Constance Gewa

Dietary micronutrients are associated with higher cognitive function gains among primary school children in rural Kenya.

With the exception of iodine and Fe, there is still very limited information on the effect of micronutrients on cognitive function, especially among school-age children. The present analysis evaluates the relationship between dietary Fe, Zn and B vitamins (B12, B6, folate and riboflavin) and gains in cognitive test scores among school children in rural Kenya. Data for the present study were obtained from The Child Nutrition Kenya Project, a 2-year longitudinal, randomised controlled feeding intervention study using animal source foods. Dietary nutrient values were based on monthly and bimonthly 24 h recall data collected during the study period. In longitudinal regression analyses, available Fe, available Zn, vitamin B12 and riboflavin showed significant relationships with improved cognitive test scores, after controlling for confounders such as energy intake, school, socio-economic status and morbidity. Available Fe intake was associated with significantly higher gains in Ravens Coloured Progressive Matrices test scores over time. Available Zn intake was associated with significantly higher gains in digit span-total test scores over time, while vitamin B12 and riboflavin intakes were each associated with significantly higher gains in digit span-forward test scores over time. This analysis demonstrates the influence of improved dietary micronutrient status on school childrens cognitive function.

Childhood overweight and obesity among Kenyan pre-school children: association with maternal and early child nutritional factors.

OBJECTIVE To report on the prevalence of overweight and obesity among pre-school children in Kenya and examine the associations between childhood overweight and selected maternal and child-related factors. DESIGN Demographic Health Survey data, multistage stratified cluster sampling methodology. SETTING Rural and urban areas of Kenya. SUBJECTS A total of 1495 children between the ages of 3 and 5 years in Kenya. RESULTS Over 30 % of the children were stunted, approximately 16 % were underweight, 4 % were wasted, approximately 18 % were overweight and 4 % were obese; 8 % were both overweight/obese and stunted. Maternal overweight and obesity, higher levels of maternal education, being a large or very large child at birth, and being stunted were each associated with higher odds of overweight and obesity among Kenyan children. Older children and large household size were each associated with lower odds of overweight and obesity among Kenyan children. CONCLUSIONS The analysis demonstrates the presence of under- and overnutrition among Kenyan pre-school children and the importance of focusing on expanding efforts to prevent and treat malnutrition within this population. It also identifies some of the modifiable factors that can be targeted in these efforts.

Undernutrition among Kenyan children: contribution of child, maternal and household factors

OBJECTIVE To examine the contribution of selected child-, maternal- and household-related factors to child undernutrition across two different age groups of Kenyan under-5s. DESIGN Demographic and Health Survey data, multistage stratified cluster sampling methodology. SETTING Rural and urban areas of Kenya. SUBJECTS A total of 1851 children between the ages of 0 and 24 months and 1942 children between the ages of 25 and 59 months in Kenya. RESULTS Thirty per cent of the younger children were stunted, 13 % were underweight and 8 % were wasted. Forty per cent of the older children were stunted, 17 % were underweight and 4 % were wasted. Longer breast-feeding duration, small birth size, childhood diarrhoea and/or cough, poor maternal nutritional status and urban residence were associated with higher odds of at least one form of undernutrition, while female gender, large birth size, up-to-date immunization, higher maternal age at first birth, BMI and education level at the time of the survey and higher household wealth were each associated with lower odds of at least one form of undernutrition among Kenyan children. The more proximal child factors had the strongest impact on the younger group of children while the intermediate and more distal maternal and household factors had the strongest impact on child undernutrition among the older group of children. CONCLUSIONS The present analysis identifies determinants of undernutrition among two age groups of Kenyan pre-school children and demonstrates that the contribution of child, maternal and household factors on childrens nutritional status varies with childrens age.

