Anselimo Makokha

Existence and functionality of emergency obstetric care services at district level in Kenya: theoretical coverage versus reality

BackgroundThe knowledge on emergency obstetric care (EmOC) is limited in Kenya, where only partial data from sub-national studies exist. The EmOC process indicators have also not been integrated into routine health management information system to monitor progress in safe motherhood interventions both at national and lower levels of the health system. In a country with a high maternal mortality burden, the implication is that decision makers are unaware of the extent of need for life-saving care and, therefore, where to intervene. The objective of the study was to assess the actual existence and functionality of EmOC services at district level.MethodsThis was a facility-based cross-sectional study. Data were collected from 40 health facilities offering delivery services in Malindi District, Kenya. Data presented are part of the “Response to accountable priority setting for trust in health systems” (REACT) study, in which EmOC was one of the service areas selected to assess fairness and legitimacy of priority setting in health care. The main outcome measures in this study were the number of facilities providing EmOC, their geographical distribution, and caesarean section rates in relation to World Health Organization (WHO) recommendations.ResultsAmong the 40 facilities assessed, 29 were government owned, seven were private and four were voluntary organisations. The ratio of EmOC facilities to population size was met (6.2/500,000), compared to the recommended 5/500,000. However, using the strict WHO definition, none of the facilities met the EmOC requirements, since assisted delivery, by vacuum or forceps was not provided in any facility. Rural–urban inequities in geographical distribution of facilities were observed. The facilities were not providing sufficient life-saving care as measured by caesarean section rates, which were below recommended levels (3.7% in 2008 and 4.5% in 2009). The rates were lower in the rural than in urban areas (2.1% vs. 6.8%; p < 0.001 ) in 2008 and (2.7% vs. 7.7%; p < 0.001) in 2009.ConclusionsThe gaps in existence and functionality of EmOC services revealed in this study may point to the health system conditions contributing to lack of improvements in maternal survival in Kenya. As such, the findings bear considerable implications for policy and local priority setting.

Efficacy of mid-upper arm circumference in identification, follow-up and discharge of malnourished children during nutrition rehabilitation

BACKGROUND/OBJECTIVES Although it is crucial to identify those children likely to be treated in an appropriate nutrition rehabilitation programme and discharge them at the appropriate time, there is no golden standard for such identification. The current study examined the appropriateness of using Mid-Upper Arm Circumference for the identification, follow-up and discharge of malnourished children. We also assessed its discrepancy with the Weight-for-Height based diagnosis, the rate of recovery, and the discharge criteria of the children during nutrition rehabilitation. SUBJECTS/METHODS The study present findings from 156 children (aged 6-59 months) attending a supplementary feeding programme at Makadara and Jericho Health Centres, Eastern District of Nairobi, Kenya. Records of age, weight, height and mid-upper arm circumference were selected at three stages of nutrition rehabilitation: admission, follow-up and discharge. The values obtained were then used to calculate z-scores as defined by WHO Anthro while estimating different diagnostic indices. RESULTS Mid-upper arm circumference single cut-off (< 12.5 cm) was found to exhibit high values of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio at both admission and discharge. Besides, children recorded higher rate of recovery at 86 days, an average increment of 0.98 cm at the rate of 0.14mm/day, and a weight gain of 13.49gm/day, albeit higher in female than their male counterparts. Nevertheless, children admitted on basis of low MUAC had a significantly higher MUAC gain than WH at 0.19mm/day and 0.13mm/day respectively. CONCLUSIONS Mid-upper arm circumference can be an appropriate tool for identifying malnourished children for admission to nutrition rehabilitation programs. Our results confirm the appropriateness of this tool for monitoring recovery trends and discharging the children thereafter. In principle the tool has potential to minimize nutrition rehabilitation costs, particularly in community therapeutic centres in developing countries.

Hydration properties and texture fingerprints of easy- and hard-to-cook bean varieties.

The objective of this study was to understand the factors that affect the hydration and cooking profiles of different bean varieties. During this study, nine bean varieties were classified as either easy-to-cook (ETC) or hard-to-cook (HTC) based on a subjective finger pressing test and an objective cutting test. Rose coco, Red haricot, and Zebra beans were classified as ETC, while Canadian wonder, Soya fupi, Pinto, non-nodulating, Mwezi moja, Gwaku, and New mwezi moja were HTC. The effect of different soaking (pre)-treatments on the cooking behavior and/or water absorption of whole or dehulled beans was investigated. Dehulling, soaking in high pH and monovalent salt solutions reduced the cooking time of beans, while soaking in low pH and CaCl2 solutions increased the cooking time. Moisture uptake was faster in ETC and dehulled beans. Soaking at high temperatures also increased the hydration rate. The results point to pectin-related aspects and the rate of water uptake as possible factors that influence the cooking rate of beans.

