Participation and the focus of nutrition education in a rural child growth monitoring program in Kenya

Nutrition education is one of the strategies that addresses high levels of malnutrition in the world. Since independence in 1963. Kenya has instituted socio-economic, food security, nutrition and health policies to improve the nutrition and quality of life of it\u27s people. In spite of these policies, one third of the Kenyan population is undernourished. This study was planned to establish how nutrition education is conducted in the Ministry of Health Thika District through a rural child growth monitoring program and to generate and reflect on women\u27s participation in decision making in the program. Open-ended interviews were conducted with 21 women from the program, 4 community health workers and 16 nutrition stuff from Thika District. Focus groups, in-depth interviews and eight observations of the child growth monitoring sessions over nine months of fieldwork, provide data for this study. Participants were engaged actively in the entire research process. A participatory process was introduced by asking participants to contribute to the research agenda and make suggestions on what they wanted the program to address and how to do so. The process was developed through continuous dialogue and decision making. Reliability of data was ensured by conducting the research in the natural environment of the program and for an extended period of time. Triangulation of data and data collection methods and providing feedback to participants as a way to crosscheck the findings, validated data. Descriptive statistics analysed the data from the open-ended interviews whereas qualitative data were coded and analysed according to emerging themes and issues and synthesised to address the research questions. Results are presented by use of narrative to exemplify the concepts. The findings of this study show that nutrition education is important but what makes it work are the economic and food security concerns of the people. Findings reveal that although government nutrition staff and participants of the program identify a wide spectrum of causes and solutions to nutrition problems, implementation of nutrition education narrowly focuses on provision of nutrition information. This narrow focus is emphasised by government nutrition staff who focus more on curative than preventive nutrition. Nutrition staff have minimal training in primary health care and none in participatory approaches although they are expected to promote community participation. On the other hand, volunteer community health workers once trained, are left to plan and implement the program with minimal supervision, motivation or visible recognition. Findings show that there are no written nutrition education plans and that once nutrition programs are set in place, the programs are left to go on without reflection on their achievements. This study revealed that grassroot personnel have not accessed government policies on nutrition and community participation that they are supposed to implement and that there are limited resources set aside for nutrition within the Ministry of Health. Participation was promoted in the growth monitoring program by planning the research together with and progressing according to the expressed needs of participants. Women\u27s participation in the program identified the realities of food accessibility and lack of money that influence nutrition. Empowerment was evidenced by diversifying the program to include an income activity and development of a curriculum based on the knowledge women wanted. Selection of a separate committee for the income activity, evidence of interdependent decision making and criticism of dependency are some of the outcomes of participation. Findings show that participation demands commitment and time from all actors. Participants are willing to make that commitment when they perceive individual benefits for them as a result of their participation. This research reveals that motivation and supervision are considered important for the community health workers. These findings show that there is potential for a nutrition program to respond to the realities of people such as appropriate nutrition knowledge, food accessibility and incomes by negotiating program priorities between the participants and nutrition facilitators through participation. A model of participation that I recommend in this study is one that has clear reasons for participation and incorporates an outsider’s perspectives to catalyse the process. This enables local participants to see possibilities which they have not seen due to familiarity with their circumstances. Participation strategy should be able to link with research in order to contribute to publicity and advocacy. Linkage with policy ensures that the process may be addressed practically by current government policies. Participants should engage in a continuous process of assessing the program goals, design, action and analysis. This research recommends nutrition education strategies that explore training in participatory approaches for facilitators. Training should extend to work with community health workers in the community to design and clarify monitoring and evaluation at the community level. Participants in the program should have a voice to decide how the program functions. For effectiveness, an analysis of the resources required to implement participatory approaches is essential. Research that focuses on non-participating mothers, that analyses measures and cost effectiveness of participation und studies that compare the process in different contexts in order to make positive decisions that can influence policy are recommended. The ultimate outcome of this research is that although government policies that promote nutrition and participation in health are in existence in Kenya, grassroot nutrition staff do not access these policies. Promotion of nutrition is worsened by the weak link between the growth monitoring program, the health sector and collaborating non-governmental organisations at the grassroot level on the one hand and between nutrition staff at different government levels. This research recommends that what is required to address the broad nature of nutrition problems are not only policies on nutrition and participation but ensuring the practice of these policies that will bring about a more realistic manner of solving complex nutrition problems. This thesis explains how policy on food security and nutrition at the government level is useless unless those at all relevant levels espccially grassroot government personnel and the community are actively engaged in planning and implementing such policies

