Development of a Bovine Blood Enriched Porridge Flour for Alleviation of Anaemia among Young Children in Kenya

The prevalence of iron deficiency and anaemia among young children in Kenya is high. This is because the main diet is porridge prepared from cereal flours which have very low iron levels and poor bioavailability. This study was designed to investigate the effect of enriching porridge flour mixes prepared from cereals and cassava with iron from bovine blood meal, for use in an intervention for anaemic children. The mixes were formulated to provide approximately 50% of the recommended daily allowance of iron for children.The mix was tested for nutritional, sensory and storage properties. The most acceptable mix contained sorghum, finger millet, cassava, and blood powder in the ratios of 6:14:10:0.5 providing 54% of the recommended daily intake of iron for 1-3 year old children, when consumed per day as porridge containing 30.5g flour. The mix could be stored at 35ºC for up to three months without adverse changes in microbiological quality. The study concludes that acceptable and shelf-stable porridge mix can be formulated from local cereals and cassava flour with iron enrichment from bovine blood meal. Keywords: Bovine blood, Composite flour, Anaemia, Young children, Keny

Relationship Between Perceptions of Masculinities and Incidences of Family Crises Facing the Modern Family: A Case of Selected Faith-Based Organisations in Bahati Sub-County, Nakuru County, Kenya

Perception of masculinities plays an important role in transforming masculinities in the context of incidences of family crises facing the modern family. These incidences include, Gender Based Violence (GBV), separation and divorce, alcohol and substance abuse, neglect of family responsibilities and mental breakdown. Perception of masculinities is linked with the incidences family crises. This study sought to determine the association between perceptions of masculinities and incidences of family crises in Kenya Anglican Men Association (KAMA) and Presbyterian Church Men Fellowship (PCMF) as selected FBOs in Bahati Sub-County, Nakuru County. To determine this association, the study used seven perception items which are that men are perceived as, head of the family, father, protector, provider, stronger than women, ‘lover of women’ and superior than women. Stratified random sampling procedure was used to obtain a total sample size of 209 participants. Data was collected through a questionnaire, interviews and Focused Group Discussion (FGD) schedules. Descriptive and inferential statistics, specifically Pearson Chi-square test were used for analysis, with the help of Statistical Package for Social Sciences (SPSS) version 20 for windows. Descriptive statistics included frequency tables and mean scores. Findings of the study established that perception of masculinities have a positive and significant relationship with incidences of family crises. In this regard the study recommends that there is need of Faith Based Organizations and other organizations which are engaged in transforming masculinities to use the perception of masculinities as an entry point into the hearts of men, while they target to strengthen the positive aspects. Keywords: Perception, Family crises, Masculinities, KAMA, PCMF. DOI: 10.7176/RHSS/10-4-08 Publication date: February 29th 2020

Relationship Between Categories of Masculinities and Incidences of Family Crises in Modern Family:A Case of Selected Faith-Based Organisations in Bahati Sub-County, Nakuru County, Kenya

Globally, the modern family is faced by incidences of family crises which include Gender Based Violence (GBV), separation and divorce, alcohol and substance abuse, neglect of family responsibilities and mental breakdown. While numerous suggestions have been offered as to why this is the case, a growing body of literature links negative masculinities with the incidences of family crises. In response to this, some Faith-Based Organisations (FBOs) have begun working with men as a way of transforming masculinities. This study used Kenya Anglican Men Association (KAMA) and Presbyterian Church Men Fellowship (PCMF) as selected FBOs to explore the relationship between categories of masculinities and incidences of family crises in Bahati Sub-County, Nakuru County. The study was guided by Connell theory of masculinity which conceives that the relationships among male individuals consist of four categories of masculinity: hegemonic, subordinate, complicit and marginalized. Stratified random sampling procedure was used to obtain a total sample size of 209 participants. Data was collected through a questionnaire, interviews and Focused Group Discussion (FGD) schedules. Descriptive and inferential statistics, specifically ordered logistic regression were used for analysis, with the help of Statistical Package for Social Sciences (SPSS) version 20 for windows. Descriptive statistics included frequency tables, charts and mean scores. Findings of the study established that categories of masculinities have a positive and significant relationship with incidences of family crises. In this regard the study recommends that there is need of transforming masculinities especially by FBOs, institutions of learning and family. Keywords: Categories of Masculinities, Family crises, Modern family, Faith-Based Organisations, KAMA, PCMF. DOI: 10.7176/RHSS/10-4-07 Publication date: February 29th 202

Efficacy of Mobile phone use on adherence to Nevirapine prophylaxis and retention in care among the HIV-exposed infants in prevention of mother to child transmission of HIV: a randomized controlled trial

