Feeding Options Research Articles

Breastfeeding media coverage and beliefs during the COVID-19 pandemic in Mexico: implications for breastfeeding equity

BackgroundBecause breastfeeding offers short- and long- term health benefits to mothers and children, breastfeeding promotion and support is a public health priority. Evidence shows that SARS-CoV-2 is not likely to be transmitted via breastmilk. Moreover, antibodies against SARS-CoV-2 are thought to be contained in breastmilk of mothers with history of COVID-19 infection or vaccination. WHO recommends direct breastfeeding as the preferred infant feeding option during the COVID-19 pandemic, even among women with COVID-19; but conflicting practices have been adopted, which could widen existing inequities in breastfeeding. This study aims to describe how information about breastfeeding was communicated in Mexican media during the pandemic and assess Mexican adults’ beliefs regarding breastfeeding among mothers infected with COVID-19.MethodsWe conducted a retrospective content analysis of media coverage on breastfeeding in Mexico between March 1 and September 24, 2020, excluding advertisements. For the content analysis, we performed both a sentiment analysis and an analysis based on strengths, weaknesses, opportunities, and threats (SWOT) for breastfeeding promotion. Additionally, we conducted a descriptive analysis of nationally representative data on adults’ beliefs about breastfeeding from the July 2020 round of the ENCOVID-19 survey in Mexico and stratified the results by gender, age, and socioeconomic status.ResultsA total of 1014 publications on breastfeeding were identified on the internet and television and in newspapers and magazines. Most information was published during World Breastfeeding Week, celebrated in August. The sentiment analysis showed that 57.2% of all information was classified as positive. The SWOT analysis indicated that most information focused on current actions, messages, policies, or programs that enable breastfeeding (i.e., strengths) or those not currently in place but that may enable breastfeeding (i.e., opportunities) for breastfeeding promotion. However, ENCOVID-19 survey results showed that 67.3% of adults living in households with children under 3 years of age believe that mothers with COVID-19 should not breastfeed, and 19.8% do not know whether these mothers should breastfeed. These beliefs showed differences both by gender and by socioeconomic status.ConclusionsWhile the Mexican government endorsed the recommendation on breastfeeding during the COVID-19 pandemic, communication was sporadic, inconstant and unequal across types of media. There was a widespread notion that mothers with COVID-19 should not breastfeed and due to differences on beliefs by socioeconomic status, health inequities could be exacerbated by increasing the risk of poorer breastfeeding practices and preventing vulnerable groups from reaping the short and long-term benefits of breastfeeding.

Clinical comparison between thoracoscopic and thoracotomy repair of Gross type C esophageal atresia

BackgroundTo compare the clinical outcomes between thoracoscopic approach and thoracotomy surgery in patients with Gross type C Esophageal atresia (EA) and tracheoesophageal fistula (TEF).MethodsPatients with Gross type C EA/TEF who underwent surgery from January 2007 to January 2020 at Beijing Children’s Hospital were retrospectively analyzed. The patients were divided into two groups according to surgical approaches. The perioperative factors and postoperative complications were compared among the two groups.ResultsOne hundred and ninety patients (132 boys and 58 girls) with a median birth weight of 2975 (2600, 3200) g were included. The primary operations were performed via thoracoscopic (n = 62) and thoracotomy (n = 128) approach. After comparison of clinical characteristics between the two groups, we found that there were statistically significant differences in associated anomalies, method of fistula closure, duration of mechanical ventilation after surgery, feeding option before discharge, management of pneumothorax, and prognosis (all P < 0.05). To a certain extent, thoracoscopic surgery reduced the incidence of anastomotic leakage and increased the incidence of anastomotic stricture in this study. However, there were no statistically significant differences between the two groups in terms of operative time, postoperative pneumothorax, anastomotic leakage, anastomotic stricture, and recurrent tracheoesophageal fistula (all P > 0.05).ConclusionsThoracoscopy surgery for Gross type C EA/TEF is a safe and effective, minimally invasive technique with comparable operative time and incidence of postoperative complications.

