223 Joint Aspirations for Suspected Native Septic Arthritis: A Retrospective Audit of the Diagnostic Accuracy of Aspirations and Clinical Factors Associated with a Diagnosis of Septic Arthritis

Aim

This study aimed to determine the diagnostic accuracy of native joint aspirations for adult septic arthritis (SA), and to determine clinical factors associated with a positive diagnosis of SA.

Method

Retrospective review of adult patients (≥16yrs) undergoing a major joint aspiration at a single centre over a year period (2019) were identified. Patient demographics, clinical and biochemical data, joint aspiration details, post-aspiration diagnosis, management and patient outcomes were recorded. Culture negative SA was defined as Newman's Criteria C or D.

Results

There were 161 native joint aspirations identified. The rate of positive diagnosis of SA was 13.0%, (n=21), with 16 (9.9%) culture positive SA and five (3.1%) culture negative SA. The presence of organisms on gram stain, high synovial white cell count (WCC), history of fever, intravenous drug use (IVDU) and previous SA diagnosis were associated with a diagnosis of SA (all p<0.05). A history of crystal arthropathy made the diagnosis of SA less likely (p=0.025). C-reactive protein (CRP) was not statistically different in the SA and non-SA groups (Area Under Curve of ROC=0.63, p=0.55).

Conclusion

Joint aspiration is still the preferred diagnostic test when it comes to accurately diagnosing native joint SA. However, while synovial culture and gram stain are pending, a high index of suspicion for SA can be based on a combination of patient's presenting symptoms (history of fever), previous SA or IVDU, and a high synovial WCC. These factors can aid the decision as to whether an emergency surgical washout of the joint is indicated.

Heterosis and Responses to Selection in Orange-Fleshed Sweetpotato (Ipomoea batatas L.) Improved Using Reciprocal Recurrent Selection

Sweetpotato is a highly heterozygous hybrid, and populations of orange-fleshed sweetpotato (OFSP) have a considerable importance for food security and health. The objectives were to estimate heterosis increments and response to selection in three OFSP hybrid populations (H1) developed in Peru for different product profiles after one reciprocal recurrent selection cycle, namely, H1 for wide adaptation and earliness (O-WAE), H1 for no sweetness after cooking (O-NSSP), and H1 for high iron (O-HIFE). The H1 populations were evaluated at two contrasting locations together with parents, foundation (parents in H0), and two widely adapted checks. Additionally, O-WAE was tested under two environmental conditions of 90-day and a normal 120-day harvest. In each H1, the yield and selected quality traits were recorded. The data were analyzed using linear mixed models. The storage root yield traits exhibited population average heterosis increments of up to 43.5%. The quality traits examined have exhibited no heterosis increments that are worth exploiting. The storage root yield genetic gain relative to the foundation was remarkable: 118.8% for H1-O-WAE for early harvest time, 81.5% for H1-O-WAE for normal harvest time, 132.4% for H1-O-NSSP, and 97.1% for H1-O-HIFE. Population hybrid breeding is a tool to achieve large genetic gains in sweetpotato yield via more efficient population improvement and allows a rapid dissemination of globally true seed that is generated from reproducible elite crosses, thus, avoiding costly and time-consuming virus cleaning of elite clones typically transferred as vegetative plantlets. The population hybrid breeding approach is probably applicable to other clonally propagated crops, where potential for true seed production exists.

Loop-Mediated Isothermal Amplification assays for on-site detection of the main sweetpotato infecting viruses

Globally, Sweet potato feathery mottle virus (SPFMV) and Sweet potato chlorotic stunt virus (SPCSV) occur frequently and in combination cause sweetpotato virus disease (SPVD). Many viral diseases are economically important and negatively impact the production and movement of germplasm across regions. Rapid detection of viruses is critical for effective control. Detection and quantification of viruses directly from sweetpotato remains a challenge. Current diagnostic tests are not sensitive enough to reliably detect viruses directly from the plant or require expensive laboratory equipment and expertise to perform. We developed a simple and rapid loop-mediated isothermal amplification (LAMP) assay for the detection of SPFMV, SPCSV and begomoviruses related to sweet potato leaf curl virus (SPLCV). Laboratory validation recorded 100 % diagnostic sensitivity for all the three viruses. The LAMP assays were customized for field testing using a lyophilized thermostable isothermal master mix in a ready-to-use form that required no cold chain. The average time to positivity (TTP) was: SPFMV 5-30 min, SPCSV 15-43 min s and begomoviruses 28-45 mins. LAMP on-site testing results were comparable to PCR and RT-PCR confirmatory laboratory tests. The LAMP assay is a powerful tool for rapid sweetpotato virus detection at a reasonable cost and thus could serve as quality control systems for planting materials.

