Complementary feeding practices and nutritional status of children 6 to 24 months: A cross-sectional descriptive study

Background: Complementary feeding refers to a process of introducing the infant to additional sources of nutrition other than the breast milk, usually at the age of six months. Infant and Young Child Feeding guidelines provided by United Nations Children’s Fund/ World Health Organization require that children are exclusively breastfed from birth to six months of age when addition foods is introduced to meet the increasing nutritional requirements of the growing child. Proper initiation of the complementary feeding is critical as any deviation may lead to inadequate energy and nutrient intake, leading to sub-optimal growth and development. Objective: The study aimed to assess complementary feeding practices in relation to nutritional status of children aged 6 to 24 months at the Well baby Clinic at Mbagathi Hospital, Nairobi County. and Methods: A cross-sectional study involving 300 children aged 6 to 24 months was conducted at the Well Baby Clinic at Mbagathi Hospital. Anthropometric measurements were taken using standard procedures and interviewer administered questionnaire was administered to mothers to gather data on complementary feeding practices of study children. Anthropometric data was analyzed using WHO anthro2005 software and descriptive statistics analyzed using SPSS version 20. Results were presented in tables. Results: Majority (81.7%) of children were first initiated complementary feeding at the recommended age of six months with a mean age of 5.71(±1.033). Almost a quarter (24.3%) of the children were given ≤ 3 meals per day with a mean of 4.35 (±1.210) meals per day. 15.3% of the children were wasted (W/H z-score <-2SD), 22% underweight (W/A z-score <-2SD) and 14.3% stunted (H/A z-score <-2SD. Most complementary foods were Carbohydrates (starchy) based from locally available cereals with limited combination from other food classifications. Conclusion and recommendation: Despite the impressive rates of compliance with the recommended age of introduction of complementary feeding, malnutrition was high among the children attending the Well Baby clinic at Mbagathi District Hospital. There is need for health care providers to proactively address gaps in complementary feeding practices especially on food diversity, food composition and frequency of meals. Key words: Complementary feeding practices, malnutrition, food quality, complementary food diversity

Asthma control and factors associated with control among children attending clinics at a national referral hospital in western Kenya

Background: Asthma control is the extent to which the various manifestations of asthma have been reduced or removed by treatment. In developing countries including Kenya, many children continue to visit hospitals with acute symptoms of asthma, which is a pointer to poor control.Objectives: To determine the level of asthma control and factors associated with the observed control among children at a national referral hospital.Design: Cross-sectional studySetting: Moi Teaching and Referral Hospital, Eldoret, Kenya paediatric clinics.Subjects: A total of 166 asthmatic children aged 6-11 years and their parents/caretakers were enrolled between August 2016 and October 2017.Main Outcome: Level of control using childhood asthma control test (c-ACT)Results: The median age of enrolled children was 8.17 years with males being the majority, 94 (56.6%). Using c-ACT, 92 (55.4%, 95%CI: 47.52, 63.10) had well controlled asthma at baseline. At univariate analysis, having a medical insurance cover (p=0.034), dry season (p=0.036), and parental perception of asthma control (p=0.002) were significantly associated with good control of asthma. Acceptance that a child had asthma was associated with poor control of asthma, p=0.046. On multivariate logistic regression, a perception of a well-controlled child by the parent/caretaker correlated well with good control of asthma.Conclusion: About half of the children in this set up have good control of asthma with the observed status of control being affected by parental/caretaker perception on asthma

Profile: The Kilifi Health and Demographic Surveillance System (KHDSS).

The Kilifi Health and Demographic Surveillance System (KHDSS), located on the Indian Ocean coast of Kenya, was established in 2000 as a record of births, pregnancies, migration events and deaths and is maintained by 4-monthly household visits. The study area was selected to capture the majority of patients admitted to Kilifi District Hospital. The KHDSS has 260 000 residents and the hospital admits 4400 paediatric patients and 3400 adult patients per year. At the hospital, morbidity events are linked in real time by a computer search of the population register. Linked surveillance was extended to KHDSS vaccine clinics in 2008. KHDSS data have been used to define the incidence of hospital presentation with childhood infectious diseases (e.g. rotavirus diarrhoea, pneumococcal disease), to test the association between genetic risk factors (e.g. thalassaemia and sickle cell disease) and infectious diseases, to define the community prevalence of chronic diseases (e.g. epilepsy), to evaluate access to health care and to calculate the operational effectiveness of major public health interventions (e.g. conjugate Haemophilus influenzae type b vaccine). Rapport with residents is maintained through an active programme of community engagement. A system of collaborative engagement exists for sharing data on survival, morbidity, socio-economic status and vaccine coverage

