Browsing by Author "Makori, Nyabasi"

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The effect of an intervention to reduce aflatoxin consumption from 6 to 18 mo of age on length-for-age z-scores in rural Tanzania: a cluster-randomized trial
(Elsevier, 2025-02-01) Phillips, Erica; Ngure, Francis; Kassim, Neema; Turner, Paul; Makule, Edna; Smith, Laura; Makori, Nyabasi; Cramer, Benedikt; Humpf, Hans-Ulrich; Nelson, Rebecca; Stoltzfus, Rebecca
Background Linear growth faltering continues to negatively affect children in low- and middle-income countries and is associated with poor cognitive, developmental, and educational outcomes. Laboratory and observational data suggest that aflatoxin (AF) is a contributor to stunting. Objective The Mycotoxin Mitigation Trial was a cluster-randomized, community-based 2-group trial conducted in Kongwa District, Tanzania, between 2018 and 2020. The trial assessed whether a 12-mo intervention to reduce AF consumption increased length-for-age z-scores (LAZ) at 18 mo. Methods Low-AF maize and groundnut flours were provided to the intervention group each month; skin lotion was distributed to the control group monthly. Infant and young child feeding education was delivered equally in 52 health facilities (clusters). Anthropometry and the AF blood biomarker serum AF-albumin (AF-alb) were assessed at 6, 12, and 18 mo of age. Outcomes were analyzed as intention-to-treat and per-protocol using linear mixed-effects models. Results Two thousand eight hundred forty-two maternal–infant dyads were recruited into the study. The intervention did not create a contrast in AF-alb. At 18 mo, 36% (n = 186/520) of infants had detectable levels of AF-alb compared with 54% (n = 195/364) at baseline, with no difference between groups. Mean LAZ in the intervention group at 18 mo was −1.83 (n = 1231, 95% CI: −1.93, −1.73) compared to −1.90 (n = 1287, 95% CI: −1.99, −1.82) in the control group (P = 0.28). Conclusions An intervention to reduce AF exposure did not alter AF-alb nor anthropometric measures between treatment groups. Drought and agricultural data indicated less favorable conditions for toxin production, resulting in low levels of exposure in both trial arms. Annual, seasonal, and geographic heterogeneity of AF contamination make it difficult to study in an ethically designed trial. Our formative research and early trial data indicate that stunting and intermittent AF exposure continue to be a problem in this region. However, the low-AF exposure levels during the trial led to inconclusive results.
Factors associated with stunting in Dodoma region, Tanzania
(African Journal of Food, Agriculture, Nutrition and Development, 2018-12) Makori, Nyabasi; Kassim, Neema; Matemu, Athanasia; Kinabo, Joyce
Child undernutrition is a major public health concern, claiming the lives of numerous children below five years of age in the developing world. The objective of this study was to assess the factors associated with stunting of children of age 6 – 23 months in Dodoma Municipality and Chamwino District in Dodoma region. Dodoma region located in the central zone of Tanzania was chosen for this study because of its high prevalence (56%) of stunting among children under five years of age. A systematic random sampling technique was used to choose wards, villages, and households that had children aged 6 - 23 months, resulting in 394 households participating in this cross-sectional study. A standardized questionnaire was used to collect socio-demographic information and infant feeding practices. Anthropometric measurements were taken as per WHO standard procedures. A repeated 24-hour dietary recall was used to assess food intake among the study population. Multivariate logistic regression using backward stepwise selection method was used to obtain independent factors of stunting. The overall prevalence of stunting was 40.4% (95% CI; 29.8; 50.9), Chamwino District had a higher prevalence of stunting (44.3%) compared to Dodoma municipality (26.3%). Multivariate logistic regression analysis showed that, age of introduction of complementary food [AOR = 13.3; (95% CI: 2.6 – 67.6)], maternal education [AOR = 5.5; (95% CI: 1.0 – 9.8)], residence in Chamwino District [AOR = 3.2; (95% CI: 1.3 – 5.9)] were factors associated with stunting. About half of the study population (49%) was introduced to complementary foods early, the median age was four months instead of 6 months as recommended by WHO. Infant’s diet was mainly cereal-based, other foods such as animal food source, fruits, and dairy products were consumed by 18%, 11% and 7.1% of children respectively. The dietary pattern of infants was not diversified as 47.7% of infants scored 1 to 3 points out of 12 points categorized as low dietary diversity. Failure to attain normal growth pattern is the most prevalent form of undernutrition in childhood. Associated factors are many, diverse and interrelated. The present study identified maternal education, early introduction of complementary foods and being a resident of Chamwino District as factors to be associated with stunting. Prioritization of identified factors serves as a highlight for better planning of nutrition intervention programs that intend to promote child growth.
