PHD-Department of Foods, Nutrition & Dietetics

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Enhancement farming practices for improved household food and nutritonal security in Kamae, a peri-urban area-Nairobi
(2011-07-27) Njogu, Eunice Wambui; Kuria, E. N.; Keraka, M.
Urban food insecurity has risen to alarming levels. Urban agriculture is proposed as an effective strategy to reduce urban poverty and enhance urban food security. Kenyan urban poverty is high. This has pushed the urban poor to agricultural activities. Households in Kamae in the peri-urban area of Nairobi, produced crops but they lacked diversity. They needed intervention to diversify their farming activities by producing diversity of crops and rearing small livestock. It is in this light that this study was designed. The household food security and farming practices were determined from June to July 2005 in baseline survey covering 300 households obtained through cluster sampling. An intervention to diversify the household farming practices was designed and implemented from October 2005 to February 2006 to enhance household food security in 30 out of the 300 households. Another survey in 180 households (30 participating and 150 nonparticipating) households was done at the end of the research from March 2006 to April 2006 to determine the impact of the intervention. Data were collected using interview schedules, observation checklists and focus group discussion guides. The quantitative data were analysed using (SPSS) Programme. Nutrients were analysed using NutriSurvey, (2004) while nutrition status data were analysed using EpiInfo, (2000). Pearson product moment (r) established relationships and tested the hypothesis at 0.05 significant levels. Cross tabulation and t-test were used to determine the changes in the households after intervention. The qualitative data were organized into themes for interpretation. The results indicated improvement in social economic status, in farming practices and in food consumption. There were 13(43.3%) women without occupations before intervention, but they started farming, selling vegetables and did casual jobs after intervention. Participating households increased diversity of crops they produced from no crops to diversity of crops and they all started rearing small livestock. The mean caloric, vitamin A and iron intakes for all children in all age groups in the 300 households in baseline survey were below the RDAs. However, the mean protein intakes for the children in all age groups were above the RDAs. Consumption of calories, proteins, vitamin A and iron increased in all the 30 households. Those whose caloric intakes were below the RDAs decreased from 23(76.7%) before intervention to 20(66.7%) after intervention. Protein intake that was below RDAs decreased from 17(56.7%) to 12(40%), vitamin A intakes from 22(73.3%) to 18(60%) and iron intake from 29(96.7%) to 25(83.3%) before and after intervention, respectively. These improvements in consumption are attributed to the activities of the intervention of producing a diversity of crops and rearing of small livestock. The findings of the baseline survey showed that 62% of the children were stunted, 53.7% were underweight and 31% were wasted. T-test showed significant difference in iron intake before and after intervention t=2.715 and P= 0.009. There were positive relationships between nutrition knowledge and caloric r=0.040 p=0.494, protein r=0.055 p=0.341, vitamin A r=0.123 p=0.034 and iron r=0.052 p=0.372 intake. There was also a positive and significant relationship between crop diversity and dietary diversity r =0.123 and p =0.034. This shows that increase in food production and nutrition knowledge increased household food consumption. This project impacted positively on the community members by increasing access to more food. This improved their household food consumption by providing them with diversified diets that enhanced their household food and nutrition security. It is recommended that production of diversity of crops and rearing of small livestock be promoted in the available urban and peri-urban garden spaces. These gardens form a sustainable food based strategy to prevent malnutrition in the urban and peri-urban areas.
Food security, nutritional quality and safety of fruits and their products in Nairobi, Kenya
(2011-07-27) Olielo, Tom K.O.; Judith Kimiywe; George Omolo Romo
In Kenya, 56% of the population lives in low income and are below poverty line. This is compounded with 60% of population who are afflicted by deficiencies of protein. energy and micronutrients. Vitamin A deficiency is responsible for lack of immunity to diseases that kill 23% of children and other people, worldwide. Regrettably 30% of fruits, the good sources of vitamins, go to waste in Kenya for lack of market. Enhanced consumption of fruit products could help the country meet the Millennium Development Goals on reduction of poverty, malnutrition and mortality. The objective of this research was to determine socio-economic and product characteristics that influence consumption of fruit products and recommend ways for enhancing consumption of the products. Research methods involved purposive selection of three estates in Nairobi that represent the low, middle and high income groups. Monthly income by the low income, middle income and high income households were respectively KES :_14000, KES 14001 to 56000 and KES >56000 (Exchange rate in 2007 was KES 69 for US$1). In each estate, 130 households were sampled and every household was interviewed using a 24 hour recall for consecutive seven days to assess food consumption and consumers' attitudes to processed fruit products. The most consumed and least consumed specified fruit products (e.g. mango juice, corresponding to brands) of each of fruit product types that are fruit juices, fruit flavored drinks, fruit based soft drink, jams, marmalade and canned fruit slices were analyzed in the laboratory for quality and safety. Ten packages of each selected product brand were sampled from the market and analysed for contents of vitamins A and C, °Brix, microorganisms TPC, coliforms, yeasts and moulds, preservative benzoic acid and sulphurous acid. Fruits were also analysed for pesticide residues. Results on food consumption showed that the low-income group did not meet FAO/WHO recommendations, and had mean per capita daily intake of 1915 kcal, vitamins A (RE) at 335 µg and C at 55 mg. Other income groups met nutrient requirements, but like low income group, consumed lower amounts of fruit products and carrots than FAO recommendations. Fresh fruits were consumed by 26% of the population and processed fruit soft drinks by 17% among whom the low income were 4.5%, middle income were 33% and the high income were 63%. Per capita mean daily consumption of fruit products was 44 g (24 g fruit plus 19.2 ml fruit soft drink and 1.4 g fruit preserve). The mean per capita annual consumption of processed fruit products by low income averaged 2.9 L fruit soft drinks, by middle income were 5.9 L fruit soft drinks and 0.5 kg preserve, by high income group were 12 L fruit soft drinks and 1 kg preserve, and by all consumers were 7 L fruit soft drinks and 0.5 kg preserve compared to world consumption of 9.5 L. Significant difference of consumption among income groups was at p :_ 0.05. Concerning consumer attitudes on processed fruit products they bought, 64% of consumers said that prices were fair and 84.8% said quality and safety were good. Laboratory analysis found contents of vitamins A and C reasonable compared to literature information. However, there are no national standards for content of vitamins in the products. Quality failures were one fruit based soft drink with low °Brix and one fruit flavour drink because it had fruit pictorial label. Safety failure was one brand of jam that had excess content of sulphurous acid. It is recommended that the public should be sensitized to enhance consumption of fruit products. Processors should apply quality standards, truthful labelling and controlled pricing. Results of this study shall be useful to processors, consumers, nutritionists, government and UN organisations in promoting production, processing and consumption of fruit products for raising incomes and health of Kenyans
Factors influencing acceptance of institutional meals by students at public and private universities in Uganda
(2012-01-04) Kabanza, Ndosi Phoebe