Iodine status and sources of dietary iodine intake in Kenyan women and children

In 2009, the Government of Kenya adopted a mandatory iodine standard for all ediblesalt of 30-50 mg/kg with potassium iodate as a required fortificant. To assess the new standard, iodine nutrition measurements were included in the Kenya National Micronutrient Survey (KNMS) in 2011. Spot urine samples were obtained from 951 school-age children (SAC, 5 - 14y of age) and 623 non-pregnant women (NPW, 15 – 49y), together with 625 salt samples from their households. Because salt is the major dietary source of iodine as well as sodium in Kenya, sodium concentrations were measured in the same urine samples. Using the iodine and sodium data, the report introduces a novel regression technique to apportion the urinary iodine concentrations (UIC) in both survey groups to the key sources of iodine intake, namely, naturally present (native) iodine content, iodized salt in processed foods and iodized household salt. The salt iodine (SI) content in Kenya’s households (mean 40.3 mg/kg, SD 19.4 mg/kg) showed high-quality iodized salt supply. The SI content in 94.9% of households was ≥15 mg/kg. Median UIC findings in SAC (208 μg/L) and NPW (167 μg/L) indicated adequate iodine nutrition. Although variations in UIC values existed by age, gender (only in SAC), residence type, household wealth index, and region, median UIC findings were within the accepted optimum range in virtually all sub-categories. The findings do not suggest the need for change in Kenya’s universal salt iodization (USI) strategy or adjustment of the current salt iodine standard. Partitioning of UIC values by dietary sources of iodine intake in each survey group attributed ± 35% to native dietary iodine content, ± 45% to processed food and ± 20% to household salt. The UIC levels from native iodine intake alone (60.8 μg/L and 65.3 μg/L in SAC and NPW, respectively) fell below the threshold for iodine deficiency, which supports the inference that the current USI strategy in Kenya is effective in preventing iodine deficiency. The results from regression analysis indicate that the iodine intakes of SAC and NPW can be explained mainly, and in the same way, by their urinary sodium concentrations (UNaC) and the SI contents in salt from their households. The spot UNaC data do not accurately represent salt intake estimates but the mean UNaC findings may be useful for analyzing future changes in salt supply and use from efforts to reduce the salt intake of Kenya’s population.Keywords: Universal Salt Iodization, Dietary Iodine Sources, Population Iodine Status, Keny

Model-based estimates of transmission of respiratory syncytial virus within households.

INTRODUCTION: Respiratory syncytial virus (RSV) causes a significant respiratory disease burden in the under 5 population. The transmission pathway to young children is not fully quantified in low-income settings, and this information is required to design interventions. METHODS: We used an individual level transmission model to infer transmission parameters using data collected from 493 individuals distributed across 47 households over a period of 6 months spanning the 2009/2010 RSV season. A total of 208 episodes of RSV were observed from 179 individuals. We model competing transmission risk from within household exposure and community exposure while making a distinction between RSV groups A and B. RESULTS: We find that 32-53% of all RSV transmissions are between members of the same household; the rate of pair-wise transmission is 58% (95% CrI: 30-74%) lower in larger households (≥8 occupants) than smaller households; symptomatic individuals are 2-7 times more infectious than asymptomatic individuals i.e. 2.48 (95% CrI: 1.22-5.57) among symptomatic individuals with low viral load and 6.7(95% CrI: 2.56-16) among symptomatic individuals with high viral load; previous infection reduces susceptibility to re-infection within the same epidemic by 47% (95% CrI: 17%-68%) for homologous RSV group and 39% (95%CrI: -8%-69%) for heterologous group; RSV B is more frequently introduced into the household, and RSV A is more rapidly transmitted once in the household. DISCUSSION: Our analysis presents the first transmission modelling of cohort data for RSV and we find that it is important to consider the household social structuring and household size when modelling transmission. The increased infectiousness of symptomatic individuals implies that a vaccine against RSV related disease would also have an impact on infection transmission. Together, the weak cross immunity between RSV groups and the possibility of different transmission niches could form part of the explanation for the group co-existence

Integrating epidemiological and genetic data with different sampling intensities into a dynamic model of respiratory syncytial virus transmission.

