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Desai A, Smith LE, Mbuya MNN, Chigumira A, Fundira D, Tavengwa NV, Malaba TR, Majo FD, Humphrey JH, Stoltzfus RJ. The SHINE Trial Infant Feeding Intervention: Pilot Study of Effects on Maternal Learning and Infant Diet Quality in Rural Zimbabwe. Clin Infect Dis 2016; 61 Suppl 7:S710-5. [PMID: 26602298 PMCID: PMC4657591 DOI: 10.1093/cid/civ846] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial is designed to measure the independent and combined effects of improved water, sanitation, and hygiene and improved infant feeding on child stunting and anemia in Zimbabwe. We developed and pilot-tested the infant feeding intervention delivered by 9 village health workers to 19 mothers of infants aged 7–12 months. Between September 2010 and January 2011, maternal knowledge was assessed using mixed methods, and infant nutrient intakes were assessed by 24-hour recall. We observed positive shifts in mothers' knowledge. At baseline, 63% of infants met their energy requirement and most did not receive enough folate, zinc, or calcium; none met their iron requirement. Postintervention, all infants received sufficient fat and vitamin A, and most consumed enough daily energy (79%), protein (95%), calcium (89%), zinc (89%), folate (68%), and iron (68%). The SHINE trial infant feeding intervention led to significant short-term improvements in maternal learning and infant nutrient intakes.
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Affiliation(s)
- Amy Desai
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura E Smith
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Mduduzi N N Mbuya
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Division of Nutritional Sciences, Cornell University, Ithaca, New York Zvitambo Institute for Maternal and Child Health Research
| | | | - Dadirai Fundira
- Division of Nutritional Sciences, Cornell University, Ithaca, New York Zvitambo Institute for Maternal and Child Health Research
| | | | | | | | - Jean H Humphrey
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Zvitambo Institute for Maternal and Child Health Research
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Büttner BE, Witthöft CM, Domellöf M, Hernell O, Öhlund I. Effect of type of heat treatment of breastmilk on folate content and pattern. Breastfeed Med 2014; 9:86-91. [PMID: 23786311 DOI: 10.1089/bfm.2013.0008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Breastmilk is the recommended aliment for preterm infants. Milk banks provide donated breastmilk for the neonatal care of preterm infants when mother's own milk is not is available. To avoid pathogen transmission, donated breastmilk is heat-treated according to different procedures before administration. There is varying information on the effect of heat treatment on folate in breastmilk. Sufficient folate intake, however, is essential for normal growth and brain development. This study determined and compared the effects of different heat treatments on breastmilk folate content and pattern of individual folate forms. MATERIALS AND METHODS Donated Swedish breastmilk samples were heat-treated according to three procedures: two low temperature treatments (57°C, 23 minutes; 62.5°C, 12 minutes) and a rapid high temperature treatment (heating to 73°C in boiling water). The folate content and pattern were determined before and after treatment by high-performance liquid chromatography. RESULTS The folate content in 38 untreated Swedish breastmilk samples was 150±46 nmol/L. Two different folate vitamers were detected: 5-methyltetrahydrofolate (78±7%) and tetrahydrofolate (22±7%). Heat treatment affected only tetrahydrofolate stability and decreased folate content by 15-24%; however, the effects on folate content did not differ among the investigated heat treatment procedures. CONCLUSIONS Folate losses during heat treatment of human milk were considered acceptable. Yet, native folate content of heat-treated, non-fortified breastmilk supplied only 25% of the recommended daily intake for preterm infants.