The study identified factors that influence acceptance of institutional meals by students at public and private universities in Uganda. Constant agitation of students institutional meals suggested a problem in the catering systems, particularly in boarding institutions such as universities in Uganda. Attendance at meals was poor. Students complained that the quantity of food served to them was inadequate and could not satisfy hunger but at times it was observed that a lot off cooked institutional food was left uneaten causing wastage. Students cooked in their residential rooms or bought food from food vendors. There was need, therefore, to investigate and analyze the problems related to management of institutional meals. The aim of the study was to identify factors that influence acceptance of meals by students at Makerere University and Mbarara University, the selected public universities, and Nkumba University and Nkozi University, the selected private universities in Uganda. The information on students' perceptions of institutional meals was obtained from 403 student respondents through use of self-administered questionnaires. The student respondents were selected proportionately from the target student population. Interview guides helped in obtaining information from the administrators and food handlers to explain issues related to institutional meal management. Observation checklists were used to get first-hand information regarding management of the meals. Relevant documents, such as menu plans and recipes, were also analyzed. Proximate (chemical) analysis for nutrient content of food samples collected from cooked meals at the universities was carried out to assess the nutritional adequacy of cooked meals with special emphasis on metabolisable energy value of the diet. The chemical food analysis findings were compared with the values from planned meals, which had been calculated from institutional menus using Food Composition Tables prepared for East, Central and Southern Africa by World Health Organization (1987). The nutrient allowances for each student in institutional meals were compared with the World Health Organization (WHO, 1987) recommended dietary allowances (RDAs) for the specific age group (19-30 years) at moderate physical activity level. With exception of Nkozi University, students considered institutional meals not only unpalatable owing to the unacceptable appearance (77%), taste (78%) and flavour/aroma (79%), meals were also found inadequate in quantity. While the metabolisable energy of planned meals at Makerere University (2924 kilocalories) and Nkumba University (2952 kilocalories) appeared to be within acceptable ranges, the diets at Mbarara University (4341 kilocalories) and Nkozi University (3617 kilocalories) would suggest excess energy value in terms of metabolisable energy. But the actual food served to students, regardless of the status of the institution appeared to be inadequate. The food for meals was never enough even when high student turn up was expected: therefore, there was tendency to serve small quantities for everyone to get a portion of food. The students were actually starving, especially those who were financially disadvantaged. On average, the metabolisable energy of cooked food at Makerere University was 700 kilocalories per day, mainly obtained from protein-rich foods, with little carbohydrate source. On the other hand the cooked meals at Mbarara University yielded 440 kilocalories per day. The meals at Mbarara University had the lowest energy value compared to the meals at the other universities that were studied. If eaten in estimated quantities, the cooked food at private universities appeared to be slightly better than that at public universities, although it would not meet the recommended allowances of the nutrients either. Nkumba University diet would yield metabolisable energy of 958 kilocalories per day, mainly derived from fat, while Nkozi University diet would yield 1410 kilocalories per day. The targeted energy RDA of 2200 kilocalories for females and 3000 kilocalories for males remained too high to be attained by institutional diet. The big question was on what happens to the food in menu plans if it was purchased at all! The study showed lack of seriousness on the side of universities when handling institutional food. Everything was taken for granted. The cooking facilities were inadequate because all the attention was geared towards academic facilities. When planning meals was not considered. In any case, the technical knowledge and skills in food handling were not appreciated. Therefore there was tendency to recruit any one to handle institutional meals while those engaged in menu formulation focused on financial control. The marginalized catering officers had no morale to supervise their subordinates therefore the food cooked for students was unpalatable and not even enough to go round. There was dishonesty in the system where all the parties concerned would share blame. Other than illegal meal cards that were issued to people who were not supposed to eat the food, food also disappeared from stores and never found its way into the cooking pots contributing to poor aesthetic and nutritional quantity of meals. Members of the kitchen staff were also overworked because in some institutions they doubled as waiters. In such cases they were bound to make mistakes in handling the food. It also contributed to poor timing of the meals especially where students had to attend to their studies during mealtimes. The time set for meals need to be adhered to so that all students get their share of the food. It is therefore recommended that universities improve on food handling facilities, especially appropriate kitchen facilities. Kitchen staff should not be overworked. Food handlers with relevant technical knowledge and skills should be recruited and special attention paid to nutritional quality of meals for the age groups rather than emphasizing quantity of food. Seminars and workshops should be organized for food handlers to sort-related problems. Universities have to cultivate honesty among workers so that loss of the budgeted food does not affect students. The work of food handlers needs to be respected and appreciated so that they get motivated to work efficiently and effectively. Effective monitoring and supervision of food preparation and service need to be promoted so that problems are corrected in time. Students have to be facilitated to enjoy their meals; for instance, sitting arrangement at meals needs improvement. The aesthetic and nutritional quality of meals should be worth the money paid for feeding. Food vending should be more organized and made legal so that students are able to have a meal when they want it. If institutions cannot manage running the catering services efficiently and effectively, catering service should be privatized to capable contractors. It should be appreciated that hungry students would not achieve much from the education system. Therefore, nutritional policy at national level needs to be strengthened to enlighten the population on the relevance and application of nutritional knowledge in food selection from available foods, cooking and consumption to promote good health and productive life
Dietary, social, and environmental determinants of obesity in Kenyan women
(2012-03-15) Mbithe, David Dorcus
Nutrient composition of hypochondiacus amaranthus grain and contribution to nutritional status of HIV and AIDS infected children attending Thika District Hospital
(2012-04-12) Maoga, W. N.
Food and nutrition interventions are critical components of comprehensive responses to the HIV and AIDS pandemic. High nutrition quality of amaranth grain has been established but it remains an underutilized crop in Kenya despite the potential to broaden the food base which is critical in the context of HIV and AIDS. Information on the utilization of amaranth grain and its contribution to the nutrition status of vulnerable groups has not been sufficiently documented. The purpose of this study was to determine the nutrient composition of hypochondriac us amaranth us grain and assess the contribution of amaranth-based porridge consumption to nutrition status of HIV and AIDS infected children attending Thika District Hospital Comprehensive Care Clinic. The study was a longitudinal (6 months), experimental pre and post single group design, with a comprehensive sample of 52 children. The study was conducted in two phases. In phase one, data on nutrient composition and sensory evaluation of researcher-developed amaranth-based porridges were collected (6 months). Phase two included baseline assessment and the intervention. Intervention included monthly provision of adequate amaranth flour to be consumed by the children on a daily basis, nutrition education and counselling. Phase two data comprised demography, dietary intake, anthropometric, morbidity, and CD4 counts) and during and after intervention data on, anthropometry (monthly), morbidity prevalence (monthly) dietary intake (at month six) and CD4counts (at month six). Quantitative data were analysed using SPSS 16.0 and anthropometry data were analyzed using BPI INFO anthro pack then transformed into Z-Score. Dietary intakes were analyzed using