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Assessing healthcare providers’ knowledge and practices relating to insecticide-treated nets and the prevention of malaria in Ghana, Laos, Senegal and Tanzania
(Malaria journal, 2014) Ndossi, Godwin D.
Background: Research evidence is not always being disseminated to healthcare providers who need it to inform their clinical practice. This can result in the provision of ineffective services and an inefficient use of resources, the implications of which might be felt particularly acutely in low- and middle-income countries. Malaria prevention is a particularly compelling domain to study evidence/practice gaps given the proven efficacy, cost-effectiveness and disappointing utilization of insecticide-treated nets (ITNs). Methods: This study compares what is known about ITNs to the related knowledge and practices of healthcare providers in four low- and middle-income countries. A new questionnaire was developed, pilot tested, translated and administered to 497 healthcare providers in Ghana (140), Laos (136), Senegal (100) and Tanzania (121). Ten questions tested participants’ knowledge and clinical practice related to malaria prevention. Additional questions addressed their individual characteristics, working context and research-related activities. Ordinal logistic regressions with knowledge and practices as the dependent variable were conducted in addition to descriptive statistics. Results: The survey achieved a 75% response rate (372/497) across Ghana (107/140), Laos (136/136), Senegal (51/ 100) and Tanzania (78/121). Few participating healthcare providers correctly answered all five knowledge questions about ITNs (13%) or self-reported performing all five clinical practices according to established evidence (2%). Statistically significant factors associated with higher knowledge within each country included: 1) training in acquiring systematic reviews through the Cochrane Library (OR 2.48, 95% CI 1.30-4.73); and 2) ability to read and write English well or very well (OR 1.69, 95% CI 1.05-2.70). Statistically significant factors associated with better clinical practices within each country include: 1) reading scientific journals from their own country (OR 1.67, 95% CI 1.10-2.54); 2) working with researchers to improve their clinical practice or quality of working life (OR 1.44, 95% CI 1.04-1.98); 3) training on malaria prevention since their last degree (OR 1.68, 95% CI 1.17-2.39); and 4) easy access to the internet (OR 1.52, 95% CI 1.08-2.14). Conclusions: Improving healthcare providers’ knowledge and practices is an untapped opportunity for expanding ITN utilization and preventing malaria. This study points to several strategies that may help bridge the gap between what is known from research evidence and the knowledge and practices of healthcare providers. Training on acquiring systematic reviews and facilitating internet access may be particularly helpful.
Bridging the gaps among research, policy and practice in ten low- and middle-income countries: Development and testing of a questionnaire for researchers
(Health Research Policy and Systems, 2010) Ndossi, Godwin D.
Background: A questionnaire could assist researchers, policymakers, and healthcare providers to describe and monitor changes in efforts to bridge the gaps among research, policy and practice. No questionnaire focused on researchers’ engagement in bridging activities related to high-priority topics (or the potential correlates of their engagement) has been developed and tested in a range of low- and middle-income countries (LMICs). Methods: Country teams from ten LMICs (China, Ghana, India, Iran, Kazakhstan, Laos, Mexico, Pakistan, Senegal, and Tanzania) participated in the development and testing of a questionnaire. To assess reliability we calculated the internal consistency of items within each of the ten conceptual domains related to bridging activities (specifically Cronbach’s alpha). To assess face and content validity we convened several teleconferences and a workshop. To assess construct validity we calculated the correlation between scales and counts (i.e., criterion measures) for the three countries that employed both and we calculated the correlation between different but theoretically related (i. e., convergent) measures for all countries. Results: Internal consistency (Cronbach’s alpha) for sets of related items was very high, ranging from 0.89 (0.86- 0.91) to 0.96 (0.95-0.97), suggesting some item redundancy. Both face and content validity were determined to be high. Assessments of construct validity using criterion-related measures showed statistically significant associations for related measures (with gammas ranging from 0.36 to 0.73). Assessments using convergent measures also showed significant associations (with gammas ranging from 0.30 to 0.50). Conclusions: While no direct comparison can be made to a comparable questionnaire, our findings do suggest a number of strengths of the questionnaire but also the need to reduce item redundancy and to test its capacity to monitor changes over time.
Comparison of the effects of supplemental red palm oil and sunflower oil on maternal vitamin A status1
(The American journal of clinical nutrition, 2001) Ndossi, Godwin D.