Breeding Progress for Vitamin A, Iron and Zinc Biofortification, Drought Tolerance, and Sweetpotato Virus Disease Resistance in Sweetpotato

Sweetpotato is a resilient food crop with great potential to contribute to reduced hunger in the world. Sweetpotato shows significant potential to contribute to reducing the Global Hunger Index, which reflects deficiencies in calories and micronutrients based on the components of hunger, undernourishment, under-five mortality rate, stunting and wasting. Its genetic diversity has been harnessed through breeding to increase vitamin A, iron, and zinc content, virus resistance and climate resilience for the world's food needs. Africa and India are the most food-insecure regions. The main objectives of this research were to: provide information and a knowledge base on sweetpotato breeding in Africa for biofortification of vitamin A, iron, and zinc, drought tolerance and virus resistance; recommend procedures for generating new breeding populations and varieties; and develop new tools, technologies and methods for sweetpotato improvement. The research was implemented between 2009 and 2020 in 14 collaborating African countries using introduced and local genotypes. The redesigned accelerated breeding scheme resulted in increased genetic gains for vitamin A, iron, zinc contents and virus resistance, and the release by sub-Saharan African countries of 158 varieties; 98 of them orange-fleshed; 55 varieties bred by an accelerated breeding scheme; 27 drought-tolerant and two with enhanced iron and zinc content. Our experience has demonstrated that through the use of more optimized, standardized and collaborative breeding procedures by breeding programs across Africa, it is possible to speed official sweetpotato variety release and contribute to reducing the severe micronutrient deficiencies on the continent.

Review of knowledge to guide product development and breeding for sweetpotato frying quality in West Africa

This review provides background about sweetpotato in West Africa to identify the current importance and future potential of sweetpotato fried products in the region. We drew on global literature to consider current best practices and health aspects in addition to information from West Africa where frying in the form of large wedges or 'chunk fries' is predominant over other forms (i.e. chips (often referred to as crisps in England and the Commonwealth) and 'French fries'). Chunk fries are produced mostly by female-run microenterprises selling them as a filling snack to roadside and market customers. Boiling, drying and reconstituting in various foods, pounding and consumption of leaves as a vegetable are also important in the region. Further research will inform the development of a product profile for chunk fried sweetpotato and inform breeding strategies to improve sweetpotato for frying and other uses.

Fried sweetpotato user preferences identified in Nigeria and Ghana and implications for trait evaluation

Fried sweetpotato quality is important for variety adoption in West Africa. To inform breeding efforts, the study developed a product profile for sweetpotato chunk fries using mixed qualitative and quantitative methods. Root characteristics, processing attributes, in-mouth attributes and appearance of fried product were critical to final product quality. Raw roots should be hard, have smooth skin and no off-odours. Peeled roots should be hard to slice and not sticky. Stickiness and moist surface indicate high moisture content, associated with excessive oil absorption during frying. Hard to slice roots connote high dry matter. Fried product should be crisp, slightly sugary and mealy, have a uniform colour with brown tint and not be soggy. Crispness, mealiness and short frying time with limited oil absorption may be functions of starch. Understanding starch characteristics and other attributes that contribute to quality fried sweetpotato is critical for breeding sweetpotato genotypes with superior quality for frying.

Sensory characteristics and consumer segmentation of fried sweetpotato for expanded markets in Africa

Prepared foods are increasing in popularity in West Africa alongside rapid urbanisation. Growing demand for fried products calls for targeted breeding efforts to meet consumer needs, but little is known regarding consumer preferences. This research identified the sensory attributes of fried sweetpotato preferred by different consumer groups using a combination of consumer acceptance testing and descriptive sensory analysis. Market and community surveys identified three consumer segments in Ghana and Nigeria with contrasting preferences for fried sweetpotato sensory attributes. One group preferred crispy, crunchy, mealy and sweet fried sweetpotato; another preferred characteristic yam flavour and dry texture; and the third preferred uniform orange colour appearance, ripe plantain flavour and palm nutty flavour. Such consumer segmentation can help emerging West African fried sweetpotato industries identify target markets and provides valuable information to breeders, growers and retailers to prioritise attributes in their breeding, growing or product sourcing decisions.

