Engaging fathers and grandmothers to improve maternal and child dietary practices: Planning a community-based study in western Kenya

Fathers and grandmothers are key family influencers who have an impact on maternal and child health. This paper describes the planning, design, and implementation of a four-phased evaluation study on the impact of engaging fathers or grandmothers in improving diets of mothers and feeding practices of infants and young children in a rural setting in western Kenya. The study used a quasi-experimental, non-equivalent comparison group design with pre- and post-test observations. It tested the hypothesis that families participating in activities to engage fathers or grandmothers have better knowledge and adopt better practices related to maternal nutrition and complementary feeding than families for which nutrition messages are targeted only to mothers. Information generated from previous formative research was used to design culturally relevant interventions for fathers and grandmothers. Interventions included separate but parallel peer education dialogue groups with fathers and grandmothers. They were held twice a month, and family bazaars and special fathers’ days at local clinics were held once per month. The study team selected the dialogue-based group methodology, including promotion of social support actions, because it engages participants to actively discuss new information and experiences providing social support rather than passively receive information. Community health extension workers and Ministry of Health nutritionists provided supportive supervision and monitoring of the dialogue group activities. Father and grandmother interventions were implemented in two separate sub-locations of Kenya’s former Western Province, and the program effects were compared to findings in a population with a similar socioeconomic background living in a similar sub-location in the same province. An examination of the study implementation methodology provides useful insights into practical issues that need to be addressed in programs seeking to engage key household influencers of maternal nutrition and infant and young child feeding behaviours. Results showed that the dialogue group methodology, formative research to inform intervention design, use of the existing Ministry of Health community health unit structure to provide critical support supervision, and actions that motivated peer mentors were key factors for successful implementation of the study intervention.Keywords: Maternal nutrition, infant feeding, complementary feeding, grandmother, father, design, formative researc

Perceptions and Experiences of School Teachers During the Implementation of a School-Based Deworming Activity in Kenya

Background: Primary school teachers are key stakeholders in the success of school-based deworming activity as they are responsible for drug administration and provision of health education to the School-Age Children (SAC). In Kenya, the National School-Based Deworming Programme (NSBDP) for control of soil-transmitted helminths and schistosomiasis was initiated in the year 2012 in prioritised areas. By the year 2013, over 6 million SAC had been treated. The present study sought to assess the teachers’ perceptions and experiences of the school-based deworming activity in an effort to improve programme effectiveness.   Methods: Qualitative data were collected, using in-depth interviews, in 4 subcounties of the coastal region of Kenya. Using purposive selection, 1 primary school teacher from each of the 38 schools also purposively selected participated in the study. The data were audio-recorded, transcribed, coded and analysed manually by study themes which included: reason for being selected for training to administer drugs; perceptions of training content and duration; experiences during drug acquisition, administration and record-keeping and motivation to continue participating in the deworming of school-age children.   Results: Half of the teachers indicated that they were selected to administer drugs to children as they were responsible for school health matters. The duration and content of the training were considered sufficient, and no challenges were faced during drug acquisition. Challenges faced during drug administration included non-compliance and experience of side effects of the drugs. No major problems were experienced in record-keeping, although the teachers felt that the forms needed to be simplified. Improvement of the children’s health and class performance was reported as a source of motivation to the teachers to continue administering the drugs. Fellow teachers were reported to have given moral support while over half of the respondents indicated that parents did not provide much support.   Conclusion: Generally, teachers have positive experiences and perceptions of the deworming activity. There is, however, a need to involve all stakeholders especially the parents through the school board of management to help counter non-compliance and possibly support in providing meals to the children to help minimise side effects after drug consumption. Inadequate moral support and incentives are negative factors on the teachers’ motivation

Diversity and utilization of indigenous wild edible plants and their contribution to food security in Turkana County, Kenya

