STANDARDIZATION OF CASSAVA MAHEWU FERMENTATION AND ASSESSMENT OF THE EFFECTS OF IRON SOURCES USED FOR FORTIFICATION

Cassava root is the main staple for 70% of the population in Mozambique, particularly in inaccessible rural areas, but is known to be low in iron. Anaemia is a public health problem in mothers and preschool children in Mozambique and up to 40% of these cases are probably due to dietary iron deficiency. The World Health Organization (WHO) and Food and Agriculture Organization of the United Nations (FAO) recognize the fortification of foodstuff as an effective method to remedy dietary deficiencies of micronutrients, including iron. Cassava mahewu, a non-alcoholic fermented beverage is prepared at subsistence level from cassava roots using indigenous procedures. The aim of the study was to standardize mahewu fermentation and investigate if the type of cassava fermented, or the iron compound used for fortification affected the final product. Roots of sweet and bitter varieties of cassava from four districts (Rapale, Meconta, Alto Molocue and Zavala) in Mozambique, were peeled, dried and pounded to prepare flour. Cassava flour was cooked and fermented under controlled conditions (45°C for 24 h). The fermentation period and temperature were set, based on the findings of a pilot study which showed that an end-point pH of about 4.5 was regularly reached after 24 h at 45°C. Cassava mahewu was fortified with ferrous sulfate (FeSO4.7H2O) or ferrous fumarate (C4H2FeO4) at the beginning (time zero) and at the end of fermentation (24 h). The amount of iron added to the mahewu was based on the average of the approved range of iron used for the fortification of maize meal. The mean pH at the endpoint was 4.5, with 0.29% titratable acidity. The pH and acidity were different to those reported in previous studies on maize mahewu, whereas the solid extract of 9.65% was found to be similar. Lactic acid bacteria (LAB) and yeast growth were not significantly different in mahewu fortified with either of the iron compounds. There was no significant difference between cassava mahewu made from bitter or sweet varieties. A standard method for preparation and iron fortification of cassava mahewu was developed. It is recommended that fortification occurs at the end of fermentation when done at household level.

PREVALENCE OF IRON DEFICIENCY ANAEMIA AND DIETARY IRON INTAKE AMONG INFANTS AGED SIX TO NINE MONTHS IN KEIYO SOUTH SUB COUNTY, KENYA

The increased prevalence of iron deficiency among infants can be attributed to the consumption of an iron deficient diet or a diet that interferes with iron absorption at the critical time of infancy, among other factors. The gradual shift from breast milk to other foods and liquids is a transition period which greatly contributes to iron deficiency anaemia (IDA). The purpose of this research was to assess iron deficiency anaemia among infants aged six to nine months in Keiyo South Sub County. The specific objectives of this study were: to establish the prevalence of infants with iron deficiency anaemia and dietary iron intake among infants aged 6 to 9 months. The cross sectional study design was adopted in this survey. This study was conducted in three health facilities in Keiyo South Sub County. The infants were selected by use of a two stage cluster sampling procedure. Systematic random sampling was then used to select a total of 244 mothers and their infants. Eighty two (82) infants were selected from Kamwosor sub-district hospital and eighty one (81) from both Nyaru and Chepkorio health facilities. Interview schedules, 24-hour dietary recall and food frequency questionnaires were used for collection of dietary iron intake. Biochemical tests were carried out by use of the Hemo-control photochrometer at the health facilities. Infants whose hemoglobin levels were less than 11g/dl were considered anaemic. Further, peripheral blood smears were conducted to ascertain the type of nutritional anaemia. Data was analyzed using the Statistical Package for Social Sciences (SPSS) computer software version 17, 2009. Dietary iron intake was analyzed using the NutriSurvey 2007 computer software. Results indicated that the mean hemoglobin values were 11.3± 0.84 g/dl. Twenty one percent (21.7%) of the infants had anaemia and further 100% of peripheral blood smears indicated iron deficiency anaemia. Dietary iron intake was a predictor of iron deficiency anaemia in this study (t=-3.138; p=0.01). Iron deficiency anaemia was evident among infants in Keiyo South Sub County. The Ministry of Health should formulate and implement policies on screening for anaemia and ensure intensive nutrition education on iron rich diets during child welfare clinics.