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Affiliation(s)
- Barbara E Büttner
- 1 Department of Food Science, Uppsala BioCenter, Swedish University of Agricultural Sciences , Uppsala, Sweden
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Marembo J, Zvinavashe M, Nyamakura R, Shaibu S, Mogobe KD. Factors influencing infant-feeding choices selected by HIV-infected mothers: perspectives from Zimbabwe. Jpn J Nurs Sci 2013; 11:259-67. [PMID: 25306930 DOI: 10.1111/jjns.12027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
Abstract
AIM To assess factors influencing infant-feeding methods selected by HIV-infected mothers. METHODS A descriptive quantitative study was conducted among 80 mothers with babies aged 0-6 months who were randomly selected and interviewed. Descriptive statistics were used to summarize the findings. RESULTS Factors considered by women in choosing the infant-feeding methods included sociocultural acceptability (58.8%), feasibility and support from significant others (35%), knowledge of the selected method (55%), affordability (61.2%), implementation of the infant-feeding method without interference (62.5%), and safety (47.5%). Exclusive breast-feeding was the most preferred method of infant feeding. Disclosure of HIV status by a woman to her partner is a major condition for successful replacement feeding method, especially within the African cultural context. However, disclosure of HIV status to the partner was feared by most women as only 16.2% of the women disclosed their HIV status to partners. CONCLUSION The factors considered by women in choosing the infant-feeding option were ability to implement the options without interference from significant others, affordability, and sociocultural acceptability. Knowledge of the selected option, its advantages and disadvantages, safety, and feasibility were also important factors. Nurses and midwives have to educate clients and support them in their choice of infant-feeding methods.
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Young S, Leshabari S, Arkfeld C, Singler J, Dantzer E, Israel-Ballard K, Mashio C, Maternowska C, Chantry C. Barriers and promoters of home-based pasteurization of breastmilk among HIV-infected mothers in greater Dar es Salaam, Tanzania. Breastfeed Med 2013; 8:321-6. [PMID: 23131094 PMCID: PMC4932788 DOI: 10.1089/bfm.2012.0044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND For the past decade, heat-treating breastmilk has been an infant feeding option recommended by the World Health Organization as a strategy to reduce vertical transmission. However, little is known about field experiences with it. Our primary objective was to explore the barriers and promoters of the implementation of breastmilk pasteurization, "flash-heating" (FH), in the real-world setting of Dar es Salaam, Tanzania. SUBJECTS AND METHODS Nineteen in-depth interviews were conducted with participants in a home-based infant feeding counseling intervention in which FH was promoted after 6 months of exclusive breastfeeding. Additionally, three focus group discussions were conducted with peer counselors. Interviews were transcribed, translated, and coded independently using NVivo 8 software (QSR International). Data were analyzed using the socioecological framework. RESULTS Information and support provided by peer counselors were the most important promoters of initiation and continuation of FH; this impacted individual-, interpersonal-, and institutional-level promoters of success. Other promoters included perceived successful breastmilk expression, infant health after initiation of FH, and the inability to pay for replacement milks. Stigma was the most important barrier and cut across all levels of the framework. Other barriers included doubt about the safety or importance of pasteurized breastmilk, difficulties with expressing milk (often attributed to poor diet), and competing responsibilities. The most common suggestion for improving the uptake and duration of FH was community education. CONCLUSIONS Given the acknowledged role of breastmilk pasteurization in the prevention of vertical transmission, further implementation research is needed. A multilevel intervention addressing barriers to FH would likely improve uptake.
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Affiliation(s)
- Sera Young
- Division of Nutritional Sciences, Cornell University , Ithaca, NY 14853, USA
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Abstract
This article provides the pediatric community with a practical overview of milk expression and an update on the recent literature. Approaches for working mothers, preterm infants, critically ill infants, and mothers before lactogenesis II are presented separately, as these groups may benefit from practices tailored to individual needs.
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Affiliation(s)
- Valerie J Flaherman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143-0503, USA.