Efficiency of the Polycross and Controlled Hybridization Methods in Sweetpotato Breeding in Uganda

Sweetpotato is an important crop in many parts of the world especially in developing countries. It is used for both human consumption as well as livestock feed. It is an important source of carbohydrates, vitamin C, fibre, iron, potassium, protein and β-carotene. Its production is, however, constrained by several biotic and abiotic factors, including pests and diseases, low soil fertility, drought, cold and salinity. Breeding is one of the ways to overcome some of these constraints and in sweetpotato the polycross or controlled cross methods can be used. To determine which of the two methods was more efficient, genotypes generated by both methods were evaluated over two seasons at Namulonge and Kachwekano. The type of cross (polycross or controlled) was significantly (P ≤ 0.05) different for storage root yield, response to sweetpotato virus disease, Alternaria blight, and harvest index (HI). The controlled cross families had a significantly higher mean HI of 43.2% than the polycross families with a mean HI of 31.8%. Therefore, controlled crosses could be deployed to systematically increase the HI in sweetpotato breeding populations. Significant (P ≤ 0.05) differences were observed among families for all traits. This stresses that the parents used in a cross are very important in generating genotypes with desired attributes. It was apparent that both the polycross and controlled crosses are good methods for generating new sweetpotato genotypes in a sweetpotato breeding program. Where aggregate performance was considered (selection index) the controlled crosses method produced more (75% of the top 20 desirable genotypes) than the polycross method across the two sites. However, the best three genotypes over the two sites were from the polycross family of Ejumula. Therefore, sweetpotato controlled crosses could be very useful for population improvement using recurrent selection while polycrosses could be suitable for variety development. Both hybridization methods require cautious selection of parents to match the breeding objectives.

Do Market-oriented Engendered Agriculture-health Interventions Affect Household Nutrition Outcomes: Evidence from an Orange-fleshed Sweetpotato Project in Rwanda

The number of agricultural interventions promoting biofortified crops as a strategy to combat micronutrient malnutrition have increased significantly during the past decade. These interventions aim to improve the intake of key nutrients and sometimes other nutrition outcomes. In this study, we assess the impact of a market-oriented gender-sensitive agriculture-health project on household food consumption and food security. We use gender-disaggregated data from 842 sweetpotato farmers and a series of econometric techniques to assess the project's impact on food consumption household food security. The study finds unambiguous and strong impact of the project on both household food consumption and food security. Moreover, female-headed participant households benefitted much more from participation than did male-headed households. We further find that nonparticipant households would also have benefitted had they participated. The findings imply the importance of designing market-focused projects with a gender lens. They also imply that market-oriented agriculture-sensitive interventions do not necessarily harm the nutritional status of farm households.

Iron Absorption from Iron-Biofortified Sweetpotato Is Higher Than Regular Sweetpotato in Malawian Women while Iron Absorption from Regular and Iron-Biofortified Potatoes Is High in Peruvian Women

BACKGROUND

Sweetpotato and potato are fast-maturing staple crops and widely consumed in low- and middle-income countries. Conventional breeding to biofortify these crops with iron could improve iron intakes. To our knowledge, iron absorption from sweetpotato and potato has not been assessed.

OBJECTIVE

The aim was to assess iron absorption from regular and iron-biofortified orange-fleshed sweetpotato in Malawi and yellow-fleshed potato and iron-biofortified purple-fleshed potato in Peru.

METHODS

We conducted 2 randomized, multiple-meal studies in generally healthy, iron-depleted women of reproductive age. Malawian women (n = 24) received 400 g regular or biofortified sweetpotato test meals and Peruvian women (n = 35) received 500 g regular or biofortified potato test meals. Women consumed the meals at breakfast for 2 wk and were then crossed over to the other variety. We labeled the test meals with 57Fe or 58Fe and measured cumulative erythrocyte incorporation of the labels 14 d after completion of each test-meal sequence to calculate iron absorption. Iron absorption was compared by paired-sample t tests.

