Food Safety Characterization of Food Enterprises for Inclusive Nutrition Sensitive Value Chain Development in Sub-Saharan Africa. A Case Study of the Orange Fleshed Sweet Potato Value Chain in Kenya

Food safety receives minimal attention and only captures national attention during foodborne disease outbreaks. The objective of this study was to explore the knowledge, attitudes and practices on food safety aspects related to Orange Fleshed Sweet potato (OFSP) along the food value chain in Kenya. A cross-sectional study was designed and investigated food safety knowledge, attitudes and practices (KAP) among the OFSP processors, traders, and consumers of street foods in Kenya. A socio-demographic questionnaire and KAP questionnaire were used as data collection instruments. The study included OFSP traders OFSP puree processors, large retailer’s bakeries and consumers in Nairobi. The OFSP traders included were the suppliers of OFSP in the markets around Nairobi city. The OFSP consumers included the people who buy cooked OFSP from the street vendors in Nairobi city. Descriptive statistics such as percentage means and standard deviation were used to summarize the socio-demographic data and the knowledge, attitude, practices, and overall KAP. Pearson’s correlation was used to establish an association of the three study components. Adjusted linear regression was used to assess the effect of food safety on knowledge, attitude, and practices. Knowledgeable, positive attitude and good practice on food safety were considered for mean scores above 80%. Statistical significance was set at p < 0.05. The findings from the OFSP processors revealed a mean percentage score for knowledge, attitude, practices at 70.7%, 93.5%, and 90%, respectively, with an overall mean score of 84.6%.  Lower education level was statistically significantly associated with food safety practices at p = 0.002. Adjusted linear regression found a significant effect of food safety on knowledge at p<0.001.  Adjusted multiple regression revealed that age was statistically significantly associated with food safety knowledge, and food safety attitude (both at p <0.001).  Education level was significantly associated with food safety practices (p<0.001). Findings from OFSP traders revealed mean percentage scores for knowledge, attitude, practices at 63.1%, 74.4%, and 64.7%, respectively, with an overall mean score of 67.4%.  Pearson’s correlation analysis revealed a strong positive correlation between food safety attitude and food safety practice p= 0.015. Similarly, a strong positive correlation between food safety practice and food safety knowledge was noted (p <0.001). Adjusted linear regression found that Food safety practice was significantly impacted by both knowledge and attitude R2=0.578 F=49.6 p=0.000. Results from OFSP consumers revealed mean percentage scores for knowledge, attitude, practices at 66.2%, 87.3%, and 91.6%, respectively with an overall mean score of 81.7%. Lower education level was statistically significantly associated with inappropriate practices among OFSP consumers p = 0.040. Pearson’s correlation analysis revealed a week positive correlation between food safety knowledge attitude and practice. : This study reveals a gap in the area of food safety knowledge, attitude, and practice along the OFSP value chain. The study highlights the need for policymakers to address and review the knowledge, attitude, and practices in the food industry, to raise food safety awareness campaigns and organize more targeted training along the food chains to reduce the foodborne disease burden. Keywords: Food safety, Knowledge, attitude, practices, processor, traders, consumers DOI: 10.7176/FSQM/110-05 Publication date:September 30th 202

Cultural and contextual adaptation of mental health measures in Kenya: An adolescent-centered transcultural adaptation of measures study

Introduction: There is paucity of culturally adapted tools for assessing depression and anxiety in children and adolescents in low-and middle-income countries. This hinders early detection, provision of appropriate and culturally acceptable interventions. In a partnership with the University of Nairobi, Nairobi County, Kenyatta National Hospital, and UNICEF, a rapid cultural adaptation of three adolescent mental health scales was done, i.e., Revised Children’s Anxiety and Depression Scale, Patient Health Questionnaire-9 and additional scales in the UNICEF mental health module for adolescents. Materials and methods: Using a qualitative approach, we explored adolescent participants’ views on cultural acceptability, comprehensibility, relevance, and completeness of specific items in these tools through an adolescent-centered approach to understand their psychosocial needs, focusing on gender and age-differentiated nuances around expression of distress. Forty-two adolescents and 20 caregivers participated in the study carried out in two primary care centers where we conducted cognitive interviews and focused group discussions assessing mental health knowledge, literacy, access to services, community, and family-level stigma. Results: We reflect on process and findings of adaptations of the tools, including systematic identification of words adolescents did not understand in English and Kiswahili translations of these scales. Some translated words could not be understood and were not used in routine conversations. Response options were changed to increase comprehensibility; some statements were qualified by adding extra words to avoid ambiguity. Participants suggested alternative words that replaced difficult ones and arrived at culturally adapted tools. Discussion: Study noted difficult words, phrases, dynamics in understanding words translated from one language to another, and differences in comprehension in adolescents ages 10–19 years. There is a critical need to consider cultural adaptation of depression and anxiety tools for adolescents. Conclusion: Results informed a set of culturally adapted scales. The process was community-driven and adhered to the principles of cultural adaptation for assessment tools