Extraction and characterization of pectic polysaccharides from easy- and hard-to-cook common beans (Phaseolus vulgaris)

The occurrence of the hard-to-cook (HTC) defect in legumes is characterized by the inability of cotyledons to soften during the cooking process. This phenomenon may be influenced by pectin properties. The objective of this study was to characterize the pectic polysaccharides comprised in the alcohol insoluble residue (AIR) extracted from easy-to-cook (Rose coco) and hard-to-cook (Pinto) common beans. This would provide an insight in the relationship between the pectin properties and HTC defect. The AIR was extracted from raw, half-cooked hard, half-cooked soft and fully-cooked bean samples. Subsequently, it was fractionated into water-, chelator- and Na2CO3-soluble pectin fractions and a hemicellulose fraction. For the AIR and the pectin fractions, determination of the galacturonic acid content, neutral sugars, degree of methylesterfication (DM), degree of acetylation (DAc) and molar mass (MM) distribution was performed. Results on the pectin fractions, MM distribution and pectin content profile, revealed that Rose coco pectin generally showed higher pectin solubility than Pinto. Neutral sugar profiles indicated that Pinto contained higher amounts of branched pectin (i.e. arabinans) than Rose coco. There was no difference between the DM of Pinto and Rose coco, however, the DAc was higher in Rose coco. In conclusion, the differences in pectin structure and solubility properties between easy- and hard-to-cook common beans might contribute to the differences in their cooking behavior.

Barriers to emergency obstetric care services: accounts of survivors of life threatening obstetric complications in Malindi District, Kenya.

Introduction Pregnancy-related mortality and morbidity in most low and middle income countries can be reduced through early recognition of complications, prompt access to care and appropriate medical interventions following obstetric emergencies. We used the three delays framework to explore barriers to emergency obstetric care (EmOC) services by women who experienced life threatening obstetric complications in Malindi District, Kenya. Methods A facility-based qualitative study was conducted between November and December 2010. In-depth interviews were conducted with 30 women who experienced obstetric “near miss” at the only public hospital with capacity to provide comprehensive EmOC services in the district. Resuls Findings indicate that pregnant women experienced delays in making decision to seek care and in reaching an appropriate care facility. The “first” delay was due to lack of birth preparedness, including failure to identify a health facility for delivery services regardless of antenatal care and to seek care promptly despite recognition of danger signs. The “second” delay was influenced by long distance and inconvenient transport to hospital. These two delays resulted in some women arriving at the hospital too late to save the life of the unborn baby. Conclusion Delays in making the decision to seek care when obstetric complications occur, combined with delays in reaching the hospital, contribute to ineffective treatment upon arrival at the hospital. Interventions to reduce maternal mortality and morbidity must adequately consider the pre-hospital challenges faced by pregnant women in order to influence decision making towards addressing the three delays.

Consumer evaluation of food with nutritional benefits: a systematic review and narrative synthesis.

Abstract As a consequence of the growing interest in, and development of, various types of food with nutritional benefits, the modern consumer views their kitchen cabinet more and more as a medicine cabinet. Given that consumer evaluation of food is considered key to the successful production, marketing and finally consumption of food, a procedure commonly used in medical fields was employed to systematically review and summarize evidence of consumer evaluation studies on nutritious foods. The focus is primarily on consumer understanding of nutritious food and the underlying determinants of consumer evaluation. Our results highlight four groups of key determinants: (1) nutrition knowledge and information; (2) attitudes, beliefs, perceptions and behavioural determinants; (3) price, process and product characteristics; and (4) socio-demographics. The findings also point to the importance of understanding consumer acceptance as one many concepts in the consumer evaluation process, and provide support for developing appropriate strategies for improving health and well-being of consumers.

Potential Contribution of Mangoes to Reduction of Vitamin A Deficiency in Kenya

The β-carotene content of fresh and dried mangoes commonly consumed in Kenya was evaluated and converted to retinol equivalent (RE). Mango fruits of varieties Ngowe, Apple, and Tommy Atkins were harvested at mature green, partially ripe, and ripe stages and their β-carotene content analyzed. The stability of β-carotene in sun dried mangoes was also studied over 6 months under usual marketing conditions used in Kenya. The effect of using simple pretreatment methods prior to drying of mango slices on retention of β-carotene was as well evaluated. In amounts acceptable to children and women, fresh and dried mangoes can supply 50% or more of the daily required retinol equivalent for children and women. Stage of ripeness, variety, postharvest holding temperature, method of drying, and storage time of dried mango slices affected β-carotene content and consequently vitamin A value of the fruits. Apple variety grown in Machakos had the highest β-carotene. It exceeded the daily RE requirements by 11.8% and 21.5% for women and children respectively. Fresh or dried mangoes are a significant provitamin A source and should be included in food-based approaches aiming to reduce vitamin A deficiency.