Background: Conflicting results have been reported on the ability of dietary carotenoids to improve vitamin A status in lactating women. Red palm oil is one of the richest dietary sources of β-carotene. Objective: We aimed to determine the efficacy of red palm oil in increasing retinol and provitamin A status in pregnant and lactating women. Design: Ninety rural, pregnant Tanzanian women from 3 randomly selected villages were recruited during their third trimester to participate in 3 dietary intervention groups: a control group, who were encouraged to maintain the traditional practice of eating staples with dark-green leafy vegetables, and 2 study groups, who were given either sunflower or red palm oil for use in household food preparations. The intervention lasted 6 mo. Plasma samples were collected at the third trimester and 1 and 3 mo postpartum, and breast-milk samples were collected 1 and 3 mo postpartum. Results: Supplementation with red palm oil, which is rich in provitamin A, increased α- and β-carotene concentrations significantly (P < 0.001) in both plasma and breast milk. Plasma retinol concentrations were similar in all dietary groups. Breast-milk retinol concentrations tended to decrease from 1 to 3 mo postpartum in the control group, but were maintained in both oil groups. The difference in change in breast-milk retinol concentration between the red palm oil group and the control group was significant (P = 0.041). Conclusions: Consumption of red palm oil increases concentrations of α- and β-carotene in both breast milk and serum and maintains breast-milk retinol concentrations. Sunflower oil consumption seems to conserve breast-milk retinol similarly to consumption of red palm oil. Breast-milk retinol might be maintained through increased dietary intake of these vegetable oils and use of mild cooking preparation methods (such as the addition of oil at the end of cooking and avoidance of frying).
Effect of cooking on the nutritive value of common food plants of Tanzania: Part 1—Vitamin C in some of the wild green leafy vegetables
(Food Chemistry, 1983) Ndossi, Godwin D.
The vitamin C (ascorbic acid) content of fresh and cooked material of sixteen varieties of wild leafy vegetables was estimated. In fresh leaves, the vitamin varied from 204 mg/100 g fresh weight in Moringa oleifera to 0·7 mg in Emilia javanica. When 20 mg samples were cooked in 400 ml of water, the vitamin C content decreased considerably. Losses observed ranged from 98·5% (Moringa oleifera) to nil (Emilia javanica). Smaller losses of the vitamin were observed when vegetable samples were cooked in 100 ml of water. Since most leafy vegetables are cooked prior to consumption, it is recommended that the vegetables are cooked in small amounts of water for short periods to minimise loss of vitamin C and that the cooking water be consumed if no bitter compounds are present.
Effect of germination of ﬁnger millet on nutritional value of foods and effect of food supplement on nutrition and anaemia status in Tanzanian children
(Tanzania Journal of Health Research, 2007) Ndossi, Godwin D.
Inadequate dietary intake, often combined with an infection can lead to malnutrition that often manifest as growth failure or deficiency of essentials nutrients including iron leading to iron deficiency anaemia. In an effort to investigate diet in relation to nutrition status of children, diet and dietary intake were investigated in rural Tanzania. The effect of germination of finger millet based food recipe on its nutritional value was evaluated. The food consisted of finger millet flour, kidney beans, ground peanuts and dried mangoes at predetermined proportions of 75:10:10:5 respectively. Dietary habits of young children were investigated and effects of a fortified food supplement and the cereal based recipe on nutrition status of children were investigated. The two diets were then supplemented to children for 6 months and changes on anaemia and anthropometrical indices of children were evaluated at follow up periods. To assess anaemia and iron status, haemoglobin (Hb), haematocrit (Hct), erythrocyte protoporphyrin (EP) and serum ferritin (SF); and weights and heights were measured to assess growth. A significant improvement in nutrient density was noted in processed cereals. Bioavailability of iron in cereal based diet increased from 0.75 +/- 18 to 1.25 +/- 41 mg/100 g (P = 008), viscosity was significantly raised by 12% and phytate concentration was reduced from 4.5 +/- 0.5 to 4.1 +/- 0.5 mg/g (P = 0.03). Significantly lower intake of iron was observed in schoolchildren with Hb < 11.5 g/dl) compared to those who were normal. Total iron intake was 22+/- 7 and 27 +/- 13 mg/day, respectively (P < 0.05). There was a significant correlation between iron intake and serum ferritin (r = 0.233, P < 0.05). After six months of supplementing children with the fortified beverage a significantly larger increase in haemoglobin concentration was shown in the fortified group than in the non-fortified group (a difference of 6.2 versus 3.2 g/dl respectively). Supplementing infants with the germinated cereal based food supplement showed a general improvement on Hb status and growth that was not significantly different to that in the control group (P > 0.05). In conclusion, consumption of foods with low iron bioavailability is a major cause of anaemia. Germination improves the nutritional value of foods however there is need to fortify such processed foods for infant feeding.
Effect of grain pre‐treatment on different extractable phenolic groups in cereals and legumes commonly consumed in Tanzania
(Journal of the Science of Food and Agriculture, 2003) Ndossi, Godwin D.
