Factors affecting the uptake of Exclusive Breastfeeding (EBF) in Kisumu East District, Kenya

Exclusive breastfeeding (EBF) the best means of infant nutrition. This is because it offers great benefits to maternal and child health in general, including prevention of vertical transmission of HIV/ AIDS. This study sought to identify the factors associated with the uptake of EBF among mothers with children aged 0-<6 months. Overall, the uptake of EBF was higher than is seen in other countries in Africa and across the globe. Binary logistic regression identified having male children and ownership of certain assets as positive predictors of EBF uptake. Absence of a chronic disease and knowledge of cultural and traditional practices surrounding EBF were shown to be negatively associated with uptake of EBF. Keywords: breastfeeding, child health, maternal healt

Health Seeking behavior; perspective of the Marginalized Somali Community in Garissa County, a Semi-Arid Region of North Eastern Kenya

Appropriate medical care seeking could prevent a significant number of deaths and complications due to ill health. Unfortunately, healthcare seeking behaviors (HSB) differs according to place, the affected, disease types, beliefs and the opportunities to seek care. These decisions are not isolated to individuals but are embedded in a broader household and social organizational decision process and the capacity to allow seeking of care. This descriptive cross-sectional community-based study used a multistage cluster sampling method to enrol consenting adults from different households located in the seven (7) sub-counties in Garissa County. The data were collected by interviewing 405 adult population and the answers reported in pretested structured questionnaires. Among the surveyed respondents, the mean age (±SD) was 35.17 (12.9) years, 68.1% had no formal education, 72.8% were female and 81.2% were married. Health care seeking during the latest illness was reported by three quarters of the respondents (n=293, 72.3%). The treatment or advice during the latest illness was sought by the majority in the Government / public hospitals (n=226, 55.5%), followed by in the private hospitals (n= 37, 9.1%) and among Traditional or homeopathic or spiritual healers (n = 28, 6.9%). In multivariate analysis, household headship, possession of health insurance, reasons for choosing preferred healthcare facility, durations prior to seeking treatment and the perceived three common illnesses in the community were associated with seeking treatment during the latest illness both in any of the healthcare facility and in the government/public hospitals. Gender, occupation and reasons for choosing preferred healthcare facility independently influenced seeking treatment during the latest illness both in any of the health facility and in private hospitals.  Durations prior to seeking treatment was the only independent factor associated with seeking treatment both in any of the healthcare facility and among Traditional or homeopathic or spiritual healers. During the latest illnesses among this marginalized population, appropriate health seeking behavior was significantly high with the majority preferring the government/public facilities. Gender, occupation, household headship, possession of health insurance, reasons for choosing preferred hospital, availability and the preference of current health facility, duration with illness and perceived illnesses in the community are the predictors of HSB. Improvement in education, health facilities and medical services in the community, introduction of community based integrated management of common community illness are imperative to improve HSB among the Somali community in this Semi-arid region of Kenya. Keywords: Health seeking, Latest illnesses, Somali community, Semi-arid County of Keny

Modelling protection behaviour towards micronutrient deficiencies: case of iodine biofortified vegetable legumes as health intervention for school-going children

BACKGROUND/OBJECTIVES: Despite successes recorded in combating iodine deficiency, more than 2 billion people are still at risk of iodine deficiency disorders. Rural landlocked and mountainous areas of developing countries are the hardest hit, hence the need to explore and advance novel strategies such as biofortification. SUBJECTS/METHODS: We evaluated adoption, purchase, and consumption of iodine biofortified vegetable legumes (IBVL) using the theory of protection motivations (PMT) integrated with an economic valuation technique. A total of 1,200 participants from three land-locked locations in East Africa were recruited via multi-stage cluster sampling, and data were collected using two, slightly distinct, questionnaires incorporating PMT constructs. The survey also elicited preferences for iodine biofortified foods when offered at a premium or discount. Determinants of protection motivations and preferences for iodine biofortified foods were assessed using path analysis modelling and two-limit Tobit regression, respectively. RESULTS: Knowledge of iodine, iodine-health link, salt iodization, and biofortification was very low, albeit lower at the household level. Iodine and biofortification were not recognized as nutrient and novel approaches, respectively. On the other hand, severity, fear, occupation, knowledge, iodine status, household composition, and self-efficacy predicted the intention to consume biofortified foods at the household level; only vulnerability, self-efficacy, and location were the most crucial elements at the school level. In addition, results demonstrated a positive willingness-to-pay a premium or acceptance of a lesser discount for biofortification. Furthermore, preference towards iodine biofortified foods was a function of protection motivations, severity, vulnerability, fear, response efficacy, response cost, knowledge, iodine status, gender, age. and household head. CONCLUSIONS: Results lend support for prevention of iodine deficiency in unprotected populations through biofortification; however 'threat' appraisal and socio-economic predictors are decisive in designing nutrition interventions and stimulating uptake of biofortification. In principle, the contribution is threefold: 1) Successful application of the integrated model to guide policy formulation; 2) Offer guidance to stakeholders to identify and tap niche markets; 3) stimulation of rural economic growth around school feeding programmes

