Maria Nnyepi

Breastfeeding in Botswana: Practices, Attitudes, Patterns, and the Socio-cultural Factors Affecting Them

A cross-sectional descriptive study was conducted in four randomly selected districts of Botswana. Two study sites were chosen in each district. Four hundred households with children under 3 years old were enrolled into the study. A structured questionnaire was administered to mothers of eligible children in 50 households in each of the eight sites. About half the families had monthly incomes below 400 Pula (1 US

Vitamin D₃ Supplementation in Batswana Children and Adults with HIV: A Pilot Double Blind Randomized Controlled Trial

= 4.6 Pula). The majority of families had only one child under 3 years of age. A total of 76.4 per cent of the mothers were single and a high proportion of them had primary or secondary education. Over half, 59.3 per cent, of the mothers had a high level of information about breastfeeding mainly obtained before conception; 94.4 per cent of the mothers believed that breastfeeding was better than bottlefeeding. Ninety-five per cent of the mothers had breastfed their children, and they started breastfeeding immediately or a few hours after delivery. More than 85 per cent of the mothers were planning to continue breastfeeding for 18 months or more. The majority obtained advice about breastfeeding from health workers. The main reason for stopping breastfeeding was that the mother was at work or school. Although 58.2 per cent of mothers had little or no support for breastfeeding from the community it had a positive effect on their decision to breastfeed. The majority of mothers indicated their confidence about breastfeeding when they were pregnant. Over three-quarters (79.6 per cent) of the mothers delivered in government hospitals, and nearly all were roomed with their babies after delivery.

Evidence of nutrition transition in Southern Africa

Objectives Since vitamin D insufficiency is common worldwide in people with HIV, we explored safety and efficacy of high dose cholecalciferol (D₃) in Botswana, and evaluated potential modifiers of serum 25 hydroxy vitamin D change (Δ25D). Design Prospective randomized double-blind 12-week pilot trial of subjects ages 5.0–50.9 years. Methods Sixty subjects randomized within five age groups to either 4000 or 7000IU per day of D₃ and evaluated for vitamin D, parathyroid hormone, HIV, safety and growth status. Efficacy was defined as serum 25 hydroxy vitamin D (25D) ≥32ng/mL, and safety as no simultaneous elevation of serum calcium and 25D. Also assessed were HIV plasma viral RNA viral load (VL), CD4%, anti-retroviral therapy (ART) regime, and height-adjusted (HAZ), weight-adjusted (WAZ) and Body Mass Index (BMIZ) Z scores. Results Subjects were 50% male, age (mean±SD) 19.5±11.8 years, CD4% 31.8±10.4, with baseline VL log₁₀ range of <1.4 to 3.8 and VL detectable (>1.4) in 22%. From baseline to 12 weeks, 25D increased from 36±9ng/ml to 56±18ng/ml (p<0.0001) and 68% and 90% had 25D ≥32ng/ml, respectively (p = 0.02). Δ25D was similar by dose. No subjects had simultaneously increased serum calcium and 25D. WAZ and BMIZ improved by 12 weeks (p<0.04). HAZ and CD4% increased and VL decreased in the 7000IU/d group (p<0.04). Younger (5–13y) and older (30–50y) subjects had greater Δ25D than those 14–29y (26±17 and 28±12 vs. 11±11ng/ml, respectively, p≤0.001). Δ25D was higher with efavirenz or nevirapine compared to protease inhibitor based treatment (22±12, 27±17, vs. 13±10, respectively, p≤0.03). Conclusions In a pilot study in Botswana, 12-week high dose D₃ supplementation was safe and improved vitamin D, growth and HIV status; age and ART regimen were significant effect modifiers. Trial Registration ClinicalTrials.gov NCT02189902

Comparison of estimates of malnutrition in children aged 0–5 years between clinic-based nutrition surveillance and national surveys

Nutrition transition is characterised by shift to highly refined diets high in fat, salt and caloric sweeteners and low in fibre in rapidly growing economies. Dietary shifts occur almost concurrently with demographic and epidemiologic shifts, urbanisation and industrialisation and together contribute to increased prevalence of nutrition related (NR)-non-communicable disease (NCR). The emergence of nutrition transition in Southern Africa countries (SAC) was examined using anthropometric, NCD prevalence, and food consumption data. The findings reveal growing prevalence of overweight and obesity (OWOB) across SAC, with national prevalence estimated between 30 and 60 % in all but two SAC. Overweight prevalence in excess of 60 % has been reported in some sub-population groups. Hypertension prevalence of at least 30 % has also been reported. Further, the prevalence of OWOB and hypertension in many SAC exceeds that of HIV and is often at par with stunting in children. NCD are equally serious public health problems as stunting and HIV. Collectively, NR-NCD explain 20-31 % of mortality for Botswana, South Africa, Swaziland, Mozambique and Zambia. At least 72 % of adults in SAC have fewer servings of fruit and vegetable servings daily than recommended. Additionally, adults in SAC do poorly in physical activity; 31-75 % do not exercise regularly. Not surprisingly, 15-40 % of adults in SAC have at least three risk factors of CVD. SAC are grappling with NR-NCD which threaten to surpass infectious diseases burden. SAC are at various levels in interventions for moving their populations to stage 5, but there is room for much improvement.

