Drought resistant 'banana' - Field Exchange - Emergency Nutrition ...

ResearchAdequacy of Replacement Milks for Infants of HIV-Infected MothersSummary of published research 1Feeding recommendations for infants ofinfected HIV-mothers in developing countriesremain controversial. As HIV can betransmitted to the infant by breastfeeding,the World Health Organisation (WHO) recommendsthat, “when replacement milk is acceptable,feasible, affordable, sustainable and safe,avoidance of all breastfeeding by HIV-infectedmothers is recommended; otherwise, exclusivebreastfeeding is recommended during the firstsix months of life 2 . However, little is known aboutthe nutritional adequacy and feasibility of thevarious breastmilk replacement options recommendedin related training materials 3 . A recentstudy aimed to explore suitability of the 2001feeding recommendations for infants of HIVinfectedmothers in a rural region in KwaZuluNatal, South Africa, especially with respect toadequacy of micronutrients and essential fattyacids, cost, and preparation times of replacementmilks.Nutritional adequacy, cost, and preparationtime of home-prepared replacement milks containingpowdered full cream milk (PM) and freshfull cream milk (FM) and different micronutrientsupplements (2 g UNICEF micronutrient sachet,government supplement routinely available indistrict public health clinics, and best availableliquid paediatric supplement found in local pharmacies)were compared. The costs of locally availableingredients for replacement milk were usedto calculate monthly costs for infants aged one,three, and six months. Total monthly costs ofingredients of commercial and home-preparedreplacement milks were compared with eachother, and considered in the context of the averagemonthly income of domestic or shop workers.The time needed to prepare one feed of replacementmilk was simulated by local HIV and infanttraining course participants for a rural homestead,without electricity, gas or water but close to astream and shrubs (1-2 minutes walk away).When mixed with water, sugar and eachmicronutrient supplement, PM and FM providedless than half (50%) of the required amounts ofvitamins E and C, folic acid, iodine, and seleniumand less than 75% of zinc and pantothenic acid.PM and FM made with UNICEF micronutrientsachets provided 30% of the required intake forniacin. FM prepared with any micronutrientsupplement provided no more than 32% vitaminD. All PMs provided more than adequateamounts of vitamin D. Compared with thecommercial formula, PM and FM provided8–60% of vitamins A, E, and C, folic acid, manganese,zinc, and iodine. Preparations of PM andFM provided 11% of the minimum recommendedintake of linoleic acid and 67% of the minimumrecommended αlinolenic acid, per 450 ml mixture.It took 21–25 minutes to prepare optimally 120ml of replacement feed from PM or commercialinfant formula and 30–35 minutes for the freshmilk preparation. For an infant requiring 6-8feeds per day, a carer would need 2.5 hours perday to prepare replacement milks, without takinginto account time taken to feed the infant. PM orFM costs approximately 20% of monthly incomeaveraged over the first six months of life andcommercial formula cost approximately 32%.The authors conclude that no home-preparedreplacement milks in South Africa meet all estimatedmicronutrient and essential fatty acidrequirements of infants aged under 6 months.Commercial infant formula is the only replacementmilk that meets all nutritional needs. Theauthors suggest that revision of replacement milkoptions given in WHO/UNAIDS/UNICEF HIVand infant feeding training course materials areneeded. If replacement milks are to provide totalnutrition, preparations should include vegetableoils, such as soybean oil, as a source of linoleicand αlinolenic acids, and additional vitaminsand minerals.1P.C. Papathakis, N.C. Rollins. Are WHO/UNAIDS/UNICEFrecommendedreplacement milks for infants of HIV-infectedmothers appropriate in the South African context? Bulletinof the World Health Organization, March 2004, 82 (3),pp164-1712World Health Organisation. New data on the prevention ofmother- to-child transmission of HIV and their policy implications:conclusions and recommendations. WHO TechnicalConsultation on behalf of the UNFPA/ UNICEF/WHO/UNAIDSInteragency Task Team on Mother-to-Child Transmission ofHIV. Geneva: World Health Organization; 2001. WHO documentWHO/RHR/01.28.3WHO, UNAIDS, UNICEF. HIV and infant feeding counselling:a training