HIV‐1 infection rates; internal stigma was associated with modestly decreased antiretroviral uptake. Health system factors contributed to about 60% of non‐testing among mothers who attended antenatal clinics and to missed opportunities in offering antiretrovirals and utilization of facility delivery. Eight percent of six‐week‐old HIV‐1‐exposed infants were HIV‐1 infected.ConclusionsAntenatal HIV‐1 testing and antiretroviral uptake was high (both more than 90%) and infant HIV‐1 infection risk was low, reflecting high PMTCT coverage. Investment in health systems to deliver HIV‐1 testing and antiretrovirals can effectively prevent infant HIV‐1 infection despite substantial HIV‐1 stigma.

OBJECTIVES: We evaluated the availability of workplace breastfeeding (BF) supports, and the associations between these supports and BF practices among formally employed mothers in Kenya – where many women work in horticulture farms and legislation requiring workplace BF supports is being implemented. We hypothesized that the availability of supports would be associated with a higher prevalence and greater odds of exclusive breastfeeding (EBF). METHODS: We conducted repeated cross-sectional surveys among formally employed mothers at 1–4 days, 6 weeks, 14 weeks, and 36 weeks (to estimate 24 weeks) postpartum at 3 health facilities in Naivasha from Sept. 2018 to Oct. 2019, 13 months after the 2017 Kenyan Health Act, which requires workplace BF support, was passed. We evaluated the associations of workplace BF supports with EBF practices using tests of proportions and adjusted logistic regression. RESULTS: Among formally employed mothers (n = 564), reported workplace supports included on-site housing (16.8%), on-site daycare (9.4%), and private lactation spaces (2.8%). Mothers who used workplace on-site childcare were more likely to practice EBF than mothers who used community- or home-based childcare at both 6 weeks (95.7% versus 82.4%, p = 0.030) and 14 weeks (60.6% versus 22.2%, p < 0.001; [aOR (95% CI) = 5.11 (2.3, 11.7)]. Likewise, mothers who visited daycares at or near workplaces were more likely to practice EBF (70.0%) compared to those who did not visit a daycare (34.7%, p = 0.005) at 14-weeks. Among all mothers, 84.6% with access to workplace private lactation spaces practiced EBF, compared to 55.6% without such spaces, p = 0.037. Mothers who live in on-site housing were twice as likely [aOR (95% CI) = 2.06 (1.25, 3.41)] to practice EBF compared to those without access to on-site housing. CONCLUSIONS: Formally employed mothers in Kenya who used on-site childcare, lived in on-site housing, and had access to private workplace lactation rooms are more likely to practice EBF than mothers who lack these ...