Mothers’ knowledge of mother-to-child transmission of HIV and infant feeding practices in Juba, South Sudan

Introduction: While exclusive breastfeeding for the first six months of life is recommended for HIV-infected mothers, this may not be practiced fullyin South Sudan; exclusive formula feeding, which is the best alternative to breastfeeding, may not be practical.Objective: To assess the knowledge of mother-to-child transmission of HIV (MTCT) and practices of feeding infants in the first six months of life among HIV-infected mothers attending Antiretroviral Therapy Centres in Juba Teaching Hospital (JTH) and Juba Military Hospital (JMH).Method: A cross-sectional study in which 304 HIV-infected mothers with children aged 6-18 months were interviewed between October and  December 2016 using structured questionnaires. Key informant interviews (KIIs) and focus group discussions (FGDs) were also conducted using interview guides. Quantitative data was analysed using Statistics Package for Social Sciences software. Chi-square test was used to test the presence of significant association between the variables and the association is statistically significant when the p-value is < 0.05. Multiple logistic regression analysis was used to identify which predictor variables have major effect on the dependent variable. Qualitative data was transcribed in English and summarized according to the key themes, and the information obtained was used to supplement and interpret the findings of the quantitative data.Results: Only 120 (40%) of the HIV-infected mothers had a good knowledge of MTCT; 213 mothers (70.1%) practiced mixed feeding, 70 (23.0%)  practiced exclusive breastfeeding and 20 (6.6%) practiced exclusive formula feeding. The factors that were found to have a positive effect on choice of infant feeding methods were having more than one child (odds ratio = 0.303, 95% Confidence interval: 0.161-0.571, p = 0.001) and participation in the prevention of motherto-child transmission of HIV programme (PMTCT) (odds ratio = 2.260, 95% Confidence interval: 1.251-4.084, p = 0.007). Stigma (p = 0.248) and mothers’ knowledge of MTCT (p = 0.072) were not statistically significantly associated with the mothers’ infant feeding practices.Conclusion: Knowledge of MTCT is low. Mixed feeding before six months of age is predominant among the HIV-infected mothers. It is thereforerecommended that HIV-infected mothers receive adequate information from counsellors regarding MTCT and exclusive breastfeeding for the first six monthsof an infant’s life.  Key words: Knowledge, infant feeding, HIV-infected mothers, Juba

Gender differences in HIV testing service visits and its related factors among adults: a cross-sectional study in Homa Bay, Kenya

Introduction: at least 90% of people living with human immunodeficiency virus (HIV) were expected to know their HIV status by 2020. However, only 84% are aware of their status. This study determined the frequency of HIV testing services visits (HTS) and its related factors to HTS visits among adults in Homa Bay County, Kenya. Methods: this was a cross-sectional study. Quantitative and qualitative data were collected. A backward stepwise logistic regression analysis was conducted for quantitative data by gender. Qualitative data were thematically categorised into factors of HTS visits by gender. Results: a total of 645 adults participated in quantitative survey and 17 in qualitative survey. There were no gender differences in the frequency of HTS visits (males=56.3%; females= 58.7%, P=0.785). The frequency of visits was however significantly different between the rural-based (Rachuonyo North=87.5%; Ndhiwa=58.7%) and urban-based (Homa Bay Town=36.8%) facilities at P<0.001. In males, HTS visits were positively associated with ´being in Protestant church´, ´partner´s attitude´, and ´being accompanied by a friend to HTS´. ´Distance to HTS´ was negatively associated with HTS visits in males. For females, 'sexual intercourse in the past 2-5 months´ was positively associated with HTS visits. ´Being in a polygamous marriage´, ´not married´, ´community HIV testing´, and ´affordability of transport cost to HTS centre´ were negatively associated with HTS visits. Conclusion: there were no gender differences in the frequency of HTS visits. Social position for males and position in the family for females are suggested as the factors influencing HTS visits in Homa Bay County

Food Environment in and around Primary School Children’s Schools and Neighborhoods in Two Urban Settings in Kenya

