The effect of pre-lacteal feeding on full breastfeeding in Nairobi, Kenya

Objective: To assess the effect of pre-lacteal feeding on full breastfeeding in the first six months of life in selected hospitals, Nairobi Province. Pre-lacteal feeding has been internationally discouraged because of its negative effect on the duration of breastfeeding.Methods: A prospective cohort design was used with a sample of 692 mother-infant pairs recruited at birth and followed up until 6 months of age. The sample was drawn from five major hospitals in Nairobi. Data was analyzed using the SPSS computer software. Descriptive analysis was used on all variables. Chi-test was used for univariate analysis. Logistic regression analysis was used to determine the effect of pre-lacteal feeding on full breastfeeding.Results: Slightly more than half (58.8%) of the mothers were formally employed and their mean age was 28.3 ±4.9 years. The mean income was KES 26,360 ± 34,696. The mean birth weight of the infants was 3.24 ±0.43kg and 53.3% were males. The prevalence of pre-lacteal feeding was 26.8% (95% CI 23.5%-30.1%). The most common pre-lacteal feeds used at all hospitals were infant formula and glucose solution. There were significant (

Glenoid and coracoid dimensions and their implications in the latarjet operation: a dry bone study

Background: The coracoid process is widely used as a graft in patients with recurrent anterior shoulder instability with significant glenoid bone defects. However, no local studies have determined the coracoid dimensions and correlated them to the glenoid dimensions.Objective: To measure the widest anteroposterior (AP) diameter of the glenoid cavity, the length, width and thickness of the coracoid process, compare these with other populations, determine the amount of coverage the thickness and width of the coracoid process can afford in case of bony glenoid deficiency and the adequacy of the coracoid process to safely accommodate fixation screws used in the Latarjet and congruent-arc Latarjet procedures.Methods: The dimensions were measured using digital vernier callipers on dried scapulae that were not deformed. The ratio between coracoid thickness and width to the glenoid AP diameter was determined as the percentage cover that particular dimension can provide to the deficient glenoid.Results: A total of 26 scapulae were obtained. Average AP diameter and height of the glenoid was 25.1mm and 36.2mm respectively. Average coracoid length, width and thickness was 22.3mm, 13.3mm and 7.7mm respectively. There was no significant difference between the right and left sides in all the dimensions. The average coverage provided by the coracoid thickness (Latarjet procedure) was 30% with coracoid width providing average coverage of 50% (congruent-arc Latarjet procedure). The coracoid width could safely accommodate the 3.5mm and 4.5mm screws while coracoid thickness offered a very thin margin round the screws.Conclusion: The coracoid process can cover glenoid defects of between 30% and 50% and while it may safely accommodate the 3.5mm and 4.5mm screws if oriented for the classic Latarjet operation, care is needed especially if the congruent-arc Latarjet is planned as coracoid thickness may not be adequate to accommodate the fixation screws.Keywords: Coracoid process, Glenoid, Latarjet, Congruent-arc Latarje

Growth and nutritional status of the first six months of life among selected hospitals: Nairobi Province

BACKGROUND: Exclusive breastfeeding for infants is recommended for the first six months for optimal health, development and growth. However, there is limited data on infant feeding practices and nutrition status of infants in Nairobi.OBJECTIVE: To assess infant growth and nutritional status and compare with feeding practices in the first six months of life in selected hospitals, Nairobi Province.DESIGN: Prospective cohort designSETTING: Five major hospitals in Nairobi namely; The Aga Khan, Pumwani Maternity, Mater Misercordiae, St Mary's Langata and Jamaa Hospitals.SUBJECTS: A sample of 692 mother-infant pairs were recruited at birth and followed up until six months.INTERVENTION: There was no direct experimental intervention, but there was observation of infant feeding practices, weight and height measurement was recorded every four weeks and determination of nutrition status of the infants for a period of six months.MAIN OUTCOME MEASURES: Nutritional status and infant feeding practices in the first six months.RESULTS: Slightly more than half (58.8%) of the mothers were formally employed and the rest were self employed. The mean age of the mothers was 28.3 ± 4.9 years. The mean income was KES 26,360 ± 34,696. The mean birth weight of infants was 3.24 ± 0.43 kg and 53.3% of all infants were male. Above 80% of infants were within normal weight based on weight for age Z-scores (WAZ) at 6, 10, 14 and 23 weeks. The prevalence of overweight based on WAZ was 9.5%, 11.6%, 11.9% and 11% at 6, 14, 19 and 23 weeks, respectively. There were no significant (P > 0.05) differences in WAZ between infants on different feeding methods.CONCLUSIONS: There was no significant difference in weight or length gain among children that were fully breastfed in comparison to those who were given infant formula or had mixed feeding. However, there was concern over the proportion of overweight infants, as the condition may lead to long term health problems

Enhancing the Supervision of Community Health Workers With WhatsApp Mobile Messaging: Qualitative Findings From 2 Low-Resource Settings in Kenya

An estimated half of all mobile phone users in Kenya use WhatsApp, an instant messaging platform that provides users an affordable way to send and receive text messages, photos, and other media at the one-to-one, one-to-many, many-to-one, or many-to-many levels. A mobile learning intervention aimed at strengthening supervisory support for community health workers (CHWs) in Kibera and Makueni, Kenya, created a WhatsApp group for CHWs and their supervisors to support supervision, professional development, and team building. We analyzed 6 months of WhatsApp chat logs (from August 19, 2014, to March 1, 2015) and conducted interviews with CHWs and their supervisors to understand how they used this instant messaging tool. During the study period, 1,830 posts were made by 41participants. Photos were a key component of the communication among CHWs and their supervisors: 430 (23.4%) of all posts contained photos or other media. Of the remaining 1,400 text-based posts, 87.6% (n = 1,227) related to at least 1 of 3 defined supervision objectives: (1) quality assurance, (2) communication and information, or (3) supportive environment. This supervision took place in the context of posts about the roll out of the new mobile learning intervention and the delivery of routine health care services, as well as team-building efforts and community development. Our preliminary investigation demonstrates that with minimal training, CHWs and their supervisors tailored the multi-way communication features of this mobile instant messaging technology to enact virtual one-to-one, group, and peer-to-peer forms of supervision and support, and they switched channels of communication depending on the supervisory objectives. We encourage additional research on how health workers incorporate mobile technologies into their practices to develop and implement effective supervisory systems that will safeguard patient privacy, strengthen the formal health system, and create innovative forms of community-based, digitally supported professional development for CHWs