Extractable phenolic compounds, classified as total phenolics, resorcinols, catechols and galloyls, were determined in cereals and legume food grains commonly consumed in Tanzania, using various colorimetric methods. Grain samples of red sorghum (udo), finger millet, cowpea, mung bean and brown kidney bean were further processed—soaked in water at different pHs, germinated, cooked or dehulled (legumes only)—and the effect on extractable phenolics was analysed. In untreated grains, total phenolics ranged from 0.9 to 33.7, catechols from 0.8 to 13.5 and resorcinols from 0.2 to 11 mg catechin equivalents (CE) g−1. Galloyls (tannic acid equivalents, TAE) were found in negligible amounts in most grains, but in appreciable amounts in red sorghum (5.5 mg g−1). Processing of grains led to variable effects on the extractable phenolics. Soaking the grains significantly (p < 0.05) reduced the amount of total extractable phenolics in red sorghum, finger millet and cowpea, with alkali and acidic media being more effective. Water soaking had no effect on total extractable phenolics in mung bean and water, while alkali and acidic soaking had no effect on total extractable phenolics in brown kidney bean. Extractable catechols and resorcinols were affected by soaking in a similar pattern to total extractable phenolics. Germination reduced total extractable phenolics, catechols and resorcinols in all samples, except for catechols in mung bean. Cooking (boiling of grains) was more effective in reducing total extractable phenolics in cereals than germination and water soaking, while dehulling was the most effective method for reducing total extractable phenolics in legumes (p < 0.01).
Effect of micronutrient fortified beverage on nutritional anaemia during pregnancy
(East African medical journal, 2002) Ndossi, Godwin D.
Objective: To evaluate the efficacy of a multiple micronutrient fortified beverage containing eleven nutrients at physiological levels in prevention of anaemia and improving iron and vitamin A status during pregnancy. Design: A randomised double blind placebo controlled study. Setting: Mpwapwa and Kongwa Districts in Dodoma Region of Tanzania. Subjects: Five hundred and seventy nine pregnant women were screened for entry into the study and 439 women who met the study criteria were enrolled. Interventions: Study participants received either a fortified (F) or non-fortified (NF) orange flavoured drinks identical in appearance, provided in two self administered servings per day for an eight week period. Main outcome measures: Comparison of haemoglobin (Hb), serum ferritin (SF) and serum retinol (SR) at baseline and follow up. Results: After eight weeks of supplementation, the F group (n=129) had a significantly higher Hb increase of 0.86g/dL compared to 0.45gldL in the NF group (n=130) pe0.0001. Gestational age at entry into the study, moderated the effect on Hb of the fortified drink. Women at earlier gestational age upon entry, had a higher rise in Hb than women of late gestational age (OSg/dL versus 0.04 g/dL rise respectively, p=0.038, n=188). The risk of being anaemic at the end of the study for those in the F group was reduced by 51% (RR=0.49, CI=0.28 to 0.85). Iron stores (by serum ferritin levels) increased by 3pgL in the F group (p=0.012) and a decrease of 2Clgn in the NF group (p=0.115). The follow up ferritin concentration depended on initial ferritin level. Regardless of treatment group, serum retinol concentrations were significantly higher in mothers who had delivered. Mothers who had adequate levels at entry benefited more from the supplement than those with low levels (0.26 pmoVL versus no significant difference). Conclusions: The multiple micronutrient-fortified beverage given for eight weeks to pregnant women improved their haemoglobin, serum ferritin and retinol status. The risk for anaemia was also significantly reduced. The important predictors of Hb increase at follow up were the fortified beverage, baseline Hb, serum retinol, baseline ferritin and gestational age at entry into study. Anthropological research showed that the beverage was highly acceptable and well liked.
Effect of phytate and iron-binding phenolics on the content and availability of iron and zinc in micronutrents fortified cereal flours
(African Journal of Food, Agriculture, Nutrition and Development, 2006) Ndossi, Godwin D.
Iron deficiency anaemia is highly prevalent in Tanzania—affecting predominantly children and women. Fortification of cereal flour with micro-nutrients is being carried out as a strategy for combating micro-nutrient deficiencies. Four different cereal flours were fortified with micro-nutrients and evaluated for total and bioavailable iron and zinc, iron binding polyphenolics, phytate content and ascorbic acid. The extractable total phenolics ranged from 1.3 (maize) to 19.4 (redsorghum) mg catechin equivalent (CE) g-1. Catechols ranged from 1.1 (maize) to 11.7 (red-sorghum) mg CE g-1. Red sorghum was the only flour that contained a high amount of galloyls (4.0 mg tannic acid equivalent (TAE) g-1). All samples contained high amounts of phytate (10.7 ± 1.0 ìmol g-1). The average total iron was 42.26 ± 10.26 mg kg-1 in the unfortified and 52.67 ± 10.19 mg kg-1 in the fortified cereal flours and the average in vitro available iron was 1.03 ± 0.30 mg kg-1 and 1.65 ± 0.31 mg kg-1 respectively. The average zinc content was 21.4 ± 3.10 mg kg-1 and 25.9 ± 2.84 mg kg-1 in the unfortified and fortified flours respectively and the average available zinc was 0.30 ± 0.12 mg kg-1 and 0.53 ± 0.16 mg kg-1 respectively. No ascorbic acid was detected in any of the unfortified flour, and a little amount was detected in the fortified red sorghum (4.5 mg kg-1), compared to the white sorghum (11.1 mg kg-1), finger millet (15.8 mg kg-1) and maize (29.6 mg kg-1). There was no significant increase of in vitro available iron (0.02 mg kg-1) and zinc (0.06 mg kg-1) availability in the red sorghum. The in vitro available iron increased by 3.8 % in finger millet, by 9.2 % in white sorghum, and by 10.1 % in maize four—compared to respective total iron content as a result of fortification. In vitro available zinc increased by 7.9 % in finger millet, by 4.8 % in white sorghum and by 5.9 % in maize flours, compared to respective total zinc content as a result of fortification. It was concluded that other dietary modification strategies that are being carried out for the improvement of native iron and zinc bioavailability (processing for decreasing inhibitory factors, consumption of fruits and green leafy vegetables for enhancing absorption and nutrition education) should accompany fortification of flours with micro-nutrients. The red sorghum is not recommended as a good vehicle for food fortification with iron and zinc.