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Hoque SA, Hoshino H, Anwar KS, Tanaka A, Shinagawa M, Hayakawa Y, Okitsu S, Wada Y, Ushijima H. Transient heating of expressed breast milk up to 65°C inactivates HIV-1 in milk: A simple, rapid, and cost-effective method to prevent postnatal transmission. J Med Virol 2012; 85:187-93. [DOI: 10.1002/jmv.23457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2012] [Indexed: 11/06/2022]
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Jenkins AL, Tavengwa NV, Chasekwa B, Chatora K, Taruberekera N, Mushayi W, Madzima RC, Mbuya MN. Addressing social barriers and closing the gender knowledge gap: exposure to road shows is associated with more knowledge and more positive beliefs, attitudes and social norms regarding exclusive breastfeeding in rural Zimbabwe. MATERNAL & CHILD NUTRITION 2012; 8:459-70. [PMID: 21972843 PMCID: PMC6860634 DOI: 10.1111/j.1740-8709.2011.00325.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Exclusive breastfeeding (EBF) is rarely practiced despite its significant child survival benefits. A key constraint to increasing EBF rates in Zimbabwe and most of the developing world is that key decision makers (fathers/partners and other family members) are often poorly informed about EBF and do not attend antenatal clinics where health information is routinely provided. Informed by formative research, a district-wide campaign was conducted in rural Zimbabwe to encourage EBF and expressing and heat treating (EHT) breast milk as a means to maintain EBF. The campaign combined traditional strategies of education, counselling and outreach through health service delivery with a novel road show 'edutainment' intervention to reach men and other community members. A post campaign evaluation measured the association of road show exposure with 20 knowledge items and summative scores of social norms, beliefs and attitudes obtained through exploratory factor analysis. In adjusted models, road show exposure was associated with correct EBF knowledge (β=1.0, 0.001), EHT knowledge (β=1.3, P<0.001) and greater perceived benefits of condom use during pregnancy and breastfeeding (β=0.5, P<0.001), and more positive EBF social norms (β=0.6, P<0.001), EBF beliefs and attitudes (β=1.0, P<0.001) and attitudes towards condom use during breastfeeding (β=0.6, P<0.001). Road show exposure was more strongly associated with EBF knowledge among men (P-value for gender×exposure group interaction=0.03), suggesting that it also closed the knowledge gap between men and women. Longitudinal studies will determine whether road shows were associated with changes in EBF practices.
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Affiliation(s)
| | | | | | | | | | | | - Rufaro C. Madzima
- National Nutrition Unit, Ministry of Health and Child Welfare, Harare, Zimbabwe
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Van Rompay KKA, Jayashankar K. Animal models of HIV transmission through breastfeeding and pediatric HIV infection. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 743:89-108. [PMID: 22454344 DOI: 10.1007/978-1-4614-2251-8_7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Affiliation(s)
- Koen K A Van Rompay
- California National Primate Research Center, University of California, Davis, CA 95616, USA.
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Chantry CJ, Young SL, Rennie W, Ngonyani M, Mashio C, Israel-Ballard K, Peerson J, Nyambo M, Matee M, Ash D, Dewey K, Koniz-Booher P. Feasibility of using flash-heated breastmilk as an infant feeding option for HIV-exposed, uninfected infants after 6 months of age in urban Tanzania. J Acquir Immune Defic Syndr 2012; 60:43-50. [PMID: 22362154 PMCID: PMC3380080 DOI: 10.1097/qai.0b013e31824fc06e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Heat-treating expressed breastmilk is recommended as an interim feeding strategy for HIV-exposed infants in resource-poor countries, but data on its feasibility are minimal. Flash-heating (FH) is a simple in-home technique for heating breastmilk that inactivates HIV although preserving its nutritional and anti-infective properties. Our primary objective was to determine, among HIV-infected mothers, the feasibility and protocol adherence of FH expressed breastmilk after 6 months of exclusive breastfeeding. DESIGN Prospective longitudinal. PARTICIPANTS One hundred one HIV-infected breastfeeding mothers. SETTING Dar es Salaam, Tanzania. INTERVENTION Peer counselors provided in-home counseling and support on infant feeding from 2 to 9 months postpartum. Mothers were encouraged to exclusively breastfeed for 6 months followed by FH expressed breastmilk if her infant was HIV negative. Clinic-based staff measured infant growth and morbidity monthly, and mothers kept daily logs of infant morbidity. FH behavior was tracked until 9 months postpartum using daily logs, in-home observations, and clinic-based and home-based surveys. Bacterial cultures of unheated and heated milk samples were performed. RESULTS Thirty-seven of 72 eligible mothers (51.4%) chose to flash-heat. Median (range) frequency of milk expression was 3 (1-6) times daily and duration of method use on-study was 9.7 (0.1-15.6) weeks. Mean (SD) daily milk volume was 322 (201) mL (range 25-1120). No heated and 32 (30.5%) unheated samples contained bacterial pathogens. CONCLUSIONS FH is a simple technology that many HIV-positive women can successfully use after exclusive breastfeeding to continue to provide the benefits of breastmilk while avoiding maternal-to-child transmission associated with nonexclusive breastfeeding. Based on these feasibility data, a clinical trial of the effects of FH breastmilk on infant health outcomes is warranted.