Nutrisurvey (2007). Descriptive statistics were used to describe the results on nutrient composition, sensory evaluation, demographic data, and children's dietary, anthropometric and morbidity characteristics. Inferential statistics such as ANOV A, paired t-test, independent t-test were used to determine statistically significant differences at 95% CI, Pearson's product moment correlation for significant relationships 95% CI and linear regression for significant associations between selected variables. The findings indicated that amaranth grain has higher content of proteins (l5.29±0.SOg), total lipids (S.50±0.90g) dietary fibre (5.50±0.20g), iron (20±0.Smg), zinc (4.00±0.6mg) and potassium 42S.S0±1.2mg) compared to the local cereals. The most preferred porridge was the amaranth maize blend followed by fermented amaranth porridge which was used for intervention. Baseline findings indicated inadequate mean intake of kilocalories (1281.10± 379.69 Kcal vitamin A (268.35 ± 216.65ug) calcium (412.41±253.79 mg) and selenium (26±12.93 ug) by the study children. There was significant difference (p< 0.001) between pre- and post intervention mean intake of all nutrients except for selenium. Pre intervention stunting was 36.5%, wasting 34% and underweight 30.8%. Post-intervention stunting was 32.7%, wasting was 21.2% and underweight 17.3%.Wasting and underweight reduced significantly (p=O.OOI) after intervention. There was reduced prevalence of illness and significant improvement (p
Efficacy Of Dried Amaranth Leaves (Amaranthus Cruentus) Consumption On Vitamin A, Iron and Zinc Of Children In Kajiando County, Kenya
(2013-07-19) Chege, Peter
Vitamin A, iron and zinc are currently among the major micronutrients of public health concern in the world. Children under five years are more vulnerable to the deficiencies. Globally, vitamin A deficiency affects about 250 million children under five years. It is estimated that 51% and 31% of the children in the world have iron and zinc deficiencies, respectively. In Kenya, the prevalence of vitamin A, iron and zinc deficiencies among children is 84%, 74% and 50%, respectively. Thus, there is a need for sustainable methods to address the deficiency. The intake of animal products among the Maasai community has declined. Solar dried amaranth leaves can be used to improve the dietary intake. Minimal information exists on how intake of dried vegetables incorporated into cereal flours would translate to improved micronutrient status. With this background, the possible effect of consuming dried amaranth leaves (DAL) incorporated in fermented maize flour (FMF) on the status of vitamin A, iron and zinc among children under five was investigated in Sajiloni, Kajiado County. A pre-test–post-test control group design was adopted. A comprehensive sample of 46 children aged 24 - 48 months for experimental group and 46 for control group was used in this study. A maize-amaranth blend (85:15%) which provided at least 100% of the RDAs for vitamin A was formulated using Pearson square for the experimental group while pure fermented maize flour porridge was used for the control group. The children consumed 250 mls of the porridge twice a day for six months. Dietary practices, morbidity pattern and nutrition status of the children was monitored on monthly basis while the serum levels for vitamin A, zinc and iron were done at baseline and at six months. The β - carotene in DAL, FMF and the formulated porridge were analysed using UV-VIS Spectrophotoscopy, while iron and zinc using Absorption Spectrophotometry (AAS). Serum level analysis was done by use of AAS (MINI VIDAS) for iron and (Shimadzu AA-680) for zinc content. High performance liquid chromatography (HPLC) was used to analyze β – carotene, retinol and ferittin and zinc. ENA for SMART software was used for analysis of anthropometric data while Nutri-survey was used for analysis of nutrient intake. Data were further analyzed using SPSS computer software. The relationship between amaranth intake, dietary practices, morbidity patterns and serum levels of retinol, β - carotene, ferittin and zinc was assessed using Pearson correlation, regression and chi-square. From the results, the formulated porridge DAL/FMF (15:85) was acceptable. Solar drying of amaranth led to a high concentration of nutrients and a higher retention of β – carotene, iron and zinc. The nutrient content of the DAL/FMF porridge was 6.81 ± 0.77, 12.05 ± 0.63 and 5.55 ± 0.41 mg/100g for β – carotene, iron and zinc, respectively. Intake of porridge made of 60 g of amaranth based flour enabled the children to attain the RDAs. Dried amaranth leaves were stable and safe for consumption after 9 months storage. The education level was low and household income was low. The nutrition knowledge level among caregivers was low. Inadequate intake of micronutrients led to high prevalence of illnesses. Majority of the children from both groups had low mean serum levels for retinol, β - carotene, ferittin and zinc at baseline showing deficiency. This significantly increased among the experimental group by the sixth month suggesting the role of DAL towards improving the status of these nutrients. Thus, DAL incorporated into cereals to significantly increased micronutrients intake. This study recommends the use of DAL as part of the diet for children.
Retention and bioaccessibility of provitamin a carotenoids in popular musa fruit and their derived products consumed in eastern democratic republic of Congo
(2013-07-19) Nakhauka, Ekesa Beatrice
In the Democratic Republic of Congo (DRC), bananas and plantains (Musa spp.) production is predominant in the Eastern region where they are also a major part of the diet. Recent micronutrient analyses on raw bananas from The Philippines, Uganda and Hawaii indicate that certain cultivars can contribute substantially to the daily vitamin A requirements. The objective of this study was to establish the retention and bioaccessibility of provitamin A carotenoids (pVACs) in the most popular Musa fruit and their locally derived products consumed in Eastern DRC. The study sites included Beni territory (North Kivu-NK) and Bukavu territory (South Kivu-SK). The localities, villages and specific households were established through multistage sampling. Sample size was calculated using Fisher‟s formula. A total of 14 focus group discussions were carried out and 371 households visited and mothers/caregivers interviewed. The most popular Musa cultivars identified were sub-sampled at ripening stages 1, 3, 5 and 7 based on peel color and another sub-sample processed into most common products. All the samples were then frozen at -200c and lyophilised. Using HPLC, these samples were subsequently analysed for fruit pulp pVACs contents. For bioacessibility studies, Musa samples and ingredients were processed into products following local procedures and bioaccessibility was estimated using an in vitro digestion method, content of pVACs in the products and dishes was verified using HPLC. Findings showed that the preferred cooking banana varieties included yellow-pulped AAA-East African Highland bananas [AAA-EAHBs] „Nshikazi‟ (SK) and „Vulambya‟ (NK). Preferred plantains (AAB genome), were orange-pulped and included „Musheba‟ (SK) and „Musilongo‟ (NK). The most common cooking method was simply boiling of bananas/plantains and the main accompaniments included beans and amaranth leaves. The predominant pVACs in both raw and processed fruit pulp were all-trans β- and all-trans α-carotene, together constituting about 90% of total pVACs. The proportion of β-carotene was twice that of α-carotene in the plantains varieties, while in the EAHBs tested, the proportion was almost equal. Provitamin A carotenoids observed in the fruit pulp of the tested Musa cultivars were retained and a significant increase observed during ripening. The highest levels of the pVACs were observed at ripening stage 3 in all four cultivars. Values were as high as 1081μg/100gFM in „Vulambya‟ and 1820μg/100gFM in „Musilongo‟. Although boiling AAA-EAHB cultivars led to substantial losses (40%-60%) in total pVACs contents, boiling and deep frying of the plantains led to retention and an apparent increase. After in-vitro digestion, the percentage of micellarized t-BC was higher in „Vulambya‟ (29 %) than in „Musilongo‟ (16.6 %). In the two Musa cultivars, the incorporation into micelles was similar for t-BC and t-AC, but significantly higher for 13-cis isomer. The best performing Musa-based dishes made from „Musilongo‟ and „Vulambyo‟ provided about 22% and 28% of the daily vitamin A Recommended Dietary Allowance (RDA) for a child under 5 years old. These results can guide consumer consumption patterns to maximize vitamin A intake for improved health in these regions and also direct researchers in the selection of Musa cultivars to be fast-tracked in the fight against VAD. 