Gestation and breastfeeding in schistosomotic mothers differently modulate the immune response of adult offspring to postnatal Schistosoma mansoni infection

Schistosoma mansoni antigens in the early life alter homologous and heterologous immunity during postnatal infections. We evaluate the immunity to parasite antigens and ovalbumin (OA) in adult mice born/suckled by schistosomotic mothers. Newborns were divided into: born (BIM), suckled (SIM) or born/suckled (BSIM) in schistosomotic mothers, and animals from noninfected mothers (control). When adults, the mice were infected and compared the hepatic granuloma size and cellularity. Some animals were OA + adjuvant immunised. We evaluated hypersensitivity reactions (HR), antibodies levels (IgG1/IgG2a) anti-soluble egg antigen and anti-soluble worm antigen preparation, and anti-OA, cytokine production, and CD4+FoxP3+T-cells by splenocytes. Compared to control group, BIM mice showed a greater quantity of granulomas and collagen deposition, whereas SIM and BSIM presented smaller granulomas. BSIM group exhibited the lowest levels of anti-parasite antibodies. For anti-OA immunity, immediate HR was suppressed in all groups, with greater intensity in SIM mice accompanied of the remarkable level of basal CD4+FoxP3+T-cells. BIM and SIM groups produced less interleukin (IL)-4 and interferon (IFN)-g. In BSIM, there was higher production of IL-10 and IFN-γ, but lower levels of IL-4 and CD4+FoxP3+T-cells. Thus, pregnancy in schistosomotic mothers intensified hepatic fibrosis, whereas breastfeeding diminished granulomas in descendants. Separately, pregnancy and breastfeeding could suppress heterologous immunity; however, when combined, the responses could be partially restored in infected descendants.

The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study

Background In post-stroke patients, impairment of quality of life (QOL) has been associated with functional impairment, age, anxiety, depression, and fatigue. Good social support, higher education, and better socioeconomic status are associated with better QOL among stroke survivors. In Africa, studies from Nigeria and Tanzania have reported on post-stroke QOL. Background Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization’s recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake. Methods A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites. Results Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve. Conclusions The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed.

Sociodemographic factors influencing adherence to antenatal iron supplementation recommendations among pregnant women in Malawi: Analysis of data from the 2010 Malawi Demographic and Health Survey

Background and Aim: Maternal morbidity and mortality statistics remain unacceptably high in Malawi. Prominent among the risk factors in the country is anaemia in pregnancy, which generally results from nutritional inadequacy (particularly iron deficiency) and malaria, among other factors. This warrants concerted efforts to increase iron intake among reproductive-age women. This study, among women in Malawi, examined factors determining intake of supplemental iron for at least 90 days during pregnancy. Methods: A weighted sample of 10,750 women (46.7%), from the 23,020 respondents of the 2010 Malawi Demographic and Health Survey (MDHS), were utilized for the study. Univariate, bivariate, and regression techniques were employed. While univariate analysis revealed the percent distributions of all variables, bivariate analysis was used to examine the relationships between individual independent variables and adherence to iron supplementation. Chi-square tests of independence were conducted for categorical variables, with the significance level set at P < 0.05. Two binary logistic regression models were used to evaluate the net effect of independent variables on iron supplementation adherence. Results: Thirty-seven percent of the women adhered to the iron supplementation recommendations during pregnancy. Multivariate analysis indicated that younger age, urban residence, higher education, higher wealth status, and attending antenatal care during the first trimester were significantly associated with increased odds of taking iron supplementation for 90 days or more during pregnancy (P < 0.01). Conclusions: The results indicate low adherence to the World Health Organization’s iron supplementation recommendations among pregnant women in Malawi, and this contributes to negative health outcomes for both mothers and children. Focusing on education interventions that target populations with low rates of iron supplement intake, including campaigns to increase the number of women who attend antenatal care clinics in the first trimester, are recommended to increase adherence to iron supplementation recommendations.

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.

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.