Objectives Newborns are dependent on breastmilk vitamin A for building hepatic stores of vitamin A that will become critical for survival after weaning. It has been documented that vitamin A concentrations in breastmilk decline across the first year postpartum in both well-nourished and malnourished populations. The reason for this decline has been assumed to be a sign of concurrently depleting maternal hepatic stores. This study investigates this assumption to clarify why the decline occurs, drawing on life history theory. Methods A cross sectional survey was conducted among lactating mothers in Kenya in 2006. Data were used to examine (1) the relationship between liver vitamin A and time, (2) if the relationship between milk and liver vitamin A varies by time, and (3) by maternal parity. Results The relationship between liver vitamin A and time fits the quadratic pattern with marginal significance (P = 0.071, n = 192); the liver vitamin A declined during early postpartum then recovered in late postpartum time, controlling covariates. The milk-liver vitamin A relationship varied by postpartum time periods (P = 0.03) and by maternal parity (P = 0.005). Mothers in earlier postpartum or higher parity had a stronger positive relationship between milk and liver vitamin A than mothers in later postpartum or lower parity. Conclusions Our observations are consistent with life history tradeoffs and negate the assumption that maternal hepatic and milk vitamin A decline together. Rather, maternal liver vitamin A has a dynamic relationship with milk vitamin A, particularly depending on postpartum time and maternal parity.

Background. Micronutrient powder is a potential strategy to improve iron status and reduce anemia in refugee populations.Objective. Results. At the baseline, midline, and endline visits, respectively, the mean (± SE) hemoglobin concentration in women was 121.4 ± 0.8, 120.8 ± 0.9, and 120.6 ± 1.0 g/L (p = .42); the prevalence of anemia (hemoglobin < 120 g/L) was 42. 6%, 41.3%, and 41.7% (p = .92); and the mean soluble transferrin receptor concentration was 24.1 ± 0.5, 20.7 ± 0.7, and 20.8 ± 0.7 nmol/L (p = .0006). In children, the mean hemoglobin concentration was 105.7 ± 0.6, 109.0 ± 1.5, and 105.5 ± 0.3 g/L (p = .95), respectively; the prevalence of anemia (hemoglobin < 110 g/L) was 55. 5%, 52.3%, and 59.8% (p = .26); and the mean soluble transferrin receptor concentration was 36.1 ± 0.7, 29.5 ± 1.9, and 28.4 ± 3.2 nmol/L (p = .02), in models that were adjusted for age using least squares means regression.Conclusions. In children and in women of childbearing age, the availability of micronutrient powder was associated with a small improvement in iron status but no significant change in hemoglobin in this refugee camp setting.

BackgroundSoil transmitted helminths (STHs) are among the world’s neglected tropical diseases. Morbidity due to STHs is greatest in school-age children who typically have the highest burden of infection. In 2001, WHO passed a resolution for the use of large-scale mass drug administration (MDA) to deworm vulnerable children through school based programs. Though effective, there is concern that MDA might not be sustainable over extended periods. Additionally the current MDA strategy does not consider child malnutrition, a very common malady in resource limited countries. We report a pilot evaluation of an innovation that bundles school feeding and deworming.MethodsWe designed a maize (corn) flour fortified with grounded dried papaya (Carica papaya) seeds and used it to prepare porridge as per the usual school meal recipe Children from three primary schools from Nandi County in Kenya were randomized into three arms: One school received 300 ml papaya fortified porridge daily (papaya group), the second school received similar serving of plain porridge without the pawpaw ingredient (control group) and the third school received plain porridge and the conventional MDA approach of one time 400 mg dosage of albendazole (albendazole arm). Prior to the randomization, an initial baseline stool microscopy analysis was done to determine presence and intensity of intestinal worms. Core indicators of nutrition-height, weight and hemoglobin counts were also assessed. The children were monitored daily for two months and final stool sample analysis and clinical monitoring done at the end of the study. Baseline and follow-up data were analyzed and compared through SAS version 9.1 statistical package.ResultsA total of 326 children participated in the trial. The overall prevalence of Ascaris lumbricoides was 29.4% (96), Trichuris Trichura 5.2% (17) and hookworm 1 (0.3%). Papaya seed fortified porridge reduced the Ascaris lumbricoides egg count by 63.9% after the two month period (mean 209.7epg to 75.7 p < 0.002) as compared to the albendazole arm 78.8% (129.5 epg to 27.5, p value 0.006). The control group showed an increase in egg count (42.epg to 56.3) though it was not statistically significant. Hemoglobin counts in the papaya group increased from a mean of 2 g/dL (11.5 g/dL to 13.5 g/dL, p < 0.001), as compared to the albendazole arm that increased by 1 g/dL (12.8–13.9, p < 0.001). No significant change was observed in the placebo arm (13.2 to 13.1). Interestingly the papaya group showed a significant reduction of children with Tinea capitis (ringworms) (54.4 to 34%, p < 0.002) as compared to the albendazole arm that showed an increase in ringworm infestation though not statistically significant (39.7 to 64.7% p = 0.608).ConclusionPapaya seed fortified porridge had a significant effect on reduction of Ascaris lumbricoides burden. It had a better nutritional outcome and effect on child fungal infections than albendazole. Its application as a routine school meal may aid current national school based nutrition and deworming programs in...

RBP-RDR has the potential to serve as a moderately accurate surrogate measure of retinol-RDR if the variation associated with BMI is understood and adjusted. Further studies should clarify the dynamics of the retinol-RBP molar ratio and its link to RBP-RDR performance.