1 CHAPTER ONE: INTRODUCTION 1.1 Background of the study The highlands of the Great Lakes region (Eastern Democratic Republic of Congo-DRC, Rwanda, Burundi, and Western Uganda) contain the most intensely cultivated agricultural regions of Africa. In DRC, 67% of the population depends on agricultural production for both food and income and the principal food crops include; cassava, banana and sweet potatoes (Ndungo, Fiaboe, & Mwangi, 2008). Banana and plantain production occurs predominantly in forest regions of the equator in North and South Kivu. The most dominant banana types in DRC are the plantains and cooking bananas accounting for 27% of the global production estimated to be 282,520 tonnes and 1,071,900 tonnes respectively (Ndungo et al., 2008). Studies and reports (Karamura, Karamura, & Gold, 1996; Karamura, 1998; Lescot, 1999) indicate that the majority of bananas and plantains grown within this region are consumed locally in various forms. Even though the consumption rates/patterns for the various forms of banana-based foods are not known, the different forms in which they are prepared and consumed include; cooked green, cooked ripe, cooked in the peel, steamed, prepared as juice, ripened for desert, roasted, chipped and fried or dried and floured to make a host of confectionaries. In other words, there is an affordable banana dish for virtually every income category of consumers in the region (HarvestPlus, 2007). In addition, apart from being intercropped with other nutritious ground covering food crops such
Effectiveness of couple counselling versus maternal counselling in promoting exclusive breast feeding: a randomised controlled trial in Nyando District, Kenya
(2014) Ogada, Irene Awuor
The World Health Organisation and United Nations’ Children’s Fund recommend exclusive breastfeeding (EBF) for 6 months. The prevalence of EBF among children below 6 months is 32% and 35% in Kenya and Nyanza province respectively. Despite fathers being identified as stakeholders in infant feeding, few interventions target them in activities to promote EBF. There is limited information on the effectiveness of breastfeeding interventions targeting fathers, particularly in sub-Saharan Africa. The purpose of this study was to compare the effectiveness of ‘Couple Counselling’ to ‘Maternal Counselling’ in promoting EBF practice, knowledge and attitudes among mothers and fathers, in Nyando District, Kenya. This was a community-based cluster-randomised trial in which study participants were assigned to three study groups- two experimental (maternal counselling and couple counselling) and one control, based on a ratio of 1:1:1. The final sample size for the study groups were as follows: 101 couples for the control group, 88 couples for maternal counselling and 91 couples for couple counselling. Breastfeeding counselling was conducted with mothers only in the maternal counselling group and with both mothers and fathers in the couple counselling group. Couples in the control group received no counselling from the research team. Participants in each of the experimental groups received a minimum of eight counselling sessions; 1 prenatally and 7 post-natally, on a monthly basis. To determine infant feeding practices, data was collected from mothers on a monthly basis in all study groups, through researcher-administered questionnaires. Focus group discussions and key informant interviews were conducted to collect qualitative data. Breastfeeding practices were determined based on 24- hour dietary recalls. Data was analysed using SAS version 9.2 software. From Kaplan Meier survival analysis, 12% of the infants in the control, 33% in the maternal and 44% in the couple counselling were exclusively breastfed continuously (without change) for 6 months. Significantly fewer infants in the maternal counselling group (Adjusted Hazard Ratio [AHR]: 0.63; CI: 0.50-0.80; p=0.001) and couple counselling group (AHR: 0.53; CI: 0.30-0.93; p=0.028) than in the control group were discontinued from EBF before the age of 6 months. Exclusive breastfeeding was not significantly different between the two experimental groups at 6 months (AHR: 0.81; CI 0.46-1.43; p=0.465). Maternal counselling resulted in significantly higher improvement in maternal breastfeeding knowledge (Difference in difference [DID] of -1.780, p=0.001), while couple counselling resulted in significantly higher improvements in maternal attitudes towards breastfeeding (DID of 3.381, p=0.001). Among the fathers, couple counselling led to significantly higher improvements in knowledge (DID of 2.600, p=0.001), and no significant differences in the change of attitudes among the experimental groups (DID of 0.637, p=0.299). Couple counselling was acceptable to 99.2% of the mothers and 87.6% of the fathers. Factors negatively influencing paternal involvement in breastfeeding issues were: time constraints (89.6%), gender roles (72.7%), limited information and unintentional exclusion of fathers by mothers from the breastfeeding process. The predictors of EBF were: being a female infant (AHR: 1.39; CI: 1.15-1.66; p<0.001), being a housewife (AHR: 0.65; CI: 0.5-0.84; p=0.001) and being of lower socio-economic status (AHR: 1.55; CI: 1.13-2.14; p=0.006). Younger mothers also tended to be more likely to exclusively breastfeed compared to older ones (AHR: 1.03; CI: 1.00-1.05; p=0.022). The findings of this study may be useful to the Ministry of Health and organisations concerned with children’s health to strengthen or re-design current EBF programmes and strategies to include the fathers.
Development and utilization of amaranth sorghum Grains product to enhance the Nutritional status of moderately malnourished Children in Thika District
(Kenyatta University, 2014) Okoth, Judith Kanensi
Poor complementary foods are a major cause of undernutrition in sub-Saharan Africa. Thin porridge prepared predominantly from cereals and starchy tubers is a common complementary food. Such porridge is low in energy and nutrient density and may be high in anti nutrients thus not providing the child's requirements. Infants at this stage of rapid development have high requirements of energy and nutrients per unit body weight. There is need therefore to develop nutrient-dense complementary foods that will provide adequate nutrients for the children. The main objective of this study was to develop a nutrient-dense complementary food from amaranth and sorghum grains then determine its effect on the nutritional status of moderately acutely malnourished (MAM) children 6 to 23 months old. Amaranth grain has high biological value proteins and a better amino acid profile than other staples. It is not commonly used as a complementary food in Kenya. Amaranth and sorghum grains were steeped and germinated for various periods to get the optimum steeping and germination time that would result in best nutrient composition and least antinutrients content. Product formulation was done and its nutritional value determined by proximate analysis. The effect of the developed food product in rehabilitating MAM children was tested using a randomized controlled study, at Kiandutu slum, Thika. The study had two arms: control group (CG) in which children received maize-sorghum flour and the treatment group (TG) received the developed flour. The sample size per study group was 73 mother-child pairs. The children in the TG received Kcal 1000 worth of porridge per day while those in the CG received Kcal 266.8. Mothers of children in both groups were given nutrition education at baseline and monthly for six months. Anthropometric measurements, morbidity and food intake data were taken at baseline, then monthly for six months. Product acceptability was determined through focus group discussions and questionnaires administered to the mothers. Descriptive statistics were used to describe the study population in terms of food security, morbidity, nutrient intake and children's nutritional status. The effect of the developed food product in rehabilitating MAM children was tested by Relative Risk and Mann Whitney U tests. Amaranth grains steeped for 5 hours and germinated for 24 hours had the least dry matter loss and best nutritional quality. Sorghum grains had optimal antinutrient reduction after steeping for 24 hours and germination for 72 hours. The formulation with a ratio of 90 to 10 amaranth to sorghum grains provided jhe highest energy (5 kcal per gram on dry weight basis) content. At baseline characteristics of the two groups were similar. On a monthly basis, nutrient intake in the TG was significantly higher for a majority of the nutrients than in the CG. At months 5 (RR=1.35, p=0.03) and 6 (RR=2.23, p
Efficacy of Sorghum Peanut Blend in The Treatment of Moderate Acute Malnutrition in Children Aged 6 - 59 Months in Karamoja Sub-Region, Uganda
(Kenyatta University, 2015) Amegovu, A. K.