Endoscopic negative pressure therapy as stand-alone treatment for perforated duodenal diverticulum: presentation of two cases

BackgroundEndoscopic negative pressure therapy is a novel and successful treatment method for a variety of gastrointestinal leaks. This therapy mode has been frequently described for rectal and esophageal leakages. Duodenal diverticular perforations are rare but life-threatening events. The early diagnosis of duodenal diverticular perforation is often complicated by inconclusive symptoms. This is the first report about endoscopic negative pressure therapy in patients with perforated duodenal diverticula.Case presentationWe present two cases of duodenal diverticula perforations treated with endoscopic negative pressure therapy as stand-alone treatment. Start of symptoms varied from one to three days before hospital admission. Early sectional imaging led to the diagnosis of duodenal diverticular perforation. Both patients were treated with endoluminal endoscopic negative pressure therapy with simultaneous feeding option. Three respective changes of the suction device were performed. Both patients were treated with antibiotics and antimycotics during their hospital stay and be discharged from hospital after 20 days.ConclusionsThis is the first description of successful stand-alone treatment by endoscopic negative pressure therapy in two patients with perforated duodenal diverticulum. We thus strongly recommend to attempt interventional therapy with endoluminal endoscopic negative pressure therapy in patients with duodenal diverticular perforations upfront to surgery.

Environmental sustainability of future aquaculture production: Analysis of Singaporean and Norwegian policies

To address global food demand and sustainability challenges, aquaculture has appeared as an essential element in food systems, and an increasing number of national aquaculture policies have emerged over the past decades. However, several of these policies have failed because of an often-argued inability to anticipate their far-reaching implications on environmental and socio-economic variables. To tackle this gap, we propose a step-wise framework to assess the national environmental impacts from aquaculture industries with a prospective and systemic approach. Starting from identifying policy-based national targets, the methodology relies on economic equilibrium modeling to develop realistic future-oriented scenarios of the aquaculture sector, and couples them with life cycle assessment principles. To evidence its operability, we apply the framework to two distinct case countries: Norway and Singapore. Beyond our key findings from the analyses of the policies in both countries, we observed that feed production and usage are important drivers of impacts, hence calling for new and more environmentally-friendly feed options. Our results additionally show that the development of aquaculture following existing governmental policies may not directly reduce greenhouse gases emissions and, hence, not support climate change mitigation objectives. These findings should however be cautioned as potential shifts of diets due to the increasing seafood availability might occur, leading to indirect environmental benefits. We therefore advocate the further expansion of our framework to cover the entire food system, so it can integrate such indirect effects. Meanwhile, we recommend its interim application to support policy-making and help move towards more environmentally sustainable aquaculture systems.

What are LGBTQI+ parental experiences of healthcare support and decision-making regarding infant feeding options? A grounded theory study.

To explore LGBTQI+ parental experiences regarding their interactions with healthcare professionals as a resource for feeding options during the prenatal-to-neonatal period. This single-center, interview-based qualitative study of LGBTQI+ parents utilized grounded theory to identify and verify emergent themes and subthemes. We developed a conceptual framework to illustrate relationships among themes and subthemes, as well as opportunities for healthcare professionals and families to improve LGBTQI+ parental support. Thematic saturation was attained after interviewing 21 parents from 12 families. Analyses revealed four main themes representing opportunities for improvement: education, continuity of care, parental engagement and open communication. Personal and interpersonal factors influenced parental experiences and decisions, which shaped ultimate feeding outcomes. LGBTQI+ parents revealed challenges of establishing feeding practices that best aligned with their values and goals. Recognizing these factors can help healthcare professionals improve their counseling, engagement and support of LGBTQI+ parents.