Respiratory syncytial virus (RSV) is responsible for a significant burden of severe acute lower respiratory tract illness in children under 5 years old; particularly infants. Prior to rolling out any vaccination program, identification of the source of infant infections could further guide vaccination strategies. We extended a dynamic model calibrated at the individual host level initially fit to social-temporal data on shedding patterns to include whole genome sequencing data available at a lower sampling intensity. The study population was 493 individuals (55 aged < 1 year) distributed across 47 households, observed through one RSV season in coastal Kenya. We found that 58/97 (60%) of RSV-A and 65/125 (52%) of RSV-B cases arose from infection probably occurring within the household. Nineteen (45%) infant infections appeared to be the result of infection by other household members, of which 13 (68%) were a result of transmission from a household co-occupant aged between 2 and 13 years. The applicability of genomic data in studies of transmission dynamics is highly context specific; influenced by the question, data collection protocols and pathogen under investigation. The results further highlight the importance of pre-school and school-aged children in RSV transmission, particularly the role they play in directly infecting the household infant. These age groups are a potential RSV vaccination target group

Boundary work: becoming middle class in suburban Dar es Salaam

Suburban space provides a useful window onto contemporary class practices in Africa, where it is difficult to identify social classes on the basis of income or occupation. In this article I argue that the middle classes and the suburbs are mutually constitutive in the Tanzanian city of Dar es Salaam. Using interviews with residents and local government officials in the city's northern suburbs, I discuss the material and representational practices of middle-class boundary work in relation to land and landscape. If the middle classes do not presently constitute a coherent political-economic force, they are nevertheless transforming the city's former northern peri-urban zones into desirable suburban residential neighbourhoods

Can biomedical and traditional health care providers work together? Zambian practitioners' experiences and attitudes towards collaboration in relation to STIs and HIV/AIDS care: a cross-sectional study

BACKGROUND: The World Health Organization's World health report 2006: Working together for health underscores the importance of human resources for health. The shortage of trained health professionals is among the main obstacles to strengthening low-income countries' health systems and to scaling up HIV/AIDS control efforts. Traditional health practitioners are increasingly depicted as key resources to HIV/AIDS prevention and care. An appropriate and effective response to the HIV/AIDS crisis requires reconsideration of the collaboration between traditional and biomedical health providers (THPs and BHPs). The aim of this paper is to explore biomedical and traditional health practitioners' experiences of and attitudes towards collaboration and to identify obstacles and potential opportunities for them to collaborate regarding care for patients with sexually transmitted infections (STIs) and HIV/AIDS. METHODS: We conducted a cross-sectional study in two Zambian urban sites, using structured questionnaires. We interviewed 152 biomedical health practitioners (BHPs) and 144 traditional health practitioners (THPs) who reported attending to patients with STIs and HIV/AIDS. RESULTS: The study showed a very low level of experience of collaboration, predominated by BHPs training THPs (mostly traditional birth attendants) on issues of safe delivery. Intersectoral contacts addressing STIs and HIV/AIDS care issues were less common. However, both groups of providers overwhelmingly acknowledged the potential role of THPs in the fight against HIV/AIDS. Obstacles to collaboration were identified at the policy level in terms of legislation and logistics. Lack of trust in THPs by individual BHPs was also found to inhibit collaboration. Nevertheless, as many as 40% of BHPs expressed an interest in working more closely with THPs. CONCLUSION: There is indication that practitioners from both sectors seem willing to strengthen collaboration with each other. However, there are missed opportunities. The lack of collaborative framework integrating maternal health with STIs and HIV/AIDS care is at odds with the needed comprehensive approach to HIV/AIDS control. Also, considering the current human resources crisis in Zambia, substantial policy commitment is called for to address the legislative obstacles and the stigma reported by THPs and to provide an adequate distribution of roles between all partners, including traditional health practitioners, in the struggle against HIV/AIDS