Sophie Ochola

Predictors of overweight and obesity in adult women in Nairobi Province, Kenya

BackgroundSince obesity in urban women is prevalent in Kenya the study aimed to determine predictors of overweight and obesity in urban Kenyan women.MethodsA cross-sectional study was undertaken in Nairobi Province. The province was purposively selected because it has the highest prevalence of overweight and obesity in Kenya.A total of 365 women aged 25–54 years old were randomly selected to participate in the study.ResultsHigher age, higher socio-economic (SE) group, increased parity, greater number of rooms in the house, and increased expenditure showed greater mean body mass index (BMI),% body fat and waist circumference (WC) at highly significant levels (p <0.001). Most of the variance in BMI was explained by age, total physical activity, percentage of fat consumed, parity and SE group in that order, together accounting for 18% of the variance in BMI. The results suggest that age was the most significant predictor of all the dependent variables appearing first in all the models, while parity was a significant predictor of BMI and WC. The upper two SE groups had significantly higher mean protein (p <0.05), cholesterol (p <0.05) and alcohol (p <0.001) intakes than the lower SE groups; while the lower SE groups had significantly higher mean fibre (p <0.001) and carbohydrate (p <0.05) intakes. A fat intake greater than 100% of the DRI dietary reference intake (DRI) had a significantly greater mean BMI (p <0.05) than a fat intake less than the DRI.ConclusionsThe predictors of overweight and obesity showed that urbanization and the nutrition transition were well established in the sample of women studied in the high SE groups. They exhibited a sedentary lifestyle and consumed a diet high in energy, protein, fat, cholesterol, and alcohol and lower in fibre and carbohydrate compared with those in the low SE groups.

Impact of counselling on exclusive breast-feeding practices in a poor urban setting in Kenya: a randomized controlled trial.

OBJECTIVE To determine the impact of facility-based semi-intensive and home-based intensive counselling in improving exclusive breast-feeding (EBF) in a low-resource urban setting in Kenya. DESIGN A cluster randomized controlled trial in which nine villages were assigned on a 1:1:1 ratio, by computer, to two intervention groups and a control group. The home-based intensive counselling group (HBICG) received seven counselling sessions at home by trained peers, one prenatally and six postnatally. The facility-based semi-intensive counselling group (FBSICG) received only one counselling session prenatally. The control group (CG) received no counselling from the research team. Information on infant feeding practices was collected monthly for 6 months after delivery. The data-gathering team was blinded to the intervention allocation. The outcome was EBF prevalence at 6 months. SETTING Kibera slum, Nairobi. SUBJECTS A total of 360 HIV-negative women, 34-36 weeks pregnant, were selected from an antenatal clinic in Kibera; 120 per study group. RESULTS Of the 360 women enrolled, 265 completed the study and were included in the analysis (CG n 89; FBSICG n 87; HBICG n 89). Analysis was by intention to treat. The prevalence of EBF at 6 months was 23.6% in HBICG, 9.2% in FBSICG and 5.6% in CG. HBICG mothers had four times increased likelihood to practise EBF compared with those in the CG (adjusted relative risk = 4.01; 95% CI 2.30, 7.01; P=0.001). There was no significant difference between EBF rates in FBSICG and CG. CONCLUSIONS EBF can be promoted in low socio-economic conditions using home-based intensive counselling. One session of facility-based counselling is not sufficient to sustain EBF.

The relationship between agricultural biodiversity, dietary diversity, household food security, and stunting of children in rural Kenya

Abstract The study was to determine the role of Dietary diversity (DD), household food security (HFS), and agricultural biodiversity (AB) on stunted growth in children. Two cross‐sectional studies were undertaken 6 months apart. Interviews were done with mothers/caregivers and anthropometric measurements of children 24–59 months old. HFS was assessed by household food insecurity access scale (HFIAS). A repeated 24‐h recall was used to calculate a dietary diversity score (DDS). Agricultural biodiversity (AB) was calculated by counting the number of edible plants and animals. The study was undertaken in resource‐poor households in two rural areas in Kenya. Mothers/Care givers and household with children of 24–59 months of age were the main subjects. The prevalence of underweight [WAZ <−2SD] ranged between 16.7% and 21.6% and stunting [HAZ <−2SD] from 26.3% to 34.7%. Mean DDS ranged from 2.9 to 3.7 and HFIAS ranged from 9.3 to 16.2. AB was between 6.6 and 7.2 items. Households with and without children with stunted growth were significantly different in DDS (P = 0.047) after the rainy season and HFIAS (P = 0.009) in the dry season, but not with AB score (P = 0.486). The mean AB for households with children with stunted growth were lower at 6.8, compared to 7.0 for those with normal growth, however, the difference was insignificant. Data indicate that households with children with stunted growth and those without are significantly different in DDS and HFIAS but not with AB. This suggests some potential in using DDS and HFIAS as proxy measures for stunting.

Integrating nutrition into health systems at community level: Impact evaluation of the community-based maternal and neonatal health and nutrition projects in Ethiopia, Kenya, and Senegal

Maternal undernutrition and mortality remain high in several African countries. Key nutrition and health interventions improve maternal and birth outcomes. Evidence is scarce on how to strengthen health systems to ensure pregnant women and newborns are reached with these interventions. We conducted three quasi-experimental nonrandomized Community Based Maternal and Neonatal Health and Nutrition projects in regions of Ethiopia, Senegal, and Kenya to demonstrate how proven nutrition interventions could be integrated into health programs to improve knowledge and practices during pregnancy, birth, and postpartum. We evaluated impact on knowledge and practices related to maternal and neonatal care using logistic regression and repeated-measures models with districts as a fixed variable and adjusted for covariates. Combined country analyses show significant positive effects of the intervention on women receiving first antenatal care visit (ANC) during first trimester (OR = 1.44; p < .001), those consuming any iron and folic acid supplement during their latest pregnancy (OR = 1.60; p = .005), those whose <6 months infants were exclusively breastfed (OR = 2.01; p=.003), those whose delivery was facility based (OR = 1.48; p=.031), and those whose postnatal care was facility based (OR = 2.15; p<.001). There was no significant differences between intervention and control groups regarding one or more and four or more ANC visits, women consuming iron and folic acid for ≥90 days, and early initiation of breastfeeding. We conclude that integrating proven nutrition interventions into health programs at community level improved components of access to and use of ANC, delivery services, and postnatal care by women in three African countries.

Community perceptions towards the new role of traditional birth attendants as birth companions and nutrition advocates in Kakamega County, Kenya

Delivery with skilled birth attendants is important for reducing maternal mortality in developing countries. However, traditional birth attendants (TBAs) are abundant in such settings, managing deliveries without the skills and resources necessary to prevent mortality in this situations. Interventions that have been proposed to mitigate the situation include redefining the role of TBAs to nutrition advocates and birth companions for pregnant women to health facilities. We thus explored community perceptions on these new roles of TBAs, as birth companions and nutrition advocates, and their influence on health facility deliveries in Kakamega County, Kenya. Qualitative data was collected through key informant interviews with health workers and focus group discussions with lactating mothers, pregnant women, husbands, community leaders, community health volunteers, and TBA. Content analysis was conducted; data was organized into subthemes and conclusions made from each subtheme using Atlas.ti software. TBAs adopted their birth companion role as the majority offered companionship to mothers delivering at health facilities. Mothers were happy with this role as TBAs continued providing companionship even after delivery. The community members were happy with the new role of TBAs and reported increased deliveries at the health facilities. In contrast, TBAs did not adopt the nutrition advocacy role sufficiently. We found that redefining the role of the TBAs into birth companions to support facility-based delivery is thus feasible and acceptable. Nutrition advocacy by the TBAs should be strengthened to maximize on the opportunity provided by the close association between TBAs and mothers and the community.

Infant feeding practices among HIV-exposed infants less than 6 months of age in Bomet County, Kenya: an in-depth qualitative study of feeding choices

Background In children, HIV can be acquired from the mother during pregnancy, delivery and through breast milk. The WHO recommends exclusive breast feeding or exclusive replacement feeding for the first 6 months after birth for HIV-exposed infants. Barriers such as HIV-related stigma, inadequate resources, lack of access to safe water and negative cultural beliefs have been shown to influence infant feeding among HIV-exposed infants in some settings. In Kenya, there is limited literature on the barriers. The purpose of this study was to identify barriers to optimal feeding among HIV-exposed infants 0–5 months of age attending a mission hospital in Bomet County, Kenya. Methods A cross-sectional qualitative study was conducted at a referral mission hospital in Bomet County, Southwest Kenya. Four focused group discussions were conducted among mothers/caregivers of HIV-exposed infants aged 0–5 months in accordance with their infant feeding practices, while two key informant interviews were also held with healthcare workers. All sessions were audio recorded and later transcribed verbatim. Content analysis was performed, and conclusions were made based on identified themes. Results Factors influencing the infant feeding choices were: financial constraints, cultural beliefs and practices, HIV-related stigma and conflicting knowledge among mothers/caregivers and healthcare workers on the recommendations for feeding HIV-exposed infants 0–5 months of age. Conclusions Health worker retraining in and reinforcement of WHO guidance on feeding HIV exposed/infected infants will clarify misconceptions around feeding HIV exposed/infected infants, though there remain social and economic barriers to full implementation.

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.

Efficacy of amaranth sorghum grains porridge in rehabilitating moderately acute malnourished children in a low-resource setting in Kenya: A randomized controlled trial

In Kenya, wasting levels among children under five years reduced between 2010 (7%) and 2014 (4%), but the number of wasted children is still high. Thin porridge, mainly from cereals and starchy tubers is a popular complementary food, though inadequate for children`s nutritional requirements. It is low in energy, nutrient density and high in antinutrients. Traditionally, fortified blended foods such as corn-soy blend has been used to treat moderately acutely malnourished (MAM) children with limited effectiveness due to its low nutritive profile and relatively high level of anti-nutrients. Therefore nutrient-dense complementary foods are needed. This study aimed to determine the efficacy of amaranth sorghum grains product in rehabilitating MAM children. Villages in Kiandutu slums, were randomly assigned to two study groups; Treatment (TG) and control (CG). Mothers and their moderately malnourished children (6-23 months old) were recruited at a health centre and assigned to groups depending on their village of residence. Children in TG received germinated amaranth sorghum grains flour, those in CG received a blend of sorghum and maize grains flour, for a maximum period of 6 months. Each month, children`s morbidity status and anthropometric measurements were taken. The primary outcome was nutritional status judged by wasting. At baseline the groups’ characteristics were similar. At month 5, 35.3% and 12.9% of children in CG and TG were wasted respectively (Relative Risk [RR] RR=1.35 (95% CI: 1.03-1.77; p=0.030) and at month 6, 62.1% and 15.6% of the children CG and TG were wasted respectively RR=2.23 [(95% CI: 37-3.61; p<0.001). Germinated amaranth sorghum grains may offer an alternative to treatment of MAM children. Nonetheless, it took longer than WHO recommended 90 days for rehabilitation of MAM children. Introduction In Kenya 4%, 26% and 11% of children under five are wasted, stunted and underweight respectively [1]. Poor quality complementary foods with low nutrient density and inappropriate feeding practices are among the major causes of malnutrition in young children [2]. In sub Saharan Africa moderately wasted children are treated with cornsoy blended flour (CSB) through targeted supplementary feeding programmes. However there have been doubts on the effectiveness of CSB in treating malnutrition [3,4]. Ready to use therapeutic food (RUTF) has also been used to treat moderate acute malnutrition (MAM) [3,5]. However, milk in RUTF (25-35% w/w) makes them too expensive for sustainable use in resource-poor settings. Also, the high nutrient concentration in RUTF may make them unsafe for MAM children. It has been suggested that lipid-based ready to use foods could prevent/treat MAM [4]. There is concern that MAM children may be susceptible to immunological reactions since their immune system is intact [4]. Therefore, there is a need for alternative nutrient dense foods that are affordable by most families that could prevent undernourishment. Amaranth grain has a higher nutrient content compared to staple cereals [6,7]. It was complemented with sorghum in this study. Sorghum is drought tolerant and its nutritional profile is comparable to that of maize [8,9]. The study, aimed at evaluating the efficacy of amaranth sorghum grains product in improving the nutritional status Correspondence to: Okoth JK, Department of Food Science and Technology, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya, Tel: 254714408057/254733950524; E-mail: judithokoth@agr.jkuat.ac.ke/ kanensi@gmail.com

Efficacy of sorghum peanut blend and corn soy blend plus in the treatment of moderate acute malnutrition in children aged 6-59 months in Karamoja, Uganda: a cluster randomized trial

More than half of the worlds deaths in children below 5 years of age are caused by under nutrition. Early management of moderate acute malnutrition (MAM) is necessary to avoid deterioration to severe acute malnutrition. Corn soy blend plus (CSB+) mixed with vegetable oil and sugar is the traditional treatment for MAM but is too expensive for poor countries. The effectiveness of affordable and available local food materials are currently being studied as alter- native food supplements to treat malnutrition. In this trial, the efficacy of sorghum peanut blend (SPB) mixed with ghee and honey for the treatment of MAM was compared to that of CSB+ among children 6-59 months old in Karamoja, Uganda. This was a single-blind randomized parallel trial in which two health centers were assigned on a 1:1 ratio to the two study groups. The participants (mothers and their moderately malnourished children) were recruited at the health centers and assigned to the groups depending on the health facility attended. Each child received a daily ration of either CSB+ or SPB for a maximum period of 3 months. Anthropometric measurements of the children were taken on a bi-weekly basis. The primary outcomes were the recovery rate and duration on the program before recovery. Of the recruited 440 participants, 392 completed the study and were included in the analysis (SPB group 194; CSB+ group 198). Analysis was by intention to treat. The recovery rates were not significantly different for the SPB group and the CSB+ group (82.3% and 76.8%, respectively; chi-square test P=0.093). Duration of recovery was significantly shorter for the SPB + group, with a median of 43 days compared to 57 days for the SPB group (Kaplan-Meier survival test). The recovery rate and the duration of stay in the program were all within the acceptable Sphere Standards (

Effects of agricultural biodiversity and seasonal rain on dietary adequacy and household food security in rural areas of Kenya

75% and #90 days, respectively). SPB has the potential to treat MAM.