Moderate acute malnutrition (MAM) is estimated to affect 11% of children worldwide. In Sub-Saharan Africa, 239 million people are malnourished with 48 million of these being children. Karamoja region has the highest cases of acute malnutrition in Uganda. Corn Soya Blend Plus (CSB+) is the traditional treatment for moderate acute malnutrition (MAM) in children 6-59 months. CSB+ was introduced as a substitute for CSB but does not provide a sustainable treatment for moderate acute malnutrition (MAM) due to unavailability to local communities and its high cost. Despite the availability of local foods to constitute dietary supplements for children that are relatively cheaper than CSB+ and with greater potential to provide a more sustainable solution to treat MAM, they are not widely promoted. There is need therefore to formulate food supplements from locally grown foods and to test their efficacy in treating MAM among children 6-59 months of age. The study was conducted in Karamoja region, Northern Eastern Uganda. The study was conducted in two phases: phase I involved formulating a test food supplement from sorghum and peanut, mixed with honey and ghee (SPB) along with assessing its nutritional and anti- nutrient profile. Phase II comprised the intervention, in which the acceptability and efficacy of SPB versus CSB+ in treating MAM was tested. The sample size for efficacy study was 440 children, 220 for each study arms; SPB and CSB+. A randomised single-blind parallel cluster trial was conducted in which two health centres were assigned on a 1:1 ratio by computer to the two study groups. Each child received a daily ration of 269g of either SPB or CSB+ for a maximum period of 3 months. Anthropometric measurements were taken on a bi-weekly basis. The primary outcomes were the recovery rate and the mean length of stay in the programme before full recovery. Data was analysed using (SPSS version 17). Levels of macronutrients, CSB+ had significantly higher amounts of protein and carbohydrates whereas SPB had significantly higher amounts of fat and crude fibre. There was no significant difference in terms of energy content in SPB and CSB+. Proximate components, beta-carotene, iron, zinc, calcium, magnesium, phosphorus, potassium, manganese and sodium amounts were available in adequate amounts in both products. Vitamin A level was higher in CSB+ than SPB. Levels of anti- nutrients; condensed tannin, phytates, and trypsin inhibitors were significantly higher in SPB but were in amounts lower than the acceptable limits. Aflatoxins were also below the 20ppb upper limits by FDA. The two food supplements were acceptable to the study participants in terms of all the sensory attributes. The recovery rates were not significantly different (91.4%) in the SPB and 87.1% in the CSB+ group (Chi-square test; P=0.193). Duration of recovery was significantly shorter for CSB+ group; median 43 days compared to 57 days in the SPB (Kaplan-Meir Survival test). The recovery rate and the duration of stay in the programme for those children fed on CSB+ and those on SPB were all within the acceptable Sphere Standards 2004 (≥75% and ≤90 days) respectively. The cost of SPB was much lower than the CSB+ if transportation costs are considered. SPB has the potential to become a cost-effective, sustainable locally-available home-based food supplement for treatment of MAM in the study community and other similar circumstances.
Nutrition Education on Iron Status of Primary School Pupils of Gatanga Sub-County, Kenya
(Kenyatta University, 2015) Gitau, Gladys Njura
Anaemia can affect the cognitive function, motor performance and educational achievements of school age children as they grow and learn. Nutrition education has not been given priority in primary schools due to the busy school curriculum. Nutrition Education is concerned with changing an individual’s behaviour. It is in this light that this study was designed. The main objective of this study was to evaluate the effects of three main nutrition education facilitators on nutrition knowledge. The facilitators used were the researcher, 5 peer educators and an Agriculture Extension official using the FAO curriculum chart. A baseline survey was conducted in 12 randomly selected schools for 601 class six pupils and 67 households. All pupils’ (154) in class six in the intervention schools participated in nutrition knowledge at pre and post-test, with a random sample of 89 proportionate pupils' for each school for biochemical data at baseline and 79 pupils’ at endline. Questionnaires and an interview schedule were used to collect data with pre and post tests. Dietary intake, biochemical data on haemoglobin levels and stool among others were assessed. The experimental schools were Mabanda, Kigio and Kirwara and the control Gakurari. Baseline data were analyzed by use of Nutri-Survey software for nutrient analysis and Statistical Package for Social Sciences (SPSS) version 17 for descriptive and inferential statistics. The data were coded to search for emerging themes. This led to the identification of variables and concepts of iron deficiency in the children, which was crucial to the design of the corrective measures model for the interventions. On average, the mean mark in nutrition knowledge at baseline was 30.05% which was low. In the post-tests; all experimental schools significantly improved in nutrition knowledge. The peer facilitated school performed best with (51.52+24.79) marks, researcher facilitated scored (49.67+22.23), and the agriculture staff facilitated scored (39.29+9.87). The pre-test post- test improvement in the control school (29.6+14.0 to 31.21+12.74) was however not significant (p>0.05). A total of 31.4 % pupils were found to be anaemic after altitude adjustments at a calculated factor 0.5 for Gatanga altitude (2237m ASL). The prevalence of intestinal parasites was 63.1%; Entamoeba histolytica accounted for 61.3% and Ascaris lumbricoides 1.8%. Improvement in the adoption and use of the projects that enhance nutrition and health significantly occurred in the experimental schools as opposed to the control school. Pupils’ haemoglobin status were not significantly different (p>0.05) between the experimental and control schools at baseline. However, notable differences in haemoglobin levels occurred in the experimental schools after the interventions. The relationship between nutrition knowledge and nutrient intake was positive and there was a significant relationship between nutrition knowledge and haemoglobin levels at p<0.05 (r=0.253, p=0.025). Anaemia and parasitic infestation were found to be a significant problem and the need for comprehensive intervention strategies by all stakeholders like deworming and growing of iron rich foods. The study findings would contribute towards operationalization of the national school health policy and guidelines, the national food security and nutrition policy in prevention and control of IDA by enhancing nutrition education.
Nutrition education on iron status of primary school Pupils of Gatanga sub-county, Kenya.
(Kenyatta University, 2015) Gitau, Gladys Njura; Kimiywe Judith; Waudo, Judith N.
Anaemia can affect the cognitive function, motor performance and educational achievements of school age children as they grow and learn. Nutrition education has not been given priority in primary schools due to the busy school curriculum. Nutrition Education is concerned with changing an individual's ehaviour. It is in this light that this study was designed. The main objective of this study was to evaluate the effects of three main nutrition education facilitators on nutrition knowledge. The facilitators used were the researcher, 5 peer educators and an Agriculture Extension official using the FAO curriculum chart. A baseline survey was conducted in 12 randomly selected schools for 601 class six pupils and 67 households. All pupils' (154) in class six in the intervention schools participated in nutrition knowledge at pre and post-test, with a random sample of 89 proportionate pupils' for each school for biochemical data at baseline and 79 pupils' at endline. Questionnaires and an interview schedule were used to collect data with pre and post tests. Dietary intake, biochemical data on haemoglobin levels and stool among others were assessed. The experimental schools were Mabanda, Kigio and Kirwara and the control Gakurari. Baseline data were analyzed by use ofNutri-Survey software for nutrient analysis and Statistical Package for Social Sciences (SPSS) version 17 for descriptive and inferential statistics. The data were coded to search for emerging themes. This led to the identification of variables and concepts of iron deficiency in the children, which was crucial to the design of the corrective measures model for the interventions. On average, the mean mark in nutrition knowledge at baseline was 30.05% which was low. In the post-tests; all experimental schools significantly improved in nutrition knowledge. The peer facilitated school performed best with (51.52+24.79) marks, researcher facilitated scored (49.67+22.23), and the agriculture staff facilitated scored (39.29+9.87). The pre-test post- test improvement in the control school (29.6+ 14.0 to 31.21+12.74) was however not significant (p>0.05). A total of 31.4 % pupils were found to be anaemic after altitude adjustments at a calculated factor 0.5 for Gatanga altitude (2237m ASL). The prevalence of intestinal parasites was 63.1%; Entamoeba I' histolytica accounted for 61.3% and Ascaris lumbricoides 1.8%. Improvement in the adoption and use of the projects that enhance nutrition and health significantly occurred in the experimental schools as opposed to the control school. Pupils' haemoglobin status were not significantly different (p>0.05) between the experimental and control schools at baseline. However, notable differences in haemoglobin levels occurred in the experimental schools after the interventions. The relationship between nutrition knowledge and nutrient intake was positive and there was a significant relationship between nutrition knowledge and haemoglobin levels at p<0.05 (r=0.253, p=0.025). Anaemia and parasitic infestation were found to be a significant problem and therefore the need for comprehensive intervention strategies by all stakeholders like deworming and growing of iron rich foods. The study findings would contribute towards operationalization of the national school health policy and guidelines, the national food security and nutrition policy in prevention and control of IDA by enhancing nutrition education.