RESULTS

The regular and biofortified orange-fleshed sweetpotato test meals contained 0.55 and 0.97 mg Fe/100 g. Geometric mean (95% CI) fractional iron absorption (FIA) was 5.82% (3.79%, 8.95%) and 6.02% (4.51%, 8.05%), respectively (P = 0.81), resulting in 1.9-fold higher total iron absorption (TIA) from biofortified sweetpotato (P < 0.001). The regular and biofortified potato test meals contained 0.33 and 0.69 mg Fe/100 g. FIA was 28.4% (23.5%, 34.2%) from the regular yellow-fleshed and 13.3% (10.6%, 16.6%) from the biofortified purple-fleshed potato meals, respectively (P < 0.001), resulting in no significant difference in TIA (P = 0.88).

CONCLUSIONS

FIA from regular yellow-fleshed potato was remarkably high, at 28%. Iron absorbed from both potato test meals covered 33% of the daily absorbed iron requirement for women of reproductive age, while the biofortified orange-fleshed sweetpotato test meal covered 18% of this requirement. High polyphenol concentrations were likely the major inhibitors of iron absorption. These trials were registered at www.clinicaltrials.gov as NCT03840031 (Malawi) and NCT04216030 (Peru).

Storage Root Yield of Sweetpotato as Influenced by Sweetpotato leaf curl virus and Its Interaction With Sweetpotato feathery mottle virus and Sweetpotato chlorotic stunt virus in Kenya

In this study, the effect of a Kenyan strain of Sweetpotato leaf curl virus (SPLCV) and its interactions with Sweetpotato feathery mottle virus (SPFMV) and Sweetpotato chlorotic stunt virus (SPCSV) on root yield was determined. Trials were performed during two seasons using varieties Kakamega and Ejumula and contrasting in their resistance to sweetpotato virus disease in a randomized complete block design with 16 treatments replicated three times. The treatments included plants graft inoculated with SPLCV, SPFMV, and SPCSV alone and in possible dual or triple combinations. Yield and yield-related parameters were evaluated at harvest. The results showed marked differences in the effect of SPLCV infection on the two varieties. Ejumula, which is highly susceptible to SPFMV and SPCSV, suffered no significant yield loss from SPLCV infection, whereas Kakamega, which is moderately resistant to SPFMV and SPCSV, suffered an average of 47% yield loss from SPLCV, despite only mild symptoms occurring in both varieties. These results highlight the variability in yield response to SPLCV between sweetpotato cultivars as well as a lack of correlation of SPLCV-related symptoms with yield reduction. In addition, they underline the lack of correlation between resistance to the RNA viruses SPCSV and SPFMV and the DNA virus SPLCV.[Formula: see text] Copyright © 2020 The Author(s). This is an open access article distributed under the CC BY 4.0 International license.

Understanding innovation: The development and scaling of orange-fleshed sweetpotato in major African food systems

The development and scaling of orange-fleshed sweetpotato (OFSP) during the past 25 years is a case study of a disruptive innovation to address a pressing need - the high levels of vitamin A deficiency among children under five years of age in sub-Saharan Africa. When the innovation was introduced consumers strongly preferred white or yellow-fleshed sweetpotato, so it was necessary to create a demand to respond to that need. This was at odds with the breeding strategy of responding to consumers' demands. Additional elements of the innovation package include seed systems and nutrition education to create the awareness amongst consumers of the significant health benefits of OFSP. Complementary innovation is required in promotion and advocacy to ensure a supportive institutional environment. Four dimensions-- technical, organizational, leadership, and institutional environment-- are explored across five distinct phases of the innovation process, from the emergence of the innovative idea (1991-1996) through scaling phase in 15 countries under a major institutional innovation (2015-mid-2019), the Sweetpotato for Profit and Health Initiative (SPHI). Systematically gathering evidence of nutritional impact and ability to scale cost-effectively was requisite for obtaining support for further development and diffusion of the crop. Positive findings from a major study coincided with a major change in the institutional environment which placed agriculture and nutrition at the forefront of the development agenda, resulting in an inflection point in both research and diffusion investment. The role of committed leadership during all phases was critical for success, but particularly during the first decade of limited support in a challenging institutional environment. The most critical technical achievement underpinning scaling was moving from 2 to 13 African countries having local breeding programs. Evidence is presented that adapted, well performing varieties which consumers prefer is the foundation for successful scaling to occur. Building a cadre of within country and regional advocates was critical for getting sustained commitment and local buy-in to the concept of biofortification by regional bodies and governments, which in turn built within country ownership and the willingness of donors to invest. The SPHI united diverse organizations under a common vision with a simple metric--- the number of households reached with improved varieties of sweetpotato. Since 2009, 6.2 million households were reached by July 2019 in 15 SSA countries. Much more remains to be done. Advocacy efforts led to the integration of nutritious foods into many national and regional policies, setting the stage for further investment.