186 Have New Feeding Technologies Revolutionized the Way We Design Grazing Experiments?

Abstract New technologies have enabled autonomous measurement of intake and feeding behavior of pen-fed animals and this has piqued interest in utilizing similar technologies in grazing experiments. Various feeding systems are currently available, but individual supplementation and feeding experiments have been conducted for years using individual feeding stanchions, which are the lowest level of technology for measuring supplement intake. These experiments are laborious as they require animals to be trained and acclimated, gathered at each feeding, and sorted into individual stalls for supplementation—thereby disrupting the animals grazing activities. In the mid-1980s Calan Gate systems (American Calan; Northwood, NH) became popular in pasture supplementation experiments, but still have many of the same disadvantages. Newer, more automated systems, reduce labor and possibly have less disruption of the animal’s grazing behavior, but are reliant on the animal’s willingness to use the system and ability to access it when more dominant peers are present. Individuals also do not always follow the “averages”-based rules we often hold true and behave differently in groups. Recent research with automatic feeders show steers consumed average of 60% of the potential supplement with supplement intake CVs of 50 to 100%. These technologies lead many to question the paradigm of experimental units in experimental designs. The experimental unit is defined as the smallest independently assigned unit to which the treatment is applied. This definition of experimental unit is somewhat limiting when taken to the extreme, but still applies well for experiments utilizing individual animal feeding, regardless of the level of technology involved. In many cases where the aforementioned technologies are used, the individual animal can be both the observational and experimental unit. This symposia presentation will discuss attributes of different feeding options and the implications on study design, experimental power, and the designated experimental unit.

Advice from Canadian Mothers Who Express Human Milk: An Interpretive Description Qualitative Study.

Human milk expression has become an increasingly common means for providing milk to an infant, with women expressing to address breastfeeding problems or to allow for flexible feeding options. This study explored the experiences and recommendations of mothers who expressed human milk, with this paper reporting on the advice mothers would offer to other mothers to address common challenges. Interpretive description was used in this qualitative project. Using purposive sampling, mothers of infants aged 0-24months who expressed human milk were recruited to participate from two health regions in western Canada. Individual, audio-taped interviews were completed with 35 women. NVIVO™ software was used for data analysis. Mothers reported the desire to offer experiential advice to other mothers navigating milk expression and encouraged other mothers to seek guidance from health care professionals such as lactation consultants, peer support online, and from family and friends. Experiential knowledge shared included: (a) product recommendations, (b) expression tips, (c) support for workplace expression, (d) encouragement to seek help, and (e) moral support. Healthcare professionals should include evidence-based expression information as part of routine lactation support, while recognizing the importance of mother-to-mother knowledge transfer and emotional support. Services that assist mothers to determine and access pumps appropriate to their unique breastfeeding needs and goals should be offered, and the opportunity for peer support through creation of, or referral to, appropriate in-person or online support groups should be made available.

Breeding and biotechnological efforts in Jatropha curcas L. for sustainable yields

Jatropha is a non-edible, important bioenergy plant, which can grow in marginalized land. The seeds possess about 36% oil and this would be converted into biodiesel or biojet-fuel. Jatropha provides an option for sustainable feed and fuel production due to its inherent qualities including hardy nature, drought tolerance and surviving with limited amount of water, tolerance to unfavorable conditions and excessive moisture. However, heterozygosity, low productivity and poor understanding of its genome are the major impediments to elite line development. Further, classical breeding and advanced technological investments remain limited owing to long juvenile phase and breeding cycles. Scientific technologies that lead to identification of elite genotypes and development of high yielding elite Jatropha lines and effective methods of detoxification of seeds needs immediate priority. Efficient tissue culture system, doubled haploids (DH) and genomic tools are increasingly made available to improve the seed yield and its oil quantity through the development of geminivirus disease resistant lines. The application of advanced, sequencing technologies has presented a repertoire of genomic information for this important yet orphan crop. In the present investigation, we highlight the achievements made in Jatropha towards development of high yielding, virus resistant elite lines and hybrids with yield potential ranging from 3 to 5 tons per hectare in a year, which is a first ever report in the world. We also developed potential biotechnological tools such as genetic transformation, genome editing and next generation genomics tools including linkage maps and QTLs for accelerating breeding efforts through marker assisted selection. Because of our concerted and continuous efforts during the past 15 years, we have overcome all the obstacles and developed high yielding, disease resistant hybrids/lines, advanced cultivation technologies with thorough knowledge on Agronomy of the Jatropha crop. The Jatropha cultivation technology developed for the first time in the world, could open up new avenues for higher yield productivity of commercial viability.

