Dorcus Mbithe

Dietary, social, and environmental determinants of obesity in Kenyan women

Aim: To assess the determinants of overweight and obesity in Kenyan women considered to be undergoing the nutrition transition. Methods: A nationally representative sample of women (n = 1008) was randomly drawn. Weight, height, waist, and hip circumference were measured. A 24-hour dietary recall was conducted with each participant and a socio-demographic questionnaire completed. Data was analysed by age, education, location, and socioeconomic status. Risk for obesity was calculated while adjusting for age and location. Results: Overweight and obesity (BMI ≥ 25 kg/m2) were highly prevalent in Kenya (43.3%). Urbanisation appears to be an important determinant of obesity since obesity was most prevalent in urban women in the high income group. Women in the high income group (7278 kJ) and in urban areas (7049 kJ) had the highest mean energy intakes. There were also significant urban/rural and income differences in the contribution of macronutrients to energy intake. Total fat intake was 34.5% of energy (E) in urban areas and 29.7% E in rural areas; while carbohydrates contributed 69.9% E in rural areas and 57.4% E in urban areas (p < 0.0001). Overweight was significantly more likely in the highest income group; among households where room density was low; electricity or gas was used for cooking; and households had own tap and/or own flush toilet. Conclusions: This study suggests that urbanisation and its associated economic advancement as well as changes in dietary habits are among the most important determinants of overweight and obesity in Kenyan women.

Urbanisation and the nutrition transition: A comparison of diet and weight status of South African and Kenyan women

Aims: To determine and compare the extent of the nutrition transition between Kenyan and South African women. Methods: A nationally representative sample of women aged ≥15 years (n=1008) was assessed in Kenya. Weight, height, and waist and hip circumferences were measured. A 24-hour dietary recall was conducted with each participant. This data was compared with data of the Demographic and Health Survey (DHS) of women in South Africa (n=4481). Dietary intake of South African women was based on secondary data analysis of dietary studies using the 24-hour recall method (n=1726). Results: In South Africa, 27.4% women had a BMI ≥30 kg/m2 compared with 14.2% of Kenyan women. In both countries there were large urban–rural differences in BMI, with the highest prevalence in women in urban areas. BMI increased with age, as did abdominal obesity which was equally prolific in both countries with more than 45% of women in the older groups having a waist/hip ratio ≥0.85. The nutrient mean adequacy ratio (MAR) of the South African rural diet was lower than those of the Kenyans diet (55.9; 57.3%, respectively). Dietary diversity score (DDS) and food variety score (FVS) were significantly lower in South African rural women (3.3; 4.9) compared with Kenyans (4.5; 6.8). Conclusions: Urban–rural differences in diet and weight status indicates that the nutrition transition was similar in both countries despite large sociodemographic differences; however, rural Kenyan women had a better MAR, DDS, and FVS than South African women, most probably due to 60% having access to land.

Effects of Nutrition Education on Nutrition Knowledge and Iron Status in Primary School Pupils of Gatanga District, Muranga County, Kenya

School-age children are both growing and learning, and anaemia can affect cognitive function, motor performance and educational achievements of this age group. Nutrition education has not been given the priority it deserves in primary schools due to the busy school curriculum. It is in this light this study was designed for one teaching calendar year. Subjects & methods: Pupils (n=601) covering the age 11-18 years were included. The main objective of this study was to evaluate the effects of three main Nutrition Education strategies on nutrition knowledge and iron status among primary schools children in Gatanga district. A baseline survey was conducted in 12 randomly selected schools for class six pupils and their households. Questionnaires and an interview schedule were used to collect data, with pre and post tests. The interventions schools were Mabanda, Kigio and Kirwara (experimental) and Gakurari (control school). Baseline data were analyzed by use of Statistical Package for Social Sciences (SPSS) and Nutri-Survey computer packages using both descriptive and inferential statistics. The data were coded to search for emerging themes. This led to the identification of variables and concepts of iron deficiency in the children, which was crucial to the design of the corrective measures model for the interventions. On average the mean mark, in nutrition knowledge at baseline was 30.05%. In the post-tests all experimental schools (n=154) significantly improved in nutrition knowledge, and the peer facilitated school performed best with (51.52+24.79) marks, Researcher facilitated school (48.39+22.23) and the agriculture staff (38.70+9.87). The pre-test post- test improvement in the control school (31.21+12.74) was however not significant (p>0.05). A total of 31.4 % pupils ( Sub sample n=89) were found to be anaemic after altitude adjustments at a calculated factor 0.5 for Gatanga altitude (2237m ASL). Pupils’ haemoglobin status were not significantly different (p>0.05) between the experimental and control schools at baseline, notable differences occurred in the experimental schools after the interventions. Relationship between nutrition knowledge and nutrient intake was positive and there was a statistically significant relationship between nutrition knowledge and hemoglobin levels at p<0.05 (R 2 =0.253, p=0.025). Anemia was found to be a significant problem and therefore the need for a comprehensive intervention strategy by all stakeholders to improve the iron status in this age group.

