Folate deficiencies are widespread around the world. Promoting consumption of folate-rich foods could be a sustainable option to alleviate this problem. However, these foods are not always available. Cereals, being a staple food, could contribute to folate intake. They are fermented prior to consumption in many African countries, and fermentation can modify the folate content. In Ethiopia, injera is a widely consumed fermented flat bread. The main drivers of its fermentation are lactic acid bacteria (LAB). The aim of this work was to isolate and identify folate-producing LAB from injera fermented dough and to evaluate their ability to increase folate status after depletion in a rat model. Among the 162 strains isolated from 60 different fermentations, 19 were able to grow on a folate-free culture medium and produced 1 to 43 µg/L (24 h, 30 °C incubation). The four highest folate producers belonged to the Lactobacillus plantarum species. The most productive strain was able to enhance folate status after depletion in a rat model, despite the relatively low folate content of the feed supplemented with the strain. Folate-producing L. plantarum strain has potential use as a commercial starter in injera production.

This work reviewed the maternal and child folate status and the strategies used to tackle health disorders related to folate deficiencies in Africa. Published surveys conducted between 2005 and 2018 were considered. Criteria for establishing folate deficiency are variable (folate intake or serum folate concentrations). Folate deficiencies were frequent among the 11 countries with available data, prevalence of folate adequacy was very low and coverage of strategies used to fight deficiencies is limited. To overcome folate deficiencies, fortification of staple foods is an option, but finding ways to make new folate-rich food available for the poorest is a must.

Although the advantages of introducing point of care testing for syphilis in antenatal care (ANC) are well documented, there is little evidence on how to address structural issues within health systems. A better understanding of how these interventions work in a range of settings and contexts is needed in order to overcome bottlenecks at health system level. To better understand the relationships between implementation and context we developed and implemented an intervention focused on integrating a rapid screening test for syphilis in ANC services in rural primary health care facilities in Burkina Faso. This manuscript describes the intervention and reports on feasibility and acceptability of the intervention, the facilitators and barriers to the implementation of this intervention and the likelihood that point of care test for syphilis will become routinely incorporated in practice. In Kaya Health and Demographic Surveillance System (Kaya HDSS), all 7 primary healthcare facilities were selected for intervention in 2013. A participatory approach was used to design and implement an antenatal syphilis screening intervention. The Normalization Process Model (NPM) proposed by May et al. was adapted in order to identify barriers and facilitators and to explore the likelihood to become routinely incorporated in practice. Registers, Observations (n = 14 ANC 1) of interactions between patients and health workers during ANC and interviews with health workers (n = 14) were our data sources. An intervention that included onsite training, provision of supplies and medicines, quality control and supervision was implemented in 7 health facilities in 2013. Rapid syphilis test and treatment were delivered during ANC within the examination room with no specific additional mechanism regarding staff organization. The perceived barriers were lack of training of all staff, workload, stock-outs of consumables and lack of motivation of staff. Key facilitators included political environment, ease of use of test and acceptability to pregnant women. Onsite testing for antenatal syphilis is a feasible and acceptable intervention in ANC at primary health facility in Burkina Faso. The point-of care test for syphilis is more likely to be acceptable by health workers as routine service and incorporated as a normal practice. The study was retrospectively registered on ClinicalTrials.gov under the Trial Registration Number NCT03156751 .

Poor folate status is implicated in a wide variety of health disorders including megaloblastic anaemia, neural tube defects, and cardiovascular diseases. Human diet remains the main provider par excellence. Despite several public-health options to overcome this micronutrient deficiency, dietary folate intakes of women of childbearing age and children are still below recommendations in many African countries. Therefore, this review aims at presenting the current knowledge on folate contents in various African foods, and on folate losses during food processing. Seventy one food sources were evaluated in this study. These various food sources included thirty six vegetables, six cereals, height cereal products, six processed leafy vegetables, six pulses, three fruits, three legumes and three roots. All of them were originated from six African countries including Burkina Faso, Côte d’Ivoire, Egypt, Ethiopia, Nigeria, and South Africa. Folate content ranged between 11 and 73.4 μg/100 g in cereals, 1.8 and 39 μg/100 g in cereal-based processed foods, 8.48 and 48.6 μg/100 g in cooked leafy vegetables, 11.6 and 633 μg/100 g in vegetables, 10 and 22 μg/100 g in pulses, 52 and 148 μg/100 g in legumes, 8 and 106 μg/100 g in fruits. The structure of the food matrix has been shown to influence folate digestibility in foods. High bioaccessible folate, assessed by in vitro digestion, was observed among food products with dense porosity structures while low bioaccessible folate was recorded among food products with open porous structures such as porridges and some gelatinized doughs. Numerous food processing steps have also been shown to influence negatively folate contents in foods.