S2181 Jejunostomy Feeding in Refractory Hyperemesis Gravidarum - A Case Report and Review of Literature

Introduction: Hyperemesis gravidarum (HG) is intractable vomiting experienced by < 1% of pregnant women causing dehydration, significant weight loss and electrolyte disturbances requiring hospital admission. HG is distinguished from nausea/vomiting in pregnancy by ketonuria and loss of >5% of prepregnancy weight. Nutritional support in early pregnancy reduces potential complications associated with HG. We present a patient with severe HG who failed all pharmacological treatment and had a jejunostomy (J) tube placed for nutrition. Case Description/Methods: A 31-year-old G3P1 female presented in her 21stweek of pregnancy with intractable vomiting ( >20 episodes/day) and 13-lb weight loss in 2months. Symptoms began in her 6thweek and she failed a trial of scheduled Ondansetron, Promethazine, Vitamin B1/B6 and Famotidine. Patient later agreed to complete a regimen of IV Methylprednisolone followed by Prednisone taper; however, symptoms persisted. She continued to lose weight and developed protein-calorie malnutrition with ketonuria by her 24thweek. Enteral versus parenteral feeding options were reviewed and she agreed to endoscopic nasojejunal (NJ) tube placement. Tube feeds were uptitrated gradually, however her NJ tube dislodged after 2days due to vigorous vomiting. She subsequently had central line placed and was started on parenteral nutrition. To prevent long-term complications, we opted for J-tube placement laparoscopically to avoid puncturing the uterus during the procedure. Tube feeds were restarted and increased as tolerated to reach nutritional goals. The J-tube will remain in place until she delivers. Discussion: Currently, antiemetics are recommended for HG as there are no superior treatments available with proven efficacy based on the latest Cochrane review. Glucocorticoids or Droperidol are tried for refractory cases, while smaller studies have reported benefits with Gabapentin and Mirtazapine. Early enteral or parenteral feeding should be initiated in parallel for better outcomes. Generally, post-pyloric feeding tubes are preferred due to the changing anatomy in pregnancy. Extensive literature review only revealed 1 case series reporting jejunostomy feeding in 5 patients with HG. In 2 patients, the J-tube was removed or dislodged while the remainder kept it until delivery. All patients successfully delivered at term without maternofetal complications. Though J-tubes appear to be well-tolerated, further large-scale studies are required to assess the actual benefits and risks involved.

Alternative non-oral nutrition in a rat model: a novel modified gastrostomy technique.

The gastrostomy technique is essential for esophageal reconstruction using a scaffold. To date, there are no established methods to supply nutrients through a gastrostomy tube in rats. The purpose of this study was to analyze the feasibility of a newly modified gastrostomy technique for non-oral nutrition in an adult rat model. We modified the gastrostomy technique for adult rats in a few different ways. (1) The external opening for food injection was made at the midpoint between the ears to prevent damage due to self-harm behaviour. (2) An imbedded subcutaneous tunnel was created between the internal and external openings of the gastrostomy. We compared the efficacy and safety between groups with a T-tube for biliary drainage (TT group, n=14) and a conventional silicone Foley catheter (FC group, n=7) as optimal gastrostomy tubes for in a rat model. We also evaluated the feasibility of the heparin cap connector at the end of gastrostomy tube to control food supply in the TT group (with a cap, n=7; without a cap, n=7). No mortality was observed in the TT group with a cap, whereas most rats in the FC group died within 2 weeks after the procedure. Weight loss decreased significantly in the TT group with a cap compared with all the other groups. The appearance and attitude scores were significantly better in the TT group with a cap. In addition, histologic analysis showed that the TT group a cap showed a marked decrease over time in tissue fibrosis and macrophages compared with the other experimental groups. Therefore, gastrostomy using a silicone T-tube plugged with a cap proved to be a stable and effective option for non-oral feeding in an adult rat model.

Prenatal Exposure to Innately Preferred D-Limonene and Trans-Anethole Does Not Overcome Innate Aversion to Eucalyptol, Affecting Growth Performance of Weanling Piglets.

