Nutrient composition of commonly used complementary foods in North western Nigeria (original) (raw)
African Journal of Food, Agriculture, Nutrition and Development, 2014
Adequate nutrition is important during infancy and childhood where a short period of malnutrition has long lasting effects on growth, development and health in the adult life. The period from six months to two years constitutes a critical window of opportunity for promoting optimal growth, health and development, while insufficient quantity and quality of complementary foods (CFs), poor feeding practice and high rate of infection have a detrimental impact on growth in these important years. This study was designed to evaluate the nutrient composition and suitability of four commonly used complementary foods in two Local Government Areas (LGAs) of Akwa Ibom State, Nigeria. A descriptive cross-sectional survey involving women with children aged 6-24 months old was carried out in two randomly selected LGAs to identify the commonly used CFs. A total of 300 consenting mothers (150/LGA) aged 18 to 60 years presenting their children for immunisation in the two LGAs were respondents. A pretested, semi-structured questionnaire was used to obtain information on sociodemographic characteristics, knowledge on breastfeeding, complementary feeding practice, and types of CFs used from the respondents. Standardised samples of the four most commonly used CFs were prepared and analysed for nutrient and anti-nutrient composition using standard AOAC methods of analyses. Data were analysed using descriptive statistics and Chi square test, with level of significance set at p = 0.05. Two types of unripe banana porridge, one mashed bean porridge, and mixed cereal pap with crayfish and 'turn brown' (soybean flour, groundnut and crayfish) were the four most commonly used CFs. One hundred grams portion of the CFs contained between 2.52-6.70 g crude protein, 1.26-7.23 g crude lipid, 8.16-13.97 g carbohydrates and yielded up to 415.57 kcal of energy. The mineral content ranged between 31.58-230.40 mg potassium, 46.78-184.68 mg calcium, 55.23-120.93 mg phosphorus, 10.37-23.26 mg iron, 7.53-18.53 mg of zinc / 100g portion. The four complementary foods were nutritionally adequate and were low in anti-nutrients (oxalates, phytates, trypsin inhibitors, saponins and tannins), hence there is little risk of malabsorption of available nutrients. Utilization of unripe banana and mixed cereals with turn brown for infants provides cheap CFs with adequate energy and nutrients, and promotes biodiversity.
Nutrients
The nutritional quality of commercially produced complementary food (CPCF) varies widely, with CPCF in high-income settings often containing excessive levels of sugar and sodium. Little is known about the nutritional quality of CPCF available in the West Africa region, despite their potential to improve the nutrition of infants and young children (IYC). This study evaluated the nutritional quality of CPCF available in five West African countries using the WHO Europe nutrient profiling model (NPM) and assessed their suitability for IYC based on label information. The proportion that would necessitate a “high sugar” warning was also determined, and the micronutrient (iron, calcium, and zinc) content was assessed against IYC-recommended nutrient intakes. Of the 666 products assessed, only 15.9% were classified as nutritionally suitable for promotion for IYC. The presence of added sugar and excessive sodium levels were the most common reasons for a product to fail the nutrient profiling...