course. Geneva: WHO/UNAIDS/UNICEF;2000. WHO document WHO/FCH/ CAH/00.2–4F. LambeinGrass PeaConsumption andNeurolathyrismField of green pea grown in EthiopiaSummary of published paper 1Neurolathyrism is a neurodegenerativeand irreversible spastic paraparesis 2that can be crippling and lead tocomplete dependency. This disordercan be caused by excessive consumption of thedrought resistant pulse, grass pea (Lathyrus sativus)3 . All major famines and chronic food shortagesin Ethiopia from the mid-1970s onwards havebeen accompanied by reports of neurolathyrismepidemics. A recent research study examinedwhether addition of food-aid cereals to grass peafoods reduced the risk of neurolathyrism duringsevere famines.During the epidemic in Ethiopia between 1995and 1999, a neurolathyrism surveillance systemwas set up in Delanta Dawint, one of the mostaffected districts. The research team conducted acorrelational study of the amount of food aid thatreached the population. They also compared, in aretrospective case control study, the types of grasspea preparations and cereal mixtures consumedby all people who developed the condition (identifiedthrough the surveillance system) and bycontrols in Asim Elana, a severely hit village.Information on the proportion and type of cere-Lathyrism patient in Ethiopiaals added to grass-pea foods was obtained fromthe female household member who prepared food.This information was collected for six monthsbefore the first detected case, and until the end ofthe epidemic. The enumerators classified theproportion of food aid cereal to grass pea as atleast one third or less than one third. Spearman’scorrelation coefficient was calculated to assess theassociation between the incidence of neurolathyrismand the amount of cereal food aid distributed.Between September 1995 and December 31st2000, a total of 2035 new cases of the conditionwere detected in Delanta Dawint district (periodprevalence of 12.3 per 1000). There was a significantnegative correlation between new cases per1000 and the per-person amount of food aid distributed.The food aid mainly consisted of wheat andmaize, with limited supplementary rations ofvegetable oil. However, delivery became irregularand delayed and the amount of food aid fell,which coincided with the peak of the epidemic in1997 when 1454 new cases were reported.In the case control study, the consumption ofgrass pea in roasted, boiled and raw, unripe seedF. Lambeinform was associated with an increased risk ofneurolathyrism, whereas no raised risk was notedfor the fermented pancake, unleavened bread andgravy preparations. Cereals are sometimes mixedwith grass pea in the boiled, fermented pancakeand unleavened bread forms. Use of cereal andgrass-pea flour mixtures for these preparationsreduced the risk of paralysis if they containedmore than a third cereal. The addition of wheatand maize to grass-pea preparations couldcompensate for the deficiency of methionine andcysteine, as well as diluting the concentration oftoxin.Susceptibility to neurolathyrism varies amongindividuals and communities, and an increasedrisk of paralysis is associated with the male sexand young age. The study controlled for the effectsof age and sex in the logistic regression analysis,but was unable to control perfectly for socioeconomicvariables and interfering acute-illness episodes.The study authors highlighted how reportswere showing that only grass pea was resisting thecurrent drought in most neurolathyrism proneareas, and that the population is increasinglyrelying on this pulse. The authors concluded thatfood aid should therefore not be restricted to thealmost starving, but should also be urgently sentto people in neurolathyrism prone areas beforethey are forced into exclusive grass-pea consumption.Dietary information, education and communicationon safe grass-pea preparations are alsoneeded.1Getahun, H, Lambien F, Vanhoome M, Van Der Stuyft P(2003). Food-aid cereals to reduce neurolathyrism relatedto grass-pea preparations during famine. The Lancet, vol362, Nov 2003, pp 1808- 1810. Full text available free onlineat: http://www.thelancet.com/journal/vol362/iss9398/2Increased muscle tone leading to weakness of both lowerlimbs3The clinical symptoms of neurolathyrism are identical tothose of 'konzo', a crippling disease caused by overconsumptionof insufficiently treated cassava (Manihotesculenta). See Field Exchange 16, Suspected toxic ingestionoutbreak in central Afghanistan, pp7-9, August 20025