Simple SummaryWeanling piglets appear to be poorly adapted and motivated to ingest solid feed due to the innate reluctance of young animals to ingest an unfamiliar feed or flavor, i.e., feed neophobia, which commonly results in a period of underfeeding. This, and other common wean stress factors, lead to gastrointestinal disorders and impaired growth performance. Increasing the preference or familiarity for a certain type of food or for specific flavors may improve voluntary feed intake in weanling piglets. Botanical compounds (BCs) are described as functional feed additives and include sensorial properties that are able to influence feed intake and growth in pigs by dietary supplementation or sensory maternal learning. In this study, the effects of BCs such as D-limonene, trans-anethole, and eucalyptol on innate feed preference and growth performance of weanling piglets were evaluated by means of a double-choice feeding test and pre- and postnatal exposure to these compounds.In the present research, two studies were performed to determine the effects of specific botanical compounds (BCs) on the innate feed preference and feed intake of piglets, as follows: Exp. 1 studied the innate feed preferences of post-weaning piglets using a double-choice feeding test. A total of 828 weaned piglets were distributed into 36 pens (23 pigs/pen) and assigned to three dietary pair choice feeding options (n = 12): unsupplemented prestarter diets (reference) versus reference plus D-limonene, trans-anethole, or eucalyptol. Piglets showed a preference for diets with D-limonene (53.8%) and trans-anethole (54.5%), and an aversion to eucalyptol (41.6%) (p < 0.05). Exp. 2 studied whether the prenatal and perinatal exposure to D-limonene, trans-anethole, and eucalyptol influences the feed intake and growth of newly-weaned piglets. Twenty-eight gestating and lactating sows were distributed into two dietary treatments (n = 14): unsupplemented Control diets or Control plus a blend of BCs (BBC; containing D-limonene, trans-anethole, and eucalyptol). D-limonene, trans-anethole, and eucalyptol were transferred into the placental fluid, and D-limonene and trans-anethole into the milk (p < 0.05). Furthermore, weanling piglets (n = 200; Control) and (n = 203; BBC) received the same treatment as their mothers in prestarter diets. The early response after weaning showed that piglets’ post-weaning BW gain was higher in the Control (p < 0.05) group than in those exposed to BBC. In conclusion, prenatal exposure to preferred D-limonene and trans-anethole, or familiarity to eucalyptol did not help to overcome the innate aversion to eucalyptol and its negative effect on weanling piglets’ BW.

The Earliest Food Deserts: Availability of Infant and Follow-on Formula, and Lactation Support Products among Stores in Black and Non-Hispanic White Zip Codes in Los Angeles County.

This study investigates the availability, accessibility, and product depth of in-store infant feeding and galactagogues products in majority Black and majority white zip codes in Los Angeles County. A cross-sectional study was conducted to determine racial/ethnic neighborhood differences in the availability of infant and follow-on formula and galactagogues products in 47 retail stores in 21 zip codes. Store-level data were collected in June 2019 and an observational tool for galactagogues products and infant/follow-on formula (availability, accessibility, product depth) was employed at each store. Most of the stores were grocery stores (87.2%). Stores in majority Black zip codes had less availability of infant formula ready-to-use (p = 0.001), less accessibility of follow-on powder (p = 0.028), and availability of galactagogues beverages (p = 0.036) versus majority white zip codes. Product depth (number of brands sold) of stores with one or more brands of the aforementioned products was consistently higher in majority white zip codes compared to majority Black zip codes. Stores in majority Black zip codes were most likely to have lower availability of infant formula and galactagogues products, an important part of the food environment for infant feeding options, in particular, for lactation support. Most studies investigating the association of the food environment and health outcomes have focused only on solid foods. However, additional food products (e.g., liquids, powders) may be contributors to extensive disparities in infant mortality between Black and white infants and may lead to health disparities beyond infant stage (e.g., children, adolescents, and adults). Lastly, for breastfeeding inequities to decrease, pregnant and postpartum Black persons need equitable access and education onsafe and quality galactagogues products.

Impact of Enteral Tube Feeding Compared to Oral Hand Feeding on Mortality, Pneumonia, Hospitalization and Quality of Life in Patients With Advanced Dementia: A Review

