Feeding practices and nutrient content of complementary meals in rural central Tanzania: implications for dietary adequacy and nutritional status

Influence of diet quality on nutritional status of school-aged children and adolescents in Zanzibar, Tanzania

BACKGROUND

Malnutrition among young children and adolescents poses a serious health challenge in developing countries which results in many health problems during adulthood. Poor diet quality is known as the root cause of malnutrition which is caused by unhealthy food choices and bad eating habits among young children and adolescents. However, limited evidence is available on diet quality and its association with nutrition status among young children and adolescents in Zanzibar. This study examined the diet quality and its relationship with the nutritional status of school-aged children and adolescents in Zanzibar.

METHODS

Data for this study was obtained from the cross-sectional survey of School Health and Nutrition (SHN) conducted in Zanzibar. The survey recruited children aged 5-19 years from 93 schools in Zanzibar. A seven-day food frequency questionnaire (FFQ) was used to assess dietary intake. Prime Dietary Quality Score (PDQS) consisted of 21 food groups was then constructed to assess the diet quality of school-aged children and adolescents. Body mass index (BMI-for-age Z-score) was used as the indicator of nutrition status. Both linear and logistic regression analysis techniques were used to determine the associations between BMI and PDQS.

RESULTS

A total data of 2,556 children were enrolled in the survey. The prevalence of thinness was 8.1%, normal 82.1%, overweight 7.2% and obesity 2.6%. The mean (SD) PDQS score was 18.8 (3.2) which ranged from 8 to 33. Consumptions of green leafy vegetables (49.3%), yellow or red fruits (37.8%), legumes (38.3%), fish (36.3%), and vegetable oil (31.5%) were up to three times per week, whereas consumptions of white vegetables (77.3%), cooked vegetables (32.6%), citrus fruits (66.8%), other types of fruits (66.2%), nuts (46.4%), poultry (49.6%), whole grains (61%) and eggs (67.8%) were less than once per week. In terms of unhealthy foods, eating fried foods was reported by 26.3% up to three times per week, and 31.5% reported consuming sweets and ice cream up to three times in the past week. High PDQS was significantly associated with a reduction in BMI of children (p< 0.005). For each unit increase in the consumption of unhealthy foods such as fried foods, cooked vegetables and refined grains there is a significant increase in BMI. The odds of being obese decrease significantly as diet quality increases from the first to third quintile of PDQS (AOR = 0.2, 0.04-0.89 95% CI, p = 0.035).

CONCLUSION

Consumption of high quality diet was found to be associated with a reduction in excessive weight among school-aged children and adolescents in Zanzibar. There is a need for interventions targeting to reduce unhealthy food consumption in school environment. Further research should be conducted to assess diet quality using PDQS among young children and adolescents.

Nutrition Education Package Focusing on Infant and Young Child Feeding in Tanzania

OBJECTIVE

To evaluate the effectiveness of a nutrition education package on feeding practices, nutrient intakes and growth of infants in rural Tanzania.

DESIGN

Cluster-randomized controlled trial in 18 villages allocated to nutrition education package (n = 9) or routine health education (n = 9 villages), measured at baseline (6 months) and end of the trial (12 months).

SETTING

Mpwapwa district.

PARTICIPANTS

Infants aged 6-12 months and their mothers.

INTERVENTION(S)

Six months of nutrition education package (group education, counseling, cooking demonstrations) and regular home visits by village health workers.

MAIN OUTCOME MEASURE(S)

Primary outcome measure was the mean change in length-for-age z-scores. Secondary outcomes included mean changes in weight-for-length z-scores (WLZ), intakes of energy, fat, iron and zinc, the proportion of children consuming foods from ≥ 4 food groups (ie, dietary diversity) and consuming the recommended number of semisolid/soft meals and snacks per day (ie, meal frequency).

ANALYSIS

Multilevel mixed-effects regression models.