Efficacy trials of a micronutrient dietary supplement in schoolchildren and pregnant women in Tanzania
(Food and Nutrition Bulletin, 2003) Ndossi, Godwin D.
Traditionally, the main strategies used to control micronutrient deficiencies have been food diversification, consumption of medicinal supplements, and food fortification. In Tanzania, we conducted efficacy trials using a dietary supplement as a fourth approach. These were randomized, double-blind, placebo-controlled efficacy trials conducted separately first in children and later in pregnant women. The dietary supplement was a powder used to prepare an orange-flavored beverage. In the school trial, children consumed 25 g per school day attended. In the pregnancy trial, women consumed the contents of two 25-g sachets per day with meals. This dietary supplement, unlike most medicinal supplements, provided 11 micronutrients, including iron and vitamin A, in physiologic amounts. In both trials we compared changes in subjects consuming either the fortified or the nonfortified supplement. Measures of iron and vitamin A status were similar in the groups at the baseline examination, but significantly different at follow-up, always in favor of the fortified groups. Children receiving the fortified supplement had significantly improved anthropometric measures when compared with controls. At four weeks postpartum, the breast milk of a supplemented group of women had significantly higher mean retinol content than did the milk of mothers consuming the nonfortified supplement. The advantages of using a fortified dietary supplement, compared with other approaches, include its ability to control several micronutrient deficiencies simultaneously; the use of physiologic amounts of nutrients, rather than megadoses that require medical supervision; and the likelihood of better compliance than with the use of pills because subjects liked the beverage used in these trials.
Helicobacter pylori is not a Cause of Anaemia amongst People Living with HIV and AIDS in Tanzania
(European Journal of Nutrition & Food Safety, 2015) Ndossi, Godwin D.
Objectives: Helicobacter pylori is the most common infection worldwide. Several reports have indicated an association between H. pylori infection and anaemia. The aim of the study was to determine the prevalence of H. pylori co-infection with HIV and its correlation with anaemia and CD4 cell counts. Methods: A cross sectional study of 77 people infected with human immunodeficiency virus at SHIDEPHA+ Post Test Club Mwananyamala in Dar-es-Salaam, were assessed for Helicobacter pylori infection using 13C urea breath tests, immune integrity by use of CD4 cell count and anaemia using Beckman Coulter Counter. Results: Of the 77 subjects who were HIV positive 31 (40%) were H. pylori positive, compared to 14 out of 25 (56%) H. pylori positive amongst HIV negative controls. The mean (SD) haemoglobin level in H. pylori negative subjects was 11.7 (1.6) g/dl, compared to 11.4 (1.75) g/dl amongst those who were H. pylori positive (unpaired t test, p=0.43). Of the 15 subjects with CD4 counts below 200/ml, 4 (26%) were H. pylori positive, compared to 27/62 (48%) of those with CD4 counts above 200/ml (Chi squared, p<0.005). Conclusion: Our data demonstrates that H. pylori colonization is unlikely to contribute to anaemia amongst HIV positive subjects studied. Although this suggests that H. pylori colonization does not lead to significant problems in this population, both adequate nutrition and treatment of problems such as iron deficiency remain important components of the management of HIV positivity and AIDS throughout Africa.
Impact of a micronutrient dietary supplement on growth of school children in Tanzania
(1998) Ndossi, Godwin D.