Background: HIV is a major contributor to infant mortality. A significant gap remains between the uptake of infant and maternal antiretroviral regimens and only a minority of HIV-exposed infants receives prophylaxis and safe infant feeding. Losses to follow-up of HIV-exposed infants are associated with shortcomings of facility-based PMTCT models with weak community support of linkages. Use of mobile phones offers an opportunity for improving care and promoting retention assessed by timely attendance of scheduled appointments for the mother-baby pairs and achievement of an HIV-free generation. The objective of this study was to compare self-reported adherence to infant Nevirapine (NVP) prophylaxis and retention in care assessed by timely attendance of scheduled appointments over 10 weeks in HIV exposed infants randomized to 2-weekly mobile phone calls (intervention) versus no phone calls (control). Methods: In this open label randomized controlled study, one hundred and fifty HIV infected women drawn from 3 health facilities in Western Kenya and their infants were randomly assigned to receive either phone-based reminders on PMTCT messages or standard health care messages (no calls) within 24 h of delivery. Women in the intervention arm continued to receive fortnightly phone calls. At 6- and 10-weeks following randomization we collected data on infant adherence to Nevirapine, mode of infant feeding, early HIV testing and retention in care in both study arms. All analyses were intention to treat. Results: At 6 weeks follow-up, 90.7% (n = 68) of participants receiving phone calls reported adherence to infant NVP prophylaxis, compared with 72% (n = 54) of participants in the control group (p = 0.005). Participants in the intervention arm were also significantly more likely to remain in care than participants in the control group [78.7% (n = 59) vs. 58.7% (n = 44), p = 0.009 at 6 weeks and 69.3% (n = 52) vs. 37.3% (n = 28), p \u3c 0.001 at 10 weeks]. Conclusions: These results suggest that phone calls are potentially an important tool to improve adherence to infant NVP prophylaxis and retention in care for HIV-exposed infants. Trial registration: PACTR202007654729602. Registered 6 June 2018 - Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=344

Systems analysis and improvement to optimize pMTCT (SAIA): a cluster randomized trial

BACKGROUND: Despite significant increases in global health investment and the availability of low-cost, efficacious interventions to prevent mother-to-child HIV transmission (pMTCT) in low- and middle-income countries with high HIV burden, the translation of scientific advances into effective delivery strategies has been slow, uneven and incomplete. As a result, pediatric HIV infection remains largely uncontrolled. A five-step, facility-level systems analysis and improvement intervention (SAIA) was designed to maximize effectiveness of pMTCT service provision by improving understanding of inefficiencies (step one: cascade analysis), guiding identification and prioritization of low-cost workflow modifications (step two: value stream mapping), and iteratively testing and redesigning these modifications (steps three through five). This protocol describes the SAIA intervention and methods to evaluate the intervention’s impact on reducing drop-offs along the pMTCT cascade. METHODS: This study employs a two-arm, longitudinal cluster randomized trial design. The unit of randomization is the health facility. A total of 90 facilities were identified in Côte d’Ivoire, Kenya and Mozambique (30 per country). A subset was randomly selected and assigned to intervention and comparison arms, stratified by country and service volume, resulting in 18 intervention and 18 comparison facilities across all three countries, with six intervention and six comparison facilities per country. The SAIA intervention will be implemented for six months in the 18 intervention facilities. Primary trial outcomes are designed to assess improvements in the pMTCT service cascade, and include the percentage of pregnant women being tested for HIV at the first antenatal care visit, the percentage of HIV-infected pregnant women receiving adequate prophylaxis or combination antiretroviral therapy in pregnancy, and the percentage of newborns exposed to HIV in pregnancy receiving an HIV diagnosis eight weeks postpartum. The Consolidated Framework for Implementation Research (CFIR) will guide collection and analysis of qualitative data on implementation process. DISCUSSION: This study is a pragmatic trial that has the potential benefit of improving maternal and infant outcomes by reducing drop-offs along the pMTCT cascade. The SAIA intervention is designed to provide simple tools to guide decision-making for pMTCT program staff at the facility level, and to identify low cost, contextually appropriate pMTCT improvement strategies. TRIAL REGISTRATION: ClinicalTrials.gov NCT0202365

Analysis of the TCR Repertoire in HIV-Exposed but Uninfected Infants

Maternal human immunodeficiency virus (HIV) infection has been shown to leave profound and lasting impacts on the HIV-exposed uninfected (HEU) infant, including increased mortality and morbidity, immunological changes, and developmental delays compared to their HIV-unexposed (HU) counterparts. Exposure to HIV or antiretroviral therapy may influence immune development, which could increase morbidity and mortality. However, a direct link between the increased mortality and morbidity and the infant’s immune system has not been identified. To provide a global picture of the neonatal T cell repertoire in HEU versus HU infants, the diversity of the T cell receptor beta chain (TRB) expressed in cord blood samples from HEU infants was determined using next-generation sequencing and compared to healthy (HU) infants collected from the same community. While the TRB repertoire of HU infants was broadly diverse, in line with the expected idea of a naïve T cell repertoire, samples of HEU infants showed a significantly reduced TRB diversity. This study is the first to demonstrate differences in TRB diversity between HEU and HU cord blood samples and provides evidence that maternal HIV, in the absence of transmission, influences the adaptive immune system of the unborn child

Net survival of perinatally and postnatally HIV-infected children: a pooled analysis of individual data from sub-Saharan Africa