Uptake and Emerging Issues Surrounding Hospital Deliveries Services. Perspective of One General Hospital Located in Arid and Insecure Garissa County of North Eastern Kenya

Background: Increasing the percentage of births delivered in health facilities is important for reducing the relatively high maternal mortality ratio in Kenya. Despite the increasing availability in awareness, affordability, modernization of formal obstetric care in Kenya, the majority of births in Garissa County still occur at home assisted by unskilled traditional birth attendants (TBAs). The objective of this study was to determine the factors affecting uptake of hospital delivery services by attending or receiving various services at Garissa Provincial General Hospital (GPGH).  Methodology: Data on place of delivery, reasons for place of delivery, and a range of potential explanatory factors affecting choice of place of delivery were collected by interviewer-led questionnaire among 338 women attending GPGH. Predictors of place of delivery were explored in an exploratory risk factor analysis using multiple logistic regression. Results: The mean age of the 338 women respondents was 27.03 (SD± 4.66) years, ranging from 17 to 48 years. The majority of the women, 71.6%, were aged between 21 to 30 years, 32.8% had tertiary level education, 86.1% were married, 62.4% attended the GPGH for antenatal care services, and 56.2% were currently pregnant. Three quarters (76.3%) had previously delivered at the GPGH. In multivariate analysis, women who were nulliparous (OR 0.2, 95% CI 0.09 to 0.6), delivered in the hospital in the last 2 years (OR 12.8, 95% CI 5.1 to 32.4) or 3 years ago (OR 13.1, 95% CI 4.9 to 34.4) or those who liked the cleanliness of the hospital (OR 1.9, 95% CI 1.1 to 3.7) and appreciated hospital due to availability of medical supplies (OR 1.8, 95% CI 1.1 to 3.3) were independently associated with utilization of the health facility.Conclusion: A high proportion of women from the county embraced hospital delivery. Among the factors positively affecting uptake of health services in the facility antenatal were hospital cleanliness, equipment and medical supply availability and improved privacy. Keywords: Hospital Delivery, Uptake and emerging issues, Garissa County of North Eastern Kenya

Physical characteristics, proximate composition and anti-nutritional factors in grains of lablab bean (Lablab purpureus) genotypes from Kenya

Objectives: The objectives of this study were to determine the physical characteristics, nutritional composition and anti-nutritional factors of grains from three lablab bean varieties with different colours and size developed by The Kenya Agricultural and Livestock Research Organisation (KALRO)Methodology and results: The length, thickness and width were determined using Vernier callipers. Dry matter, protein, fat and ash were determined using standard association of official analytical chemists (AOAC) methods. Phytates were determined using high performance liquid chromatography (HPLC), while the tannins and trypsin inhibition were determined by UV spectrophotometry. The mean 100 seed weight was significantly different among the three varieties, and ranged from 26.1 g to 29.2 g. The length, thickness and width ranged from 9.7 for KAT/DL-3 to 10.7 mm for KAT/DL-1, 5.2 (KAT/DL-1) to 5.6 mm (KAT/DL-2) and 6.8 (KAT/DL-3) to 7.4 mm (KAT/DL-1), respectively. The hydration and swelling coefficients of the beans ranged from 130.7 in KAT/DL-2 to 147.2 in KAT/DL-1, and 125.1 in KAT/DL-2 to 153.3 (KAT/DL-1), respectively. The mean crude protein and energy contents varied from 22.5(KAT/DL-3) to 25.4 %,( KAT/DL-1) and 347.4 (KAT/DL-3) to 353.7 KCal/100g in KAT/DL-1, respectively, and differed significantly (p<0.05) among the varieties. There were significant differences (p<0.05) in the phytic acid and tannin levels, where KAT/DL-2 recorded the highest levels of 723.6 mg/100 g, and 0.33%CE, respectively.Conclusion and application of findings: These results indicate that KAT/DL-1 has the best physical characteristics in respect to cooking and nutrition quality. This variety had the highest protein and energy content with low anti-nutritional factors, thus could offer better nutritive value in comparison to KATDL-2 and KAT/DL-3Keywords: Lablab beans, varieties, proximate composition, physical parameters, anti-nutritional factor

Dental caries and oral health practices among 12 year old children in Nairobi West and Mathira West Districts, Kenya

Background: Dental caries is a common disease in children which causes pain with resultant effect on various physiological and social functions. The main objective of the study was to determine the association between dental caries and oral health knowledge and practice among children in Nairobi West and Mathira West Districts. Methods: A cross-sectional study was conducted among 639 children aged 12 years attending public primary schools in Nairobi West and Mathira West districts between August 2009-February 2010. A questionnaire was used to determine the level of knowledge and practices employed. Oral screening was performed using World Health Organisation (WHO) recommended methods. Dental caries was measured using the Decayed, Missing, Filled Teeth (DMFT) index. Results: Nairobi West District had significantly higher caries prevalence of 37.5% than Mathira West District (24.0%). The DMFT in Nairobi West District was 0.76 ± 1.2, while in Mathira West District it was 0.36 ± 0.7. On multivariate analysis high consumption of soda was found to be a significant risk factor for dental caries in Nairobi West District(Odds Ratio (OR) = 3.0). In Mathira West District having an illiterate mother was a significant risk factor for dental caries (OR=4.3). Conclusion: Countrywide intensive oral health promotion should be carried out especially in urban areas, to reduce the higher prevalence of dental caries. The school health policy should be used to promote oral health by provision of oral health instructions and highlighting harmful dietary practices. Preventive practices such as regular dental checkups should be advocated and promoted in schools.Pan African Medical Journal 2012; 12:4

Impact of Storage Conditions on the Physical Properties and Cooking Characteristics of Two Bean Varieties Grown in Kenya

Common beans are highly nutritious and widely consumed in Kenya. Storage of common beans under adverse conditions of high temperature and high humidity renders them susceptible to the hard-to-cook (HTC) defect. This results in increased cooking time, fuel and water use which has a negative effect on acceptability and utilization of beans. The objective of this study was to determine effects of storage temperature and relative humidity on development of the HTC defect in Rose coco and Red Kidney bean varieties. Bean samples were obtained from Kenya Agricultural and Livestock Research Organization (K ALRO) - Thika. The beans were stored at varying temperature (25ºC, 35˚ C and 45˚ C) and relative humidity (RH=75% and 83%) combinations. Apart from beans stored at 25ºC/75%, samples from each treatment condition were sampled after every two months and analyzed for physical properties. Soaking pretreatments in deionized water, sodium carbonate and calcium chloride solutions were carried out to determine their effect on the cooking time. There was a significant increase in conductivity and leached solutes paralleled by decreasing hydration and swelling coefficients with increasing storage time under all the storage conditions. Characteristic dimensions and one hundred seed weight were not significantly different among the bean varieties under various storage conditions. Moisture uptake reduced by 19% for Rose coco and 23% for Red kidney under 35˚C/83%  storage whereas 45˚C/75% had a 29% reduction for Rose coco and 39% reduction for Red kidney over the 6 months storage period. Cooking time increased for all the bean varieties with increasing storage time, the most pronounced increase (100%) being observed at 45˚C and 75% RH. Across the 6 months storage period, Na2CO3 soaking pretreatment reduced the cooking time by 75% for Rose coco and 70% for Red kidney in comparison to beans cooked without prior soaking. Based on the results of this study, it was concluded that storage under high temperature and relative humidity conditions accelerated the development of the HTC defect in beans resulting in changes in physical and cooking properties. Keywords: hard-to-cook, storage, physical properties, cooking qualit

Efficacy of mid-upper arm circumference in identification, follow-up and discharge of malnourished children during nutrition rehabilitation

BACKGROUND/OBJECTIVES: Although it is crucial to identify those children likely to be treated in an appropriate nutrition rehabilitation programme and discharge them at the appropriate time, there is no golden standard for such identification. The current study examined the appropriateness of using Mid-Upper Arm Circumference for the identification, follow-up and discharge of malnourished children. We also assessed its discrepancy with the Weight-for-Height based diagnosis, the rate of recovery, and the discharge criteria of the children during nutrition rehabilitation. SUBJECTS/METHODS: The study present findings from 156 children (aged 6-59 months) attending a supplementary feeding programme at Makadara and Jericho Health Centres, Eastern District of Nairobi, Kenya. Records of age, weight, height and mid-upper arm circumference were selected at three stages of nutrition rehabilitation: admission, follow-up and discharge. The values obtained were then used to calculate z-scores as defined by WHO Anthro while estimating different diagnostic indices. RESULTS: Mid-upper arm circumference single cut-off (<12.5 cm) was found to exhibit high values of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio at both admission and discharge. Besides, children recorded higher rate of recovery at 86 days, an average increment of 0.98 cm at the rate of 0.14mm/day, and a weight gain of 13.49gm/day, albeit higher in female than their male counterparts. Nevertheless, children admitted on basis of low MUAC had a significantly higher MUAC gain than WH at 0.19mm/day and 0.13mm/day respectively. CONCLUSIONS: Mid-upper arm circumference can be an appropriate tool for identifying malnourished children for admission to nutrition rehabilitation programs. Our results confirm the appropriateness of this tool for monitoring recovery trends and discharging the children thereafter. In principle the tool has potential to minimize nutrition rehabilitation costs, particularly in community therapeutic centres in developing countries

Nutritional Status of Adolescent and Adult PLWHA on Anti-Retroviral Treatment, Attending Various Comprehensive Care Centres in Nairobi County, Kenya

Background: Maintaining nutritional needs of People Living with HIV and AIDS (PLWHA) who are on Anti-Retroviral Treatment (ART) helps to strengthen their immune system and optimize response to medical treatment. The main objective of this study was to assess the nutritional status PLWHA on ART and the associated factors. Methodology: This was a cross-sectional study where 454 adolescent and adult PLWHA on ART were randomly selected and consent obtained to join the study. Structured interviewer-administered questionnaires were used to gather data on their socio-economic characteristics, the types of food consumed in the last 24 hours and their Body Mass Index. The data was organized and analysed using SPSS version 17.0. Variables were categorized and Chi-square statistical test used to assess association where a p-value of less than or equal to 0.05 was considered statistically significant. Results: A total of 454 PLWHA were recruited into the study and 180 (39.6%) were males while 274 (60.4%) were females giving a Male: Female ratio of 1: 1.5. Over three quarters (77%) had attained secondary education and above. The main sources of income were employment (48.5%) and business (44.9%). The types of foods consumed were beans and beef for body building (proteins); Ugali (maize meal) and rice for energy (Carbohydrates); kales and cabbages (vegetables), bananas and pineapples (fruits) as protective foods. Over half (51.1%) were overweight/obese. Sources of income and the monthly earnings were significantly associated with the overweight/obesity. Conclusion: The PLWHAs’ sources of income and monthly earnings had statistical significance on their nutritional status (BMI) of being over-weight/obese. However, other factors such as: ART’s ability to decrease resting-energy expenditure and basal metabolic rate resulting in replenishment of muscle bulk and hence weight gain; or intentional over-eating to avoid the stigmatized weight loss which is often “associated” with being HIV positive may have had a part to play. Keywords: PLWHA; ART; Nutritional status (BMI); food groups and consumption; food availability, affordability and use