Variance component estimations and mega-environments for sweetpotato breeding in West Africa

The current study was aimed at identifying mega-environments in Ghana and evaluating adaptability of superior sweetpotato [Ipomoea batatas (L.) Lam.] genotypes from a targeted breeding effort. Three sets of genotypes were evaluated in multi-environment trials (MET). Twelve sweetpotato varieties were evaluated across nine environments representing the main agro-ecological zones in Ghana. MET analysis was conducted using a stage-wise approach with the genotype × environment (G × E) table of means used as a starting point to model the G × E interaction for sweetpotato yield. Emphasis was given to the genetic correlation matrix used in a second-order factor analytic model that accommodates heterogeneity of genetic variances across environments. A genotype main effect and G × E interaction of storage root yield explained 82% of the variation in the first principal component, and visualized the genetic variances and discriminating power of each environment and the genetic correlation between the environments. Two mega-environments, corresponding to northern and southern trial sites, were delineated. Six breeding lines selected from the south and eight breeding lines selected from the north were tested and compared to two common check clones at five locations in Ghana. A Finlay-Wilkinson stability analysis resulted in stable performances within the target mega-environment from which the genotypes were selected, but predominantly without adaptation to the other region. Our results provide a strong rationale for running separate programs to allow for faster genetic progress in each of these two major West African mega-environments by selecting for specific and broad adaptation.

Nutrition and food security impacts of quality seeds of biofortified orange-fleshed sweetpotato: Quasi-experimental evidence from Tanzania

This study examined the nutrition and food security impacts of a project that was designed to improve availability of disease-free planting materials of biofortified orange-fleshed sweetpotato (OFSP) in rural Tanzania. Difference-in-difference and matching techniques were employed to estimate causal effects using panel data. Participation in the project increased agronomic and nutritional knowledge of households, raised uptake rate for OFSP varieties, and improved food security status. Effects on nutrition are, however, weak. These results suggest that timely access to quality seeds accompanied by a transfer of skills is important to reduce barriers to adoption of biofortified crops with resulting positive effects on the welfare of rural households. Adequate promotion of both agronomic and nutrition aspects of the technologies may enhance nutrition effects.

What is the cost of integration? Evidence from an integrated health and agriculture project to improve nutrition outcomes in Western Kenya

Integrated nutrition and agricultural interventions have the potential to improve the efficiency and effectiveness of investments in food security and nutrition. This article aimed to estimate the costs of an integrated agriculture and health intervention (Mama SASHA) focused on the promotion of orange-fleshed sweet potato (OFSP) production and consumption in Western Kenya. Programme activities included nutrition education and distribution of vouchers for OFSP vines during antenatal care and postnatal care (PNC) visits. We used expenditures and activity-based costing to estimate the financial costs during programme implementation (2011-13). Cost data were collected from monthly expense reports and interviews with staff members from all implementing organizations. Financial costs totalled US$507 809 for the project period. Recruiting and retaining women over the duration of their pregnancy and postpartum period required significant resources. Mama SASHA reached 3281 pregnant women at a cost of US$155 per beneficiary. Including both pregnant women and infants who attended PNC services with their mothers, the cost was US$110 per beneficiary. Joint planning, co-ordination and training across sectors drove 27% of programme costs. This study found that the average cost per beneficiary to implement an integrated agriculture, health and nutrition programme was substantial. Planning and implementing less intensive integrated interventions may be possible, and economies of scale may reduce overall costs. Empirical estimates of costs by components are critical for future planning and scaling up of integrated programmes.