ObjectivesTo assess the effectiveness of enteral tube feeding in comparison to oral hand feeding in improving survival, hospitalization, pneumonia incidence, and quality of life in adults 60 years and older with advanced dementia. MethodsPubMed, CINAHL, Cochrane Library, and Academic Search Premier, supplemented by hand-searching, were probed for articles published between January 2006-June 2020. Eligible articles compared clinical outcomes (mortality, survival, pneumonia, hospitalization, and quality of life) amongst patients 60 years and older with advanced dementia, fed via an enteral tube or oral hand-feeding route. Of the 53 articles screened and assessed, 4 cohort studies involving 508 patients were extracted after excluding based on the above criteria and summarized for this review. ResultsOf the 4 articles, 3 were prospective cohort studies and 1 was a retrospective cohort study. Half of the studies reported significantly increased rates of mortality in groups of advanced dementia patients fed via enteral tube. Meanwhile, 1 study reported a similar nonsignificant increase in mortality rates in those fed via oral hand route. Half of the studies indicated a nonsignificant increase in hospitalization frequency for those fed via enteral tube. Additionally, 1 study reported an increased risk of pneumonia in patients fed via nasogastric tube. Regarding quality of life, 1 article reported significantly increased complaints of pain and discomfort from patients fed via oral hand feeding, that severity of dementia may have contributed to. ConclusionsConcerning clinical outcomes and mortality, these findings suggest no significant advantage to using enteral tube feeding options in older patients with advanced dementia. Thus, the healthcare professional should place primary emphasis on the patient’s advance directives and provide the primary caregiver a thorough review of feeding options. Funding SourcesNone.

Parental nutrition in emergency surgery: A multicentre cross-sectional study.

Emergency general surgical patients are inherently at high risk of malnutrition. Early decision-making with implementation is fundamental to patient recovery. For many patients, parenteral nutrition (PN) is the only feeding option available. The present study assessed the timing and outcomes of this decision-making process. A sample of at least 10 consecutive adult patients admitted as a general surgical emergency to eight UK hospitals over 1year who had received PN was identified. Patient demographics, basic descriptors and nutritional data were captured. Process measures regarding dates decisions were made or activities completed were extracted from records, as were outcome measures including PN complications. Six time frames examining the process of PN delivery were analysed. Associations between categorical and binary variables were investigated with a chi-squared test with significance determined as p<0.05. In total, 125 patients were included. Intestinal obstruction was the most common diagnosis with 59% of all patients deemed high risk on nutritional assessment at admission. Median time to decision for PN was 5days following admission (n=122, interquartile range=7). Patients received PN for a mean of 11days. Eighty-five percent of patients developed a complication, with a phosphate abnormality being the most commonly reported (54%). Only altered blood glucose levels appeared to correlate with a delay in starting PN (p<0.01). The present study shows there are delays in the decision to use PN in the acutely ill surgical patient. Once initiated, the pathway is relatively short. There are high rates of electrolyte abnormalities in this population.

156 Effect of Anti-yeast on Sugarcane Silage Gas Production

Abstract Although sugarcane produces a large amount of energy per hectare, its ensiled storage leads to losses, which makes it one of the most expensive options for animal feeding. These losses occur due to fermentation of sugars and organic acids by yeasts, producing alcohol and gas. Inoculants containing Lactobacillus buchneri increase acetic acid production, which has effect against yeast. In this study, we produced egg yolk antibodies (IgY) against yeasts that ferment lactate (Candida glabrata, Pichia kudriavzevii, and Pichia manshurica) and sugar (Saccharomyces cerevisiae, Torulospora delbrueckii, Schizosaccharomyces pombe and Debaryomyces etchellsii) isolated in sugarcane silage. Shortly before ensiling, doses of 0, 175, 350, and 700 g/t IgY, and Lactobacillus buchneri were applied to chopped forage. Gas losses were calculated using experimental silos in triplicate, according to the equation: G = (PCf - PCa)/(MFf) × 100, in which: G = gas losses (kg/t); PCf = weight of full silo (equipped with a Bunsen valve to allow gas outflow) at sealing (kg); PCa = weight of full bucket at opening (kg); MFf = forage mass at sealing (kg). The data were analyzed as a completely randomized design and submitted to analysis of variance and regression using the SAS (SAS, 1998), which was chosen because of the significance of the regression parameters, tested by Tukey’s test (P &amp;lt; 0.05) and the values of the coefficients of determination. Thirty days after sealing the L. buchneri inoculant and doses of 350 and 700 g/t IgY promoted less gas losses than control that had no any product (12.74; 15.59 and 15.28 versus 27.74, respectively, P &amp;lt; 0.05) and the L. buchneri did not differ from IgY doses. The gas losses decreased quadratically with the anti-yeast addition, estimating maximum of 530 g/t fresh forage. We conclude that anti-yeast use reduces gas production during fermentation. With continuity of this research, we may obtain a roughage with higher nutritional value, as its mode of action in yeast control does not involve consumption of sugars or organic acids.