Maternal nutrition in rural Kenya: health and socio-demographic determinants and its association with child nutrition

High levels of food insecurity and human immunodeficiency virus (HIV) infection place most breastfeeding mothers in Kenya at high risk of malnutrition. We examined the role of selected socio-economic, demographic and health factors as determinants of nutritional status among HIV-infected and HIV-uninfected mothers in rural Kenya and further examined the interrelationship between maternal nutritional and child nutritional status within this population. A cross-sectional design was used to collect data from non-pregnant mothers with children ages 4-24 months in Kisumu District, Kenya. Over 80% of the mothers were breastfeeding at the time of the study. Mean maternal body mass index (BMI) (21.60 ± 3.15) and percent body fat (22.29 ± 4.86) values were lower than among lactating mothers in other Sub-Sahara African countries. Maternal HIV status was not significantly associated with any of the maternal nutritional indicators assessed in the study. Breastfeeding, recent severe illness and having multiple children below 2 years of age were negatively associated with maternal nutritional status, while higher maternal age, socio-economic status and household food security were each positively associated with maternal nutritional status. Significant positive association was reported between maternal weight, height, BMI, mid-upper arm circumference (MUAC), body fat and fat-free mass estimates, and childrens height-for-age, weight-for-age, weight-for-height and MUAC-for-age z-score. This analysis identifies determinants of maternal nutritional status in rural Kenya and highlights the importance of interventions that address malnutrition in both HIV-infected and HIV-uninfected mothers in rural Kenya. Significant association between maternal and child nutritional status stresses the importance of addressing maternal and young child nutritional status as interrelated factors.

Maternal-child overweight/obesity and undernutrition in Kenya: a geographic analysis.

OBJECTIVE The purpose of the study was to examine geographic relationships of nutritional status (BMI), including underweight, overweight and obesity, among Kenyan mothers and children. DESIGN Spatial relationships were examined concerning BMI of the mothers and BMI-for-age percentiles of their children. These included spatial statistical measures of the clustering of segments of the population, in addition to inspection of co-location of significant clusters. SETTING Rural and urban areas of Kenya, including the cities of Nairobi and Mombasa, and the Kisumu region. SUBJECTS Mother-child pairs from Demographic and Health Survey data including 1541 observations in 2003 and 1592 observations in 2009. These mother-child pairs were organized into 399 locational clusters. RESULTS There is extremely strong evidence that high BMI values exhibit strong spatial clustering. There were co-locations of overweight mothers and overweight children only in the Nairobi region, while both underweight mothers and children tended to cluster in rural areas. In Mombasa clusters of overweight mothers were associated with normal-weight children, while in the Kisumu region clusters of overweight children were associated with normal-weight mothers. CONCLUSIONS These findings show there is geographic variability as well as some defined patterns concerning the distribution of malnutrition among mothers and children in Kenya, and suggest the need for further geographic analyses concerning the potential factors which influence nutritional status in this population. In addition, the methods used in this research may be easily applied to other Demographic and Health Survey data in order to begin to understand the geographic determinants of health in low-income countries.

Determining minimum food intake amounts for diet diversity scores to maximize associations with nutrient adequacy: an analysis of schoolchildren's diets in rural Kenya.

OBJECTIVE To explore multiple methods of calculating diet diversity scores (DDS) to maximize associations with predicted dietary micronutrient adequacy among schoolchildren in rural Kenya. DESIGN Up to three 24 h recall interviews were administered for each child for a total of 1544 d of intake from all schoolchildren. Daily amounts of food consumed were assigned to one of eight food groups. Five DDS were developed based on various minimum intake amounts from each food group: (i) 1 g; (ii) 15 g; (iii) a variable minimum based on the content of a target nutrient for each group; (iv) the median intake level for each group; and (v) the 90th percentile intake level for each group. A diet was assigned 1 point towards the daily DDS if the food group intake was above the defined minimum level. Five scores were calculated for each child, and bivariate longitudinal random-effects models were used to assess the correlation between each DDS and the mean probability of adequacy for fourteen nutrients. SETTING Embu District, Kenya. SUBJECTS Schoolchildren (n 529), mean age 7·00 (sd 1·41) years. RESULTS Only DDS based on a 15 g minimum and DDS based on nutrient content were significantly associated with mean probability of adequacy after adjusting for energy intake (0·21 and 0·41, respectively). CONCLUSIONS A DDS using minimum intakes based on nutrients contributed by a food group best predicted nutrient adequacy in this population. These analyses contribute to the continued search for simpler and more valid dietary quality indicators among low-income nations.

