Reducing Child Undernutrition through Dietary Diversification, Reduced Aflatoxin Exposure, and Improved Hygiene Practices: The Immediate Impacts in Central Tanzania

Mycotoxins and bone growth: a review of the literature on associations between xenobiotic exposure and bone growth and development

Mycotoxins are secondary metabolites of fungi that are known to be associated with linear growth faltering because of their impact on inflammation, intestinal damage, inhibition of protein synthesis, and micronutrient absorption. In this narrative review, we aim to extend this analysis to further explore associations between mycotoxins (aflatoxins, ochratoxins, trichothecenes including deoxynivalenol, T-2 toxin, and fumonisins) and long-bone growth, particularly during the saltatory periods of development. Linear growth is a direct function of skeletal development and long-bone growth. We therefore explored biological pathways and mechanisms of impact of these toxins in both animal and human studies, in addition to the epidemiology literature (post-2020). Given what is known of the effects of individual and combinations of mycotoxins based on the animal literature, we have identified a need for further research and examination of how these toxins and exposures may be studied in humans to elucidate the downstream impact on bone-related biomarkers and anthropometric indices used to identify and predict stunting in population-based studies.

Feeding practices, dietary adequacy, and dietary diversities among caregivers with under-five children: A descriptive cross-section study in Dodoma region, Tanzania

INTRODUCTION

Suboptimal feeding practices among caregivers contribute to nutritional-related health problems in children in low and middle-income countries, such as Tanzania. The continuum of the recommended feeding practices has been an utmost challenge among caregivers during the transition from health facilities to homes for improved under-five children's health.

OBJECTIVE

This study assessed feeding practices, dietary diversities, and dietary adequacy among caregivers with under-five children in the Dodoma region, Tanzania.

METHODS

A community-based descriptive cross-sectional study in a quantitative research approach was adopted to study 289 randomly selected caregivers of under-five children in Dodoma region, Tanzania from March to August 2022. The World Health Organization Infant and Young Children Feeding Guidelines was the main data collection tool. Data were analyzed descriptively using a Statistical Package for Social Sciences computer software program version 25. Statistical limits were set at a 95% confidence interval and a 5% significance level.

RESULTS

Mean age was 26±6.47 of which 68.2% (n = 197) were females. Findings revealed 66.1% of caregivers had unsatisfactory feeding practices. It was observed that 67.8% of the caregivers fed their under-five children inadequately. Only 32.2% of them attained the minimum dietary diversity while 35.3% and 31.5% of caregivers demonstrated feeding practices < and > the recommended minimum Dietary diversity respectively. Moreover, 90.7% of caregivers fed their children group one food while 59.1% of them did not practice feeding the children snacks between meals. Feeding practice, dietary diversity, and dietary adequacy were significantly related to the caregiver's sex, education level, and socioeconomic status (p<0.05).

CONCLUSION

Under-five children are at serious risk of nutritional problems as most caregivers in this study demonstrated unsatisfactory feeding practices on dietary diversities for dietary adequacy below the world health organization recommended Minimum Dietary diversity and Minimum Meal Frequency. Community-based nutritional education programs for caregivers need to be disseminated to the community level to address the problem accordingly.

Exposure assessment and risk characterization of aflatoxins intake through consumption of maize (Zea mays) in different age populations in the Volta Region of Ghana

Aflatoxin contamination in foods is a vital health challenge for low and middle-income countries in subtropical regions. Maize (Zea mays L.), a staple food most widely grown in Africa including Ghana, and extensively consumed as much as three times per day, is a source of aflatoxin contamination owing to its susceptibility to fungal infection. Aflatoxin levels were checked against international (European Commission, EC) and local (Ghana Standards Authority, GSA) standards, and health risks associated with maize sampled from the Volta Region (Hohoe, Ho, Battor Dugame, and Keta) of Ghana were determined. Total aflatoxins (totalAFs) and the constituent aflatoxins (AFB1, AFB2, AFG1, and AFG2) were measured with High-Performance Liquid Chromatography (HPLC) with a Fluorescence Detector (FLD). Intake and Risk assessments were also conducted using deterministic models prescribed by the Joint FAO/WHO Expert Committee on Additives (JECFA). The degree of occurrence of aflatoxins was observed to be in decreasing order of AFG2 < AFG1 < AFB2 < AFB1 and were within the ranges of 0.78 ± 0.04 $$-$$ - 234.73 ± 3.8 µg/kg, 0.47 ± 0.03 $$-$$ - 21.6 ± 0.33 µg/kg, 1.01 ± 0.05 $$-$$ - 13.75 ± 1.2 µg/kg and 0.66 ± 0.06 $$-$$ - 5.51 ± 0.26 µg/kg respectively. Out of the 100 samples analyzed for total aflatoxins (totalAFs), 68 (68%) exceeded the limits of EC and were of range 4.98 ± 0.6 $$-$$ - 445.01 ± 8.9 µg/kg whereas 58 (58%) and ranged between 12.12 ± 1.4 $$-$$ - 445.01 ± 8.9 µg/kg exceeded GSA limits. Intake and risk assessments of total aflatoxins (totalAFs) for infants, toddlers, children, adolescents, and adults in the Volta Region were; 0.037–1.14 µg/kg bw/day, 0.35–10.81, and 1.47 -45.14 cases/10,000 person/yr respectively for Estimated Daily Intake (EDI), Margin of Exposure (MOE), and Cancer Risks. It was inferred that the consumption of maize posed potential adverse health effects on all age categories studied because all calculated MOE values were less than 10,000.

