Snacking and its effect on nutritional status of adolescents in two national high schools in Nairobi Kenya

Snacking is defined as any intake of food or energy-containing beverage outside of breakfast, lunch and dinner (Bellisle, 2007). Previous studies have shown that snacking among adolescents is most common in the afternoon (Cross et al., 1994; Howarth et al., 2007). This study focused on snacking and its effect on dietary intake of macronutrients from normal school balanced meals and nutritional status of adolescents in two public national high schools namely Nairobi School for boys and Kenya High School (KHS) for girls, in Kenya. These schools were purposefully and randomly selected. A cross-sectional study on nutritional status and level of snacking was carried out involving 172 and 180 adolescent girls and boys respectively aged 13 to 18 years. A total of 352 adolescent high school girls and boys were assessed. A semi- structured questionnaire was used to collect quantitative data on socio-economic status (SES) of the respondents’ families while qualitative data were collected through focus group discussions, key informant interviews and observations. Anthropometric measurements on height and weight for nutritional status were used. Food consumption frequency was used to assess food intake from school meals and snacks. Energy and protein intake data were collected using a 24-hour recall based on a sub-sample of 31 students (14 boys and 17 girls). Eleven percent (11.0%) boys and 10.2% girls was stunted. Almost an equivalent number of both boys and girls (45.2% and 44.1% respectively) were found to be normal and nourished. Although, the girls are more likely to be stunted than boys stunting was not significantly different between the two groups and underweight was significantly higher in boys than in girls. Significantly more girls were overweight and obese than boys. Among the students who reported to be snacking, 10.4% were underweight and 76.9% had normal BMI-for-age as compared to those who did not snack where 20.0 % were underweight and 63.3% with normal BMI-for-age. It was observed that amongst those who snacked, an equal number of boys and girls at 5.2% were underweight while 6.9% more girls than boys (5.9%) were overweight. Most of the students who snacked had a normal (89.3%) height-for-age. Amongst those who snacked and based on gender, more boys (5.9%) than girls (4.8%) were found to be stunted. Among the gender the difference between those who snacked and those who didn’t was insignificant There were almost an equivalent percentage of those who snacked at 10.7% and those who didn’t at12.0% and were stunted. There was no significant difference between the BMI-for-age among those who were snacking and those who were not (?2=5.84, p value=0.120). Whether one snacks or not there is no significant relationship between snacking, BMI- for-Age, and hence nutritional status of both adolescent boys and girls in national boarding high schools. This study shows that snacking has no effect on adolescents’ nutritional status.   Key words: adolescent, snacking, high school, malnutrition, nutritional status, underweight, overweight, obese, stunting, githeri, ugal

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa