Jan Low

Health and nutrition knowledge, attitudes and practices of pregnant women attending and not-attending ANC clinics in Western Kenya: a cross-sectional analysis

BackgroundAntenatal care (ANC) is a key strategy to decreasing maternal mortality in low-resource settings. ANC clinics provide resources to improve nutrition and health knowledge and promote preventive health practices. We sought to compare the knowledge, attitude and practices (KAP) among women seeking and not-seeking ANC in rural Kenya.MethodsData from a community-based cross-sectional survey conducted in Western Province, Kenya were used. Nutrition knowledge (NKS), health knowledge (HKS), attitude score (AS), and dietary diversity score (DDS) were constructed indices. χ2 test and Student’s t-test were used to compare proportions and means, respectively, to assess the difference in KAP among pregnant women attending and not-attending ANC clinics. Multiple regression analyses were used to assess the impact of the number of ANC visits (none, <4, ≥4) on knowledge and practice scores, adjusting for maternal socio-demographic confounders, such as age, gestational age, education level and household wealth index.ResultsAmong the 979 pregnant women in the survey, 59% had attended ANC clinics while 39% had not. The mean (±SD) NKS was 4.6 (1.9) out of 11, HKS was 6.2 (1.7) out of 12, DDS was 4.9 (1.4) out of 12, and AS was 7.4 (2.2) out of 10. Nutrition knowledge, attitudes, and DDS were not significantly different between ANC clinic attending and non-attending women. Among women who attended ANC clinics, 82.6% received malaria and/or antihelmintic treatment, compared to 29.6% of ANC clinic non-attendees. Higher number of ANC clinic visits and higher maternal education level were significantly positively associated with maternal health knowledge.ConclusionsSubstantial opportunities exist for antenatal KAP improvement among women in Western Kenya, some of which could occur with greater ANC attendance. Further research is needed to understand multi-level factors that may affect maternal knowledge and practices.

Promotion of Orange-Fleshed Sweet Potato Increased Vitamin A Intakes and Reduced the Odds of Low Retinol-Binding Protein among Postpartum Kenyan Women

Background: Orange-fleshed sweet potato (OFSP) improves vitamin A (VA) status of young children; research with pregnant and lactating women is limited. Objective: We examined the effectiveness of the Mama SASHA (Sweetpotato Action for Security and Health in Africa) program to improve nutrition knowledge, diets, and nutritional status of pregnant and lactating women (PLW) in Western Kenya. Methods: Eight health facilities were allocated to the Mama SASHA intervention or comparison arms. PLW in intervention facilities received enhanced nutrition counseling at health clinics, were linked with community-based maternal support groups, and received vouchers for OFSP vine cuttings. Control PLW received clinic-based nutrition counseling only. A total of 505 women in early and midpregnancy, attending their first antenatal care visit, and with no previous engagement in project activities were enrolled from the 8 facilities. Nutrition and health-seeking knowledge, food security, dietary patterns, and anthropometric measurements were collected at 4 time points at ≤9 mo postpartum. VA intakes were assessed with multipass 24-h recalls in a subsample of 206 mothers at 8–10 mo postpartum. VA status was assessed by using serum retinol-binding protein (RBP). Impacts were estimated with multilevel mixed models adjusted for clustering and differences at enrollment. Results: At enrollment, 22.9% of women had RBP <1.17 μmol/L. By 9 mo postpartum, intervention women had significantly higher intakes of VA [adjusted difference = 297.0 retinol activity equivalent (RAE) units; 95% CI: 82, 513 RAE units; P = 0.01; n = 206], greater consumption of VA-rich fruit and vegetables in the previous 7 d (difference-in-difference estimate: 0.40 d; 95% CI: 0.23, 0.56 d; P < 0.01), and a 45% reduction in the odds of RBP <1.17 μmol/L (OR: 0.55; 95% CI: 0.33, 0.92; P = 0.01). Conclusion: Promotion of OFSP to PLW through health services is a feasible strategy to improve women’s nutrition knowledge, VA intakes, and maternal RBP.

Planning an integrated agriculture and health program and designing its evaluation: Experience from Western Kenya

Highlights • Complex, integrated development programs present planning and evaluation challenges and opportunities.• Multiple evaluation components are needed to respond to different disciplinary cultures of evidence in cross-sectoral programs.• Delineating impact pathways helps visualize cross-sectoral outcomes and guides implementation monitoring.• Feedback meetings are critical to build understanding across sectors and problem-solve in real time.

Effect of technology awareness and access on the conservation of clean planting materials of vegetatively produced crops: The case of sweetpotato.

Efforts to combat vitamin A deficiency in children and pregnant mothers have focused on promotion of nutritionally enhanced food security crops. Such efforts have recently targeted the production and consumption of these crops. The orange-fleshed sweetpotato (OFSP) is one of the most known nutritionally enhanced crops. However, access to quality planting materials of OFSP and most vegetatively propagated crops by farmers remains a major constraint. This study used discrete and count data regression models and data collected from 732 farm households in Tanzania to test the effect of participation on a project designed to break this quality “seed” bottleneck (via technology awareness and targeted access to clean planting materials) on a) the decision to conserve planting materials during dry periods for future planting and b) the number of conservation strategies used by farmers. The study found that participation in such a project increases both the likelihood of conserving quality planting materials and also the number of conservation strategies employed by the farmers. It also found that varietal attributes and the agroecology of the area affect conservation of OFSP planting materials. It concludes that awareness and access to clean sweetpotato planting materials of nutritionally enhanced crops promote farmers’ conservation of own planting materials. The study discusses the policy implications of the findings.

A Study of Household Food security and Adoption of Biofortified Crop Varieties in Tanzania: The Case of Orange- Fleshed Sweetpotato

Food insecurity has become a key issue in the field of development in recent years with major inadequate intake of vitamin A-rich foods. Specifically, vitamin A deficiency (VAD) remains a major health problem among poor developing-country households, especially in Africa. Efforts to combat VAD currently focuses on food-based approach that entails breeding for crops that are rich in beta carotene, a precursor for Vitamin A. Success has been registered in sweetpotato, cassava and maize. Among these crops, the greatest effort has gone into promoting the production and consumption of orange-fleshed sweetpotato (OFSP). These efforts include sensitization of farmers on the nutritional benefits of OFSP and the provision of clean sweetpotato planting materials. This study used a rich dataset collected from 732 farm households in Tanzania to assess of effect of household food insecurity and benefit awareness on the adoption of OFSP varieties. The study found that the household food security and awareness of the benefit of OFSP affect the decision to adopt OFSP varieties. It also found evidence that agroecology and farmer endowment with financial and physical assets affect the decision to grow OFSP varieties. It discusses lessons and policy implications of the findings for other countries.