Acta Scientifci Nutritional Health, 2020
The second six months in a child's life opens with the complementary feeding period. During this period, breast feeding, though no longer adequate to meet the growing child's nutritional needs, is expected to continue. It is thus anticipated that complementary foods provide energy, macronutrients and micronutrients to bridge the gaps between daily requirements for infants and young children and the amount consumed through breastfeeding [1]. Unfortunately, complementary foods which ought to be energy and nutrient dense are more commonly of low quality in Nigeria [2]. Consequently, children aged 6-24 months are the most vulnerable group for malnutrition as 41% deaths of children in developing countries in this age group (2.3 million) is linked to this menace [3]. Nigeria has been ranked the country with the second highest burden of stunted children in the world with a prevalence of 32% of the children under five years of age. The states in northern Nigeria where malnutrition and insecurity now go hand in hand, are the most affected with wasting and stunting [4], thus, it is not unusual to see mothers carrying their malnourished babies around as though everything is normal; a large number not even aware of Complementary feeding in Low-and-Middle-Income-Countries (LMICs) such as Nigeria remains a major concern as the burden of childhood malnutrition has worsened in Northern Nigeria. The study was designed to formulate complementary foods using available staples, compare energy and macronutrient density to international standards, estimate the cost of production of the blends and carry out a sensory evaluation on the diets. Ingredients were purchased from a grain market in Gombe, Gombe state, Nigeria. The diets were formulated by a 60:40 (cereal/tuber : legume) mix ratio using a household level approach. Diet A: Sweet potatoes + millet + groundnut + bambaranut (25:35:30:10%w/w) Diet B: Tiger nut + millet + groundnut + bambaranut (25:35:30:10% w/w). Cereals, tubers and legumes were prepared using simple household level approaches. Diets were constituted and homogenously blended into fine powder, sieved, packed and labeled. Proximate composition analysis to determine macronutrient and energy density was carried out using standard analytical methods. Analysis of data was done using descriptive statistics.Th e results show that energy density of diets were between 4.04 ± 1.84 kcal/g-4.13 ± 2.84 kcal/g, crude protein (15.84 ± 0.59%-18.28 ± 0.35%), crude fat (5.84 ± 0.4%-8.41 ± 0.21) and were comparable to International Food Standard values as amended in 2017. Moisture values were between 1.17 ± 0.12%-2.46 ± 0.15% suggesting longer shelf life for the foods. Cost of production of 400g commercial packaging was less than 1USD (N272). The diets had good energy and macronutrient density, a very low cost of production and overall acceptability which presents as a strong tool in tackling malnutrition in low income populations.
IOSR Journals , 2019
Socioeconomic characteristics of mothers has been observed to have effect on the knowledge and kinds of complementary foods given to infants. This research examined the socioeconomic analysis of complementary diets fed to infant in Ido Local Government Area of Oyo State, Nigeria. Interviewers administered questionnaires were used to obtain data for the study. 270 respondents (mothers) who presented their children for immunization were selected from five different Primary Health care centers in the Local Government Area. The result revealed that mothers preferred traditional home made (63.3%) to commercial complementary foods (33.7%)54.8% of the mothers were between the age of 28-37 years. 56.7% had secondary school education while 40% had a certificate from tertiary institution. 33% of the mothers engage in trading while 19.3% were employed by the state of federal government as civil servant. 44.4% of the mothers earn between ₦10,000-₦25,000 on monthly basis while just 1.1% earn above ₦70,000. 49.3% of the mothers reported that they start feeding their children complementary food from about 6-10 months. Cereals such as maize and sorghum form the majority of staple used in the formulation of complementary food in the study area, other food commodities are infrequently used.
Energy, Iron and Zinc Densities of Commonly Consumed Traditional Complementary Foods in Nigeria
Aim: To assess the energy, iron and zinc densities of ten selected commonly consumed traditional complementary foods in Nigeria. Study Design: Survey and Experimental study. Place and Duration of Study: Department of Hotel and Catering Management, Yaba College of Technology, Lagos, and Department of Human Nutrition, University of Ibadan, Oyo State, Nigeria between June and August, 2004. Methodology: A validated interviewer-administered questionnaire was distributed to 600 nursing mothers and used to identify the most commonly consumed traditional complementary foods in Nigeria. Thereafter, ten traditional complementary foods were selected and analyzed for proximate composition, iron and zinc using Association of Official Analytical Chemists (AOAC) and Atomic Absorption Spectrophotometric methods. Results: The traditional complementary foods have high moisture content ranging from 55.80% to 91.17%. The protein content of the complementary foods ranged from 1.06g/100g to 13.81g/100g. The energy densities of the selected traditional complementary ranged from 0.48kcal/g to1.50kcal/g. The study revealed that half of the traditional complementary foods in this study did not meet the PAHO/WHO recommendation of 0.8kcal/g while the remaining half exceeded this basic requirement for energy densities. However, the high requirement of 7.7mg and 1.6mg for iron and zinc densities respectively, could not be met by any of the complementary foods assessed. Conclusion: Incorporation of some animal foods into these plant based diets will have a lot of advantages as animals-source foods are good sources of readily available haem-iron and zinc. Therefore, more recipes should be developed to improve the intake of animal source foods which are needed to ensure adequate protein, iron and zinc densities of complementary foods for infants in Nigeria.
