Distribution and determinants of young child feeding practices in the East African region: demographic health survey data analysis from 2008-2011

We utilized the most recent Demographic Health Survey data to explore the distribution of feeding practices and examine relationships between complementary feeding and socio-demographic and health behaviour indicators in Kenya, Uganda and Tanzania. We based our analysis on complementary dietary diversity scores calculated for children 6-23 months old. Geographically, Kenya displayed clear division of children\u2019s diet diversity scores across its regions, unlike Uganda and Tanzania. Less than 40% of the children\u2019s meal frequencies in Uganda and Tanzania had met the minimum daily recommended levels. Only 30-40% of children in Kenya, Tanzania and Uganda had consumed diets with adequate diversity. Children\u2019s age, breastfeeding status, mother\u2019s education level and working status, household wealth index, prenatal care visits, receiving vitamin A supplements, using modern contraceptives and meal frequencies were significantly associated with adequate complementary food diversity in at least one of the three countries included in the current analyses. These analyses contribute to a better understanding and targeting of infant and young child feeding within the East African region

Maternal knowledge, outcome expectancies and normative beliefs as determinants of cessation of exclusive breastfeeding: a cross-sectional study in rural Kenya

Abstract Background Despite the importance of multiple psychosocial factors on nutrition-related behavior, very few studies have explored beyond the role of mothers’ knowledge and perception of child-focused outcomes on the duration of exclusive breastfeeding in Africa. Our objective was to determine the relationships among mothers’ knowledge, outcome expectancies, normative beliefs, and cessation of exclusive breastfeeding in rural Kenya. Methods A cross-sectional survey was conducted among 400 mothers of children, 0-24 months old, in rural Kenya. Early child-feeding practices, knowledge of breastfeeding recommendations, beliefs associated with impact of exclusive breastfeeding on child- and mother-focused outcomes and perception of acceptability of exclusive breastfeeding by important others were examined. Cox regression analysis was used to assess the relationship between independent variables of interest and cessation of exclusive breastfeeding. Results Being knowledgeable of breastfeeding-related recommendations, positive beliefs on the impact of exclusive breastfeeding on child- focused outcomes, having a more positive perception of the impact of exclusive breastfeeding on mother-focused outcomes and a more positive perception of acceptability of exclusive breastfeeding by important others were associated with significantly lower risks of premature cessation of exclusive breastfeeding. Conclusion In addition to knowledge levels, mothers’ beliefs play an important role in mothers’ decisions to practice exclusive breastfeeding. Mother’s beliefs on the impact of exclusive breastfeeding on the mother’s health, physical appearance and ability to engage in other activities were shown to have the strongest relationship with premature cessation of exclusive breastfeeding. Addressing these beliefs has the potential to contribute to more effective exclusive breastfeeding promotion efforts in rural Kenya

A school-based supplementary food programme in rural Kenya did not reduce children's intake at home

OBJECTIVE: To examine changes in energy intake along with markers of dietary quality (animal-source energy and protein intakes) among household members in the presence of supplementary school feeding in rural Kenya. DESIGN: A 2-year, longitudinal, randomized controlled feeding intervention study. SETTING: Kyeni South Division, Embu District, Kenya. SUBJECTS: A total of 182 schoolchildren and selected household members. RESULTS: There was no evidence that schoolchildren who received supplementary snacks at school experienced reduced intakes at home or that intakes by other family members were increased at the expense of the schoolchild's intake. CONCLUSIONS: This analysis highlights a number of factors useful in planning for supplementary feeding interventions in rural Kenya and similar communities

Determining minimum food intake amounts for diet diversity scores to maximize associations with nutrient adequacy: an analysis of schoolchildren’s diets in rural Kenya

OBJECTIVE: To explore multiple methods of calculating diet diversity scores (DDS) to maximize associations with predicted dietary micronutrient adequacy among schoolchildren in rural Kenya. DESIGN: Up to three 24 h recall interviews were administered for each child for a total of 1544 d of intake from all schoolchildren. Daily amounts of food consumed were assigned to one of eight food groups. Five DDS were developed based on various minimum intake amounts from each food group: (i) 1 g; (ii) 15 g; (iii) a variable minimum based on the content of a target nutrient for each group; (iv) the median intake level for each group; and (v) the 90th percentile intake level for each group. A diet was assigned 1 point towards the daily DDS if the food group intake was above the defined minimum level. Five scores were calculated for each child, and bivariate longitudinal random-effects models were used to assess the correlation between each DDS and the mean probability of adequacy for fourteen nutrients. SETTING: Embu District, Kenya. SUBJECTS: Schoolchildren (n 529), mean age 7·00 (sd 1·41) years. RESULTS: Only DDS based on a 15 g minimum and DDS based on nutrient content were significantly associated with mean probability of adequacy after adjusting for energy intake (0·21 and 0·41, respectively). CONCLUSIONS: A DDS using minimum intakes based on nutrients contributed by a food group best predicted nutrient adequacy in this population. These analyses contribute to the continued search for simpler and more valid dietary quality indicators among low-income nations

Dietary micronutrients are associated with higher cognitive function gains among primary school children in rural Kenya

With the exception of iodine and Fe, there is still very limited information on the effect of micronutrients on cognitive function, especially among school-age children. The present analysis evaluates the relationship between dietary Fe, Zn and B vitamins (B12, B6, folate and riboflavin) and gains in cognitive test scores among school children in rural Kenya. Data for the present study were obtained from The Child Nutrition Kenya Project, a 2-year longitudinal, randomised controlled feeding intervention study using animal source foods. Dietary nutrient values were based on monthly and bimonthly 24 h recall data collected during the study period. In longitudinal regression analyses, available Fe, available Zn, vitamin B12 and riboflavin showed significant relationships with improved cognitive test scores, after controlling for confounders such as energy intake, school, socio-economic status and morbidity. Available Fe intake was associated with significantly higher gains in Raven's Coloured Progressive Matrices test scores over time. Available Zn intake was associated with significantly higher gains in digit span-total test scores over time, while vitamin B12 and riboflavin intakes were each associated with significantly higher gains in digit span-forward test scores over time. This analysis demonstrates the influence of improved dietary micronutrient status on school children's cognitive function