Risk factors and experiences of prepartum depression in urban- low-income settlement Nairobi Kenya: a mixed-method study [version 3; peer review: 2 approved]

Background: Prepartum depression is common among pregnant women and has not been studied much in low and middle-income countries. Evidence shows that mental illnesses are prevalent in urban than in rural areas. The study objective was to determine the magnitude of prepartum depression, risk factors, and real-life experiences of depression among pregnant women. Method: A mixed-method cross-sectional study was conducted. It included 262 pregnant women attending antenatal clinics in two public health facilities in urban low-income settlement Nairobi, Kenya. Edinburgh Postnatal Depression Scale (EPDS) with cut-off >13 was used to classify clinical depressive illness. Further, a focus group discussion was conducted with 20 women identified with depression. Univariable analysis with Odd's Ratio was used to test associations. Variables with a p13. Women's gestational age was statistically significantly associated with prepartum depression [OR 4.27 (95% C.I. 2.08 - 8.79), p < 0.001]. Income level ≤ 5000 KES was statistically significantly associated with prepartum depression [OR 3.64 (95% C.I.1.25 -10.60), p=0.018]. Further, thematic analysis of qualitative indicated that poverty, lack of social support, domestic violence, and unfriendly health care were major contributors to prepartum depression. Conclusion: Significant numbers of pregnant women were found to experience depression. This prevalence rate indicates a high disease burden of women who live with depression, which is not diagnosed because screening of depression is not done in primary health care centers. This study calls for a need and consideration for screening for perinatal depression in primary health care facilities, mainly in resource-poor areas. Interventions targeting means of resolving conflicts in families are highly needed. Such steps would help achieve key sustainable development goals where maternal and child health remains key priority

Shifting parental roles, caregiving practices and the face of child development in low resource informal settlements of Nairobi: experiences of community health workers and school teachers

Abstract Approximately, 42% of the Kenyan population live below the poverty line. Rapid growth and urbanization of Kenya’s population have resulted in a changing poverty and food security environment in high-density urban areas. Lack of basic food needs in Kenya affects approximately 34.8% rural population and 7.6% of its urban population. Using multi-community stakeholders such as teachers and community health workers (CHWs), this paper examined food insecurity and its consequences on caregiving practices and child development. A qualitative study design was utilized. Key informant interviews and focused-group discussions with four primary school teachers and three CHWs and a nurse in-charge working within Kariobangi and Kangemi were applied to elicit various perspectives from family-, school- and community-level challenges that influence caregiving practices and child development. Grounded theory method was applied for qualitative data sifting and thematic analysis. Our findings exposed various challenges at the school, family and the community levels that affect caregiving practices and consequent child development. School-level challenges included lack of adequate amenities for effective learning, food insecurity, absenteeism and mental health challenges. Family-level barriers included lack of parenting skills, financial constraints, domestic violence and lack of social support, while community challenges such as unemployment, poor living conditions, cultural practices, lack of social support and poor community follow-up mechanisms contributed to poor parenting practices and child development. Parenting practices and holistic child development strategies in resource poor settings should focus on parenting skills, food security, quality education and addressing parents and children’s mental health challenges

Nutritional factors associated with maternal depression among pregnant women in Urban Low-Income Settlements in Nairobi, Kenya