Inadequate management of complementary foods contributes to the risk of aflatoxin exposure and low nutrition status among children
(World Mycotoxin Journal, 2018-11-22) Makori, Nyabasi; Matemu, Athanasia; Kimanya, Martin; Kassim, Neema
Early exposure to aflatoxins through complementary food is linked to impaired growth in childhood. The current study assessed the household’s practices on management of complementary foods in relation to the risk of aflatoxin exposure and poor nutritional status among infant and young children in Tanzania. A cross-sectional study of complementary feeding practices, aflatoxin exposure and nutritional status was conducted to 101 infants and young children aged between 6-23 months in Dodoma region of Tanzania. The intake of complementary food was estimated by using repeated 24 h dietary recall. Flour used as complementary food was sampled from each of the 101 families and aflatoxins were analysed using high-performance liquid chromatography. A deterministic approach was used to estimate dietary exposure of aflatoxins in the complementary foods. Anthropometric measurements were taken and rates of stunting, underweight and wasting estimated according to the WHO standard procedures. Multivariate logistic regression analysis was used to assess the association between feeding practices and aflatoxin exposure or the growth performance among subjects. The average consumption of complementary flour was 118 g per child per day and 52% of the flours contained groundnuts. AFB1 was detected in 42.5% of the flour and levels ranged from 0.3 to 2,128.0 μg/kg (mean 228.11±49.84 μg/kg). Dietary exposures of aflatoxin B1 ranged from 0.1 to 23,172.81 ng/kg body weight per day (mean 1,337±392.5 ng/kg). Of the subjects, 40.4% (95% CI; 29.8; 50.9) were stunted and significant association was found between stunted growth and dietary exposure of AFB1 (adjusted odd ratio (AOR)=5.9; 95% CI: 0.019-0.028). Early introduction of cereal-and groundnut-based complementary foods in Tanzania is associated with high risk of aflatoxin exposure and impaired growth in children. There is need to integrate aflatoxin management measures in the guidelines for Infant and Young Children Feeding of Tanzania.
Nutrient Composition of Cereals based Complementary F lour and its Nutritional Adequacy in Infants Nutrition
(Canadian Center of Science and Education, 2017-10-20) Makori, Nyabasi; Kassim, Neema; Kinabo, Joyce; Matemu, Athanasia
Evaluation of the quality of complementary flour and its nutritional adequacy in relation to infant’s nutritional requirements was done to four different types of complementary flour (composite cereals with groundnuts, maize, millet and sorghum). The collected samples were analysed for determination of macronutrient, micronutrients and phytate content. The mean protein content in all types of complementary f lour was 7.30 ± 2.52 g/100 g. A significant difference in protein content between composite cereals ( p ≤ 0.001) and other types of cereals based foods was observed. Fat and iron content were found to be inadequate in all types of complementary flours. Phytate content rang ed from 59.47 1176.8 mg/100 g, the highest content was observed in sorghum. On the other hand, the mean iron and zinc content in all types of complementary flour was 5.25 ± 1.35 mg/100 g and 2.99 ± 1.36 mg/100 g respectively. The molar ratios of phytate: iron and phytate: zinc were at a level that would tend to inhibit bioavailability of iron and zinc in 97% and 45% of analysed samples respectively. An association between anemia and phytate: iron molar ratio (AOR = 4.2, 95%, 1.2 6.9) was observed. The quality and adequacy of nutrients in cereal-based complementary flour has shown to be inadequate and likely to be compromised by the presence of phytate.