We conducted a cross-sectional study to provide an overview primary school children food environment in two urban settings in Kenya. Six schools, catering to children from low-, medium- and high-income households in the cities of Nairobi and Kisumu in Kenya, participated in the study. Data on types of food places and foods offered were collected and healthy and unhealthy food availability scores calculated for each place. We utilized prevalence ratio analysis to examine associations between food availability, food place characteristics and neighborhood income levels. Altogether, 508 food places, located within 1 km of the schools and the school children’s neighborhoods were observed. Open-air market sellers and kiosks were most common. The proportion of food places with high healthy food availability was 2.2 times greater among food places in Nairobi compared to Kisumu, 1.9 times greater in food places with multiple cashpoints, 1.7 times greater in medium/large sized food places and 1.4 times greater in food places located in high income neighborhoods. These findings highlight differences in availability of healthy foods and unhealthy foods across types of food places and neighborhood income levels and inform public health interventions aimed at promoting healthy food environments in Kenya

Effect of fish oil omega-3 fatty acids on reduction of depressive symptoms among HIV-seropositive pregnant women: a randomized, double-blind controlled trial

Abstract Background Globally, it is known that HIV-infected pregnant women are prone to depressive symptoms. Research evidences also suggest that nutrient deficiencies may enhance the depressive illness, and that fish oil omega-3 fatty acids may alleviate the depressive symptoms. The aim of this study was to assess the effect of fish oil omega-3 eicosapentaenoic acid-rich supplements on depressive symptoms among HIV-seropositive pregnant women. Trial design A randomized double-blinded controlled trial with two parallel groups was conducted. The intervention group received fish oil omega-3 of 3.17 g (eicosapentaenoic acid = 2.15 g; docosahexaenoic acid = 1.02 g) per day for 8 weeks, while the control group received soybean oil for a similar period. Method Participants were HIV-seropositive pregnant women who were enrolled in prevention of mother-to-child transmission programs and attending antenatal clinics at selected Nairobi city county’s health facilities. Recruitment was done from health records of HIV-infected pregnant women. Data analysis followed per-protocol analysis. Participants who completed the 8-week trial were included in the analysis of covariance statistical model with omega-3 as main effect. The covariates in the change in BDI-II depressive symptom score outcome were baseline characteristics and nutrient adequacy. Results 282 participants were recruited 109 randomized to fish oil, and 107 to soybean oil. Completion rate was 86/109 (78.9%) and 96/107 (89.7%) respectively. At the end of week-8 of follow up most participants in both arms had mild depressive symptoms 82/86 (95.3%) in the Fish oil group and 94/96 (97.9%) in the Soybean oil group. The difference in effect between the intervention and control group was not statistically significant (1.01 (95% CI − 0.58 to 2.60), p = 0.21). Conclusion Fish oil omega-3 with a daily dosage of 3.17 g (eicosapentaenoic acid = 2.15 g; docosahexaenoic acid = 1.02 g) appears to provide no added benefit in reduction of the symptoms of depression in HIV-infected pregnant women. Trial Registration Clinical Trial Registry: NCT01614249. Registered on June 5, 2012. https://clinicaltrials.gov/ct2/show/NCT0161424

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

High Adherence to the Food Pyramid&rsquo;s Recommendations Avoids the Risk of Insufficient Nutrient Intake among Farmers in Peri-Urban Kenya

This study aimed to investigate whether the Kenyan Food Pyramid (FP) can evaluate excess or insufficient nutrient intake. Participants were farmers (56 men and 64 women, aged 18&ndash;60 years) in Wangige Village, Kiambu County&mdash;a peri-urban area of Kenya. Cross-sectional data were collected for demographic characteristics, physical measurements, and 2-day and 24-h dietary recalls. The average adherence level to the FP (hereafter, &ldquo;FP score&rdquo;) was 25.0 out of 50.0, with a minimum and maximum of 14.1 and 41.5, respectively. Energy and protein % energy ratio were significantly higher (p for trend &lt; 0.05) in the higher FP score group. A higher FP score was also associated with a higher energy-adjusted micronutrient intake, and it was more likely to meet nutrient requirements. However, the higher FP score group had a higher risk of excess sodium intake (p for trend &lt; 0.001). The Kenyan FP could be a useful tool for avoiding the risk of insufficient nutrient intake, but not for avoiding high energy and sodium intake. It is necessary to include appropriate evaluations to limit energy, sugar, and salt. Food groups and recommendations of the FP should be optimised according to the dietary environment of the target population so as to promote their health

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