[Archives de Pédiatrie. Breast feeding: health benefits for child and mother. Editorial].
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Biomedical subjects
Publications and source records attributed to M Chauliac.
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Food consumption patterns in urban environments are changing and diversifying. This longitudinal study of individual food consumption took into account the coexistence of two types of food consumption: within the home and outside the home. This article presents a summary of qualitative and quantitative research carried out in Bamako, Mali in 1995 and 1996 among 74 families from different socio-economic groups. It provides a comprehensive analysis of their food strategies (at the family and individual level) and their nutritional intake. In the home, similarities are found: three meals a day, and a single dish with a "base" ingredient and sauce at each meal. Heterogeneity is expressed in the number of dishes prepared each day, the type of "base", and ingredients in the sauce. Almost all individuals, no matter what their age or socio-economic status, consume food outside the home. This does not substitute meals at home. Street food accounts for 19-27% of food expenses and provides 134-417 Kcal per day per person. It offers a market for local products not often consumed at home and provides a necessary nutritional supplement to people from families of intermediate or low socio-economic status, especially for children. For people from higher socio-economic levels, street food provides mainly gustative and symbolic satisfaction. Following the devaluation of the CFA franc, the most disadvantaged populations seem to have reached a limit in their capacity for adaptation, which includes not only the quality of consumed products but also quantities. In order to ensure food security in urban areas, food and nutritional policies must take into account all the factors that influence food consumption behaviours of different groups of individuals, in particular the behaviours inside and outside the home. The latter is too often overshadowed.
The effect of maternal HIV infection on birthweight was estimated. In the prenatal clinic of the Centre Hospitalier de Kigali, HIV screening was proposed to women with a gestational age (GA) of less than 28 weeks. HIV-infected (HIV+) and uninfected (HIV-) women were recruited, when they consented. At inclusion, socioeconomic, obstetrical data, and body weight were collected, a clinical examination was performed, and tests for sexually transmitted diseases (STDs) and malaria were performed. Two prenatal visits were made, at 28-32 and 32-36 weeks, with clinical data and weight measurement. At delivery, birthweight, body length, and head circumference of the infant were documented. At inclusion and at the second follow-up visit, HIV+ women (N = 177) weighed less than HIV- women (N = 194) (p = 0.004). Mean birthweight in infants born to HIV+ women was 2947 g (SD = 429) and 3104 g (SD = 461) in infants born to HIV- women (p = 0.001). Frequencies of low birthweight (LBW, weight < 2500 g), prematurity (GA < 37 weeks, according to Finnström score at birth), and intrauterine growth retardation (defined by LBW and GA > or = 37 weeks) were higher in infants born to HIV+ women than to HIV- women (p = 0.009, 0.01, and 0.053, respectively). In multivariate logistic regression, the association between maternal HIV infection and LBW disappeared (p = 0.61), while low GA (p = 0.01) and low last prenatal weight (p = 0.01) were independant risk factors of LBW. LBW in infants born to HIV+ women could be partly attributable to impaired maternal weight. These results underline the need for nutritional surveillance and dietary counselling, hoping to improve the prognosis of pregnancy in HIV+ women, regardless of other therapeutic interventions.
BACKGROUND: Great modifications in social and family relationships and life style come from rapid urbanisation in developing countries. Various types of malnutrition coexist in these towns. Food consumption outside the home is more and more common. This in turn encourages rapid growth in the food informal economic sector which must be taken into account in food and nutrition policy and planning. The aim of this study was to analyse the characteristics and complementarities between home and outside the home food consumption of different kinds of individuals coming from different kinds of families in Bamako, in terms of expenditures and aspects of food and nutritional intakes. METHODS: 366 individuals from 74 families were interviewed. They were chosen according to defined criteria in three districts of Bamako of high, middle and poor socio-economic level. RESULTS: At home the daily food expenditure is 2.27 and 3.79 times greater per individual in rich than in middle income and poor families respectively. Animal proteins are respectively 41%, 19% and 9% of daily protein intake. Energy from lipids is 20 to 30% in rich and middle families. In poor ones it is only 15% which is the lower limit of nutritional recommendations. Moreover, contrary to proteins and carbohydrates, the cost of lipids seems, almost incompressible. Almost everybody eats out of home food, particularly children. Its cost, on an energy basis, is higher than home food. The expense is 19 to 27% of the family food budget. It appears necessary to the satisfaction of nutritional requirements in middle income and poor families. Despite various costs, whatever be the socio-economic level, energy intakes coming from that food are equivalent in absolute terms among various kinds of individuals: children, men and women. CONCLUSION: Families had to adapt their food strategies after the 1994 Franc CFA devaluation. Various hypotheses are presented, linked to intra-family relationships and, within poor families, to insertion in the street food economic sector, in order to understand, the logic of food choices. Such an analysis, where health, nutritional, economic, social and cultural aspects of food are taken into account, allows some concrete orientations for urban food and nutrition policy.