Optimal model formula for ensuring nutritional adequacy for infants and young children (6 – 23 months)
(NM-AIST, 2018-08) Makori, Nyabasi
Infant and young child feeding practices rank among the most effective interventions to promote child growth and development. Improving the quality of complementary food has been observed as an important strategy for promoting child growth in resource-poor settings. Therefore, the objective of this study was to design a safe and nutritious model formula that meets nutritional requirement for infants and young children aged 6 – 23 months. The objective was achieved by conducting a cross-sectional study aimed to assess the nutritional status of 394 children and identify factors associated to under-nutrition. Then, complementary flours were collected randomly from selected households and analyzed for macro- and micro-nutrients, phytate content and presence of aflatoxins. Exposure assessment was done to evaluate the contribution of aflatoxins exposure on nutritional status of children. Finally, the model formula was designed using commonly consumed foods to meet the nutritional requirements for children. Data analysis was performed by using SPSS (IBM version 21), ENA for smart, Microsoft Excel and LINDO (version 6.1). The results showed that prevalence of stunting was 40.4% (95% CI; 29.8% - 50.9%). Children aged between 12 - 23 months were more stunted compared to those aged between 6 – 11 months (p ≤ 0.001). The age of introducing complementary foods (AOR = 13.3, 95%CI, 2.6 – 67.6), maternal education (AOR = 5.5, 95% CI, 1.0 – 9.8) and residence in Chamwino district (AOR = 3.2, 95%, 1.3 – 5.9) were identified as factors associated with stunting. Analysis of cereal-based complementary foods indicated that protein and fat content ranged from 1.17 - 11.17 g/100 g and 0.61 - 11.19 g/100 g respectively. A significant difference in protein content between composite cereals and other types of complementary foods was observed (p ≤ 0.001). Sorghum had the highest iron and phytate content of 8.37 mg/100 g and 1176.8 mg respectively. Aflatoxins contamination was detected in 42.5% of home-made complementary flours at the levels ranging from 0.3 μg/kg to 2,128 μg/kg. There was a significant association between stunting and infants dietary exposure to aflatoxin B1 (p = 0.05, 95% CI; 0.019 - 0.028). Cereal-based complementary foods consumed by the studied children were observed to have dual burdens in a sense that they contained high level of phytate and being contaminated with aflatoxins to the levels of health concern that may contribute to impairment of growth. Developed optimized model formula serves as a basis for ensuring adequate nutrient intake, minimized intake of phytate and reduced dietary exposure of infants
Provision of low‐aflatoxin local complementary porridgeflour reduced urinary aflatoxin biomarker in childrenaged 6–18 months in rural Tanzania
(Wiley Online Library, 2023-03-09) Kassim, Neema; Ngure, Francis; Smith, Laura; Turner, Paul; Stoltzfus, Rebecca; Makule, Edna; Makori, Nyabasi; Phillips, Erica
Aflatoxins are toxic secondary metabolites of fungi that colonize staple food crops, such as maize and groundnut, frequently used in complementary feeding. In preparation for a large trial, this pilot study examined if provision of a low‐aflatoxin infant porridge flour made from local maize and groundnuts reduced the prevalence of a urinary aflatoxin biomarker in infants. Thirty‐six infants aged 6–18 months were included from four villages in Kongwa District, Tanzania. The study was conducted over 12 days with a three‐day baseline period and a 10 days where low‐AF porridge flour was provided. Porridge intake of infants was assessed using quantitative 24‐h recalls by mothers. Household food ingredients used in infant porridge preparation and urine samples were collected on Days 1–3 (baseline) and 10–12 (follow‐up). Aflatoxins were measured in household foods, and AFM1 was measured in urine. At baseline and follow‐up, 78% and 97%, respectively, of the infants consumed porridge in the previous 24 h, with a median volume of 220 mL (interquartile range [IQR]: 201, 318) and 460 mL (IQR: 430, 563), respectively (p < 0.001). All 47 samples of homemade flour/ingredients were contaminated with AFs (0.3–723 ng/g). The overall prevalence of individuals with detectable urinary AFM1 was reduced by 81%, from 15/36 (42%) at baseline to 3/36 (8%) at follow‐ up (p = 0.003). Provision of low‐aflatoxin porridge flour was acceptable to caregivers and their infants and successfully reduced the prevalence of detectable urinary AFM1 in infants, thus, confirming its potential to be tested in future large‐scale health outcomes trial.