Validation of a HACCP community-based infants' complementary food safety assurance method in cash crop producing communities in Gedeo zone, Southern Ethiopia

A method based on a hazard analysis critical control point (HACCP)-based standard operating procedure (SOP) has been developed and implemented in community-based (CB) production of complementary foods (CFs) in agrarian regions in rural Ethiopia. The objective of this study was to validate the method in another setup, more specifically in cash crop (coffee and khat) producing communities in Southern Ethiopia. A quasi-experimental study was employed for the method validation. Two villages in the Gedeo zone, Southern Ethiopia were selected and a total of 40 mother-child pairs, 20 in each village, were involved in the study. Sociodemographic data, knowledge, and complementary feeding practices were collected using pretested questionnaires. The training was given to each mother for 1 h about community-based CFs production and implementation of the method. Then, 30 CF samples were collected and the level of aflatoxins (AFB1, AFB2, AFG1, and AFG2) was determined using a validated method. The majority (77.5%) of the mothers understand the importance of complementary feeding and give it to their infants beyond 6 months. Nearly two-thirds (62.5%) of the mothers had knowledge about the health impacts of aflatoxins, but the remaining 37.5% lacked awareness about the health risks of aflatoxins. Mothers were very well-motivated for the training and they promised to implement the knowledge and skill gained from the training for improving the nutritional status of their children. Overall, 23.3% of the CFs were contaminated by aflatoxins. AFB1 and AFG1 were detected in 6.7 and 16.7% of the CF samples, respectively. In cash crop-producing communities around the country, the HACCP-based SOP is easily validated in CB CFs production. Therefore, a scaleup of the method at the national level and beyond is recommended.

Interference of anthocyanin extracted from black soybean coats on aflatoxin B1-human serum albumin in the binding process

The effect of the anthocyanin cyanidin-3-O-glucoside (C3G) and its main gastrointestinal metabolites (PCA and PGA) on the binding of AFB1 and HSA were studied via spectrometry. C3G is relatively stable in the gastric environment, and the intestinal environment promotes its metabolism into PCA and PGA. Binary fluorescence experiments showed that both AFB1 and C3G, including PCA and PGA, can react with HSA. AFB1, C3G and PCA can bind at site I and site II of HSA; PGA binds at site II. The presence of C3G/PCA/PGA inhibits the degree of quenching. C3G/PCA does not change the quenching mechanism; it is still static quenching; however, dynamic quenching occurs in the (AFB1-HSA)-PGA system. In addition, the apparent binding constant and number of binding sites of AFB1-HSA also diminish to different degrees. C3G and its metabolites (PCA and PGA) interfere with the interaction between AFB1 and HSA, and can reduce AFB1 transport at pH 7.4 in vitro.Abbreviations: C3G: cyanidin-3-O-glucoside; M: metabolite; PCA: protocatechuic acid; PGA: phloroglucinol aldehyde; AFB1: aflatoxin B1; HSA: human serum albumin.

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.

Knowledge, Attitude and Practice of Malawian Farmers on Pre- and Post-Harvest Crop Management to Mitigate Aflatoxin Contamination in Groundnut, Maize and Sorghum-Implication for Behavioral Change

A knowledge, attitude and practice (KAP) study was conducted in three districts of Malawi to test whether the training had resulted in increased knowledge and adoption of recommended pre- and post-harvest crop management practices, and their contribution to reducing aflatoxin contamination in groundnut, maize and sorghum. The study was conducted with 900 farmers at the baseline and 624 farmers at the end-line, while 726 and 696 harvested crop samples were collected for aflatoxin testing at the baseline and end-line, respectively. Results show that the knowledge and practice of pre- and post-harvest crop management for mitigating aflatoxin were inadequate among the farmers at the baseline but somewhat improved after the training as shown at the end-line. As a result, despite unfavorable weather, the mean aflatoxin contamination level in their grain samples decreased from 83.6 to 55.8 ppb (p < 0.001). However, it was also noted that increased knowledge did not significantly change farmers' attitude toward not consuming grade-outs because of economic incentive incompatibility, leaving potential for improving the practices further. This existing gap in the adoption of aflatoxin mitigation practices calls for approaches that take into account farmers' needs and incentives to attain sustainable behavioral change.