In Northern Nigeria, malnutrition remains a major public health problem. This is because the predominant population of rural communities who are low income subsistence farmers cannot afford the commercial fortified infant's food. This research was design to formulate and assess the nutrient composition of a cost effective infant's diet from locally/readily available staple foodstuffs. This is aimed at improving the nutritional status of vulnerable infants and young Children in Northern Nigeria. Standard chemical methods were used to determine the nutrients and antinutrients of the formulated diet and the respective values compared to commonly used commercial complementary diet (as indicated by the manufacturer) in Nigerian market. The results showed that the crude protein of formulated diet was 16.29g/100g which is higher than 15g/100g for control (commercial weaning diet). The energy value of the formulated diet (416.7kcal/100g) is comparable to that of the commercial diet (410.0kcal/100g). The concentrations of zinc (31.0mg/100g) and iron (8.01mg/100g) in the formulated diet were significantly higher (p<0.05) than their corresponding values in the commercial diet. All the essential amino acids were present in the formulated diet. It can be concluded that proper selection and combination of local foodstuffs can provide a cheap and nutritionally rich weaning diet.
European Journal of Nutrition & Food Safety, 2020
Toddlers malnutrition is a health problem in developing countries like those found in Sub-Saharan Africa. Owing to prevalence of poverty, families are generally not able to afford the commercial complementary foods available in the market stalls, since such complementary foods are imported and made from non-local foodstuffs. In order to overcome these issues, FAO/WHO recommends the use of local foodstuffs in formulation of complementary foods and defines the virtues that the complementary foods should possess. In this light, researchers in Sub-Saharan Africa have proposed several formulations of complementary foods. The present work reviews these research findings on complementary foods available in the Sub-Saharan Africa utilizing the local food materials, the treatment that is required to be meted to such food ingredients, nutritional quality of formulated complementary foods and ultimately their biological effects. The limitations of the research work, if any, has been highlighte...
Journal of Health, Population and Nutrition
Background: Mothers and caregivers typically feed infants according to their culture, purchase power and level of awareness with no due diligence to nutritional quality of the diet. Scientific evidence on nutritional adequacy of predominant complementary foods is critical for planning and prioritising interventions. The purpose of the current study was to evaluate the quality of complementary foods and the optimality of complementary feeding practices in Southwest Ethiopia. Methods: In this cross-sectional study, a stratified multistage sampling procedure was used to sample 433 children, 6-24 months old. A semi-structured questionnaire was used to collect demographic, socioeconomic and dietary data. Dietary diversity score was measured using a 24-h dietary recall. Six customary complementary food types were assayed for proximate composition, energy and mineral density using standard methods. Adequacy of the complementary foods in nutrients for complementary feeding purposes was assessed as a ratio between actual composition and recommended composition of complementary foods. Results: Only 16.1% of the children get the minimum dietary diversity. The children were reported to be fed with cereals & grains (68.8%), discretionary calories (53.6%), protein-rich foods (44.6%), oils and fat (40.5%), vegetables (38. 5%), dairy products (17.9%) and fruits (28.1%). The sampled foods contained 4.3-24.4%, 0.9-8.5%, 8.2-11.9%, 27.9-162.6 Kcal/100 g, 168.4-250.4 mg/100 g, 1.8-4.1 mg/100 g and 22.5-42.4 mg/100 g of total carbohydrate, crude fat, protein, energy content, calcium, zinc and iron, respectively. All the complementary food samples predominantly fed to children were not composed of adequate protein, fat, carbohydrate, energy and calcium as recommended for complementary feeding purposes. However, most of the complementary foods are composed of adequate iron and zinc. Conclusions: The nutrient density and diversity of complementary foods of 6-24-month-old children in the study area were found to be sub-optimal. Upgrading the nutritional composition of the starchy complementary foods should be of highest priority to improve nutrition of the infants and young children.
ICAN: Infant, Child, & Adolescent Nutrition, 2010
Diversification in complementary feeding of children is important in meeting the need for essential nutrients. This study investigated diet diversification in complementary feeding of children between the ages of 0 and 24 months. The cross-sectional study was carried out in Osun State of Nigeria and 450 mothers were interviewed. Results revealed that diet was based on cereals, roots, and tubers with little animal products. The consumption of protein-rich foods, both of plant and animal origin, was particularly low. None of these foods recorded 50% of total consumption, except for milk with 50.4%. Fewer than 30% of the children population consumed legumes. Foods such as meat, eggs, and fish recorded below 50% consumption as well. Cheese was not consumed at all in the rural communities. Only 9.7% consumed vegetables and 12.9% consumed fruits. Most of the children experienced stunting (58.2%), followed by wasting (7.8%), and underweight (23.8%). Diet diversity was also shown to be asso...
