Re: [pronut-hiv] Nutrient and energy rich foods - nutrient dense foods (3)

["francis khadudu" <fkwere@yahoo.com>]

Thanks very much for the list of nutrition dense food items.This is indeed the type of information we need to communicate in the village without appearing to be one of those confused by the MZUNGU ie European  foods. Please keep up with this approach.

Kind Regards Francis Were

---- Kristof & Stacia Nordin <nordin@eomw.net> wrote: Hi Stella, yes sort of -

Nutrient dense means that there are a lot of nutrients in a serving 
(Nutrients are Proteins, Fats, Carbohydrates, Vitamins, Minerals, and 
Water).

Energy dense means that there area lot of energy (calories) in a serving.

Both types of foods are available in Africa, but you would need to look into your own food sources.  Some general tips for finding foods are:

NUTRIENT Dense:

* Dark colors are often more nutrient dense than light colors, for example, whole grain flour is more nutrient dense than white coloured highly processed flours; and dark leafy greens like the African spinach are more nutrient dense than whiter leafy greens like lettuce or cabbage.

* Edible skins are often nutrient dense - foods should be cleaned well 
before eating the skin:  sweet potatoe or irish potatoe skins are delicious and edible; tomato skins; apple skins; cucumber skins, etc.

* Edible seeds are often nutrient dense - pumpkin, sunflower, sesame, etc.

* Edible nuts are often nutrient dense - there are several types of African Fruits that have an edible nut inside.

* Foods that are not very processed are often more nutrient dense than when they are processed.  Processing often removes protein, vitamins, and 
minerals, as well as fiber and medicinal properties.

ENERGY Dense:

* Fat has the highest amount of energy and can be found in:  Nuts; Oilseeds; 
some fruits like Avocado, Coconut or Olives;  most Animal products (unless 
the fat has been processed out) like milks and milk products, meats, 
insects, and some fish; various oils, margarines and spreads that are made 
from plant or animal oils/fats.

I hope that helps, it is just a general overview.