RESULTS

Mean change in length-for-age z-scores (β = 0.20, P = 0.02), energy (in kcal) (β = 43.8, P = 0.02), and fat (in grams) (β =2.7, P = 0.03) intakes were significant in the intervention but not in the control group. There was no effect on iron and zinc intakes. More infants in the intervention than the control group consumed meals from ≥ 4 food groups (71.8% vs 45.3%, P = 0.002). The mean increase in meal frequency (β = 0.29, P = 0.02) and dietary diversity (β = 0.40, P = 0.01) were more significant in the intervention than control.

CONCLUSIONS AND IMPLICATIONS

The nutrition education package is feasible and can be implemented with high coverage, demonstrating the potential to improve feeding practices, nutrient intake and growth in rural Tanzania.

Dietary Diversity, Household Food Insecurity and Stunting among Children Aged 12 to 59 Months in N'Djamena-Chad

BACKGROUND

Household food insecurity is increasingly recognized as a global health problem, particularly in sub-Saharan Africa. This study aimed to contextualize the associations between household food insecurity, dietary diversity and stunting in N'Djamena.

METHODS

This study is a community-based cross-sectional study, and the SMART (Standardized Monitoring and Assessment of Relief and Transitions) methodology was used to calculate the sample size. A total of 881 households were selected for the survey. A 24-h recall evaluated the dietary diversity score (DDS), the Household Food Insecurity Access Scale (HFIAS) made it possible to assess household food insecurity (HFI), and stunting among children aged 12 to 59 months was assessed by anthropometric measurements. Logistic regression was constructed to determine the association between household food insecurity, dietary diversity, and stunting. The study was conducted from January to March 2022.

RESULTS

The prevalence of severe food insecurity was 16.6%, and that of stunting was 25.3%. The mean DDS was 6.5 ± 1.6. Severe food insecurity (OR 2.505, CI: 1.670-3.756) was significantly associated with stunting. The association between DDS and stunting was not significant.

CONCLUSIONS

This study's prevalence of household food insecurity and stunting was very high. Household food insecurity and household size were significantly associated with stunting.

Global Trends in the Availability of Dietary Data in Low and Middle-Income Countries

Individual-level quantitative dietary data can provide suitably disaggregated information to identify the needs of all population sub-groups, which can in turn inform agricultural, nutrition, food safety, and environmental policies and programs. The purpose of this discussion paper is to provide an overview of dietary surveys conducted in low- and middle-income countries (LMICs) from 1980 to 2019, analyzing their key characteristics to understand the trends in dietary data collection across time. The present study analyzes the information gathered by the Food and Agriculture Organization of the United Nations/World Health Organization Global Individual Food consumption data Tool (FAO/WHO GIFT). FAO/WHO GIFT is a growing repository of individual-level dietary data and contains information about dietary surveys from around the world, collected through published survey results, literature reviews, and direct contact with data owners. The analysis indicates an important increase in the number of dietary surveys conducted in LMICs in the past four decades and a notable increase in the number of national dietary surveys. It is hoped that this trend continues, together with associated efforts to validate and standardize the dietary methods used. The regular implementation of dietary surveys in LMICs is key to support evidence-based policies for improved nutrition.

A National Communications Campaign to decrease childhood stunting in Tanzania: an analysis of the factors associated with exposure

Background

Childhood stunting is a major problem in Tanzania, affecting an estimated 2.7 million children under 5 years of age. The purpose of this study was to examine the factors associated with exposure to mass media (radio and television) and IPC (interpersonal communication) components integrated in a national communications campaign aiming to decrease stunting in Tanzania.

Methods

A cross-sectional survey was conducted among 3082 men and 4996 women dyads after the campaign. The average age of men was 34.7 years (SD = 8.9) and 28.1 years (SD = 6.9) for women. Several factors affecting exposure to the campaign were studied. Comparisons were made between radio, TV, and IPC exposure.