There is increasing evidence that in deficient populations providing micronutrients may improve the growth of undernourished children. This has been shown with iron and zinc and may be due to the fact that this improves appetite and food intake. In Tanzania an investigation has been undertaken to evaluate the impact of a micronutrient dietary supplement on iron, vitamin A and iodine status of school age children. This was a randomized, double-blind, placebo-controlled trial. Reported here is an evaluation of the impact of this supplement on nutritional status using anthropometry. The subjects were 830 primary school children in Mpwapwa District. The supplement consists of 25 gm of a white powder in a sachet which is mixed with 200 ml. water to produce an orange-flavoured beverage. One serving provides 30 to 120% of RDA for 10 micronutrients including 3 minerals (iron, zinc, and iodine) and 7 vitamins (A, C, folate, niacin, thiamin, riboflavin and pyrodoxine). The children consumed one serving every school day attended over a period of 180 days. Children at the baseline found to have intestinal parasites received a dose of albendazole. As reported elsewhere, biochemical determinations showed that both iron and vitamin A status were poor in large numbers of children at the onset of the study. There was no significant difference in weight for age and height for age in the fortified and non-fortified group at the baseline. In multivariate analyses, treatment group was the strongest explanatory variable for incremental change in height and weight. The mean change in weight for the fortified group was 1.8 kg vs. 1.0 kg in the non-fortified group (p<.000). The mean change in height for the fortified group was 3.4 cm vs. 2.7 cm in the non-fortified group (p<.000). The supplement was very popular with children. School staff were pleased with the program. We conclude that this dietary supplement using physiological not medicinal doses of micronutrients can improve growth of schoolchildren and reduce malnutrition as well as improve iron and vitamin A status.
Impact of dietary iron intake on anaemia in Tanzanian schoolchildren
(South African Journal of Clinical Nutrition, 2004) Ndossi, Godwin D.
Objective. To investigate the nutritional relationship between dietary intake and prevalence of anaemia among Tanzanian schoolchildren. Methods. Dietary intakes of 101 schoolchildren aged 7 - 12 years were assessed using a pre-tested food frequency questionnaire. Haemoglobin (Hb), haematocrit, erythrocyte protoporphyrin (EP) and serum ferritin (SF) were used to determine their anaemia and iron status. Other socio-economic variables were collected using a profile questionnaire. Results. Significantly lower intake of iron was seen in 48% of schoolchildren with Hb < 11.5 g/dl (anaemic) compared with those who were normal. Total iron intake was 22 ± 7 and 27 ± 13 mg/day respectively (p < 0.05). There was a general poor intake of iron from animal sources in all children. A higher iron intake was found in schoolchildren with normal iron status (by EP and SF levels) than in those who were not normal (26 ± 11 mg/day v. 22 ± 9 mg/day, p < 0.05). Iron deficiency was found in 45% of schoolchildren (N = 80) and 31% were categorised as having iron deficiency anaemia. The mean energy intake in boys was higher than in girls (2 150 ± 770 v. 1 830 ± 895 kcal/day respectively). Boys also had a higher intake of ascorbic acid (50 ± 32 v. 31 ± 23 mg/day, p > 0.05). In stepwise multiple regression analysis, daily iron intake remained the most significant nutrient predicting for Hb status. There was a significant correlation between iron intake and serum ferritin (r = 0.233, p < 0.05). Conclusion. Iron intake in this Tanzanian community is inadequate for maintaining normal iron nutrition. The factors contributing to the inadequacy include consumption of foods with low iron bioavailability. Food-based intervention should be one of the important strategies for reducing the magnitude of the problem of anaemia in this community.
Improved solar drying of vitamin A-rich foods by women's groups in the Singida District of Tanzania
(International Center for Research on Women., 2000) Ndossi, Godwin D.