Prevalence of the female athlete triad among junior female long distance runners in Iten, Elgeyo-Marakwet County, Kenya
(2015) Muia, Esther Nduku
Adolescents regularly participating in sports and do not meet their energy intake may develop several medical conditions, such as disordered eating, menstrual dysfunction, and decreased bone mineral density, collectively referred to as the Female Athlete Triad (FAT). Limited data is available on components of FAT in adolescent athletes of African descent. This study’s aim was to investigate the presence of the components of the female athlete triad amongst a group of junior long female distance runners and non-athletes in Kenya. One hundred and ten students randomly selected from secondary schools in Iten, Elgeyo-Marakwet County, took part in this cross-sectional comparative study. Students completed demographic, health, sport and menstrual history questionnaires as well as a 5-day weighed dietary record and exercise log to calculate energy availability (EA). Heel bone mineral density was assessed with ultrasound. Subscales of the Eating Disorder Inventory and the cognitive dietary restraint subscale of the Three-Factor Eating Questionnaire measured disordered eating. Dietary intake was analysed with Nutri-survey and dietary diversity determined by the Individual Dietary Diversity Score (IDDS) using 5-day dietary records. Fewer mothers (19 vs. 40%, χ2=12.9, p=0.02) and fathers (28 vs. 50%, χ2=11.8, p=0.06) from athletes had tertiary education than non-athletes, and more mothers from non-athletes had formal employment than athletes (54 vs.13%, χ2=22, p<0.001). Energy availability was significantly lower in athletes than non-athletes (36.5 ± 4.5 vs. 39.5 ± 5.7 kcal/kg/FFM/day, p=0.003). More athletes than non-athletes were identified with clinical low EA (17.9 vs. 2 %, [OR = 9.5, 95% CI (1.17, 77), p=0.021). Subclinical (75.4 vs. 71.4%) and clinical DE behaviour was similar between athletes and non-athletes, (4.9 vs. 10.2%, respectively, χ2=1.1, p=0.56). More athletes than non-athletes had a body mass index of < 17.5 kg/m2 [16.1 vs. 0%, OR= 0.8, 95% CI (0.7, 0.9), p=0.004]. No significant differences were noted for carbohydrate, fat, calcium, magnesium, B2 and zinc intake between groups. IDDS was higher in students in day schools than in boarding schools (4.36±0.7 vs. 3.8±0.6, χ2 =13.4, p=0.001). More athletes (72.1% vs. 32.7% χ2 =17, p=0.000) reported restricting the types of food eaten and the amount to control weight (68.9% vs. 32.7%, χ2 =14, p=0.000). More athletes reported clinical menstrual dysfunction in comparison to non-athletes (32.7% vs. 18.3%, χ2=7.1 p=0.02); primary amenorrhea (13.1% vs. 2.0%) and secondary amenorrhea (19.7% vs. 10.2%). BMD tended to be higher in athletes compared to non-athletes (0.629±0.1 vs. 0.592±0.1 g/cm2, p=0.06). Kenyan adolescent athletes and non-athletes present with low energy availability and menstrual disturbances which are key components of the female athlete triad. Energy intakes should be increased in the student population to match the energy expended and menstrual disturbances closely monitored in athletic adolescent girls since exercise induced amenorrhea signals energy drain.
Chromium supplementation in management of type 2 diabetes among patients attending Thika level 5 hospital, Kenya: a randomized placebo controlled study
(Kenyatta University, 2015) Munga, Judith
Diabetes Mellitus is a condition with common elements of hyperglycaemia and glucose intolerance. It is the fourth leading cause of death in high-income countries and evidently epidemic in newly industrialized countries as well as economically developing nations such as Kenya. Type 2 Diabetes is characterized by insulin resistance and relative insulin deficiency. Studies have reported low serum chromium levels in Type 2 diabetics compared to non-diabetic population. Chromium has been reported to potentiate insulin action in muscle cells. Studies show contradictory findings on beneficial effects of chromium on; blood sugar (FBS and HbAlc), blood lipids (LDL, HDL, triglycerides and total cholesterol), adiposity measures (BMI, WC and W/H ratio), fat mass and lean body mass. Consequently similar studies have been recommended to investigate further the benefits of chromium with a view of coming up with conclusive evidence. The purpose of this study therefore was to investigate the contribution of chromium supplementation in the management of fasting blood sugar, HbAlc, LDL, HDL, triglycerides, BMI, W/H ratio and WC in Type 2 Diabetes mellitus patients in Thika level 5 Hospital, Kenya. This was a double blind randomized controlled trial with a sample size of 180 participants on hypoglycaemic drugs. The sample was randomized into two study groups at a ratio of 1:1 (control group and intervention group). Participants in the intervention group received chromium picolinate (500mcg/day) while the control group received placebo for a period of 4 months. Data was collected at baseline, monthly and end of month 4, using semi-structured questionnaires. Information collected included: demographic characteristics, medical history, physical activity and dietary patterns. Additionally, anthropometric measurements (weight, height and waist and hip circumferences) were taken. Blood samples were analysed for chromium levels, HbAlc, serum ferritin and serum lipids (LDL, HDL, total cholesterol and triglycerides). Descriptive statistics such as mean and standard deviation were used to analyze demographic, socioeconomic, blood sugar, blood lipids and anthropometry and nutrient adequacy from 24 hour recall; mode was used to describe the 7 day food frequencies. Principle component analysis was used to determine the wealth index/socioeconomic categories. T-test was used to determine differences in continuous data between the study groups and Chi-square test used to determine associations in categorized variables between the study groups. Wilcoxon test was used to determine differences in food frequencies between the study groups while GPAQ was used to analyze physical activity levels. Multiple regression was used to determine predictors of elevated HbAlc. On the whole, at baseline, the participants had high fasting blood sugar with low serum chromium levels. Chromium supplementation significantly reduced HbAlc (DID: intervention 1.44% versus control -0.79%; p=0.001) and LDL elevation (DID: intervention -0.09 mmol/l versus control -0.91 mmol/l; t-test; p=0.010). Chromium supplementation had no effect on BMI, WC and W/H ratio; no effect on chromium status (t-test; p=0.241), triglycerides (t-test; p=0.648) and HDL (t-test; p=0.648). The predictors for elevated (above 9%) HbAlc were age and fasting blood sugar; the higher the fasting blood sugar and the older the patients, the higher the likelihood of elevated HbAlc. Since chromium supplementation was effective in reducing HbAlc and LDL among Type 2 diabetics in this study; it is recommended that chromium is used in management of blood sugar in Type 2 Diabetes.