Stacia

~~~~~~~~~~~~~~~~~~~~~~
Stacia Nordin, RD
GTZ German / Malawi Basic Education Programme
MoE Sustainable School Food & Nutrition Programme
GTZ BEP, Box 31131, Lilongwe, Malawi
Tel:  + 265-(0)1-755-000 or (0) 1-757-358
Fax: + 265-(0)1-755-000
~~~~~~~~~~~~~~~~~~~~~~
Personal contacts:
Crossroads Post Dot Net X-124, Lilongwe, Malawi
Physical Location:  Chitedze Trading Centre, Lilongwe, Malawi (Africa)
+265  1-707-213  (home)
+265  9-333-073  (home cell)
nordin@eomw.net
www.NeverEndingFood.org (site being built)
~~~~~~~~~~~~~~~~~~~~~~

-----  "Mundi Stella" wrote:

Thank you Stacia and Pamela
  What do you mean by nutrient and energy rich foods - nutrient dense foods? 
Are these types of foods available in Africa?

  Stella

------Kristof & Stacia Nordin  wrote:
  Hi Stella - Jane's nutrient needs are higher because of HIV infection and
even higher because of the life stage she is in, breastfeeding (although I
assume from your message that she has stopped/or is stopping
breastfeeding?). There may be other things going on increasing her nutrient 
needs even further (including clean safe drinking water). Do you have a 
programme you can link Jane to help her access nutrient and energy rich 
foods? Are there local foods which are free through wild harvests that Jane 
may be able to get access to? Do you have a nutritionists there that can 
assist you in assisting Jane? What does the one meal consist of, is she 
buying that one meal or growing it or being given it? Is there a way to help 
Jane make more nutrient dense food choices with the resources she is 
currently using now? There are many ideas to explore but you'll need to know 
the various programmes and people around you to get assistance.

Good luck, I hope Jane is able to get access to the foods that she needs! 
Stacia


----- "Mundi Stella"wrote:


Dear colleagues,
I wrote to this forum a couple of weeks ago looking for guidance on abrupt
cessation of breastfeeding. I got some help from Ted. The HIV positive young
women (Jane)came to the clinic two weeks ago with her baby for the follow up
visit. The baby was doing very well, but Jane looked very pale and had lost
some weight. Jane did not have any opportunistic infection and was still
taking iron/folate tablets. The problem is that Jane gets only one meal a
day. I am a little bit worried about Jane.
Have you noticed some weight loss in HIV+ women who are breastfeeding?
What do you do in such situation? What are the recommendations regarding the
care of HIV positive breatfeeding women?

Thank you

Stella


------------------------------------------------
Ted Greiner wrote: Sure. This means it is not
worth the time of the health worker to get into complex prenatal counselling
(as per UN guidelines) unless she can tell that a given mother is well off.
I suspect that's what's happening in most African countries. The problem
then becomes that health workers do not know enough about how to support
exclusive breastfeeding and mothers need help in the community--otherwise
mothers in law in particular oppose it.

The sad thing is that counselling definitely is needed to decide when to
stop breastfeeding and WHO gives almost no practical advice on how to do
that. We hope to test an algorithm I've designed for this purpose in a
couple African countries in the near future.

Cheers,
Ted

Mundi Stella wrote:
Thanks Ted, this is very useful.
I agree partially with the recommendation to counsel HIV positive women so
that they can choose the most appropriate feeding option for their infant.
>From my experience, only wealthy HIV positive women can make that choice.
Most HIV positive women attending the antenatal clinic choose to breastfeed
their infant because they cannot afford breastmilk substitute.

Stella

Ted Greiner wrote:

Dear Stella,

Thank you for this question, which raises important issues.

First, if the family cannot afford milk, I do not think it is appropriate
to stop breastfeeding before about a year of age. With no milk or other
animal foods (such as liver and eggs) it is impossible to provide a
nutritionally acceptable diet that will allow an infant to survive and be
healthy.

Second, the rate of transmission of HIV during exclusive breastfeeding is
so low that the most recent published simulation study (Piwoz and Ross)
suggested that it makes no sense to do replacement feeding in a setting
where the infant mortality rate is likely to be higher than 25/1000 live
births. (You do not say what country you are writing from but I do not
believe that anywhere expect possibly wealthier urban areas of South Africa
has such a low IMR in Africa.) Thus stopping exclusive breastfeeding before
six months is hardly advisable in such a case.

Third, in 1998 the Coutsoudis study showing that exclusive breastfeeding
resulted in a lower HIV transmission rate (later confirmed by data from the
ZVITAMBO study in Harare and the DITRAME study in Abidjan) resulted in an
inappropriate assumption that mixed feeding after six months of exclusive
breastfeeding is as dangerous as it was shown to be by those three studies
in the first three months of life. While no research has been done on this,
I greatly doubt this is true, if only because the infant gut is completely
different in a newborn compared to a healthy six month old. Honey or
nitrate-rich water can kill newborns but not older babies; newborns' guts
are so immature that they can absorb entire proteins instead of breaking
them into amino acids as six month olds do; until about 8-9 months of life,
some of the lighter proteins in cow milk appear to cause occult gut bleeding
unless the milk is boiled for some time before being fed to the baby--not
just pasteurized.

Interestingly, infants who were exclusively breastfed in the first three
months of life in the ZVITAMBO data transmitted HIV at a lower rate during
the 6-18 month period than those who were mixed fed during the first three
months (5.6% versus 9.6%), though I was informed that this was not a
statistically signficant difference.

In most of Africa, the risk of death from not breastfeeding is likely to
be quite high. Bahl et al, using combined data from Ghana, India and Peru,
recently found the death rate to be 10.5% higher in the period 6 weeks to 6
months. This is 2-3 times as high as the rate based on old studies in one
city each in the Philippines, Brazil and Pakistan used in the Piwoz and Ross
simulation. The proportion likely to get HIV during breastfeeding during the
period 1.5-6 mo varies from about 1.5% to 5%, depending on whether the
breastfeeding is exclusive. Thus stopping breastfeeding would make sense
only if the infant mortality for that 1.5-6 mo period was under 5/1000,
which one sees only in industrialized countries.

Another factor to consider is Jane's health and immune status. If she has
a high CD4 count (or if you do not know it, if she has not lost much weight
in the past year or so), then her chances of transmitting HIV are less than
if her CD4 count is below say 350 (or if her BMI<19 or her weight loss >5%
recently), when the risk of transmission goes up.

Regards,

Ted Greiner, PhD
Senior Nutrition
Director, Ultra Rice Program
PATH
1800 K St. NW, Suite 800
Washington DC 20006 USA
+1 202 822-0033
Fax +1 202 457-1466

Message: 2
Date: Mon, 17 Apr 2006 07:00:44 -0700 (PDT)
From: "Mundi Stella"
Subject: [pronut-hiv] Help with transition to
replacement feeding
To: pronut-hiv@healthnet.org
Message-ID:
<20060417140044.54298.qmail@web38410.mail.mud.yahoo.com>
Content-Type: text/plain; charset="iso-8859-1"

Dear colleagues,

I am a midwife in antenatal service in the
district hospital and will
be meeting with a 21 year old young woman (Jane)
who delivered three
months ago in the maternity. Jane is HIV positive
and decided to
exclusively breastfeed her baby.
I will be meeting with Jane in two weeks to
counsel her on abrupt
cessation of breastfeeding and how to transition
to replacement feeding.
Jane lives with her parents and does not have any
income. Jane's parents
do not know about her HIV status. They cannot
afford to buy milk. The
only replacement feeding is available is "family
foods". I am very
challenged by Jane's situation. Jane's parents
may become very suspicious if Jane stops
breastfeeding their grand child. Family foods may not be
well tolerated by Jane's baby.

Any idea or suggestion on how to go about this
situation will be much
appreciated

Thanks

Stella