The problem of vitamin A deficiency (VAD) in Tanzania was first assessed in the early 1980s using a hospital-based sentinel surveillance system for xeropththalmia (Foster et al. 1986). Community-based surveys conducted in the late 1980s suggested that VAD was a problem of public health significance in Tanzania (Pepping et al. 1988). Data collected by the Tanzania Food and Nutrition Centre (TFNC) suggests that xerophthalmia leads to between 2,000 and 4,000 new cases of blindness every year, so that, at any one time, as many as 10,000 children are likely to be suffering from nutritional blindness (TFNC 1990). It is further estimated that VAD and xerophthalmia affect about six percent of the Tanzanian population and 98 percent of these are children under six years of age. This means that about one out of every three children under six are affected by the problem. Although vitamin A deficiency has been found in most agro-ecological zones of Tanzania, subclinical cases of the deficiency are more prevalent in the drought prone areas of the country due to limited availability and consumption of vitamin Aand provitamin A-rich foods, particularly vegetables and yellow fruits, during the dry season.In Singida, a dry area in central Tanzania, results of several community-based surveys support this relationship. In a survey conducted during the 1991 dry season (October-November), 60 percent of 226 children less than six years old had serum retinol levels less than 20 micrograms/decilitre (mcg/dl) and 15 percent were severely deficient (serum levels less than 10 mcg/dl) (Mselle and Temalilwa 1993). A second study conducted during the rainy season (December) of the same year found that, of 250 children, 35 percent were vitamin A deficient and three percent were severely affected (Kavishe 1993). A final study conducted during the rainy season (March-April) in 1993 found a slightly lower prevalence of VAD, that is, 27 percent of a total of 238 children were VAD with approximately one percent severely deficient (Mselle and Temalilwa 1993). The government of Tanzania has promoted a range of interventions to reduce vitamin A deficiency. These include information-educationcommunication (IEC) programs to increase awareness and knowledge of the problem, its causes and solutions; promotion of red palm oil with marketing in the southern highlands; production of vitamin A-rich foods in home gardens; and universal capsule distribution to children less than two years old and to women within four weeks post-partum. Recognizing that a constraint to using food-based interventions in rural areas in Tanzania is the limited supply of vitamin A-rich foods (particularly fruits and vegetables), TFNC, in collaboration with the Ministry of Agriculture, initiated a horticulture pilot project in 1992. The project mobilized community leaders and farmers to establish vegetable gardens and plant fruit trees in five randomly selected communities in the Ilongero Division of the Singida Rural District. Indigenous dark green leafy vegetables, such as amaranth, sweet potato leaves, cowpea leaves, and maimbe, and such fruits as papaya, mango, and guava were promoted in the production-focused project. Farmers purchased seedlings at a subsidized rate from nurseries prepared by agricultural extension agents. These agents also provided technical support in planting, caring for, and harvesting the fruits and vegetables. As a result, there was an increase in production of the promoted plants, although severe droughts beginning in 1995 and seasonal water shortages impacted on yields. An equally important effort to provide year-round sources of vitamin A in Tanzania has been the focus by government and other agencies on improving preservation techniques for vitamin Arich foods. The most common traditional food preservation method used in Tanzania is sun drying. Foods are placed on mats or the bare ground, primarily by women, and exposed to direct sunlight. While limited inputs are needed to use this technique (principally, the food source 6 INTERNATIONAL CENTER FOR RESEARCH ON WOMEN and women’s time), the technique carries high risks of contamination by dust, birds and other animals and insects, and it changes the natural colors of the unprocessed food products, making it undesirable to some consumers. Further, traditional drying results in excessive losses of carotenoids due to the vulnerability to oxidation that is accelerated by oxygen, ultra violet and visible light, heavy metals, and high temperatures (Clydesdale 1991). To address these issues, improved solar dying methods have been developed and introduced to rural communities worldwide. Compared to sun drying, improved enclosed solar drying provides high air temperatures and consequential lower relative humidities leading to improved drying rates and a lower final moisture content of the dried crop. As a result, the risk of spoilage during the drying process and in subsequent storage is reduced (ILO 1978). Drying in an enclosed structure has the additional benefit of providing protection against rain and contamination. All these factors contribute to an improved and more consistent product quality with increased market value. In Tanzania, as in other African countries, women are generally responsible for food processing activities. Appropriate technologies have long been an accepted means to increase women’s efficiency and productivity, and improve household food security (FAO 1959; Huffman in Gittinger et al. 1987; ECART 1994). This is critical given that women can spend on average 15 hours per day in productive activities (Rutahakana et al. 1991). In this study, the solar dryers have the potential of increasing efficiency and productivity, with the additional advantage of increasing availability of vitamin A-rich food sources. Thus, it makes sense that the technology be targeted to women—given their roles as food processors, caregivers, and income earners—and that other community members be drawn into the process to support women in their decisions and actions. Improved enclosed solar drying was first introduced to the Singida area in 1992 by TFNC in collaboration with the USAID-supported Vitamin A Field Support Project (VITAL) (Mgoba et al. 1993; Linehan 1994). The technology had been tested in Haiti and the Dominican Republic for drying mangoes and was found to be generally effective and acceptable by community members. The 1992 Tanzania project trained local carpenters in the construction of wooden dryers for community use. Women group leaders from five communities were invited to view the construction of the dryers and were trained in preparing foods for drying and proper drying and storage techniques. At the end of the training, dryers were donated to the women (two dryers per community) for communal use. The women leaders were urged to train other women in using the new dryers and constructing more of them. Two years later, the technology had not diffused beyond the original communities nor had any additional dryers been constructed in these communities. This was attributed to the lack of individual ownership reducing the incentive to maintain the communally-operated dryers; the large size of the dryers making them less amenable for household use and expensive to build and maintain; and the low level of awareness of the advantages of the technology over traditional drying processes. The conclusion was that the process of introduction limited its eventual adoption.
Micronutrient dietary supplements - a new fourth approach
(Lancet, 1998) Ndossi, Godwin D.