European Journal of Nutrition & Food Safety
Background: Malnutrition is still among the leading causes of death in children <5 years, contributing to about 50% of infant deaths in Sub-Saharan Africa. Undernutrition is the more common form of malnutrition in developing countries, and results from insufficient intake of protein and/or energy, and may sometimes result from poor breastfeeding and/or complementary feeding practices. WHO recommends exclusive breastfeeding for the first six months of the baby’s life, followed by gradual introduction of complementary foods, with continuous breastfeeding till baby is at least two years. Most babies are not exclusively breastfed for six months, and even more not breastfed till 24 months. Most complementary foods in developing countries are homemade, with plant-based ingredients, using improper processing techniques, making them low in nutrient content. Aims: This work aimed at formulating Complementary foods from ten different proportions of local staples; yellow maize, rice, potato...
Asian Food Science Journal
This study was carried out to assess complementary feeding practices of under-five children in Akuku Toru Local Government Area of Rivers State. A cross-sectional descriptive survey research was adopted for the study. The population for the study consisted of nursing mothers with children (0-24 months) attending their normal health services in seven (7) major primary health care centres in Akuku Toru Local Government Area, Rivers State. A sample size of 210 nursing mothers was selected for the study. The instrument used for data collection was a self-structured questionnaire titled “Assessment of Complementary Feeding Practices of Children Questionnaire”. The questionnaire was validated by three validates. Data generated using the research instrument was analyzed using frequency, percentages and mean. The findings obtained showed that most nursing mothers initiate complementary feeding at early age and their reasons often times are pressure from their family members who do not under...
Nutrient content of complementary foods for children in Kilimanjaro, Tanzania
African Journal of Food Science, 2022
Complementary feeding is an effective strategy in reducing the levels of malnutrition among children aged 6-23 months. Little is known about the preparation and nutrient content of locally made complementary foods in Tanzania. This study was carried out with the aim of analysing nutrient content of the frequently used complementary foods for children of age 6 to 23 months. A cross-sectional study was conducted in three randomly selected villages in Rombo district, Kilimanjaro region, Tanzania. Information on the types of complementary foods was collected using semi-structured and 24-h dietaryrecall questionnaires. Seven samples of frequently consumed complementary foods (banana, rice and maize-based porridges) were collected and analysed for proximate, vitamins and minerals composition. The results were as follows:
European Journal of Clinical Nutrition, 1998
Objective: To assess the energy and nutrient adequacy of a variety of complementary foods used in parts of Africa, India, Papua New Guinea, the Philippines and Thailand. Method: The energy, nutrient and anti-nutrient (dietary ®bre and phytic acid) content (per 100 g as eaten, per 100 kcal, and per day) of twenty-three plant-based complementary foods consumed in developing countries was calculated from food composition values based on chemical analysis for the trace minerals, non-starch polysaccharide and phytic acid, and the literature. Results were compared with the estimated nutrient needs (per day; per 100 kcal) from complementary foods for infants 9±11 months, assuming a breast milk intake of average volume and composition and three complementary feedings per day, each of 250 g. Results: Complementary foods should provide approximately 25±50% of total daily requirements for protein, ribo¯avin and copper; 50±75% for thiamin, calcium and manganese; and 75±100% for phosphorus, zinc and iron. Most or all appear to meet the estimated daily nutrient needs (per day; per 100 kcal) from complementary foods for protein, thiamin and copper (per day), but not for calcium, iron, and in some cases zinc, even if moderate bioavailability for iron and zinc is assumed. Some of those based on rice are also inadequate in ribo¯avin (per day; per 100 kcal). Conclusions: Even if strategies to improve the bioavailability of iron and zinc are employed, they are probably insuf®cient to overcome the de®cits in calcium, iron and zinc. Therefore, research on the feasibility of fortifying plant-based complementary foods in developing countries with calcium, iron and zinc is urgently required.