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Affiliation(s)
- Caroline J. Chantry
- Department of Pediatrics, University California Davis Medical Center, Sacramento, CA, USA
| | - Sera L. Young
- Department of Pediatrics, University California Davis Medical Center, Sacramento, CA, USA
| | | | | | - Clara Mashio
- University Research Company, Dar es Salaam, Tanzania
| | | | - Janet Peerson
- Department of Nutrition, University of California Davis, Davis, CA, USA
| | | | - Mecky Matee
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deborah Ash
- Academy for Educational Development, Dar es Salaam, Tanzania
| | - Kathryn Dewey
- Department of Nutrition, University of California Davis, Davis, CA, USA
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Kindra G, Coutsoudis A, Esposito F. Effect of nutritional supplementation of breastfeeding HIV positive mothers on maternal and child health: findings from a randomized controlled clinical trial. BMC Public Health 2011; 11:946. [PMID: 22192583 PMCID: PMC3268126 DOI: 10.1186/1471-2458-11-946] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 12/22/2011] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It has been well established that breastfeeding is beneficial for child health, however there has been debate regarding the effect of lactation on maternal health in the presence of HIV infection and the need for nutritional supplementation in HIV positive lactating mothers. AIMS To assess the effect of nutritional supplementation to HIV infected lactating mothers on nutritional and health status of mothers and their infants. METHODS A randomized controlled clinical trial to study the impact of nutritional supplementation on breastfeeding mothers. Measurements included anthropometry; body composition indicators; CD4 count, haemoglobin and albumin; as well as incidence rates of opportunistic infections; depression and quality of life scores. Infant measurements included anthropometry, development and rates of infections. RESULTS The supplement made no significant impact on any maternal or infant outcomes. However in the small group of mothers with low BMI, the intake of supplement was significantly associated with preventing loss of lean body mass (1.32 kg vs. 3.17 kg; p = 0.026). There was no significant impact of supplementation on the infants. CONCLUSIONS A 50 g daily nutritional supplement to breastfeeding mothers had no or limited effect on mother and child health outcomes. CLINICAL TRIAL REGISTRATION ISRCTN68128332 (http://www.controlled-trials.com/ISRCTN68128332).