Effectiveness of mother-to-mother support groups in promoting of exclusive breastfeeding in Igembe South- Sub County, Meru County , Kenya: A Randomized Controlled Trial
(2015-05) M'Liria, Joseph Kobia
survival, growth and development because it reduces infant morbidity, mortality and ensures better nutrition outcomes. The major challenge has been the low rates of EBF globally (36%) despite the gradual increase in EBF rates in recent years. Prevalence of EBF is 32% and 18.6% in Kenya and Igembe South Sub-County the study site, respectively. Mother-to-mother support groups (MTMSGs) is a strategy used in Kenya and other countries to promote of EBF. There is scarcity of data on the effectiveness of MTMSGs in promotion of EBF in Kenya. The aim of this study was to assess the effectiveness of MTMSGs in promoting EBF in Igembe South Sub-County, Meru County, Kenya. The study adopted a cluster randomized controlled trial design in which the 3 health centres were randomly allocated on a 1:1:1 ratio to 3 study groups: 2 treatment groups and one control group (CG). In one treatment group (MES), the mothers in the MTMSGs received education support whereas in the second treatment group (MESIGA) the mothers were engaged in an income generating activity (lGAs) in addition to receiving education support. In both groups, the mothers held 7 monthly meetings, one pre-natally and six post-natally. The mothers in the control group received no education support from the research team but followed the usual irregular nutritionlhealth education at the health centre. The sample sizes for each group were: MES 88; MESIGA 82; and the control group 79 mothers. The determination of infant feeding practices was done on a monthly basis from months 1 to 6. Observations of infant feeding practices were carried out on a1O% of the study sample to verify maternal selfreported information at the interviews. Data on infant morbidity and weight measurements was collected on a monthly basis. Six focus group discussions were held to collect in-depth information on the rationale for maternal choices of infant feeding methods. The study outcome was EBF prevalence at 6 months as defined by crosssectional data based on 24-hour recall and cumulative or continuous EBF to six months. Data was entered using Epi-Enfo 3.5 software (CDC), cleaned using SPSS software Version 17.0 and analysed using SAS 9.3 software. Mothers in MESIGA and MES were two times more likely to exclusively breastfeed at 6 months compared to mothers in CG {RR=2.42; CI(1.36-4.28); (p=0.004}and {RR=1.89; CI(1.02-3.49); (p=O.033)} respectively using cross-sectional 24-hr recall data. There was no significant difference between EBF rates at 6 months in MES and MESIGA. The median duration of cumulative EBF for the CG was significantly lower at 0.68 months as compared with MES at 2.8 months and MESIGA at 3.36 months (p=O.OOl). IGAs significantly (p
Prevalence of the Female Athlete Triad among Junior Female Long Distance Runners in Iten, Elgeyo-Marakwet County, Kenya
(Kenyatta University, 2015-11) Muia, Esther Nduku
Adolescents regularly participating in sports and do not meet their energy intake may develop several medical conditions, such as disordered eating, menstrual dysfunction, and decreased bone mineral density, collectively referred to as the Female Athlete Triad (FAT). Limited data is available on components of FAT in adolescent athletes of African descent. This study’s aim was to investigate the presence of the components of the female athlete triad amongst a group of junior long female distance runners and non-athletes in Kenya. One hundred and ten students randomly selected from secondary schools in Iten, Elgeyo-Marakwet County, took part in this cross-sectional comparative study. Students completed demographic, health, sport and menstrual history questionnaires as well as a 5-day weighed dietary record and exercise log to calculate energy availability (EA). Heel bone mineral density was assessed with ultrasound. Subscales of the Eating Disorder Inventory and the cognitive dietary restraint subscale of the Three-Factor Eating Questionnaire measured disordered eating. Dietary intake was analysed with Nutri-survey and dietary diversity determined by the Individual Dietary Diversity Score (IDDS) using 5-day dietary records. Fewer mothers (19 vs. 40%, χ2=12.9, p=0.02) and fathers (28 vs. 50%, χ2=11.8, p=0.06) from athletes had tertiary education than non-athletes, and more mothers from non-athletes had formal employment than athletes (54 vs.13%, χ2=22, p<0.001). Energy availability was significantly lower in athletes than non-athletes (36.5 ± 4.5 vs. 39.5 ± 5.7 kcal/kg/FFM/day, p=0.003). More athletes than non-athletes were identified with clinical low EA (17.9 vs. 2 %, [OR = 9.5, 95% CI (1.17, 77), p=0.021). Subclinical (75.4 vs. 71.4%) and clinical DE behaviour was similar between athletes and non-athletes, (4.9 vs. 10.2%, respectively, χ2=1.1, p=0.56). More athletes than non-athletes had a body mass index of < 17.5 kg/m2 [16.1 vs. 0%, OR= 0.8, 95% CI (0.7, 0.9), p=0.004]. No significant differences were noted for carbohydrate, fat, calcium, magnesium, B2 and zinc intake between groups. IDDS was higher in students in day schools than in boarding schools (4.36±0.7 vs. 3.8±0.6, χ2 =13.4, p=0.001). More athletes (72.1% vs. 32.7% χ2 =17, p=0.000) reported restricting the types of food eaten and the amount to control weight (68.9% vs. 32.7%, χ2 =14, p=0.000). More athletes reported clinical menstrual dysfunction in comparison to non-athletes (32.7% vs. 18.3%, χ2=7.1 p=0.02); primary amenorrhea (13.1% vs. 2.0%) and secondary amenorrhea (19.7% vs. 10.2%). BMD tended to be higher in athletes compared to non-athletes (0.629±0.1 vs. 0.592±0.1 g/cm2, p=0.06). Kenyan adolescent athletes and non-athletes present with low energy availability and menstrual disturbances which are key components of the female athlete triad. Energy intakes should be increased in the student population to match the energy expended and menstrual disturbances closely monitored in athletic adolescent girls since exercise induced amenorrhea signals energy drain.