Currently the three main widely used strategies to control micronutrient deficiencies are food diversification, fortification, and consumption of medicinal supplements. In Tanzania a fourth strategy has been evaluated in school children. and is to be studied in pregnant and lactating women. The dietary supplement comes in the form of a powder used to prepare a fruit flavored drink. Children consumed for six months 25 grams per school day attended, the powder being added to 200 ml of water. The dietary supplement provides between 40 and 100 percent of the RDA of 10 micronutrients, which includes iron, vitamin A and iodine. Unlike medicinal supplements it provides the multiple vitamins and minerals in physiologic, not megadoses. In a well conducted randornized double blind placebo controlled trial, a dietary supplement in the form of a fortified powder fruit drink produced statistically significant differences not only in vitamin A and iron status, but also in the growth of young school age children.
A Micronutrient-fortified beverage prevents iron deficiency, reduces anemia and improves the hemoglobin concentration of pregnant Tanzanian women
(The Journal of nutrition, 2003) Ndossi, Godwin D.
Maternal malnutrition continues to be a major contributor to adverse reproductive outcomes in developing countries, despite longstanding efforts to fortify foods or to distribute medicinal supplements to pregnant women. The objective of this study was to test the effect of a micronutrient-fortified beverage containing 11 micronutrients (iron, iodine, zinc, vitamin A, vitamin C, niacin, riboflavin, folate, vitamin B-12, vitamin B-6 and vitamin E) on the hemoglobin, iron and vitamin A status of pregnant women in Tanzania. A group of 259 pregnant women with gestational ages of 8 to 34 wk were enrolled in a randomized double-blind controlled trial in which study women received 8 wk of supplementation. Hemoglobin, ferritin and dried blood spot retinol were measured at baseline and at the end of the supplementation period. The supplement resulted in a 4.16 g/L increase in hemoglobin concentration and a 3 μg/L increase in ferritin and reduced the risk of anemia and iron deficiency anemia by 51 and 56%, respectively. The risk of iron deficiency was reduced by 70% among those who had iron deficiency at baseline and by 92% among those who had adequate stores. The micronutrient-fortified beverage may be a useful and convenient preventative measure, one that could help improve the nutritional status of women both before and during pregnancy and thereby help avoid some of the potential maternal and fetal consequences of micronutrient deficiencies.
The occurrence of aflatoxin M1 in fresh cow milk retailed in Dar es Salaam, Tanzania
(Wageningen Academic Publishers,, 2006) Ndossi, Godwin D.
Aflatoxins are toxic substances produced by Aspergillusflavus and Aspergillusparasiticus during their growth on foods or feeds. Aflatoxin M1 (AFM1) occurs in cow’s milk as a result of dairy cows consuming aflatoxin B1 (AFB1) contaminated feeds. The number of dairy cattle in Dar es Salaam has been on the increase over the years as part of individual efforts to supplement income. In addition to grass, dairy cattle are fed feeds that are likely to contain AFB1 because of susceptibility to fungal contamination. Little is known about the occurrence of aflatoxins in fresh milk retailed in Dar es Salaam. The aim of this investigation was to determine the occurrence of AFM1 in local milk supplies retailed in Dar es Salaam. Thirty seven samples of raw cow’s milk were randomly collected from milk stalls and retail shops in Dar es Salaam and analysed for the presence of AFMI. The samples were analysed using high-performance liquid chromatography. Thirty four of the 37 milk samples (92%) had AFM1 levels between 0.005 and 0.855 μg/kg with a mean concentration of 0.246 μg/kg. Sixty eight percent contained low levels of AFM1 ranging from 0.005 to 0.336 μg/kg while twenty four percent contained high levels ranging from 0.545 to 0.855 μg/kg. Eight percent contained no AFM1 or undetected amounts. Dairy cattle in Dar es Salaam are fed on feed contaminated with AFBI and therefore dairy and dairy products consumers are at risk of aflatoxin M1 exposure. Dairy cattle keepers and local feed producers need to be educated on the potential hazard of mycotoxins and available preventive measures that are based on principles of Hazard Analysis Critical Control Points (HACCP). Also surveillance on aflatoxin contamination in animal feeds should be strengthened.
Prevalence and aetiology of juvenile skeletal ﬂuorosis in the south-west of the Hai district, Tanzania – a community-based prevalence and case–control study
(Tropical Medicine and International Health, 2013) Ndossi, Godwin D.
Introduction Fluorosis is endemic throughout the East African Rift valley, including parts of Tanzania. The aim of the study was to identify all cases of deforming juvenile skeletal fluorosis (JSF) in a northern Tanzanian village and to document the extent of dental fluorosis (DF). Methods Door‐to‐door prevalence survey of all residents of the village. Residents were assessed for the presence of DF and JSF. Those with JSF and randomly selected controls from the same age range were further assessed for possible JSF risk factors. Results The village had a population of 1435. DF was endemic within the population, being present in 911 (75.5%; 95% CI, 73.0–77.9) of dentate individuals who were examined (n = 1207). JSF was present in 56 of 1263 people examined, giving a prevalence of 4.4% (95% CI, 3.3–5.6) and was more common in males. Low body mass index, drinking predominantly well water 3 years previously, not being weaned on bananas, the use of fluoride salts in cooking during childhood and drinking more cups of tea per day were independent predictors of JSF. Conclusions Juvenile skeletal fluorosis is a common and preventable public health problem. Providing clean, low‐fluoride, piped water to affected communities is of obvious health benefit.