Results

Mothers who reported i) higher wealth, ii) being the primary decision-makers in the home, iii) receiving support from their husbands, iv) frequent access to radio and TV and, v) ownership of a cell phone, were more likely to report exposure to the mass media component of the communications campaign. Contrarily, the same factors were not predictors of exposure to the IPC component. Fathers who reported: i) higher wealth and education, ii) ownership of a cell phone, iii) recently listened to the radio, iv) that the mother made the decisions in the home and v) helping at home, were more likely to be exposed to the mass media component.

Conclusion

Significant factors affecting exposure to the communications campaign were varied but not consistent between mass media and IPC. Because of the high frequency of exposure to the campaign overall, both media and IPC components are important in a large-scale, health-related communications campaign.

Prevalence and overlap of known undernutrition risk factors in children in Nairobi Kenya

We aimed to describe the co‐occurrence of known risk factors for undernutrition and the prevalence of modifiable risks in wasted, stunted and healthy children. Quota sampling was used to recruit healthy [weight for age Z scores (WAZ) > −2 SD] and undernourished [weight for length (WLZ) or WAZ scores ≤ −2 SD] children aged 6–24 months from seven clinics in low‐income areas of Nairobi. Structured interviews were used to identify exposure to socioeconomic, water and hygiene, infant feeding, dietary and behavioural risks (low interest in food, high food refusal and force feeding). We recruited 92 wasted WLZ ≤ −2 SD, 133 stunted (length for age Z scores LAZ ≤ −2 SD) and 172 healthy (LAZ and WLZ > 2SD) children. Nearly all children were exposed to hygiene risks (90%) and low dietary diversity (95%) regardless of nutritional status. Stunted children were more likely to be exposed to socio‐economic risks (54% healthy, 64% wasted and 72% stunted; P = 0.001). Compared with healthy children, wasted and stunted children were more likely to be exposed to infant feeding (25% healthy, 40% wasted and 41% stunted; P = 0.02) and behaviour risks (24% healthy, 49% wasted, and 44% stunted; P = 0.004). Overall, wasted and stunted children were twice as likely to be exposed to more than three risks (23% healthy, 48% wasted, and 50% stunted; P = <0.001). They were also more likely to be exposed to more than three modifiable risks (dietary, handwashing and behaviour risks). Wasting and stunting are associated with exposure to multiple risk factors, many of which are potentially modifiable using targeted advice.

Effect of Pre-treatment and Processing on Nutritional Composition of Cassava Roots, Millet, and Cowpea Leaves Flours

Cassava roots, millet and cowpea leaves have short storage life thus the need for simple post-harvest handling and storage protocol to ensure prolonged availability to fully contribute toward food and nutrition security, a major challenge within Sub-Saharan Africa. The current study sought to investigate the effect of pre-treatment and processing on cyanide safety and nutrition composition of cassava roots, millet and cowpea leaves flours. The study used three popular cassava varieties grown along the Kenyan coast, cowpea leaves (M66) grown as vegetable and pearl millet. The study used analytical techniques as guided by AOAC standard methods, to determine the nutritional composition of the individual crops while subjecting them to pre-treatment processes (blanching, peeling, washing, drying, and fermentation) and optimizing for maximum nutrient composition. The cyanide content ranged 7.8–9.5, 3.4–5.0, and 2.2–2.8 ppb for raw, untreated, and fermented cassava flours, respectively. The carbohydrates content was in the range of 35–37, 81.73–83.49, and 70.28–71.20% for raw cowpea leaves, cassava roots, and millet, respectively; the carbohydrate content for untreated flours was in the range of 35.68–35.19, 66.07–83.49, and 66.07–68.89% for cowpea leaves, cassava roots, and millet, respectively; the carbohydrate content for the fermented flours was in the range of 29.06–28.01, 79.68–84.36, and 69.08–70.12% for cowpea leaves, cassava roots, and millet, respectively. The protein content was in the range of 25.69–26.01, 1.2–18, and 11.1–13.3% for untreated cowpea, cassava, and millet flours, respectively; fermented flours protein content was in the range of 25.7–29.3, 1.3–2.2, and 8.5–11.1% cowpea, cassava, and millet flours, respectively. Iron and zinc contents were in the range of 4.31–9.04, 1.0–1.3; 7.98–7.89, 1.21–1.25; 6.58–8.23, 0.99–1.22 (mg/100 g dwb) for raw, untreated, and fermented cowpea flours, respectively. Pre-treatment had significant effects (P ≤ 0.05) on cyanide content and nutritional composition of each of the flours. Farmers should be trained to utilize such simple processing techniques.