2020
Malnutrition among infants in Sierra Leone still ranks one of the highest globally. Potency of some locally-formulated complementary food at resolving the problem had been proven. The experiment aimed at evaluating nutrient contents in traditional complementary foods consumed by infants in Eastern and Northern regions of Sierra Leone was carried out between 2016 and 2018. Ten common recipes identified through semi-structured questionnaire were standardized and analyzed using standard laboratory methods. Data were analyzed using SAS statistical package while means were separated using the new Duncan’s Multiple Range Test. Results showed that Bennie-mix, pamahun, as well as pap prepared from rice, millet and rice-one pot are richer in protein content (9.92% – 16.87%) and essential micronutrients (Iron ranged from 0.45mg – 3.58mg and zinc ranged from 1.24mg – 4.38mg). phytate (0.61mg – 3.76mg) and trypsin inhibitors (0.26mg – 5.79mg) which were low in all the selected samples as recomm...
International Journal of MCH and AIDS (IJMA)
Background and Objectives: Inappropriate complementary feeding is a major cause of child malnutrition and death. This study determined the complementary feeding knowledge, practices, minimum dietary diversity, and acceptable diet among mothers of under-five children in an urban Local Government Area of Lagos State, Southwest Nigeria.Methods: This descriptive cross-sectional study was conducted in Eti-Osa area of Lagos State, Nigeria. Multi-stage sampling technique was employed to select 355 mothers and infants. Data was collected using a pre-tested interviewer administered questionnaire and 24-hour diet recall was used to assess dietary diversity. Data was analyzed using Epi-Info.Results: Knowledge of complementary feeding was low (14.9%) and was associated with older mothers’ age, being married, and higher level of education. The prevalence of timely initiation of complementary feeding (47.9%), dietary diversity (16.0%) and minimum acceptable diet for children between 6 and 9 month...
African Research Review, 2012
Locally processed complementary foods, appropriately enriched can complement breast milk and traditional foods during the nutritionally vulnerable periods of a child life. The study therefore examines the adoption of enriched local complementary foods in Osun State Nigeria. Structured interview schedule was used to collect information from 384 women about new home made complementary foods introduced to them during ante and post natal clinic. Awareness, adoption and discontinuity of the foods were also determined. Results revealed that majority of the women (44.3%) were between 30-39years of age and have attended secondary school (45%). Of the foods introduced in the urban center mothers were aware of "eko ilera" (12.8%), groundnut milk (11.1%), soya milk (23.5%), mashed potato and milk (11.1%), pap and banana (12.8%), cowpea milk (7.6%) and tom brown (6.4%). Their rural counterparts were only aware of food such as "eko ilera", soya milk and pap and banana with low percentage which are 1.3%, 6% and 2% respectively. The adoption for "eko ilera" was (86.7%), pap and banana (93.3%), cowpea milk 88.8% and tom brown (86.6%) for the urban
Journal of the science of food and agriculture, 2017
This paper reviews indigenous Beninese food resources as potential ingredients for complementary infant foods with the aim to develop affordable formulations for low-income households in each agro-ecological zone of the country. Potential ingredients were selected on their documented nutritional value. The selected foods encompass 347 food resources, namely 297 plant products from home gardens or collected from natural vegetation and 50 animals, either domesticated or from the wild. The compiled data reveal that the distribution of the available food resources was unbalanced between agro-ecological zones. Only a few animal ingredients are obtainable in northern Benin. Most resources are seasonal, but their availability may be extended to northern Benin. A high variation was observed in energy and nutrient contents. Anti-nutritional factors were identified in some resources, but processing techniques were reported to reduce their presence in meals. In general, ingredients from local ...
Background: Children, pregnant and lactating mother are the most affected groups by malnutrition in Cameroon. Breast milk is considered as an essential food that enabled the survival of infant, young children and the entire humanity. The aim: The aim of this work was to determine the factors that influence the duration of exclusive breastfeeding and complementary feeding (CF) practices. Methods: A questionnaire previously developed was submitted to the mothers of 152 children aged 0 -2 years during nutritional survey in Douala city (Cameroon) to understand breastfeeding and CF practices. Anthropometrics measures were taken and statistical analyses where done using Chi 2 test. Results: Low breastfeeding rate 48.67 % (P < 0.01) was observed. The frequency of exclusive breastfeeding was 18.67 %. The most frequent complementary foods were cereals and tubers (55.74 %). Early CF was observed in 51.09 % of children between 0-5 months, 4.69 % of children were underweight, 30.47 % stunted and 5.47 % wasted. Conclusion: Several diseases related to malnutrition were linked to inappropriate breastfeeding, as proposed by WHO/UNICEF. Mother's education was correlated with good complementary feeding practices.
