Health and Nutritional Status of Children in Western Kenya in Relation to Vitamin A Deficiency

A cross-sectional study was conducted from September to December 1998 among 300 children aged 1-3 years in Bungoma district of western Kenya. This is an area endemic for malaria with a high prevalence of vitamin A deficiency. In 1993 the prevalence of vitamin A deficiency was 37.8%. In the present study effects of vitamin A deficiency on health and growth of children were studied. Twenty-nine percent (29%) of the children had severe vitamin A deficiency 92% had anaemia, 76% had malaria parasitaemia and 21% were stunted. Anthropometric measures significantly correlated with haemoglobin concentration (P value <0.0001). There was significant difference in the retinol levels of the stunted and normal children (P value = 0.02). Retinol concentration differed significantly among children with high and low C-reactive protein (P = 0.0004). Vitamin A deficiency and anaemia are a public health problem among the children studied. High prevalence of vitamin A deficiency and anaemia was associated with impaired growth

Factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis in national referral hospitals in Kenya : a mixed-methods survey

CITATION: Opiyo, R. O., et al. 2019. Factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis in national referral hospitals in Kenya : a mixed-methods survey. Renal Replacement Therapy, 5:41, doi:10.1186/s41100-019-0237-4.The original publication is available at https://rrtjournal.biomedcentral.comIntroduction: Adherence to dietary prescriptions among patients with chronic kidney disease is known to prevent deterioration of kidney functions and slow down the risk for morbidity and mortality. This study determined factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis. Methods: A mixed-methods study, using parallel mixed design, was conducted at the renal clinics and dialysis units at the national teaching and referral hospitals in Kenya from September 2018 to January 2019. The study followed a QUAN + qual paradigm, with quantitative survey as the primary method. Adult patients with chronic kidney disease on hemodialysis without kidney transplant were purposively sampled for the quantitative survey. A sub-sample of adult patients and their caregivers were purposively sampled for the qualitative survey. Numeric data were collected using a structured, self-reported questionnaire using Open Data Kit “Collect software” while qualitative data were collected using in-depth interview guides and voice recording. Analysis on STATA software for quantitative and NVIV0 12 for qualitative data was conducted. The dependent variable, “adherence to diet prescription” was analyzed as a binary variable. P values < 0.1 and < 0.05 were considered as statistically significant in univariate and multivariate logistic regression models respectively. Qualitative data were thematically analyzed. Results: Only 36.3% of the study population adhered to their dietary prescriptions. Factors that were independently associated with adherence to diet prescriptions were “flexibility in the diets” (AOR 2.65, 95% CI 1.11–6.30, P 0.028), “difficulties in following diet recommendations” (AOR 0.24, 95% CI 0.13–0.46, P < 001), and “adherence to limiting fluid intake” (AOR 9.74, 95% CI 4.90–19.38, P < 0.001). Conclusions: For patients with chronic kidney disease on hemodialysis, diet prescriptions with less restrictions and requiring minimal extra efforts and resources are more likely to be adhered to than the restrictive ones. Patients who adhere to their fluid intake restrictions easily follow their diet prescriptions. Prescribed diets should be based on the individual patient’s usual dietary habits and assessed levels of challenges in using such diets. Additionally, diet adherence messages should be integrated with fluid limitation messages. Further research on understanding patients’ adherence to fluid restriction is also suggested.Publisher's versio

Perceptions on Adherence to Dietary Prescriptions for Adults with Chronic Kidney Disease on Hemodialysis: A Qualitative Study

Diet is one of the modifiable lifestyle factors in management of kidney disease. We explored perceptions on adherence to dietary prescriptions for adults with chronic kidney disease on hemodialysis. This was a qualitative descriptive study. Participants were purposively selected at renal clinics/dialysis units at national referral hospitals in Kenya. Data were collected using in-depth interviews, note-taking and voice-recording. The data were managed and analyzed thematically in NVIV0-12 computer software. Study participants were 52 patients and 40 family caregivers (42 males and 50 females) aged 20 to 69 years. Six sub-themes emerged in this study: &ldquo;perceived health benefits&rdquo;; &ldquo;ease in implementing prescribed diets&rdquo;; &ldquo;cost of prescribed renal diets&rdquo;; &ldquo;nutrition information and messages&rdquo;; &ldquo;transition to new diets&rdquo; and &ldquo;fear of complications/severity of disease&rdquo;. Both patients and caregivers acknowledged the health benefits of adherence to diet prescriptions. However, there are mixed messages to the patients and caregivers who have challenges with management and acceptability of the prescriptions. Most of them make un-informed dietary decisions that lead to consumption of unhealthy foods with negative outcomes such as metabolic waste accumulation in the patients&rsquo; bodies negating the effects of dialysis and undermining the efforts of healthcare system in management of patients with chronic kidney disease