Abstract: Background: Nutritional deficiencies are common during pregnancy and a year after childbirth. At the same time, maternal depression affects many women during pregnancy up to 1 year after childbirth. The objectives of this study were to determine the associations between nutrition status, dietary intake, and maternal depression among pregnant women. Methods: This was a cross-sectional study that included 262 pregnant women aged 15 to 49 years attending the antenatal clinic in 2 public health facilities in urban low-income settlements in Nairobi, Kenya. Maternal depression was assessed using Edinburgh Postnatal Depression Scale (EPDS). Mid-upper arm circumference (MUAC) was used to determine nutritional status. Dietary intake was assessed using the 24-hour recall, and brain essential nutrients were assessed through a questionnaire. Odds ratio was used to test the associations. All maternal characteristics with P \u3c .001 in the univariable analysis were considered in the multivariable logistic regression, variables with P \u3c .05 were considered significant. Results: Of the 262 pregnant women, 33.6% (95% CI: 27.9-40.7) had depressive illness as indicated by EPDS \u3e13. About 9.9% of pregnant women had MUAC \u3c 23 cm. The study established statistically significant association between poor nutrition by MUAC and maternal depression (P \u3c .001). Maternal depression was statistically significantly associated with inadequate intake of brain food essential (P = .002). Maternal depression was statistically significantly associated with lower income (P \u3c .001). In multivariable regression analysis, the main predictor of maternal depression was poor nutrition (P \u3c .004). Conclusion: These findings reveal an association between poor nutrition and maternal depression. These results suggest that nutritional deficiencies could be a contributing factor for maternal depression. Study recommends dietary interventions as cost-effective way to reduce deficiencies and improve mental health problems for pregnant women. Assessment of maternal depression and dietary intake be integrated as fundamental components of antenatal care

Attachment and Its Social Determinants, Kenyan Child and Adolescent Perspective from Two Informal Settlements in Nairobi: A Qualitative Study

Abstract: There has been a sustained interest in examining social determinants of health (SDH) for late childhood and adolescence to shift the focus from individual risk factors to social patterns, material conditions and to improve long-term health outcomes. This study offers an opportunity to look at the number of risk and protective factors associated with SDH using children\u27s narratives around their attachment relationships. The research was carried out in Kariobangi and Kangemi health centers of Nairobi County, Kenya. All 83 participants were recruited from the community with the assistance of community health workers. Fifty-seven percent of participants were girls; 65.1% of ages 12–14 and 34.9% of ages 8–11 years. Child Attachment Interview (Target et al., 2003) was used to study attachment security as well as adolescents’ understanding of their relational and social world. Inductive thematic analysis was informed by preexisting themes identified from the literature on “risk” and “protective” factors within different layers of SDH and focused on identifying children’s understanding and appraisals of those factors. Secure attachment with both parents had 37.3% of participants 33.7% had insecure attachment with one parent, and 28.9% had insecure attachment with both parents. The overarching themes included poverty, parenting, religion, and schooling. Some factors commonly classified as protective or risk factors were described and appraised by children as a more complex and multidimensional phenomenon. Apart from it, these factors appeared interconnected and interrelated with each other on different levels of SDH

Mechanisms associated with maternal adverse childhood experiences on offspring’s mental health in Nairobi informal settlements: a mediational model testing approach

Abstract Background Adverse childhood experiences (ACEs) is a significant public health and social welfare problem in low-and middle income countries (LMICs). However, most ACEs research is based on developed countries, and little is known about mechanisms of early ACEs on adulthood health and offspring’s wellbeing for populations in LMICs. This area is needed to guide social welfare policy and intervention service planning. This study addresses these research gaps by examining patterns of ACEs and understanding the role of ACEs on adulthood health (i.e., physical, mental health, experience of underage pregnancy) and offspring’s mental health in Kenya. The study was guided by an Integrated Family Stress and Adverse Childhood Experiences Mediation Framework. Methods Three hundred ninety four mothers from two informal communities in Kariobangi and Kangemi in Nairobi were included in this study. The Adverse Childhood Experiences International Questionnaire (ACE-IQ), the Kessler Psychological Distress Scale (K10), Overall Health and Quality of Life items, and Child Behavior Checklist were used to study research questions. Data was gathered through a one-time interview with mothers. Structural Equational Modeling (SEM) was applied for mediational mechanism testing. Results Among 13 ACE areas, most mothers experienced multiple adversity during their childhood (Mean (SD) = 4.93 (2.52)), with household member treated violently (75%) as the most common ACE. SEM results showedthat all domains of ACEs were associated with some aspects of maternal health, and all three domains of maternal health (maternal mental health, physical health, and adolescent pregnancy) were significantly associated with development of offspring’s mental health problems. Conclusion ACEs are highly prevalent in Kenyan informal settlements. Consistent with cross cultural literature on family stress model, maternal ACEs are robust predictors for poor child mental health. Preventive interventions for child mental health need to address maternal adverse childhood traumatic experiences as well as their current health in order to effectively promote child mental health