Randomized Efficacy Trial of a Micronutrient-Fortified Beverage in Primary School Children in Tanzania
(The American journal of clinical nutrition, 2003) Ndossi, Godwin D.
Background: Dietary supplements providing physiologic amounts of several micronutrients simultaneously have not been thoroughly tested for combating micronutrient deficiencies. Objective: We determined whether a beverage fortified with 10 micronutrients at physiologic doses influenced the iron and vitamin A status and growth of rural children (aged 6–11 y) attending primary schools. Design: In this randomized, double-blind, placebo-controlled efficacy trial, children were assigned to receive the fortified beverage or an unfortified beverage at school for 6 mo. Results: There were nonsignificant differences at baseline between children in the fortified and nonfortified groups in iron status, serum retinol, and anthropometry. At the 6-mo follow-up, among children with anemia (hemoglobin < 110 g/L), there was a significantly larger increase in hemoglobin concentration in the fortified group than in the nonfortified group (9.2 and 0.2 g/L, respectively). Of those who were anemic at baseline, 69.4% in the nonfortified group and 55.1% in the fortified group remained anemic at follow-up (RR: 0.79), a cure rate of 21%. The prevalence of children with low serum retinol concentrations (< 200 μg/L) dropped significantly from 21.4% to 11.3% in the fortified group compared with a nonsignificant change (20.6% to 19.7%) in the nonfortified group. At follow-up, mean incremental changes in weight (1.79 compared with 1.24 kg), height (3.2 compared with 2.6 cm), and BMI (0.88 compared with 0.53) were significantly higher in the fortified group than in the nonfortified group. Conclusion: The fortified beverage significantly improved hematologic and anthropometric measurements and significantly lowered the overall prevalence of anemia and vitamin A deficiency.
Remaining challenges in Tanzania’s efforts to eliminate iodine deﬁciency
(Public Health Nutrition, 2007) Ndossi, Godwin D.
Objective To determine iodine levels in salt and iodine deficiency prevalence in school-aged children in 16 districts in Tanzania with previous severe iodine deficiency. Design A cross-sectional study in schoolchildren. Systematic probability sampling was used to select schools and subjects for goitre assessment and urinary iodine determination. Setting Sixteen districts randomly selected from the 27 categorised as severely iodine-deficient in Tanzania. Subjects The study population was primary-school children aged 6–18 years who were examined for goitre prevalence and urinary iodine concentration (UIC). Salt samples from schoolchildren's homes and from shops were tested for iodine content. Results The study revealed that 83.3% of households (n = 21 160) in the surveyed districts used iodised salt. Also, 94% of sampled shops (n = 397) sold iodised salt, with a median iodine level of 37.0 ppm (range 4.2–240 ppm). Median UIC in 2089 schoolchildren was 235.0 μg l− 1 and 9.3% had UIC values below 50 μg l− 1. The overall unweighted mean visible and total goitre prevalence was 6.7% and 24.3%, respectively (n = 16 222). The age group 6–12 years had the lowest goitre prevalence (3.6% visible and 18.0% total goitre, n = 7147). The total goitre prevalence had decreased significantly in all districts from an unweighted mean of 65.4% in the 1980s to 24.3% in 1999 (P < 0.05). We believe this difference was also biologically significant. Conclusion These findings indicate that iodine deficiency is largely eliminated in the 16 districts categorised as severely iodine-deficient in Tanzania, and that the iodine content of salt purchased from shops is highly variable
Research ethics committees in Africa: authors’ reply
(PLoS Med, 2007) Ndossi, Godwin D.
We thank Dr. Benatar [1] for pointing out that South Africa has two Fogarty-funded bioethics training programs: one that focuses primarily on providing short-term training to mid-career professionals from Southern Africa; and another that provides modular training in research ethics to professionals from the African continent. In addition, there are now several other Fogarty-funded trainingprograms that either target African professionals exclusively or include African professionals, among others, in their programs (see http:⁄⁄www.fi c.nih.gov/programs/training grants/bioethics/index.htm). All of these programs share the goal of increasing professional capacity in bioethics and research ethics on the African continent. Our own paper demonstrated that training even a small number of individuals can make a difference in changing policy and practice regarding research ethics in several institutions; that so many training efforts are now ongoing is a major step forward. Again, having more people teaching and discussing researchethics and starting and staffing research ethics committees will never itself guarantee that research with humans is more ethical, but it seems to be a critical first step. Capacity development for Africa still remains a challenge and worthy of increasing investments in global health

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