Retention of ?- Carotene, Iron and Zinc in Solar Dried Amaranth Leaves in Kajiado County, Kenya

Amaranth is one of the underutilized vegetable with high nutritive value. Availability of amaranth leaves is seasonal and therefore preservation for use in other seasons is necessary. Solar drying is one of the recommended methods for vegetable preservation. Minimal information exists on nutrient content of amaranth leaves grown in dry areas. There is also scarce information on the effect of solar drying on the

GWAS meta-analysis of intrahepatic cholestasis of pregnancy implicates multiple hepatic genes and regulatory elements

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder affecting 0.5–2% of pregnancies. The majority of cases present in the third trimester with pruritus, elevated serum bile acids and abnormal serum liver tests. ICP is associated with an increased risk of adverse outcomes, including spontaneous preterm birth and stillbirth. Whilst rare mutations affecting hepatobiliary transporters contribute to the aetiology of ICP, the role of common genetic variation in ICP has not been systematically characterised to date. Here, we perform genome-wide association studies (GWAS) and meta-analyses for ICP across three studies including 1138 cases and 153,642 controls. Eleven loci achieve genome-wide significance and have been further investigated and fine-mapped using functional genomics approaches. Our results pinpoint common sequence variation in liver-enriched genes and liver-specific cis-regulatory elements as contributing mechanisms to ICP susceptibility

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Role of school gardens : a case study of Webuye division, Bungoma district

This research was carried out in six purposefully selected ·schools in "Webuye Division of Bungoma District to determine the "functioning cd school gardens. The random sample comprised thirty one (31) teachers, two hundred and eighty eight (288) pupils both boys and girls from classes five to eight, two hundred and fifty eight (258) parents and three (3) zonal education officers belonging to the selected schools. Data was collected by means of the interview schedules, Individual interviews and observation checklist. Descriptive statistics were used for analysis of quantitative data whereas transcriptions according to themes were used for the analysis oi qualitative data..

Oral amoxicillin versus benzyl penicillin for severe pneumonia among kenyan children: a pragmatic randomized controlled noninferiority trial.

BACKGROUND: There are concerns that the evidence from studies showing noninferiority of oral amoxicillin to benzyl penicillin for severe pneumonia may not be generalizable to high-mortality settings. METHODS: An open-label, multicenter, randomized controlled noninferiority trial was conducted at 6 Kenyan hospitals. Eligible children aged 2-59 months were randomized to receive amoxicillin or benzyl penicillin and followed up for the primary outcome of treatment failure at 48 hours. A noninferiority margin of risk difference between amoxicillin and benzyl penicillin groups was prespecified at 7%. RESULTS: We recruited 527 children, including 302 (57.3%) with comorbidity. Treatment failure was observed in 20 of 260 (7.7%) and 21 of 261 (8.0%) of patients in the amoxicillin and benzyl penicillin arms, respectively (risk difference, -0.3% [95% confidence interval, -5.0% to 4.3%]) in per-protocol analyses. These findings were supported by the results of intention-to-treat analyses. Treatment failure by day 5 postenrollment was 11.4% and 11.0% and rising to 13.5% and 16.8% by day 14 in the amoxicillin vs benzyl penicillin groups, respectively. The most frequent cause of cumulative treatment failure at day 14 was clinical deterioration within 48 hours of enrollment (33/59 [55.9%]). Four patients died (overall mortality 0.8%) during the study, 3 of whom were allocated to the benzyl penicillin group. The presence of wheeze was independently associated with less frequent treatment failure. CONCLUSIONS: Our findings confirm noninferiority of amoxicillin to benzyl penicillin, provide estimates of risk of treatment failure in Kenya, and offer important additional evidence for policy making in sub-Saharan Africa. CLINICAL TRIAL REGISTRATION: NCT01399723