Complementary feeding in Kongwa, Tanzania: Findings to inform a mycotoxin mitigation trial

Complementary feeding of 6‐ to 24‐month‐old infants and young children with adequate, safe and developmentally appropriate food is essential to child health. Inappropriate complementary foods and feeding practices are linked to the high incidences of undernutrition among infant and young children in most developing countries, including Tanzania. Mycotoxin risk is an additional concern, given the documented presence of aflatoxin and fumonisin in food systems of Africa, especially maize and groundnut. In preparation for a trial of mycotoxin mitigation, we conducted focus group discussions and recipe trials to explore complementary foods and feeding practices in Kongwa, a rural district of central Tanzania. Sixty mothers of infants from 6 to 18 months of age in five villages across the district were purposefully sampled. During focus group discussions, mothers reported to mostly feed their children with cereal and groundnut‐based foods as thin or thick porridges. The most common porridge preparations contained cereal (mostly, maize) ranging from 66.7% to 80.0% by weight and groundnuts from 7.7% to 33.3%. The ratio of cereal to groundnut ranged from 3:1 to 4:1. For the recipe trial sessions, mothers chose similar ingredients reported during discussions to prepare complementary foods. The reliance on maize and groundnuts in complementary foods predisposes the children to undernutrition and exposure to aflatoxins and fumonisins. These formative research results suggest multiple intervention points to improve complementary feeding and reduce mycotoxin exposure in this population, including education messages package on feeding practices, mycotoxin control practices and complementary food formulation.

Prevalence and Determinants of Undernutrition among 6- to 59-Months-Old Children in Lowland and Highland Areas in Kilosa District, Tanzania: A Cross-Sectional Study

Background

Undernutrition is the most dominant form of malnutrition among children in developing countries. Studies conducted in Tanzania have reported high levels of undernutrition among children below five years of age. However, there is limited information on differences in stunting prevalence across agroecological zones. This study aimed to determine the prevalence of undernutrition and its determinants in the lowland and highland areas in Kilosa District, Tanzania.

Methods

A cross-sectional study was conducted in a sample of 200 randomly selected households from the lowland and 141 from the highland areas of Kilosa District in Morogoro Region, Tanzania. Sociodemographic, feeding practices, hygiene, and sanitation data were collected using a structured questionnaire. Weight and height of children were measured using a standard procedure, and age was calculated from the birth date obtained from the child growth card. Anthropometric data were analyzed by using Emergency Nutrition Assessment (ENA) software. The logistic regression model was used to explore the determinants of undernutrition.

Results

Prevalence of stunting, underweight, and wasting was 41.0%, 11.5%, and 2.5% in lowland and 64.5%, 22.0%, and 1.4% in highland areas, respectively. The prevalence of stunting and underweight was higher in the highland compared to the lowland areas (p < 0.001). Significant determinants of underweight were areas of residence (AOR 4.21, 95% CI: 1.62–10.9), age of the children (AOR 5.85, 95% CI: 1.81–18.97), and child birth weight (AOR, 4.98 95% CI: 1.65–15.05), while determinants of stunting were the area of residence (AOR, 2.77 95% CI: 1.43–5.36), maternal age (AOR, 0.33 95% CI: 0.14–0.79), sex of a child (AOR, 1.89 95% CI: 1.03–3.50), and child birth weight (AOR, 3.29 95% CI: 1.21–8.97).

Conclusion

The prevalence of undernutrition, especially stunting and underweight, was high in the study areas. Determinants of stunting differed between highlands and lowland areas, highlighting the needs of having properly integrated interventions based on the geographical location.