Background Previously, HIV epidemic models have used a double Weibull curve to represent high initial and late mortality of HIV-infected children, without distinguishing timing of infection (peri- or post-natally). With more data on timing of infection, which may be associated with disease progression, a separate representation of children infected early and late was proposed. Methods Paediatric survival post-HIV infection without anti-retroviral treatment was calculated using pooled data from 12 studies with known timing of HIV infection. Children were grouped into perinatally or post-natally infected. Net mortality was calculated using cause-deleted life tables to give survival as if HIV was the only competing cause of death. To extend the curve beyond the available data, children surviving beyond 2.5 years post infection were assumed to have the same survival as young adults. Double Weibull curves were fitted to both extended survival curves to represent survival of children infected perinatally or through breastfeeding. Results Those children infected perinatally had a much higher risk of dying than those infected through breastfeeding, even allowing for background mortality. The final-fitted double Weibull curves gave 75% survival at 5 months after infection for perinatally infected, and 1.1 years for post-natally infected children. An estimated 25% of the early infected children would still be alive at 10.6 years compared with 16.9 years for those infected through breastfeeding. Conclusions The increase in available data has enabled separation of child mortality patterns by timing of infection allowing improvement and more flexibility in modelling of paediatric HIV infection and surviva

Uptake of prevention of mother to child transmission interventions in Kenya: health systems are more influential than stigma

<p>Abstract</p> <p>Background</p> <p>We set out to determine the relative roles of stigma versus health systems in non-uptake of prevention of mother to child transmission (PMTCT) of HIV-1 interventions: we conducted cross-sectional assessment of all consenting mothers accompanying infants for six-week immunizations.</p> <p>Methods</p> <p>Between September 2008 and March 2009, mothers at six maternal and child health clinics in Kenya's Nairobi and Nyanza provinces were interviewed regarding PMTCT intervention uptake during recent pregnancy. Stigma was ascertained using a previously published standardized questionnaire and infant HIV-1 status determined by HIV-1 polymerase chain reaction.</p> <p>Results</p> <p>Among 2663 mothers, 2453 (92.1%) reported antenatal HIV-1 testing. Untested mothers were more likely to have less than secondary education (85.2% vs. 74.9%, p = 0.001), be from Nyanza (47.1% vs. 32.2%, p < 0.001) and have lower socio-economic status. Among 318 HIV-1-infected mothers, 90% reported use of maternal or infant antiretrovirals. Facility delivery was less common among HIV-1-infected mothers (69% vs. 76%, p = 0.009) and was associated with antiretroviral use (p < 0.001). Although internal or external stigma indicators were reported by between 12% and 59% of women, stigma was not associated with lower HIV-1 testing or infant HIV-1 infection rates; internal stigma was associated with modestly decreased antiretroviral uptake. Health system factors contributed to about 60% of non-testing among mothers who attended antenatal clinics and to missed opportunities in offering antiretrovirals and utilization of facility delivery. Eight percent of six-week-old HIV-1-exposed infants were HIV-1 infected.</p> <p>Conclusions</p> <p>Antenatal HIV-1 testing and antiretroviral uptake was high (both more than 90%) and infant HIV-1 infection risk was low, reflecting high PMTCT coverage. Investment in health systems to deliver HIV-1 testing and antiretrovirals can effectively prevent infant HIV-1 infection despite substantial HIV-1 stigma.</p

Perinatal care and breastfeeding education during the COVID-19 pandemic: Perspectives from Kenyan mothers and healthcare workers

The impact of the COVID-19 pandemic on breastfeeding (BF) practices in low- and middle-income countries (LMICs) is not well understood. Modifications in BF guidelines and delivery platforms for breastfeeding education during the COVID-19 pandemic are hypothesised to have affected BF practices. We aimed to understand the experiences with perinatal care, BF education and practice among Kenyan mothers who delivered infants during the COVID-19 pandemic. We conducted in-depth key informant interviews with 45 mothers who delivered infants between March 2020 and December 2021, and 26 health care workers (HCW) from four health facilities in Naivasha, Kenya. While mothers noted that HCWs provided quality care and BF counselling, individual BF counselling was cited to be less frequent than before the pandemic due to altered conditions in health facilities and COVID-19 safety protocols. Mothers stated that some HCW messages emphasised the immunologic importance of BF. However, knowledge among mothers about the safety of BF in the context of COVID-19 was limited, with few participants reporting specific counselling or educational materials on topics such as COVID-19 transmission through human milk and the safety of nursing during a COVID-19 infection. Mothers described COVID-19-related income loss and lack of support from family and friends as the major challenge to practising exclusive breastfeeding (EBF) as they wished or planned. COVID-19 restrictions limited or prevented mothers’ access to familial support at facilities and at home, causing them stress and fatigue. In some cases, mothers reported job loss, time spent seeking new means of employment and food insecurity as causes for milk insufficiency, which contributed to mixed feeding before 6 months. The COVID-19 pandemic created changes to the perinatal experience for mothers. While messages about the importance of practising EBF were provided, altered HCW education delivery methods, reduced social support and food insecurity limit EBF practices for mothers in this context