Determinants of Early Child-Feeding Practices Among HIV-Infected and Noninfected Mothers in Rural Kenya:

Quantitative and qualitative data were collected from mothers with children aged 4 to 24 months to examine the determinants of child-feeding practices among HIV-infected and noninfected mothers in the rural parts of Kisumu District in Kenya. More than 40% of children had received other foods or drinks by 3 months of age. Home-based births, perceived small child size at birth, and larger household size were associated with significantly higher risks of premature cessation of exclusive breastfeeding. Maternal HIV infection, overweight/obesity, and having multiple “under-2’s” were associated with higher risks of overall breastfeeding cessation. Higher socioeconomic status was associated with significantly lower risks of premature cessation of exclusive breastfeeding. Child-feeding decisions were often made postpartum. Mothers were more likely to discuss feeding methods with their partners only if they were HIV infected. Poverty was identified as a barrier to exclusive breastfeeding in the first 6 months.

Distribution and determinants of young child feeding practices in the East African region: demographic health survey data analysis from 2008-2011

We utilized the most recent Demographic Health Survey data to explore the distribution of feeding practices and examine relationships between complementary feeding and socio-demographic and health behaviour indicators in Kenya, Uganda and Tanzania. We based our analysis on complementary dietary diversity scores calculated for children 6-23 months old. Geographically, Kenya displayed clear division of children’s diet diversity scores across its regions, unlike Uganda and Tanzania. Less than 40% of the children’s meal frequencies in Uganda and Tanzania had met the minimum daily recommended levels. Only 30-40% of children in Kenya, Tanzania and Uganda had consumed diets with adequate diversity. Children’s age, breastfeeding status, mother’s education level and working status, household wealth index, prenatal care visits, receiving vitamin A supplements, using modern contraceptives and meal frequencies were significantly associated with adequate complementary food diversity in at least one of the three countries included in the current analyses. These analyses contribute to a better understanding and targeting of infant and young child feeding within the East African region.

Geographic distribution and socio-economic determinants of women's nutritional status in Mali households.

OBJECTIVE Mali is one of the poorest countries in Africa, with 72% of its population surviving on less than

Maternal knowledge, outcome expectancies and normative beliefs as determinants of cessation of exclusive breastfeeding: a cross-sectional study in rural Kenya

US 1.00 per day. Health and demographic indicators are bleak. With few exceptions, studies related to the health of women in Mali have largely been under-represented. In addition, in recent years a new type of malnutrition stemming from weight gain and obesity has been observed throughout Africa. The present study aimed to (i) describe geographic and health variations of women of reproductive age, (ii) describe geographic variations of household salt iodine levels and (iii) investigate potential factors associated with women’s anthropometric status and use of adequately iodized salt among households in Mali. DESIGN Demographic and Health Survey data, multistage-stratified cluster sampling methodology. SETTING Rural and urban areas of Mali. SUBJECTS Non-pregnant women (n 6015) between the ages of 19 and 44 years. RESULTS Nineteen per cent of the women were overweight or obese while 11% were underweight. Seventy-eight per cent of the households utilized adequately iodized salt. Underweight women were more prevalent in southern Mali, while obesity was more frequent in the north-east and within the major urban areas. Households located within the southern parts of Mali were more likely to utilize adequately iodized salt. Education, age, modern contraceptive use, breast-feeding status at time of the survey and household wealth index were significantly associated with the women’s BMI or households’ use of adequately iodized salt. CONCLUSIONS The combined use of statistical and geographic system analysis contributes to improve targeting of interventions among vulnerable populations.