Introduction Indigenous Wild edible plants (IWEPs) are consumed daily in some form by at least one in seven people worldwide. Many of them are rich in essential nutrients with the potential for dietary and nutrition improvement particularly for poor households. They are, however, often overlooked. This study investigated diversity, consumption frequency, and perceptions of IWEPs and the contribution they make to the food security of communities in Turkana County, northern Kenya. Our findings are aimed at stimulating targeted discussions among stakeholders involved in food security programs on best way to overcome the poverty stigma associated with IWEPs consumption and to promote their utilization for food security, nutritional and dietary improvement, and enhanced community resilience. Methods Applying a mixed-methods approach, we collected data using 12 gender-disaggregated focus group discussions and a questionnaire applied to a random sample of 360 households. Results and Discussion Participants identified 73 IWEPs, of which 24 were consumed in the preceding six months by 48.5% of households. Almost all surveyed households (96%) were classified as severely food insecure, and food insecurity did not differ significantly between households that consumed IWEPs and those that did not. Our results indicate that more IWEPs consumers than non-consumers reported eating foods they had not wanted to consume to cope with food scarcity, as well as having to eat fewer meals than normal. Just over half of the respondents (57.1%) held positive attitudes towards IWEPs, which was positively associated with a higher likelihood of IWEPs consumption. Long distances to harvest sites, lack of knowledge about the plants, their seasonality, and how to cook them appetizingly, coupled with overall unfavorable perceptions, are probable reasons for non-consumption of IWEPs among the survey respondents. In line with other studies cited on wild foods, we conclude that IWEPs have the potential to bridge food and nutritional deficits in food insecure households in the study area, although currently their consumption remains limited. Given this potential, further analysis of IWEPs’ nutritional composition and restoration of wild edible foods to local areas should be given priority, as well as interventions that help to overcome the challenges to their consumption and promote their wider use

Determinants of contraceptive use among postpartum women in a county hospital in rural KENYA

Abstract Background There is a high unmet need for limiting and spacing child births during the postpartum period. Given the consequences of closely spaced births, and the benefits of longer pregnancy intervals, targeted activities are needed to reach this population of postpartum women. Our objective was to establish the determinants of contraceptive uptake among postpartum women in a county referral hospital in rural Kenya. Methods Sample was taken based on a mixed method approach that included both quantitative and qualitative methods of data collection. Postpartum women who had brought their children for the second dose of measles vaccine between 18 and 24 months were sampled Participants were interviewed using structured questionnaires, data was collected about their socio-demographic characteristics, fertility, knowledge, use, and access to contraceptives. Chi square tests were used to determine the relationship between uptake of postpartum family planning and: socio demographic characteristics, contraceptive knowledge, use access and fertility. Qualitative data collection included focus group discussions (FDGs) with mothers and in-depth interviews with service providers Information was obtained from mothers’ regarding their perceptions on family planning methods, use, availability, access and barriers to uptake and key informants’ views on family planning counseling practices and barriers to uptake of family planning Results More than three quarters (86.3%) of women used contraceptives within 1 year of delivery, with government facilities being the most common source. There was a significant association (p ≤ 0.05) between uptake of postpartum family planning and lower age, being married, higher education level, being employed and getting contraceptives at a health facility. One third of women expressing no intention of having additional children were not on contraceptives. In focus group discussions women perceived that the quality of services offered at the public facilities was relatively good because they felt that they were adequately counseled, as opposed to local chemist shops where they perceived the staff was not experienced. Conclusion Contraceptive uptake was high among postpartum women, who desired to procure contraceptives at health facilities. However, there was unmet need for contraceptives among women who desired no more children. Government health facility stock outs represent a missed opportunity to get family planning methods, especially long acting reversible contraceptives, to postpartum women

Additional file 2: of Determinants of contraceptive use among postpartum women in a county hospital in rural KENYA

Focus Group Discussion Guide. (DOCX 12 kb

Additional file 1: of Determinants of contraceptive use among postpartum women in a county hospital in rural KENYA

Respondents’ Questionnaire. (DOCX 16 kb

Lessons from implementing mass drug administration for soil transmitted helminths among pre-school aged children during school based deworming program at the Kenyan coast