Use of insecticide-treated clothes for personal protection against malaria: a community trial

<p>Abstract</p> <p>Background</p> <p>The study sought to determine the effect of using insecticide-treated clothes (ITCs) on personal protection against malaria infection. The specific objectives were to determine the effect of using ITCs on the rate of infection with malaria parasites and the effect on indoor mosquito density.</p> <p>Methods</p> <p>This study was done in Dadaab refugee camps, North Eastern Province Kenya between April and August 2002, and involved a total of 198 participants, all refugees of Somali origin. The participants were selected through multi-stage cluster sampling. Half of the participants (treatment group) had their personal clothes worn on a daily basis (<it>Diras, Saris, Jalbaab</it>s, <it>Ma'awis </it>and shirts) and their bedding (sheets and blankets) treated with insecticide (permethrin). The other half (comparison group) had their clothes treated with placebo (plain water). Indoor mosquito density was determined from twelve households belonging to the participants; six in the treatment block and six in the comparison block. During pre-test and post-test, laboratory analysis of blood samples was done, indoor mosquito density determined and questionnaires administered. Using STATA statistical package, tests for significant difference between the two groups were conducted.</p> <p>Results</p> <p>Use of ITCs reduced both malaria infection rates and indoor mosquito density significantly. The odds of malaria infection in the intervention group were reduced by about 70 percent. The idea of using ITCs for malaria infection control was easily accepted among the refugees and they considered it beneficial. No side effects related to use of the ITCs were observed from the participants.</p> <p>Conclusion</p> <p>The use of ITCs reduces malaria infection rate and has potential as an appropriate method of malaria control. It is recommended, therefore, that this strategy be considered for use among poor communities like slum dwellers and other underprivileged communities, such as street children and refugees, especially during an influx to malaria-prone regions. Further research on cost-effectiveness and sustainability of this strategy is worthwhile.</p

Predictors of overweight and obesity in adult women in Nairobi Province, Kenya

<p>Abstract</p> <p>Background</p> <p>Since obesity in urban women is prevalent in Kenya the study aimed to determine predictors of overweight and obesity in urban Kenyan women.</p> <p>Methods</p> <p>A cross-sectional study was undertaken in Nairobi Province. The province was purposively selected because it has the highest prevalence of overweight and obesity in Kenya.</p> <p>A total of 365 women aged 25–54 years old were randomly selected to participate in the study.</p> <p>Results</p> <p>Higher age, higher socio-economic (SE) group, increased parity, greater number of rooms in the house, and increased expenditure showed greater mean body mass index (BMI),% body fat and waist circumference (WC) at highly significant levels (p <0.001). Most of the variance in BMI was explained by age, total physical activity, percentage of fat consumed, parity and SE group in that order, together accounting for 18% of the variance in BMI. The results suggest that age was the most significant predictor of all the dependent variables appearing first in all the models, while parity was a significant predictor of BMI and WC. The upper two SE groups had significantly higher mean protein (p <0.05), cholesterol (p <0.05) and alcohol (p <0.001) intakes than the lower SE groups; while the lower SE groups had significantly higher mean fibre (p <0.001) and carbohydrate (p <0.05) intakes. A fat intake greater than 100% of the DRI dietary reference intake (DRI) had a significantly greater mean BMI (p <0.05) than a fat intake less than the DRI.</p> <p>Conclusions</p> <p>The predictors of overweight and obesity showed that urbanization and the nutrition transition were well established in the sample of women studied in the high SE groups. They exhibited a sedentary lifestyle and consumed a diet high in energy, protein, fat, cholesterol, and alcohol and lower in fibre and carbohydrate compared with those in the low SE groups.</p