Factors associated with low birth weight among neonates born at Olkalou District Hospital, Central Region, Kenya

Introduction Ninety-two percent of Low Birth Weight(LBW) infants are born in developing countries, 70% in Asia and 22% in Africa. WHO and UNICEF estimate LBW in Kenya as11% and 6%by 2009 Kenya Demographic Health Survey. The same survey estimated LBW to be 5.5% in Central Province, Kenya. Data in Olkalou hospital indicated that prevalence of LBW was high. However, factors giving rise to the problem remained unknown. Methods A cross-sectional analytic study was therefore conducted to estimate prevalence and distribution and determine the factors associated with LBW in the hospital. LBW was defined as birth of a live infant less than 2500g. We collected data using a semi-structured questionnaire and review of health records. A total 327 women were randomly selected from 500mothers. Data was managed using Epi Info 3.3.2. Results The prevalence of LBW was 12.3% (n=40). The mean age of mothers was 25.6±6.2 years. Mean birth weight was 2928±533 grams. There were 51.1% (n=165) male neonates and 48.9% (n=158) females. The following factors were significantly associated with LBW:LBW delivery in a previous birth (OR=4.7, 95%C.I.=1.53-14.24), premature rapture of membranes (OR=2.95, 95%C.I.=1.14-7.62), premature births (OR=3.65, 95%C.I.=1.31-10.38), and female newborn (OR=2.32, 95%C.I.=1.15-4.70). On logistic regression only delivery of LBW baby in a previous birth (OR=5.07, 95%C.I.=1.59-16.21) and female infant (OR=3.37, 95%C.I.=1.14-10.00)were independently associated with LBW. Conclusion Prevalence of LBW in the hospital was higher than national estimates. Female infant and LBW baby in a previous birth are independent factors. Local prevention efforts are necessary to mitigate the problem. Population-based study is necessary to provide accurate estimates in the area.

Using the unmet obstetric needs indicator to map inequities in life-saving obstetric interventions at the local health care system in Kenya.

BackgroundDeveloping countries with high maternal mortality need to invest in indicators that not only provide information about how many women are dying, but also where, and what can be done to prevent these deaths. The unmet Obstetric Needs (UONs) concept provides this information. This concept was applied at district level in Kenya to assess how many women had UONs and where the women with unmet needs were located.MethodsA facility based retrospective study was conducted in 2010 in Malindi District, Kenya. Data on pregnant women who underwent a major obstetric intervention (MOI) or died in facilities that provide comprehensive Emergency Obstetric Care (EmOC) services in 2008 and 2009 were collected. The difference between the number of women who experienced life threatening obstetric complications and those who received care was quantified. The main outcome measures in the study were the magnitude of UONs and their geographical distribution.Results566 women in 2008 and 724 in 2009 underwent MOI. Of these, 185 (32.7%) in 2008 and 204 (28.1%) in 2009 were for Absolute Maternal Indications (AMI). The most common MOI was caesarean section (90%), commonly indicated by Cephalopelvic Disproportion (CPD)–narrow pelvis (27.6% in 2008; 26.1% in 2009). Based on a reference rate of 1.4%, the overall MOI for AMI rate was 1.25% in 2008 and 1.3% in 2009. In absolute terms, 22 (11%) women in 2008 and 12 (6%) in 2009, who required a life saving intervention failed to get it. Deficits in terms of unmet needs were identified in rural areas only while urban areas had rates higher than the reference rate (0.8% vs. 2.2% in 2008; 0.8% vs. 2.1% in 2009).ConclusionsThe findings, if used as a proxy to maternal mortality, suggest that rural women face higher risks of dying during pregnancy and childbirth. This indicates the need to improve priority setting towards ensuring equity in access to life saving interventions for pregnant women in underserved areas.

A novel framework for analysing stakeholder interest in healthy foods: A case study on iodine biofortification

ABSTRACT Despite the availability of novel strategies to prevent micronutrient malnutrition, such as biofortification, limited understanding of stakeholders often hampers their success. We build upon the existing literature on protection motivations (PMT) and technology acceptance (TAM) to develop an integrated PMTAM model for analyzing stakeholders’ reactions, on both the supply and demand sides. Regarding the latter, the case of the iodine biofortified food chain is used to evaluate African households’ interest. All model constructs, and threat appraisal in particular, are decisive in determining the uptake of biofortification, while also social demographics and own nutrition status play an important role.