Sorghum bean composite porridge nutritional quality and acceptability

This study documents a marked discrepancy between the nutritional status of children aged 0–5 years in Botswana when measured by national surveys compared to clinic-based surveillance. We compared the average prevalence of underweight (weight-for-age z-scores below 2 standard deviations of the mean of the Center for Disease Control (CDC)/WHO reference standards) in children 0–5 years of age. According to clinic surveillance, prevalence of underweight has fallen from 14.6±0.03 to 3.5±0.04 per cent between 1993 and 2010. In national surveys, it had fallen from 14.6±0.01 to 11.5±0.01 per cent between 1993 and 2007. We explored several possibilities to explain this discrepancy, and conclude that it is because of sampling bias in the clinic surveillance. This finding underlines the need for properly conducted surveys to ensure accurate information about the nutritional status of children.

Nutrition status of HIV+ children in Botswana

Purpose – The purpose of this paper is to study the quality of porridge made from cereal legume composite flour and to compare with a porridge that it is traditionally eaten.Design/methodology/approach – The nutritional composition as well as protein, microbiological, and sensory quality of porridge from a sorghum bean composite flour was assessed and compared with sorghum porridge (SP) that is traditionally eaten in Botswana.Findings – Results indicated that the nutrient composition and the protein quality of the sorghum bean composite porridge were significantly higher than that of the SP. The majority of children and adults rated the sensory attributes of the sorghum composite porridge highly and adult consumers indicated willingness to buy it.Originality/value – The study demonstrates that using traditionally consumed foods, which are culturally acceptable and low cost, such as sorghum and sugar beans, can improve nutritional and sensory attributes when composited. These composited foods can then be r...

Effects of a High Protein Food Supplement on Physical Activity, Motor Performance and Health Related Quality of Life of HIV Infected Botswana Children on Anti-Retroviral Therapy (ART)

Purpose – Identifying and addressing poor nutritional status in school-aged children is often not prioritized relative to HIV/AIDS treatment. The purpose of this paper is to elucidate the benefits of integrating nutrition (assessment and culturally acceptable food supplement intervention) in the treatment strategy for this target group. Design/methodology/approach – The authors conducted a randomized, double blind pre-/post-intervention trial with 201 HIV-positive children (six to 15 years) in Botswana. Eligibility included CD4 cell counts < 700/mm3 (a marker for the severity of HIV infection), documented treatment with antiretroviral (ARV) drugs, and no reported evidence of taking supplemental food products with one or more added nutrients in the six-month period prior to the study. The intervention (12 months) consisted of two food supplements for ethical reason, one with a higher protein content, bean (bean-sorghum based) group (n=97) and a cereal (sorghum) group (n=104) both of which contained added e...

Factors affecting prevalence of malnutrition among children under three years of age in Botswana

Objective Despite existing evidence about the benefits of nutrition, physical activity (PA) and sport to the overall health and wellbeing of children, knowledge gaps remain on this relationship in children living with chronic conditions like HIV/AIDS. Such knowledge should inform context specific programs that could enhance the quality of life of children. The purpose of this study was to examine the effects of integrating a nutrition intervention (culturally tailored food supplement) into antiretroviral therapy (ART) on psychosocial outcomes and physical activity among HIV-positive children in Botswana. Method 201 HIV-positive children (6–15 years; M = 9.44, SD = 2.40) were recruited and randomly assigned (stratified by age and gender) to two groups. The intervention group (n = 97) received a high protein (bean-sorghum plus micronutrients) food supplement, while the control group (n = 104) received a sorghum plus micronutrients supplement. Participants were followed over 12 months. Anthropometric measures, PA, motor performance, and health related quality of life (HRQL) were collected at baseline, 6 and 12 months. Results Mixed repeated-measures ANOVA revealed a significant time effect of the food supplement on target variables except body fat percentage, speed, and school functioning. Time × treatment interaction was found for physical functioning, psychosocial functioning and total quality of life score. Scores on physical functioning and total of quality life in the intervention group significantly increased from baseline to 6 months compared with the control group (p = 0.015). Conclusion A combination of ART and nutritional intervention had a positive effect on physical functioning and total quality of life of HIV-positive children in this study. There were also improvements to physical activity and motor performance tests over time. More research is needed on long term effects of nutrition and PA interventions on HRQL in children living with HIV.