RETRACTED ARTICLE: Individual level and community level factors affecting exclusive breast feeding among infants under-six months in Ethiopia using multilevel analysis

BackgroundExclusive breastfeeding (EBF) is the safest and healthiest option of feeding among infants in the first 6 months throughout the world. Thus, promotion of EBF is essential to prevent complex infant health problems even at the adulthood level. But majority of previous studies focused on individual level determinants of EBF by using basic regression models in localized areas. This study aims to identify individual level and community level determinants of EBF which would be helpful to design appropriate strategies in reducing infant mortality and morbidity.MethodsIt is a secondary data analysis using the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total of 1185 infants under 6 months of age were included in the analysis. Multilevel logistic regression model was employed to investigate factors significantly associated with EBF among under-six month’s infants in Ethiopia. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to measure the association of variables whereas Intra cluster correlation (ICC), median odds ratio (MOR), and proportional change in variance (PCV) were used to measure random effects (variation).ResultIn multilevel logistic regression; 4–5 months age infant (AOR = 0.04, 95%CI:0.02–0.07), female infants (AOR = 2.51, 95%CI:1.61–3.91), infant comorbidities (AOR = 0.35, 95%CI: 0.21–0.57), household wealth index (AOR = 10.34, 95%CI: 3.14–34.03) and antenatal care (AOR = 2.25, 95%CI:1.32–3.82) were determinants of EBF at individual level. Whereas, contextual region (AOR = 0.30, 95% CI: 0.10–0.87), community level of postnatal visit (AOR = 2.77, 95% CI: 1.26–6.58) and community level of maternal employment (AOR = 2.8, 95% CI: 1.21–6.47) were determinants of EBF at community level. The full model showed up with higher PCV; that is, 46.8% of variation of exclusive breastfeeding was explained by the combined factors at the individual and community levels. Similarly, it showed that the variation in EBF across communities remained statistically significant (ICC = 8.77% and variance = 0.32 with P < 0.001). The MOR at final model indicates there was significant cluster difference for EBF indicating the heterogeneity was explained by both individual and community level factors.Conclusion and recommendationOur study showed that both individual and community level determinants were significantly associated with EBF practice. Based on our findings it is strongly recommended to promote and enhance antenatal and postnatal care services utilization of mothers and more emphasis should be given for infants with comorbid conditions and those who live in the pastoralist regions.

Slaughter performance and meat quality of Begait breed lambs fattened under different diets

This study was conducted to evaluate slaughter performance and meat quality of Begait sheep breed reared under different feeding options. Thirty intact fattening lambs (32.81 ± 2.39 kg) were used in randomized completely block design with three dietary treatments in ten replicates for a 90 day feeding trial. Dietary treatments constituted grass hay fed ad libitum to all treatments plus supplemented with mixed diet of 48% wheat bran, 15% molasses, 35% cotton seed cake, 1% salt and 1% limestone (T1); 43% wheat bran, 20% sorghum grain, 35% noug seed cake, 1% salt and 1% limestone (T2) and 47% wheat bran, 16% molasses, 35% sesame seed cake, 1% salt and 1% limestone (T3). At the end of the experimental period, six lambs randomly chosen from each treatment were slaughtered to determine the carcass traits and meat quality. Results showed that most carcass and meat traits were affected by diets. Average daily gain (ADG) was higher (P < 0.001) for T3 (158 g/day) than T2 (120 g/day) and T1 (118 g/day). Hot carcass weight (HCW) was higher (P < 0.001) for T3 (19.50 kg) than T2 (17.43 kg) and T1 (17.20 kg). Meat pH (5.43–5.56) and drip loss (3.03–3.23%) were similar (P > 0.05) among all treatments. Meat from animals in T3 (33.97 L∗) was lighter (P < 0.001) than T2 (30.75 L∗) and T1 (29.43 L∗). Shear force and cooking loss were greater (P < 0.05) for T1 (42.6 N and 26.12%) than T2 (40.4 N and 24.39%) and T3 (40.7 N and 24.18%). No variation was seen in meat moisture, protein and ash contents (P > 0.05) while intramuscular fat was higher in T3 (4.18%) than T2 (3.87%) and T1 (3.79%) (P < 0.01). The study indicated that carcass traits and meat quality could be modulated through dietary manipulation.

