Increased Maternal Education and Knowledge of Nutrition and Reductions in Poverty are Associated with Dietary Diversity and Meal Frequency in an Observational Study of Indonesian Children

Background: Optimal infant and young child feeding during the first two years of life is essential to optimum child development and health. While the link between feeding practices and child health outcomes is well documented, little is known about the determinants of these feeding practices in Indonesia. The purpose of this study was to better understand factors associated with appropriate child feeding among Indonesian children 6–23 months of age.Methods: Interviewers conducted interviews with 1498 mothers of children 6–23 months of age to identify practices. Measures of feeding practices included dietary diversity, meal frequency, and minimum acceptable diet. Multivariate logistic regression was used to identify factors associated with dietary diversity and separately with meal frequency.Results: After adjusting for covariates, increased maternal education was associated with improved dietary diversity. Age of child [OR=1.11], knowledge of stunting [OR=1.80], and having ever received nutrition information [OR=1.89] were also associated with greater dietary diversity. Wealth [OR=0.86] and age of child [OR=0.92] were inversely associated with meal frequency. Maternal education, age of child, being a male child, knowledge of stunting, and having received nutrition information increased the odds of the child consuming a minimum acceptable diet.Conclusion: Increasing maternal education, knowledge of stunting, and knowledge of nutrition may improve dietary diversity while poverty alleviation has the potential to improve minimum meal frequency. These findings corroborate similar studies and confirm the importance of government efforts that help girls stay in school, improve families’ understanding of nutrition, and reduce poverty

Urban Health Systems Strengthening: The Community Defined Health System for HIV/AIDS and Diabetes Services in Korogocho, Kenya

Background: Low- and middle-income countries have been experiencing unprecedented rates of urbanization. Rapid urbanization has attributed to an upsurge in non-communicable diseases, such as diabetes, cardiovascular diseases, and cancers in these countries. Most low- and middle-income countries are also still struggling to control communicable diseases such as HIV/AIDS, tuberculosis, and malaria. This phenomenon, described as the double burden of disease, places greater strains on urban health systems and vulnerable urban populations, such as slum dwellers, who are likely to bear the brunt of any negative health outcomes. Given the potential impacts of urbanization and quality of health services on poverty and disease in the urban poor, there is urgent need to study urban health systems and the ways in which services can be made more available, accessible, and acceptable to socioeconomically disadvantaged and culturally/ethnically diverse populations. Objectives: This dissertation is a case study that investigated the community-defined health system for Korogocho slum residents in Nairobi, Kenya. Specifically, the purpose of the research study was to (1) determine the readiness of health workers to provide HIV- and diabetes-related services, (2) define the components of the health system as perceived by Korogocho residents; that is, determine the community-defined health system, (3) assess the factors that affect health service utilization with respect to HIV/AIDS and diabetes prevention, care, and treatment, and (4) make recommendations for improving the availability, accessibility, and acceptability of health services for Korogocho residents. Methods: The case study research employed both quantitative and qualitative methods. Three complementary peer-review quality manuscripts were developed. Manuscript 1 presents results from one of the first assessments of health provider readiness to provide HIV/AIDS- and diabetes-related services using data from the Demographic and Health Survey’s Kenya Service Provision Assessment. A cross-sectional quantitative study was conducted. Readiness was defined as health workers having the training to provide the minimum HIV/AIDS services as prescribed by key government policies. Data analysis was conducted using STATA version 13 to assess the readiness of health workers in terms of a weighted proportion of providers from facility levels 2-4 who were trained in essential HIV/AIDS- and diabetes-related services according to Kenya’s national guidelines. Manuscript 2 details the results of a qualitative inquiry to understand the community-defined health system and identify factors that influence Korogocho residents’ health utilization behavior, especially in relation to HIV/AIDS and diabetes services. Manuscript 3 utilized a qualitative assessment to determine the role of informal health providers (those who have not received a Western biomedical model of medical training) in health service delivery to the Korogocho community. In both Manuscripts 2 and 3, semi-structured interviews were conducted with community members and informal health providers, respectively. Qualitative sampling was conducted with the purpose of generating a conceptual model of the urban health system for slum residents. Analysis of semi-structured qualitative interviews with community members and informal health providers in Manuscripts 2 and 3 was completed through an iterative process using NVivo 11 for Mac. Results: The results of this research demonstrate the complexity of urban health systems. Korogocho residents utilize health services from a variety of facilities and providers from both the formal and informal sectors. Their health utilization behavior is primarily influenced by the availability, accessibility, and acceptability of health services, health facilities, and health providers. Informal health providers play a critical role in terms of expanding the availability and accessibility of health services to Korogocho residents. The results of this case study also reveal that training levels of health providers in Nairobi for the delivery of HIV- and diabetes-related services are low. On average, 12% of health workers interviewed in the 2010 Kenya service provision assessment reported having training in the previous 2 years in the full complement of essential HIV-related services as prescribed by Kenyan Government policies. There were similar low proportions of training for the provision of diabetes-related services among the three health worker cadres included in this analysis of the 2010 Kenya service provision assessment. Moreover, the community’s perceptions of the availability and accessibility of diabetes services lagged behind HIV services. Conclusions: The results of this research reveal key information that can impact the health systems strengthening agenda, particularly for improving the availability and accessibility of health services to the urban poor. It is also clear from this research that there is an urgent need to scale up the training of health providers to handle the current double burden of disease. Further, among socioeconomically disadvantaged populations, such as urban slums, the intentional incorporation of informal providers into the health system is a key step towards ensuring that much needed health services reach the urban poor

Development and Optimization of a Novel Immunomagnetic Separation- Bacteriophage Assay for Detection of Salmonella enterica Serovar Enteritidis in Broth

Salmonella is the second-leading cause of food-borne illness in most developed countries, causing diarrhea, cramps, vomiting, and often fever. Many rapid methods are available for detection of Salmonella in foods, but these methods are often insensitive or expensive or require a high degree of technical ability to perform. In this paper we describe development and characterization of a novel assay that utilizes the normal infection cycle of bacteriophage SJ2 for detection of Salmonella enterica serovar Enteritidis in broth. The assay consists of four main stages: (i) capture and concentration of target cells by using immunomagnetic separation (IMS); (ii) infection of the target bacterium with phage; (iii) amplification and recovery of progeny phage; and (iv) assay of progeny phage on the basis of their effect on a healthy population of host cells (signal-amplifying cells). The end point of the assay can be determined by using either fluorescence or optical density measurements. The detection limit of the assay in broth is less than 10(4) CFU/ml, and the assay can be performed in 4 to 5 h. The results of this study demonstrate that the IMS-bacteriophage assay is a rapid, simple, and sensitive technique for detection of Salmonella serovar Enteritidis in broth cultures which can be applied to preenriched food samples