Abstract Background The 2012 London declaration which committed to “sustaining, expanding and extending drug access programmes to ensure the necessary supply of drugs and other interventions to help control soil-transmitted helminths (STH) by 2020” has seen many countries in Africa roll out mass drug administration (MDA) especially among school age children. In Kenya, however, during the National school-based deworming exercise, pre-school aged children (PSAC) have to access treatment at primary schools as the pre-school teachers are not trained to carry out deworming. With studies being conducted on the effectiveness of MDAs, the experiences of key education stakeholders which could improve the programme by giving best practices, and challenges experienced have not been documented. Methods This was a cross-sectional qualitative study using Focus group discussions (FGDs) and Key informant interviews (KIIs). It was conducted in 4 sub-counties with high STH prevalence at the Kenyan coast (Matuga, Malindi, Lunga Lunga and Msambweni) to understand best practices for implementing MDA among PSAC.FGDs categorized by gender were conducted among local community members, whereas KIIs involved pre-school teachers, primary school teachers, community health extension workers (CHEWs) and opinion leaders. Participants were purposefully selected with the saturation model determining the number of interviews and focus groups. Voice data collected was transcribed verbatim then coded and analyzed using ATLAS.Ti version 6. Results Majority of the primary school teachers and CHEWs reported that they were satisfied with the method of mobilization used and the training tools. This was however not echoed by the pre-school teachers, parents and chiefs who complained of being left out of the process. Best practices mentioned included timely drug delivery, support from pre-school teachers, and management of side effects. Overcrowding during the drug administration day, complexity of the forms (for instance the ‘S form’) and long distance between schools were mentioned as challenges. Conclusion There is need to utilize better sensitization methods to include the local administration as well as the parents for better uptake of the drugs. Extending deworming training to pre-school teachers will enhance the national deworming programme

Knowledge, practices and perceptions of geo-helminthes infection among parents of pre-school age children of coastal region, Kenya

<div><p>Background</p><p>Soil-transmitted helminthes (STHs) are common human parasitic diseases in most of the developing world particularly in Kenya. The ongoing National School-Based Deworming Programme (NSBDP) was launched in 2012 and is currently targeting 28 of the 47 endemic Counties. In an effort to improve treatment intervention strategies among Pre-School Age Children (PSAC) attending Early Childhood Development Centres (ECDC), we sought to assess parents’ knowledge, perceptions and practices on worm infection.</p><p>Methodology</p><p>We conducted a qualitative cross-sectional study in four endemic sub-counties of two counties of coastal region of Kenya. A total of 20 focus group discussions (FGDs) categorized by gender were conducted among parents of pre-school age children. Participants were purposively selected based on homogenous characteristics with the saturation model determining the number of focus group discussions conducted. The data collected was analyzed manually by study themes.</p><p>Findings</p><p><b>The</b> majority of the parents had knowledge on worms and modes of transmission of the parasitic infections among the pre-school children. Also, most of the participants knew the causes of worm infection and the pre- disposing factors mentioned included poor hygiene and sanitation practices. Due to poor knowledge of signs and symptoms, misconceptions about the drugs administered during the NSBDP were common with a large majority of the parents indicating that the drugs were ineffective in worm control. The findings also indicated that most of the participants sought medical care on the onset of the signs and symptoms of worm infestation and preferred services provided at public health facilities as opposed to private health facilities or buying drugs from the local market citing mistrust of such services. Cultural beliefs, high cost of building and availability of vast pieces of land for human waste disposal were factors that contributed to low or lack of latrine ownership and usage by a large majority of the respondents.</p><p>Conclusions</p><p>Our results show that to a large extent the parents of the pre-school age children have information on worm infections. However, some cultural beliefs and practices on the pathology and mode of transmission mentioned could be a hindrance to prevention and control efforts. There is need to implement health promotion campaigns to strengthen the impact of control strategies and reduce infection.</p></div

Additional file 2: of Lessons from implementing mass drug administration for soil transmitted helminths among pre-school aged children during school based deworming program at the Kenyan coast

In-depth Interview for ECD Center Teachers on their knowledge and perceptions of Intestinal Parasites and the National School-Based Deworming Programme (DOCX 34 kb)