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Affiliation(s)
- Gurpreet Kindra
- Department of Paediatrics and Child Health, Room 257, DDMRI Building, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Congella 4013, Durban, South Africa
| | - Anna Coutsoudis
- Department of Paediatrics and Child Health, Room 257, DDMRI Building, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Congella 4013, Durban, South Africa
| | - Francesca Esposito
- Department of Paediatrics and Child Health, Room 257, DDMRI Building, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Congella 4013, Durban, South Africa
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Informed choice in infant feeding decisions can be supported for HIV-infected women even in industrialized countries. AIDS 2011; 25:1807-11. [PMID: 21811145 DOI: 10.1097/qad.0b013e32834b3519] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Young SL, Mbuya MNN, Chantry CJ, Geubbels EP, Israel-Ballard K, Cohan D, Vosti SA, Latham MC. Current knowledge and future research on infant feeding in the context of HIV: basic, clinical, behavioral, and programmatic perspectives. Adv Nutr 2011; 2:225-43. [PMID: 22332055 PMCID: PMC3090166 DOI: 10.3945/an.110.000224] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In 2008, between 129,000 and 194,000 of the 430,000 pediatric HIV infections worldwide were attributable to breastfeeding. Yet in many settings, the health, economic, and social consequences of not breastfeeding would have dire consequences for many more children. In the first part of this review we provide an overview of current knowledge about infant feeding in the context of HIV. Namely, we describe the benefits and risks of breastmilk, the evolution of recommended infant feeding modalities in high-income and low-income countries in the last two decades, and contextualize the recently revised guidelines for infant feeding in the context of HIV current knowledge. In the second section, we suggest areas for future research on the postnatal prevention of mother-to-child transmission of HIV (PMTCT) in developing and industrialized countries. We suggest two shifts in perspective. The first is to evaluate PMTCT interventions more holistically, to include the psychosocial and economic consequences as well as the biomedical ones. The second shift in perspective should be one that contextualizes postnatal PMTCT efforts in the cascade of maternal health services. We conclude by discussing basic, clinical, behavioral, and programmatic research questions pertaining to a number of PMTCT efforts, including extended postnatal ARV prophylaxis, exclusive breastfeeding promotion, counseling, breast milk pasteurization, breast milk banking, novel techniques for making breast milk safer, and optimal breastfeeding practices. We believe the research efforts outlined here will maximize the number of healthy, thriving, HIV-free children around the world.
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Affiliation(s)
- Sera L. Young
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA 94110,Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853,To whom correspondence should be addressed. E-mail:
| | | | - Caroline J. Chantry
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA, 95817
| | | | | | - Deborah Cohan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA 94110
| | - Stephen A. Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, CA 95616
| | - Michael C. Latham
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853
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Breastfeeding in HIV Exposed Infants Significantly Improves Child Health: A Prospective Study. Matern Child Health J 2011; 16:632-40. [DOI: 10.1007/s10995-011-0795-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paul KH, Muti M, Chasekwa B, Mbuya MNN, Madzima RC, Humphrey JH, Stoltzfus RJ. Complementary feeding messages that target cultural barriers enhance both the use of lipid-based nutrient supplements and underlying feeding practices to improve infant diets in rural Zimbabwe. MATERNAL AND CHILD NUTRITION 2010; 8:225-38. [PMID: 22405701 DOI: 10.1111/j.1740-8709.2010.00265.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Supplementation with lipid-based nutrient supplements (LiNS) is promoted as an approach to prevent child undernutrition and growth faltering. Previous LiNS studies have not tested the effects of improving the underlying diet prior to providing LiNS. Formative research was conducted in rural Zimbabwe to develop feeding messages to improve complementary feeding with and without LiNS. Two rounds of Trials of Improved Practices were conducted with mothers of infants aged 6-12 months to assess the feasibility of improving infant diets using (1) only locally available resources and (2) locally available resources plus 20 g of LiNS as Nutributter®/day. Common feeding problems were poor dietary diversity and low energy density. Popular improved practices were to process locally available foods so that infants could swallow them and add processed local foods to enrich porridges. Consumption of beans, fruits, green leafy vegetables, and peanut/seed butters increased after counselling (P < 0.05). Intakes of energy, protein, vitamin A, folate, calcium, iron and zinc from complementary foods increased significantly after counselling with or without the provision of Nutributter (P < 0.05). Intakes of fat, folate, iron, and zinc increased only (fat) or more so (folate, iron, and zinc) with the provision of Nutributter (P < 0.05). While provision of LiNS was crucial to ensure adequate intakes of iron and zinc, educational messages that were barrier-specific and delivered directly to mothers were crucial to improving the underlying diet.
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Affiliation(s)
- Keriann H Paul
- Division of Nutritional Sciences, Cornell University, 120 Savage Hall, Ithaca, New York 14853, USA.
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