Feeding practices for toddlers with stunting in Jakarta: A case study

Stunting represents a child's failure to thrive. On the basis of the World Health Organization child growth standards, stunting is a height of <-2 SD of the z-score for the child's age. There are several major causes of stunting. One is the inability to optimize child feeding practices. The aim of this study was to explore the feeding practices that lead to stunting in toddlers in Jakarta. The participants in this study were 15 mothers. Content analysis was the method that was chosen for this study. The data analysis revealed four themes that describe the feeding practices for toddlers with stunting in Jakarta: i) mothers providing instant porridge and ready-to-serve steamed chicken rice; ii) a feeding frequency of small portions only 2-3 times per day; iii) a lack of diet diversity; and iv) the suboptimal intake of iron-rich foods. The provision of effective education about appropriate feeding practices to pregnant women and mothers with toddlers is expected to reduce the incidence of stunting in Indonesia.

The influence of dietary diversity on the nutritional status of children between 6 and 23 months of age in Tanzania

BACKGROUND

Undernutrition poses a serious health challenge in developing countries and Tanzania has the highest undernutrition burden of Eastern and Southern Africa. Poor infant and young child feeding practices have been identified as the main causes for undernutrition. As dietary diversity is a major requirement if children are to get all essential nutrients, it can thus be used as one of the core indicators when assessing feeding practices and nutrition of children. Therefore, adequate information on the association between dietary diversity and undernutrition to identify potential strategies for the prevention of undernutrition is critical. Here we examined to what extent dietary diversity is associated with undernutrition among children of 6 to 23 months in Tanzania.

METHODS

Using existing data from the Tanzania Demographic and Health Survey of 2015-2016, we carried out secondary data analysis. Stunting, Wasting and Underweight of the surveyed children were calculated from Z-scores of Height-for-age (HAZ), Weight-for-height (WHZ) and Weight-for-age (WAZ) based on 2006 WHO standards. A composite dietary diversity score was created by summing the number of food groups eaten the previous day as reported for each child by the mother ranging from 0 to 7. Then, minimum dietary diversity (MDD) of 4 food groups out of seven was used to assess the diversity of the diet given to children. Bivariate and multivariate logistic regression techniques were used to assess the crude and adjusted odds ratios of stunting, wasting and being underweight.

RESULTS

A total of 2960 children were enrolled in this study. The prevalence of stunting was 31%, wasting 6% and underweight 14%. Among all children, 51% were female and 49% male. The majority (74%) of children did not reach the MDD. The most commonly consumed types of foods were grains, roots and tubers (91%), and Vitamin A containing fruits and vegetables (65%). The remaining food groups were reported to be consumed by a much lower proportion of children, including eggs (7%), meat and fish (36%), milk and dairy products (22%), as well as legumes and nuts (35%), and other vegetables (21%). Consumption of a diverse diet was significantly associated with a reduction of stunting, wasting and being underweight in children. The likelihood of being stunted, wasted and underweight was found to decrease as the number of food groups consumed increased. Children who did not receive the MDD had a significantly higher likelihood of being stunted (AOR = 1.37, 95% CI; 1.13-1.65) and underweight (AOR = 1.49, 95% CI; 1.15-1.92), but this was not the case for wasting. Consumption of animal-source foods has been found to be associated with reduced stunting among children.

CONCLUSION

Consumption of a diverse diet is associated with a reduction in undernutrition among children of 6 to 23 months in Tanzania. Measures to improve the type of complementary foods in order to meet the energy and nutritional demands of children should be considered in Tanzania.

