The traditional set-up in developing countries particularly in the rural areas requires that strategies for dissemination and adoption of improved technologies and practices in complementary feeding be tailored to the cultural lifestyle of the population. This is because majority of the poor live in rural areas where the facilities for mass media education is limited. The approaches would therefore need to make use of personalised methods, most likely using community health workers (CHWs) and extension personnel with the active involvement of the community [ 92 ] . The approaches include:
1. Education on the use of local resources as a sustainable strategy for the poor. Education should centre on the use of household technologies to prepare safe and nutritious complementary foods from local products
2. Education on improved infant and young children feeding practices which should emphasise the importance of:
Proper sanitation, hygiene practices, refrigeration and re-heating
•
Proper feeding during illness and after illness
•
Increased food diversity based on local foods
•
Breaking of cultural barriers to offering food that are rich in micronutrients
•
Increased availability and accessibility to nutritious complementary foods
•
The in fl uence of breastfeeding for up to 6 months on complementary feeding
•
3. The goals of international and local organisations should aim at improving infant and young child nutrition (IYCN) along with maternal nutrition in a way that complements each other. Advocacy work should be geared towards raising issues on the political and developmental agenda by inter- national organisations, multi-sector alliances such as GAIN and BF advocacy groups and all stake- holders [ 93 ]
4. Community involvement in disseminating the knowledge base [ 94 ] improves impact by providing the neighbourhood-level supervision and social approval that motivates regular application
Conclusion
In this chapter, local complementary foods across the developing world, aspects of their processing, nutritional quality and strategies to improve complementary feeding have been considered. The car- bohydrate nature of the cereal grain base, their contents of anitinutritional factors and absence of good postharvest storage facilities mean that the cost of complementary infant food products and their nutritional quality are probably more important than products for any other groups of consumers.
Although ample research efforts to improve the quality of these local complementary foods have been undertaken, practical interventions for disseminating the technical details have to be made if these efforts are to have the desired impact. The technologies developed are easily adaptable household types and will therefore be economically viable for interested parties, especially women. In this way, complementary food processing can be a spur to rural development.
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Key Points
For the prevention of allergies in children, expert bodies recommend that the child should be
•
exclusively breastfed for the fi rst 4–6 months; afterwards complementary foods can be given alongside the breast milk.
These recommendations have been on the basis of the hypothesis that the gut mucosal immune system
•
of the infant is immature; hence introduction of solids early may trigger allergic sensitization.
Recent fi ndings from observational epidemiological studies question these recommendations by
•
showing that early introduction of solids may, in fact, be protective against allergies.
It is impossible to con fi rm these fi ndings in a randomized trial setting, since it is not feasible to
•
randomize breastfeeding, making observational studies the major source to judge the role of the timing of introduction of complementary foods in the development of allergies in childhood.
The hypothesized immaturity of the infant’s gut mucosal immune system has been suggested not
•
to be clearly elucidated.
In view of current evidence, the current recommendations on the timing of introduction of comple-
•
mentary foods as a strategy for the prevention of allergies in children may need further attention.
Keywords Allergies • Asthma • Children • Complementary foods • Gut mucosal immune system
Introduction
The prevalence of childhood allergies has been increasing in recent times, particularly in western countries, ranking one of the leading chronic diseases in children [ 1, 2 ] . Evidence also suggests that several low-income countries are already witnessing similar increase, although the reliability of the data is not clear [ 3– 5 ] . As the prevalence increases, so also the associated cost burdens on families, the health care system, and the economy at large [ 1, 6– 9 ] . Consequently, understanding and identifying the potential risk factors causing the increase will help in initiating early preventive strategies [ 10 ] .
The etiology of allergies involves an induced shift in the balance between the T helper cells 1 (Th1) and Th2 cytokines, which usually favors Th2 dominance [ 11, 12 ] . For asthma, oxidative free radicals