OBJECTIVE: To study the relationship between human immunodeficiency virus (HIV) infection and body weight in African women during and after pregnancy. METHODS: A prospective cohort study was initiated at the Centre Hospitalier de Kigali in July 1992. Every woman seen at the antenatal clinic and with a gestational age of <28 weeks was offered HIV-1 antibody testing. Comparable numbers of HIV-infected (HIV+) and uninfected (HIV-) women were recruited. At inclusion, socio-demographic characteristics and self-reported pre-pregnancy weight were recorded; height and weight were measured. Each woman enrolled had a monthly follow-up until 9 months after delivery, with a clinical examination including weighing. Three anthropometric indices were used to answer the study objectives: weight, body mass index (BMI), and pregnancy balance. RESULTS: As of April 1994, 101 HIV+ and 106 HIV- women were followed until 5 months after delivery. Weight and BMI during pregnancy were lower in HIV+ women than in HIV- women. After delivery, weight and BMI gains were significantly lower in HIV+ women. Until 5 months after delivery, the mean weight variation was -2.2 kg (standard deviation [SD] = 5.9 kg) in HIV+ women and +0.2 kg (SD = 6.6 kg) in HIV- women (P = 0.007) in comparison to pre-pregnancy weight. Comparisons of the slopes of the weight curves did not show statistical differences throughout the pregnancy, but it did during the post-partum period (P = 0.02). CONCLUSIONS: Our study suggests that HIV infection could impair nutritional status in pregnant women, especially during the post-partum period. Family planning and maternal and child health services including HIV testing and counselling, should consider a nutritional assessment and intervention programme targeted to HIV+ pregnant women.
BACKGROUND: Physical and psychological disorders in adolescence may lead to specific food behaviours. The aim of this work was to make a group of adolescents full actors of the conception and realization of a study on their food consumption and attitudes. POPULATION AND METHODS: Seventeen self-selected adolescents (age: 12 to 18 years) were enrolled in the study. They interviewed 186 peers (24% of the adolescents of the district) during March 1994. RESULTS: 5.9% of adolescents never had breakfast; only 57.7% had the three main meals every day during the last week, but 14% had these three main meals and three snacks the preceding day. During a week, 22% (12-14 years old) and 32% (15-18 years old) had had at least one lunch outside their home or school canteen. Fast-food attraction was very strong, mainly among the youngest, the boys and the foreign students. However, family meals were appreciated by 87% of them. CONCLUSION: Even though absence of representation of the sample gave doubts on the most marginal forms of food behavior, the interest manifested by adolescents for this research program and the results favor a food educational program that should be planned with them.
Food bought outside the house from woman vendors accounts for a significant part of the nutritional intake in urban areas in Africa regardless of age and socio-economic category of the inhabitants. Despite this fact outdoor food consumption is not adequately taken into account in relevant studies. The great variability in space and time of recipes used by vendors makes it very difficult to estimate the nutritional value of the food consumed. The purpose of the present study which was carried out on some female vendors in Bamako, Mali, was to evaluate a simplified assessment method. Assessment is based on information that vendors can easily provide: recipes including ingredients and quantities and sales figures. The results obtained were coherent and appeared to be fairly accurate. However they have to be confirmed by laboratory analyses. Compared to average per capita wages in Mali, the income of these female vendors appears to be high.
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Iron absorption from three typical West African meals was measured in fourteen subjects using the extrinsic-tag technique with 59Fe and 55Fe. All meals consisted of maize as the staple food. Meals were prepared in Benin under realistic conditions from locally grown foods. Of the non-haem-Fe in the meals 39-73% did not exchange with the added inorganic radio-Fe tracer, depending on the degree of Fe contamination of meals. Non-haem-Fe absorption was low in each maize meal, but was even lower for those eaten with a vegetable sauce than for those eaten with a fish sauce. When haem-Fe absorption was included, 70.0-160 micrograms Fe was absorbed. Expressed on an energy basis, the bioavailable nutrient density was 3.2-7.0 micrograms/100 kJ (13.4-29.5 micrograms/100 kcal). These findings suggest that total Fe available in the typical diets of West African countries does not meet the physiological requirements of large proportions of the population.
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An assessment of iron and folic acid status, blood thick film and haemoglobin (Hb) electrophoresis was performed on 126 pregnant women (and their newborn infants) and in ninety-five menstruating women in Cotonou (Benin). Anaemia (according to the World Health Organization (1972] was observed in 55% of pregnant women and in 39% of menstruating women. Fe-deficiency was defined as a low serum ferritin concentration (12 micrograms/l or less), combined with a low transferrin saturation (less than 16%) or a high erythrocyte protoporphyrin level (more than 3 micrograms/g Hb), or both. A moderate elevation in the serum ferritin concentration (between 13 and 50 micrograms/l), associated with a low transferrin saturation or a high erythrocyte protoporphyrin level, or both, indicated Fe-deficiency in an inflammatory context. Fe-deficiency was present in 73% of pregnant women and in 41% of menstruating women. Folate deficiency (defined as erythrocyte folate below 160 micrograms/l) was observed in 45% of pregnant women. In pregnant women, anaemia was associated with Fe-deficiency in 83% of cases and with folate deficiency in 48% of cases. Haemoglobinopathies were mainly heterozygous and did not seem to contribute significantly to anaemia. Intensity of malaria was not related to Hb level, but Plasmodium falciparum was found in 99% of subjects. Hb concentration and mean corpuscular volume were significantly lower in babies born of Fe-deficient mothers than in babies born of Fe-sufficient mothers. Hb concentration in newborn infants was positively correlated with maternal serum ferritin.
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Iron status, folacin status, haemoglobinopathies, malarial infection and intestinal parasitosis frequencies were assessed in a representative sample of 586 subjects living in a rural district of South Benin. Anaemia according to WHO reference values for haemoglobin was observed in 42 per cent of subjects. The prevalence was higher in children and menstruating women. Iron deficiency, defined by two or more abnormal values in the four independent indicators of iron status used (transferrin saturation, erythrocyte protoporphyrin, serum ferritin, and mean corpuscular volume) was present in 30 per cent of subjects. Half of the anaemias were associated with iron deficiency. Folate deficiency was associated with anaemia in 20 per cent of subjects. Anaemia, iron and folacin status were not significantly related to the degree of malarial infection nor to the type of haemoglobin. Although hookworm infection was very common, there was no significant relationship between egg count and haemoglobin level or haematological parameters of iron and folacin status. The lack of correlation can be explained by the low wormload observed.