Comparative analysis for producing sweetpotato pre-basic seed using sandponics and conventional systems

In Sub-Saharan Africa, sweetpotato pre-basic seed is multiplied in screenhouses using a sterilized soil substrate. This is expensive and unsustainable. The use of sand substrate with a fertigation system ("sandponics"), is an alternative. The study compared the cost-effectiveness for pre-basic seed production using the sandponics system to the conventional soil substrate for four genotypes. A randomized complete block split plot design was used, and data collected on vine traits over six harvests. Real-time cost data were collected for cost-effectiveness analysis. Results showed a highly significant (p < .0001) 21.8% increase in the vine multiplication rate under the sandponics system. The cost of producing one sweetpotato node in sandponics was significantly lower by 0.009 US$. The cost-effectiveness of producing pre-basic seed in sandponics varied among the genotypes. The future use of sandponics is discussed with respect to the availability of soluble inorganic fertilizers, varietal specific response to nutrients, and labor implications.

Tackling vitamin A deficiency with biofortified sweetpotato in sub-Saharan Africa

Orange-fleshed sweetpotato (OFSP) is a rich plant-based source of beta-carotene, which the body converts into vitamin A. In sub-Saharan Africa, sweetpotato is known as a food security crop but most varieties grown are high dry matter white-fleshed types, lacking beta-carotene. In 1995, researchers recognized the potential of OFSP varieties to address widespread vitamin A deficiency in SSA using an integrated agriculture-nutrition approach. With their partners, they confronted conventional wisdom concerning food-based approaches and institutional barriers, to build the evidence base and breed 42 OFSP varieties adapted to farmer needs and consumer preferences. Subsequently, a multi-partner, multi-donor initiative, launched in 2009, has already reached 2.8 million households. This review summarizes that effort describing how the changing policy environment influenced the process.

Ensuring the Supply of and Creating Demand for a Biofortified Crop with a Visible Trait: Lessons Learned from the Introduction of Orange-Fleshed Sweet Potato in Drought-Prone Areas of Mozambique

Background

Orange-fleshed sweet potato (OFSP) is a promising biofortified crop for sub-Saharan Africa because it has high levels of provitamin A carotenoids, the formed vitamin A is bioavailable, and white-fleshed sweet potato is already widely grown.

Objectives

To examine whether farmers will adopt varieties with a distinct visible trait, young children will eat OFSP in sufficient quantities to improve vitamin A intake, OFSP can serve as an entry point for promoting a more diversified diet, and lessons can be drawn to assure sustained adoption.

Methods

The 2-year quasi-experimental intervention study followed households and children ( n = 741; mean age, 13 months at baseline) through two agricultural cycles in drought prone-areas of Mozambique.

Results

OFSP is acceptable to farmers when introduced by using an integrated approach. In the second year, intervention children ( n = 498) were more likely than control children ( n = 243) to have consumed OFSP (54% vs. 4%), dark-green leaves (60% vs. 46%), or ripe papaya (65% vs. 42%) on 3 or more days in the previous week ( p < .001 for all comparisons). Their vitamin A intakes were nearly eight times higher than those of control children (median, 426 vs. 56 μg RAE [retinol activity equivalents], p < .001). Diet diversification was limited by difficult agroecological conditions and low purchasing power. However, dietary diversity was higher among intervention than control children (32% vs. 9% consuming food from more than four groups; p < .001).

Conclusions

An integrated OFSP-based approach had a positive impact on the vitamin A intake of young children. A market development component and improved vine multiplication systems are recommended to assure sustained adoption.

The Potential Contribution of Bread Buns Fortified with β-Carotene–Rich Sweet Potato in Central Mozambique

Background

Orange-fleshed sweet potato is an efficacious source of vitamin A. Substituting wheat flour with orange-fleshed sweet potato in processed products could reduce foreign exchange outlays, create new markets for producers, and result in increased vitamin A consumption among consumers provided there is adequate retention of β-carotene during processing.

Objective

To explore whether substituting 38% of wheat flour (by weight) in bread buns (“golden bread”) with boiled and mashed orange-fleshed sweet potato from fresh roots or rehydrated chips would produce economically viable β-carotene–rich products acceptable to Mozambican rural consumers.