Determinants of infant nutrition status in rural farming households before and after harvest

Infant and young child feeding (IYCF) practices determine infant growth, development and health. Despite global recommendations for exclusive breastfeeding until 6 months, adherence rates are low worldwide for different reasons, largely dependent on environment. In low-income countries, inappropriate IYCF leads to poor nutrition status. This study examined IYCF practices and nutrition outcomes in rural farming households in Tanzania before and after harvest. Mothers and their infants were recruited from two regions in Tanzania. Demographics, health status, IYCF practices, anthropometrics and haemoglobin were measured; preharvest and postharvest. Regression analysis modelled the relationship between IYCF and nutrition outcomes. Despite high rates of breastfeeding a large proportion did not meet early initiation of breastfeeding and minimum acceptable diet standards. Undernutrition was high with 30-40% of infants classified as stunted depending on season, and the majority (81%) were anaemic. Early initiation of breastfeeding was associated with higher Length-for-age z-score and weight-for-age z-score and lower risk of stunting and underweight (p < 0.05). The introduction of fluids other than breast milk in the first 3 days after birth was associated with lower weight-for-age z-score and increased underweight (p < 0.05). Maternal age and height were strongly and positively associated with child anthropometrics. Findings confirm the importance of early infant feeding practices for growth and development and emphasize the significance of mother's nutrition status in relation to infant health. Future interventions should focus on improving maternal nutrition status before, during and after pregnancy as well as educating and supporting mothers to adopt appropriate infant feeding including breastfeeding practices for the prevention of undernutrition.

Use of chicken eggshell to improve dietary calcium intake in rural sub-Saharan Africa

Undernutrition resulting from inadequate access to high‐quality, nutritious food is a widespread issue in sub‐Saharan Africa impacting the health and survival of mothers and their children. Inadequate dietary intake leads to a deficiency in nutrients including calcium, required for growth and physiological functioning. This study investigated the potential of increasing dietary calcium intake by the addition of heat‐treated ground eggshell to locally prepared food. A mixed methods approach of literature review, Delphi expert survey and focus group discussions with women of childbearing age in rural Tanzania, were used to assess the practicality, safety, and acceptability of consumption of ground eggshell. Chicken eggshell has high calcium content (380 mg of calcium/gram) and bioavailability comparable to calcium carbonate (~39%) with 1 g sufficient to provide one half of a sub‐Saharan African adult female's dietary calcium needs. Salmonella was indicated as the most likely threat to human health through eggshell consumption. Experts agreed that eggshells boiled for 10 min when preparing hard‐boiled eggs with a further 20 min cooking of crushed eggshell in staple foods would eliminate identified egg‐associated pathogens. Five focus groups (n = 46) indicated eggshells were perceived as waste. However, there was an indication of general acceptance of the approach and a willingness to consider the incorporation of ground eggshells into their diets. Development of suitable communication methods are required to convey benefits and safe preparation methods. Ground eggshell could be a highly equitable method of increasing calcium intakes across rural sub‐Saharan Africa where calcium intake is low and village poultry ownership common.

Maternal perceptions of breastfeeding and infant nutrition among a select group of Maasai women

Background

Adverse health outcomes are higher among Maasai children in the Ngorongoro Conservation Area compared to other co-located ethnic groups and regions of Tanzania. The Mama Kwanza Socioeconomic Health Initiative, a Canadian-Tanzanian partnership delivering healthcare at clinics in this region, gathered perceptions of mothers regarding breastfeeding and infant nutrition in order to inform culturally sensitive, realistic, and effective health promotion efforts.

Methods

A qualitative description approach was used in interviewing 30 Maasai mothers of infants zero to six months of age to explore their infant feeding practices, beliefs, knowledge, and recommendations to support breastfeeding. A local research team was trained to conduct and transcribe the interviews and assist with data interpretation. Qualitative content analysis was used in analyzing the interview transcripts.

Results

Lactation is universal in this culture with all the mothers planning to breastfeed for at least one year and most having initiated breastfeeding within one hour of birth. Lactation skills and knowledge are passed down intergenerationally from the elder women. None of the infants less than six months were exclusively breastfed, with a variety of liquid and semi-solid supplements given. Mothers perceived their milk alone was nutritionally insufficient with maternal dietary deficiencies cited as a factor.