Nutrition and Dietary Supplements, 2016
Complementary feeding should be timely, adequate, and given in a way that is appropriate for the age of the child, applying responsive feeding to fill the gap between what is provided by breastfeeding and the total nutritional requirements of the infant. The purpose of this study was to assess nutrient composition and evaluate adequacy of observed nutrient densities (energy, protein, calcium [Ca], iron [Fe], and zinc [Zn]) in homemade complementary foods for children of age 6-23 months, in comparison to the desired levels in food insecure woredas of the Wolayita zone, Southern Ethiopia. A cross-sectional weighed food record method was used to assess the energy and micronutrient compositions of homemade complementary foods and evaluate adequacy of observed nutrient densities in relation to the desired levels. Multistage sampling was used to locate the children. Observation and measurement of complementary food preparations throughout the day was made. Representative portions from the diets were sampled for further laboratory analysis and to evaluate adequacy of observed nutrient levels. More than 20 different complementary food types (mostly an extension of family foods) prepared from various food items were observed. Dietary diversity of the foods was very poor. The average dietary diversity score was only 2.54, while animal-source foods and vitamin A-rich fruits and vegetables were virtually absent. The energy and protein compositions of the diets, however, were sufficient. Energy density of 0.92 kcal/g, 1.24 kcal/g, and 1.41 kcal/g and protein density of 3.41 g/kcal, 2.18 g/kcal, and 2.48 g/kcal were observed in the diets of 6-8-month, 9-11month, and 12-23-month age categories, respectively. The diets were poor in micronutrients. The observed nutrient density for Ca and Zn (mg/100 kcal) was significantly lower (P=0.000) than the desired levels. Similarly, the Fe level in the diets for 6-11 month old children was significantly lower than the desired nutrient density levels even when high bioavailability was accounted for. On the contrary, adequate nutrient density in the diets for 12-23 month old children was observed even when low bioavailability for Fe was accounted for. The complementary foods were energy dense. Micronutrients densities observed (Ca, Zn, and Fe), however, were very low as they continue to be the "problem nutrients".
Journal of Food and Nutrition Sciences
Food base approach is considered to be a more viable and sustainable method of addressing micronutrient deficiencies in developing countries. A study to develop suitable micronutrient-rich complementary infant foods was carried out and characterized using rice (Oryza sativa, var. Togo Marshal) and six other Ghanaian food ingredients; soybean (Glycine Max var. Afayak), cowpea (Vigna unguiculata, var. Bengpla), mango (Magnefera indica, var. Kent), red palm (Elaesis guineensis. var. Dura) oil, groundnut (Arachis hypogea, var. Otuhia) and eggs. The complementary foods were initially developed from six blends, LR-1 (70% rice, 20% soybean, 5% groundnut, 5% dried mango), LR-2 (70% rice, 20% soybean, 5% groundnut, 5% egg yolk), LR-3(70% rice, 20% soybean, 5% cowpea, 5% dried mango), LR-4 (65% rice, 25% soybean, 5% palm oil, 5% egg yolk), LR-5 (70% rice, 20% cowpea, 5% groundnut, 5% egg yolk), LR-6 (70% rice, 25% soybean, 5% dried mango). Sensory evaluation of these initial blends was conducted and the three most preferred blends were selected for further acceptability studies as well as the nutritional analyses using standard methods. The most desirable product based on sensory attributes was the formulation containing mango flour and soybeans (LR-6) followed by formulation containing soybean, groundnut and mango (LR-1). However there were no significant differences (p = 0.05) observed among the overall acceptability of the three best formulated products (LR-6, LR-1, LR-4). LR-4 had the highest amount of energy (427.6Kcal/100g), protein (15.82g/100g), fat (12.2g/100g), beta-carotene (5106.7 µg/100g) and iron (6.6mg/100g). LR-6 came out as the most preferred weaning food based on sensory evaluation. This study revealed the potential of using local ingredients including rice to produce micronutrient-rich complementary infant foods in developing countries. This will be of tremendous help to the less endowed households where the problem of infant malnutrition is most rife.