Potential Loss among Infant Feeding Options

Introduction: The conceptual relationship between economics and breastfeeding is still mathematically invaluable, while the family's economic burden increases along with babies born. Indicating potential loss when a family chooses other than breastmilk is a progressive way to manage campaign messages about exclusive breastmilk and prolonged breastfeeding. Descriptive studies are needed to magnify all of these indicators and transform them into measuring instruments generalized to assess family expenditures related to infant feeding.Methods: This study uses a quantitative descriptive design, questionnaire draft upon qualitative open questions containing all micro indicators impacted financially during the baby’s first year. Data collection was carried out in Makassar based on telephone surveys with 330 preliminary samples. After structural analysis and data reduction, the expenditure indicators were divided into medical and non-medical expenses.Results: The study show there is a difference in the average amount of family expenses of those who provide formula milk compared to breastmilk. This outcome is 21.1 times higher in non-medical components and 2.5 times higher in the medical component. One of the highest contributions in medical expenses is the cost of a recurrent visit to a pediatrician due to a history of illness such as allergies, respiratory infections, and diarrhea.Conclusion: This empirical fact stated the strong affirmation of how families should consider wisely to choose the best feeding pattern for babies aged 0-12 months.

Design and challenges of a large HIV prevention clinical study on mother-to-child transmission: ANRS 12397 PROMISE-EPI study in Zambia and Burkina Faso

Post-natal HIV infection through breastfeeding remains a challenge in many low and middle-income countries, particularly due to non-availability of alternative infant feeding options and the suboptimal Prevention of Mother to Child Transmission of HIV-1 (PMTCT) cascade implementation and monitoring. The PROMISE-EPI study aims to address the latter by identifying HIV infected mothers during an almost never-missed visit for their infant, the second extended program on immunization visit at 6–8 weeks of age (EPI-2). The study is divided into 3 components inclusive of an open-label randomized controlled trial aiming to assess the efficacy of a responsive preventive intervention compared to routine intervention based on the national PMTCT guidelines for HIV-1 uninfected exposed breastfeeding infants. The preventive intervention includes: a) Point of care testing for early infant HIV diagnosis and maternal viral load; b) infant, single-drug Pre-Exposure Prophylaxis (PrEP) (lamivudine) if mothers are virally unsuppressed.The primary outcome is HIV-transmission rate from EPI-2 to 12 months. The study targets to screen 37,000 mother/infant pairs in Zambia and Burkina Faso to identify 2000 mother/infant pairs for the clinical trial.The study design and challenges faced during study implementation are described, including the COVID-19 pandemic and the amended HIV guidelines in Zambia in 2020 (triple-drug PrEP in HIV exposed infants guided by quarterly maternal viral load). The changes in the Zambian guidelines raised several questions including the equipoise of PrEP options, the standard of care-triple-drug (control arm in Zambia) versus the study-single-drug (intervention arm).Trial registration number (www.clinicaltrials.gov): NCT03869944.Submission category: Study Design, Statistical Design, Study Protocols.

English

Thirty intact growing lambs were used to evaluate feed intake, digestibility and growth performance of Begait sheep breed kept under different feeding options. Animals were used in randomized completely block design with three dietary treatments in ten replicates. Treatments were grass hay fed ad libitum to all treatments plus a mixed diet of 48% wheat bran, 15% molasses, 35% cotton seed cake, 1% salt and 1% limestone (T1); 43% wheat bran, 20% sorghum grain, 35% Noug seed cake, 1% salt and 1% limestone (T2) and 47% wheat bran, 16% molasses, 35% sesame seed cake, 1% salt and 1% limestone (T3). Sheep in T3 (1123 g DM/day) consumed more feed (P &lt; 0.001) as compared to sheep in T2 (1077 g DM/day) and T1 (1057 g DM/day). Higher apparent digestibility of DM, OM, CP, NDF and ADF were obtained in T3 groups than in the other treatment groups (P &lt; 0.05). Average daily gain was significantly higher for T3 (158 g/day) than T2 (120 g/day) and T1 (118 g/day) (P &lt; 0.001). Diet 3 was better as compared to the other feeding options. Key words: Apparent digestibility, average daily gain, feed consumption, sheep.