Conclusions

While there is a strong breastfeeding culture among the Maasai in Ngorongoro, intersectoral efforts are required to provide culturally respectful health education on the benefits of exclusive breastfeeding and to ensure the maternal dietary adequacy required to achieve this goal. The findings reinforce the importance of international health projects adapting health promotion initiatives to local realities and beliefs in efforts to improve maternal child health.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-2165-7) contains supplementary material, which is available to authorized users.

Prevalence and predictors of undernutrition among underfive children in Arusha District, Tanzania

Childhood undernutrition is a global health challenge impacting child growth and survival rates. This deficit in nutritional status contributes to the increasing chronic disease prevalence and economic burden in individuals and throughout developing contexts. A community‐based cross‐sectional study was conducted in Arusha District of Tanzania to determine the prevalence and predictors of undernutrition in 436 children. A structured questionnaire was used to collect data on demographic and socio‐economic factors as well as feeding practices and prevalence of preventable childhood diseases. Anthropometric data were collected through the measurement of length/height and weight of all children. The prevalence of undernutrition was estimated based on Z‐scores indices below −2SD of the reference population for weight for age (underweight), height for age (stunting), and weight for height (wasting). Fifty percent, 28%, and 16.5% of the children were stunted, underweight, and wasted, respectively. The age above 2 years and being a male were associated with stunting. The age above 2 years, nonexclusive breastfeeding children, and living at Seliani and Oturumeti were associated with being underweight. Similarly, morbidity, none exclusively breastfed children, living at Oturumeti, and being born to a mother 35 years and above were associated with wasting. In this study, we found the prevalence of child undernutrition in Arusha District is high in comparison with national and regional trends and appears to be associated with being a male. It is recommended that nutritionists and health planners should focus on these key predictors when planning nutrition interventions to address the problem of undernutrition among underfive children in Arusha District.

Exposure to aflatoxin and fumonisin in children at risk for growth impairment in rural Tanzania

Growth impairment is a major public health issue for children in Tanzania. The question remains as to whether dietary mycotoxins play a role in compromising children's growth. We examined children's exposures to dietary aflatoxin and fumonisin and potential impacts on growth in 114 children under 36 months of age in Haydom, Tanzania. Plasma samples collected from the children at 24 months of age (N = 60) were analyzed for aflatoxin B₁-lysine (AFB₁-lys) adducts, and urine samples collected between 24 and 36 months of age (N = 94) were analyzed for urinary fumonisin B₁ (UFB₁). Anthropometric, socioeconomic, and nutritional parameters were measured and growth parameter z-scores were calculated for each child. Seventy-two percent of the children had detectable levels of AFB₁-lys, with a mean level of 5.1 (95% CI: 3.5, 6.6) pg/mg albumin; and 80% had detectable levels of UFB₁, with a mean of 1.3 (95% CI: 0.8, 1.8) ng/ml. This cohort had a 75% stunting rate [height-for-age z-scores (HAZ) < -2] for children at 36 months. No associations were found between aflatoxin exposures and growth impairment as measured by stunting, underweight [weight-for-age z-scores (WAZ) < -2], or wasting [weight-for-height z-scores (WHZ) < -2]. However, fumonisin exposure was negatively associated with underweight (with non-detectable samples included, p = 0.0285; non-detectable samples excluded, p = 0.005) in this cohort of children. Relatively low aflatoxin exposure at 24 months was not linked with growth impairment, while fumonisin exposure at 24-36 months based on the UFB₁ biomarkers may contribute to the high growth impairment rate among children of Haydom, Tanzania; which may be associated with their breast feeding and weaning practices.