Methods

Modified local recipes maximized sweet potato content within the limits of consumer acceptability. Sensitivity analysis determined parameters underlying economic viability. Two samples each of buns from five varieties of orange-fleshed sweet potato were analyzed for β-carotene content. Processed products with at least 15 μg/g product of trans-β-carotene were considered good sources of vitamin A.

Results

Golden bread made from fresh roots of medium-intensity orange-fleshed sweet potato varieties met the good source criterion, but bread from lighter-intensity sweet potato varieties did not. Bread from rehydrated dried chips was not economically viable. Consumers strongly preferred golden bread over pure wheat flour bread because of its heavier texture and attractive appearance. The ratio of the price of wheat flour to that of raw sweet potato root varied from 3.1 to 3.5 among the bakers, whose increase in profit margins ranged from 54% to 92%.

Conclusions

Golden bread is a good source of β-carotene and is economically viable when the price ratio of wheat flour to raw orange-fleshed sweet potato root is at least 1.5. Widespread adoption during sweet potato harvesting periods is feasible; year-round availability requires storage.

A food-based approach introducing orange-fleshed sweet potatoes increased vitamin A intake and serum retinol concentrations in young children in rural Mozambique

Vitamin A deficiency is widespread and has severe consequences for young children in the developing world. Food-based approaches may be an appropriate and sustainable complement to supplementation programs. Orange-fleshed sweet potato (OFSP) is rich in beta-carotene and is well accepted by young children. In an extremely resource poor area in Mozambique, the effectiveness of introduction of OFSP was assessed in an integrated agriculture and nutrition intervention, which aimed to increase vitamin A intake and serum retinol concentrations in young children. The 2-y quasi-experimental intervention study followed households and children (n = 741; mean age 13 mo at baseline) through 2 agricultural cycles. In y 2, 90% of intervention households produced OFSP, and mean OFSP plot size in intervention areas increased from 33 to 359 m(2). Intervention children (n = 498) were more likely than control children (n = 243) to eat OFSP 3 or more d in the last wk (55% vs. 8%, P < 0.001) and their vitamin A intakes were much higher than those of control children (median 426 vs. 56 microg retinol activity equivalent, P < 0.001). Controlling for infection/inflammation and other confounders, mean serum retinol increased by 0.100 micromol/L (SEM 0.024; P < 0.001) in intervention children and did not increase significantly in control subjects. Integrated promotion of OFSP can complement other approaches and contribute to increases in vitamin A intake and serum retinol concentrations in young children in rural Mozambique and similar areas in Sub-Saharan Africa.

Child anthropometry and mortality in Malawi: testing for effect modification by age and length of follow-up and confounding by socioeconomic factors

As shown in a review of 28 studies, anthropometric measurements of preschool-aged children are consistently related to the risk of subsequent mortality in community-based studies from Asia and Africa (Pelletier 1994). Although the results are consistent at this general level, a number of important questions remain concerning the relationship. The purpose of this study is to address two of these questions using data from a similar study conducted in rural northern Malawi: 1) In relation to screening, are the anthropometry-mortality relationships affected by the child's age and the interval between measurement and death ("length of follow-up") and 2) In relation to policy implications, is the anthropometry-mortality relationship due to confounding by socioeconomic factors, especially when considering mild-to-moderate malnutrition. The results reveal that mortality prediction is significantly affected by child's age and length of follow-up, but the strength and direction of this effect modification varies across the four commonly used anthropometric indicators [weight-for-age (WA), height-for-age (HA), weight-for-height (WH) and arm circumference-for-age (ACA)]. An important result for public health practice is that there are no statistically significant differences in prediction across these four indicators when applied to young children (6-23 mo) and employing a 1-y follow-up period. As regards confounding, the results indicate that the anthropometry-mortality relationship is not due to confounding by socioeconomic factors when all grades of malnutrition are considered. When only mild-to-moderate malnutrition is considered, statistically controlling for confounders reduces most of the anthropometric predictors to nonsignificance (probability values to > 0.20), but the strength of the association (odds ratio) remains of the same order of magnitude. However, when effect modification by child's age and length of follow-up is taken into account, the effect of mild-to-moderate malnutrition (WA and WH) remains statistically significant for young children dying with 1 y of follow-up.