THE AGING OF AFRICA: CHALLENGES TO AFRICAN DEVELOPMENT

The purpose of this brief discussion is to highlight issues of demographic changes associated with an aging population in Africa and what, I believe, must happen to avoid the next social crisis among African nations.

NUTRITIONAL AND AMINO ACID ANALYSIS OF RAW, PARTIALLY FERMENTED AND COMPLETELY FERMENTED LOCUST BEAN ( Parkia biglobosa ) SEEDS

The nutritional and amino acid analysis of raw and fermented seeds of Parkia biglobosa were carried out. Parameters investigated include moisture, crude protein, crude fat, ash, crude fibre and mineral contents; and the effect of the degree of fermentation on these parameters was also investigated. The amino acid compositions of all the samples were evaluated and amino acid quality determined by calculating amino acid scores and the predicted protein efficiency ratio (P-PER). Results showed that the proximate composition was significantly affected by fermentation, although there was little difference between the parameters for the partially fermented and completely fermented samples. Based on dry matter percentage, protein content was in the 39.77 – 43.74 % range while crude fibre ranged between 5.55 – 7.42 %. The ash content was lowest in the raw sample (2.34 %), while the fermented samples had ash contents between 4.27 and 8.33 % for the fully fermented and the partially fermented seeds, respectively. The fat content increased from 8.65 % in the raw seed to 24.4 % and 27.6 % for the partially and completely fermented samples, respectively. Results of the amino acid analysis showed that the partially fermented sample had the lowest quantities of all amino acids determined and had lysine as the limiting amino acid, whereas the raw and completely fermented samples had very similar amino acid profile with amino acid scores of 100, indicating that there are no limiting amino acids. All the samples were rich in essential amino acids. The P-PER also showed that the partially fermented sample had the lowest protein efficiency while the raw seed had the highest. Mineral contents generally increased from the raw, through the partially fermented, to the completely fermented seeds and results showed the samples to be good sources of potassium (K), calcium (Ca), manganese (Mn) and copper (Cu) in addition to being complementary sources of other metals. Locust bean seed does not accumulate lead and is, therefore, safe for consumption without the potential of food poisoning.

“SINGING CHASES AWAY THE BLUES.” KNOWLEDGE AND USE OF THE VOICE AS HEALTH PROMOTION RESOURCES FOR CHORISTERS

Objetivo: Compreender o conhecimento e o uso da voz por mulheres que cantam em coral e as repercussões para a promoção da saúde. Métodos: Realizou-se estudo qualitativo, de dezembro de 2011 a fevereiro de 2012, com 13 mulheres de 23 a 66 anos, membros de um coral de uma universidade, em Fortaleza, Ceará, Brasil. Coletaram-se os dados através de entrevista semiestruturada. Aplicou-se a análise temática para organizar os resultados em categorias, analisando-as à luz do interacionismo simbólico. Resultados: Identificaram-se dois núcleos de sentido: conhecimento sobre voz e uso da voz. As coralistas definiram a voz como meio de comunicação, identidade pessoal e forma para expressar emoções. Elas não demonstraram conhecimento consistente sobre os aspectos anatômicos e fisiológicos da voz, mas as definições apresentadas mostram que elas entendem que a voz permeia espaços pessoais, sociais e profissionais. A voz profissional e o envelhecimento destacaram-se no contexto do uso vocal. As participantes reconhecem que o conhecimento e o uso da voz podem ser aprimorados pelas atividades no coral, o que remete à promoção da saúde. Conclusão: As coralistas apresentam conhecimento limitado sobre a saúde vocal, porém, compreendem os efeitos benéficos do coral sobre sua saúde, ampliando a compreensão sobre a voz; isso estimula a adoção de hábitos saudáveis e de medidas preventivas, o que favorece o uso vocal.