Feeding Practices of Children Aged 0-59 Months Accompanying Incarcerated Mothers in Selected Women’s Prisons in Kenya

Infant and young child feeding practices have substantial consequences for the growth, development, and survival of children. Children should be exclusively breastfed for the first 6 months of life and thereafter continue to breastfeed for 2 years or longer. Children are vulnerable to malnutrition thus nutrition and health status of the confined children is of interest. The purpose of this study was to establish feeding practices of children 0-59 months incarcerated with their mothers in selected women’s prisons in Kenya. A cross-sectional analytical study was conducted on an exhaustive sample of 202 children and 193 mothers, drawn from a sample of eight out of the 35 women prisons in Kenya. Data collection tools included: a structured researcher-administered questionnaire for mothers and children. Exclusive breastfeeding rate was 69.4%; continued breastfeeding at 1 and 2 years year (88.5%; 52.2%). The mean Dietary Diversity Score (DDS) was 3.52 ± 1.04 foods groups out of 7 groups with 53.3% having attained the minimum DDS and 86.5% of breastfed children having attained the minimum frequency meal consumption. About half of the children (48.6%) attained the minimum acceptable diet. In terms of nutritional status, 21.4% of the children were stunted, 3.8% wasted and 7.5% were underweight. Dietary practices were associated with underweight; not attaining the minimum dietary diversity and minimum acceptable diet was associated with underweight (p = 0.012; p = 0.014); Illness 2 weeks prior to the study was correlated with underweight (p=0.012). Feeding practices significantly influenced nutritional status among children accompanying incarcerated mothers in prisons in Kenya.

Primary School Pupils in Kenya Learn and Practice Good Hygiene

Most health problems are directly or indirectly associated with environmental sanitation. Most illnesses could be associated with personal hygiene and sanitation of the pupils. Freund, Graybill, and Keith, 2005) in their study in Zambia reported that little was actually known about health of children from 6-15 years and much still remains to be learned. Research now shows that risk of poor health continues throughout childhood and childrens health status especially of girls, which actually worsens from age 5-15 years. Several studies have indicated a connection between hand sanitization and infection control in numerous settings such as extended care facilities, schools, and hospitals. Hand hygiene practices improve through increased frequency of hand washing and by increasing awareness of the importance of hand hygiene. This results in fewer Upper Respiratory Infection symptoms, lower illness rates, and lower absenteeism from school. Hand-hygiene interventions are efficacious for preventing gastrointestinal illnesses, in both developed and lesser-developed countries.

Enhancing Agricultural Production Potential Through Nutrition and Good Health Practice: The Case of Suba District in Kenya

Several studies have shown that HIV and nutrition operate in tandem. Moreover, it has been shown that the two greatly affect agricultural production due to reduced energy to work, inability to purchase agricultural inputs, low labor, and eventual death. The link between agricultural productivity, malnutrition, and HIV can therefore not be overlooked. People who are inadequately nourished are more susceptible to diseases and poor health. In an attempt to achieve optimal nutrition and good health among vulnerable groups, various intervention programs have used food supplementation and especially the plant-based food products to achieve this. Such programs have proved to be effective in restoring the nutrition and health status of the people. However, much more value would be achieved if such programs were complemented with basic health services such as deworming, water, sanitation, malaria control, hygiene. This chapter explores the benefits of research on nutrition as the basis for improving threatened rural communities’ nutria-health and potential economic performance. The premise is that good nutrition and preventive measures will reverse some of the human health problems associated with HIV, hunger, and/or malnutrition. Emphasis is placed on food preservation, processing, nutrition intervention, and education. Micronutrients through agronomic fortification/fertilization is recommended as an intervention with the benefit of improving the nutritive quality of food and thereby providing essential elements needed by the human body to combat malnutrition and poor health. The conclusion is that better nutrition will contribute to better health and increase productivity and production on the farm.