MOESM1 of Postpartum depression and infant feeding practices in a low income urban settlement in Nairobi-Kenya

Additional file 1. Dataset of postpartum depression, infant feeding and child nutritional status study

Cultural and contextual adaptation of mental health measures in Kenya: An adolescent-centered transcultural adaptation of measures study.

INTRODUCTION: There is paucity of culturally adapted tools for assessing depression and anxiety in children and adolescents in low-and middle-income countries. This hinders early detection, provision of appropriate and culturally acceptable interventions. In a partnership with the University of Nairobi, Nairobi County, Kenyatta National Hospital, and UNICEF, a rapid cultural adaptation of three adolescent mental health scales was done, i.e., Revised Childrens Anxiety and Depression Scale, Patient Health Questionnaire-9 and additional scales in the UNICEF mental health module for adolescents. MATERIALS AND METHODS: Using a qualitative approach, we explored adolescent participants views on cultural acceptability, comprehensibility, relevance, and completeness of specific items in these tools through an adolescent-centered approach to understand their psychosocial needs, focusing on gender and age-differentiated nuances around expression of distress. Forty-two adolescents and 20 caregivers participated in the study carried out in two primary care centers where we conducted cognitive interviews and focused group discussions assessing mental health knowledge, literacy, access to services, community, and family-level stigma. RESULTS: We reflect on process and findings of adaptations of the tools, including systematic identification of words adolescents did not understand in English and Kiswahili translations of these scales. Some translated words could not be understood and were not used in routine conversations. Response options were changed to increase comprehensibility; some statements were qualified by adding extra words to avoid ambiguity. Participants suggested alternative words that replaced difficult ones and arrived at culturally adapted tools. DISCUSSION: Study noted difficult words, phrases, dynamics in understanding words translated from one language to another, and differences in comprehension in adolescents ages 10-19 years. There is a critical need to consider cultural adaptation of depression and anxiety tools for adolescents. CONCLUSION: Results informed a set of culturally adapted scales. The process was community-driven and adhered to the principles of cultural adaptation for assessment tools

Cultural and contextual adaptation of mental health measures in Kenya : An adolescent-centered transcultural adaptation of measures study

Introduction: There is paucity of culturally adapted tools for assessing depression and anxiety in children and adolescents in low-and middle-income countries. This hinders early detection, provision of appropriate and culturally acceptable interventions. In a partnership with the University of Nairobi, Nairobi County, Kenyatta National Hospital, and UNICEF, a rapid cultural adaptation of three adolescent mental health scales was done, i.e., Revised Children’s Anxiety and Depression Scale, Patient Health Questionnaire-9 and additional scales in the UNICEF mental health module for adolescents. Materials and methods: Using a qualitative approach, we explored adolescent participants’ views on cultural acceptability, comprehensibility, relevance, and completeness of specific items in these tools through an adolescent-centered approach to understand their psychosocial needs, focusing on gender and age-differentiated nuances around expression of distress. Forty-two adolescents and 20 caregivers participated in the study carried out in two primary care centers where we conducted cognitive interviews and focused group discussions assessing mental health knowledge, literacy, access to services, community, and family-level stigma. Results: We reflect on process and findings of adaptations of the tools, including systematic identification of words adolescents did not understand in English and Kiswahili translations of these scales. Some translated words could not be understood and were not used in routine conversations. Response options were changed to increase comprehensibility; some statements were qualified by adding extra words to avoid ambiguity. Participants suggested alternative words that replaced difficult ones and arrived at culturally adapted tools. Discussion: Study noted difficult words, phrases, dynamics in understanding words translated from one language to another, and differences in comprehension in adolescents ages 10–19 years. There is a critical need to consider cultural adaptation of depression and anxiety tools for adolescents. Conclusion: Results informed a set of culturally adapted scales. The process was community-driven and adhered to the principles of cultural adaptation for assessment tools