Knowledge and perceptions of quality of obstetric and newborn care of local health providers: a cross-sectional study in three districts in Malawi

Aim Quality of service delivery for maternal and newborn health in Malawi is influenced by human resource shortages and knowledge and care practices of the existing service providers. We assessed Malawian healthcare providers’ knowledge of management of routine labour, emergency obstetric care and emergency newborn care; correlated knowledge with reported confidence and previous study or training; and measured perception of the care they provided. Methods his study formed part of a large-scale quality of care assessment in three districts (Kasungu, Lilongwe and Salima) of Malawi. Subjects were selected purposively by their role as providers of obstetric and newborn care during routine visits to health facilities by a research assistant. Research assistants introduced and supervised the self-completed questionnaire by the service providers. Respondents included 42 nurse midwives, 1 clinical officer, 4 medical assistants and 5 other staff. Of these, 37 were staff working in facilities providing Basic Emergency Obstetric Care (BEMoC) and 15 were from staff working in facilities providing Comprehensive Emergency Obstetric Care (CEMoC). Results Knowledge regarding management of routine labour was good (80% correct responses), but knowledge of correct monitoring during routine labour (35% correct) was not in keeping with internationally recognized good practice. Questions regarding emergency obstetric care were answered correctly by 70% of respondents with significant variation depending on clinicians’ place of work. Knowledge of emergency newborn care was poor across all groups surveyed with 58% correct responses and high rates of potentially life-threatening responses from BEmOC facilities. Reported confidence and training had little impact on levels of knowledge. Staff in general reported perception of poor quality of care. Conclusion Serious deficiencies in providers’ knowledge regarding monitoring during routine labour and management of emergency newborn care were documented. These may contribute to maternal and neonatal deaths in Malawi. The knowledge gap cannot be overcome by simply providing more training.

COMMUNITY KNOWLEDGE, ATTITUDE AND PRACTICES (KAP) ON FLUOROSIS AND ITS MITIGATION IN ENDEMIC AREAS OF ETHIOPIA

Optimum fluoride intake plays an essential role in the prevention of dental caries while fluoride consumption above recommended level interferes with the normal formation of tooth enamel and bones and may increase risk of dental and skeletal fluorosis. The knowledge and practices of endemic communities on etiology of fluorosis will help in its mitigation and prevention. The objective of this study was to investigate the knowledge, attitude and practices of endemic community on fluoride contamination, fluorosis and prevention practices in order to devise coordinated and targeted prevention mechanisms. Focus group discussions (FGD) and key-informant interview were conducted in three dietary areas to collect knowledge, attitude and practices (KAP) of the endemic community in July 2013.The results indicated that health consequences of fluoride contaminated water are fairly understood. None of the discussants mentioned the word “fluoride”. The knowledge and perception of the community on fluoride ingestion is poor. Health extension workers (HEWs) did not teach about fluoride and related health consequences. Dental fluorosis was reported to start at early ages and not commonly perceived as a major problem. However, adolescents worried and felt that they might be singled out when going to other areas. Older people have a skeletal fluorosis, which interferes with their day to day activities. In severely affected people, the teeth were weak and fragile and thus create difficulty in chewing hard foods like unfermented dry flat bread, sugar cane and toasted grains. People prefer rain water rather than water from borehole because of the inconvenient taste of the latter. The endemic communities have no sufficient knowledge and skills on potential sources of fluoride intake, the debilitating effect of high fluoride ingestion, and preventive and mitigatory measures to reduce fluoride intake. The effect of fluoride contamination and mitigatory methods should get sufficient attention by the community, health workers and concerned governmental bodies. The trend of harvesting and using rain water should be encouraged as it reduces fluoride intake. Future studies should focus on information communication on possible fluoride risks, intervention and evaluation studies on defluoridation, rain water harvesting and mitigatory techniques.