The Challenges of Providing Postpartum Education in Dar es Salaam, Tanzania: Narratives of Nurse-Midwives and Obstetricians

Postpartum education can save lives of mothers and babies in developing countries, and the World Health Organization recommends all mothers receive three postpartum consultations. More information is needed to better understand how postpartum education is delivered and ultimately improves postpartum health outcomes. The purpose of this qualitative study was to examine how postpartum care was delivered in three postnatal hospital clinics in Dar es Salaam, Tanzania. Semistructured interviews with 10 nurse-midwives and three obstetricians were conducted. Feminist poststructuralism guided the research process. Postpartum education was seen to be an urgent matter; there was a lack of supportive resources and infrastructure in the hospital clinics, and nurse-midwives and obstetricians had to negotiate conflicting health and traditional discourses using various strategies. Nurse-midwives and obstetricians are well positioned to deliver life-saving postpartum education; however, improvements are required including increased number of nurse-midwives and obstetricians.

Complementary Feeding and Diarrhea and Respiratory Infection Among HIV-Exposed Tanzanian Infants

OBJECTIVE

To examine the association between complementary feeding and risks of diarrhea and acute respiratory infection (ARI) among HIV-exposed infants aged 6-24 months.

DESIGN

We prospectively used an Infant and Child Feeding Index (ICFI) to measure complementary feeding practices (breastfeeding status, food consistency, dietary diversity, food group frequency, and meal frequency). We determined the association of ICFI and each of its components with the risk of diarrhea and ARI. Generalized estimating equations were used to estimate the relative risks for morbidity episodes.

SETTING

Dar es Salaam, Tanzania.

SUBJECTS

A total of 2092 HIV-exposed infants followed from 6 months of age to 24 months of age.

RESULTS

The ICFI score ranged from 0 to 9; the median score was 6 (interquartile range = 4-7). Low ICFI scores were likely associated with increased risk of dysentery [low vs. high tertile risk ratio (RR): 1.40; 95% confidence interval (CI): 0.93 to 2.10; P for trend = 0.02] and respiratory infection (low vs. high tertile RR: 1.16; 95% CI: 0.96 to 1.41; P for trend = 0.01). Low dietary diversity scores were likely associated with higher risk of dysentery (low vs. high tertile RR: 1.47; 95% CI: 0.92 to 2.35; P for trend = 0.03) and respiratory infection (low vs. high tertile RR: 1.41; 95% CI: 1.13 to 1.76; P for trend = 0.01). Low food consistency scores were associated with higher risk of respiratory infection (RR: 1.77; 95% CI: 1.40 to 2.26; P < 0.01).

CONCLUSIONS

In this setting, low ICFI, dietary diversity, and food consistency scores were likely associated with increased risk of diarrhea and ARI among HIV-exposed infants.

Dietary practices and nutritional status of under-five children in rural and urban communities of Lagos State, Nigeria

Background:

Evidence shows that urban children generally have a better nutritional status than their rural counterparts. However, data establishing whether this difference in prevalence of undernutrition could be ascribed to difference in dietary practices are few.

Objective:

The aim of this study was to compare dietary practices and nutritional status of children in rural and urban communities of Lagos State, Nigeria.

Methods:

This was a comparative-analytical study conducted using the multistage sampling technique to select the study cases. A total of 300 mother–child pairs were studied, including 150 each from rural and urban communities. Data collected include demographics, socioeconomic characteristics, feeding practices and anthropometric measurements of the participants. Food intake data were collected using 24-h dietary recall. Malnutrition in children was determined by calculating the prevalence of low height-for-age (stunting), low weight-for-age (underweight), and low weight-for-height (wasting) using the World Health Organization cutoff points.

Results:

The prevalence of exclusive breastfeeding for 6 months (25.3% vs. 28.7%; P = 0.516), use of formula feeds (48.7% vs. 44%; P = 0.077), and mean age of child at introduction of semisolid foods (7.54 ± 4.0 months vs. 8.51 ± 7.3 months; P = 0.117) were not significantly different between urban and rural communities. The diversity of food choices and frequencies of consumption were similar between urban and rural communities. However, prevalence levels of underweight and stunted children were significantly higher in rural than that of urban communities (19.4% vs. 9.3%, P < 0.001 and 43.3% vs. 12.6%, P < 0.001, respectively).

Conclusions:

Other risk factors besides inappropriate feeding practices need to be considered for higher prevalence of undernutrition among children in rural communities.