Impact of peanut supplementation on cardiovascular disease markers in HIV-infected adults with dyslipidemia attending Nyeri level- 5 -hospital, Kenya
(Kenyatta University, 2016-04) Wangui, Kamuhu Regina
Cardiovascular diseases (CVD) is currently second, after cancer, as the most frequent cause of death among HIV-positive subjects in areas of the world where Highly active anti-retroviral therapy (HAART) is widely available. Dyslipidemia is an important adaptable cardiovascular risk factor that is a widespread clinical feature of HIV-infected patients in the present era of HAART. Peanuts are a rich source of magnesium, folate, fibre, α- tocopherol, copper, arginine and resveratrol. These compounds have been shown to reduce the CVD risk in various ways and this suggests that peanut consumption might benefit those at risk of CVD. The purpose of this study was to investigate the effect of peanut supplementation on cardiovascular disease markers in HIV-infected adults with normal and hyperlipidemia attending comprehensive care clinic in Nyeri Level- 5- Hospital. The study design was a randomized cross-over clinical trial. The study duration was 22 weeks. The eligible participants were randomly assigned to a two arm study. In treatment I, the participants consumed their regular diet supplemented with 80g of peanuts; while in treatment II, the participants were counseled on healthy diet and supplemented it with 80g of peanut. The participants then crossed over to respective treatments. Each treatment took 8 weeks, with a six weeks washout period between treatments. Descriptive statistics were used to analyze all study variables. Relationships between all and individual CVD risk factors were analyzed using Spearman’s correlation coefficient, single line linkage and ward’s cluster method. A paired T- test was used to compare subject differences in markers at baseline and at the end of each treatment. Multiple regression analysis was used to determine the effect of peanut supplementation on CVD markers. Criterion for statistical significance was at p < 0.05 and 90% power of test. The sample comprised of 18 (21.2%) males and 67 (78.8%) females. Peanut supplementation significantly increased intake of total fat (p < 0.05), poly unsaturated fatty acid (p < 0.05), Vitamin E (p < 0.05) and mono unsaturated fatty acids (p < 0.05) while carbohydrate intake decreased significantly (p < 0.05) between baseline and the two treatments. There was no significant change in weight, BMI, waist circumference, hip circumference, body fat, body muscle, systolic and diastolic blood pressure and fasting blood glucose after consumption of peanut with regular diet and consumption of peanut combined with nutritional counseling on healthy diet. There was a significant decrease (p < 0.05) in total cholesterol, triglycerides and Low density lipoprotein in both treatments while High density lipoprotein increased significantly (p < 0.05). Also reduced significantly, was the estimated 10-year risk of coronary heart disease between baseline and end of study (p =0.03). Peanut consumption was found to lower cardiovascular risk significantly due to reduction in total cholesterol, triglyceride and Low Density Lipoprotein Cholesterol. The policy makers should promote the incorporation of this food-based supplement in order to lower the economic burden cardiovascular diseases are imposing on the economy.
Impact of Peanut Supplementation on Cardiovascular Disease Markers in Hiv-Infected Adults with Dyslipidemia Attending Nyeri Level- 5 -Hospital, Kenya
(Kenyatta University, 2016-04) Kamuhu, Regina Wangui
Cardiovascular diseases (CVD) is currently second, after cancer, as the most frequent cause of death among HIV-positive subjects in areas of the world where Highly active anti-retroviral therapy (HAART) is widely available. Dyslipidemia is an important adaptable cardiovascular risk factor that is a widespread clinical feature of HIV-infected patients in the present era of HAART. Peanuts are a rich source of magnesium, folate, fibre, α- tocopherol, copper, arginine and resveratrol. These compounds have been shown to reduce the CVD risk in various ways and this suggests that peanut consumption might benefit those at risk of CVD. The purpose of this study was to investigate the effect of peanut supplementation on cardiovascular disease markers in HIV-infected adults with normal and hyperlipidemia attending comprehensive care clinic in Nyeri Level- 5- Hospital. The study design was a randomized cross-over clinical trial. The study duration was 22 weeks. The eligible participants were randomly assigned to a two arm study. In treatment I, the participants consumed their regular diet supplemented with 80g of peanuts; while in treatment II, the participants were counseled on healthy diet and supplemented it with 80g of peanut. The participants then crossed over to respective treatments. Each treatment took 8 weeks, with a six weeks washout period between treatments. Descriptive statistics were used to analyze all study variables. Relationships between all and individual CVD risk factors were analyzed using Spearman’s correlation coefficient, single line linkage and ward’s cluster method. A paired T- test was used to compare subject differences in markers at baseline and at the end of each treatment. Multiple regression analysis was used to determine the effect of peanut supplementation on CVD markers. Criterion for statistical significance was at p < 0.05 and 90% power of test. The sample comprised of 18 (21.2%) males and 67 (78.8%) females. Peanut supplementation significantly increased intake of total fat (p < 0.05), poly unsaturated fatty acid (p < 0.05), Vitamin E (p < 0.05) and mono unsaturated fatty acids (p < 0.05) while carbohydrate intake decreased significantly (p < 0.05) between baseline and the two treatments. There was no significant change in weight, BMI, waist circumference, hip circumference, body fat, body muscle, systolic and diastolic blood pressure and fasting blood glucose after consumption of peanut with regular diet and consumption of peanut combined with nutritional counseling on healthy diet. There was a significant decrease (p < 0.05) in total cholesterol, triglycerides and Low density lipoprotein in both treatments while High density lipoprotein increased significantly (p < 0.05). Also reduced significantly, was the estimated 10-year risk of coronary heart disease between baseline and end of study (p =0.03). Peanut consumption was found to lower cardiovascular risk significantly due to reduction in total cholesterol, triglyceride and Low Density Lipoprotein Cholesterol. The policy makers should promote the incorporation of this food-based supplement in order to lower the economic burden cardiovascular diseases are imposing on the economy.
Bioequivalence of Micronutrient Powders to Conventional Fortification on Zinc Status of Children Aged 6-36 Months in Thika Informal Settlements, Kenya
(Kenyatta University, 2016-11) Kiio, Juliana N.
Corn Soy Blend (CSB) is the backbone of supplementation feeding for malnourished children. CSB however, has poor micronutrient bioavailability and may result into poor outcomes during nutrition recovery of the children. Micronutrient powders (MNPs) have a potential to improve micronutrient nutrition. Scientific evidence on the efficacy of MNPs in improving zinc (Zn) status among moderately malnourished children is scarce. This cluster randomized trial was designed to establish the bioequivalence of MNPs formulated as sprinklestm to conventional fortification in improving Zn status of moderately malnourished children aged 6-36 months in Thika informal settlements, Kenya. Secondary objectives were to determine the effect of Zn fortification on growth velocity, appetite and morbidity, to assess the predictors of Zn status at baseline and to establish the in vitro bio-accessibility of Zn. Twelve villages were randomized to four study groups. Three experimental groups received different formulations of MNPs added to CSB; multiple micronutrients (MMN) containing Zn (CSB-sprinkle-MMNZn), MMN without Zn (CSB-sprinkle-MMN) and Zn singly (CSB-sprinkle-Zn). The control group received conventionally Zn-fortified CSB containing MMN. CSB was prepared centrally in each of the participating villages and enrolled children brought there and fed daily on the assigned formulation. Standard tools were used to collect socio-demographic characteristics. Dietary practices were assessed using 24-hour recall and Food Frequency Questionnaires. Enrolled children underwent physical examination and anthropometric measurements. Hair and serum Zn levels were determined pre-post intervention. Daily consumption of CSB was monitored for a period of six months with monthly follow-up on dietary intake, anthropometric measurements and morbidity patterns. Sample size was calculated to show bioequivalence within ±20% limit. A total of 346 children (MUAC ≥11.5 - <12.5cm) were enrolled following informed consent; CSB-sprinkle-MMNZn (N=84), CSB-sprinkle-MMN (N=88), CSB-sprinkle-Zn (N=93) and control group (N=81). Analysis was by intention-to-treat. Strict adherence to assigned groups was observed and groups were similar in loss to follow-up and baseline characteristics except for a few differences. At baseline, 64.2% of the children were Zn deficient, Zn intake was sub-optimal for 95.7% of children. The prevalence of diarrhoea, acute respiratory tract infections and fever was 45.4%, 16.8% and 17.6% respectively. A mixed effects linear regression was used to model pre-post change in serum Zn levels, adjusting for age, sex and socio-economic status. Compared to control group, the change was significantly lower for CSB-sprinkle-MMN (β= -20.0μg/dL; 95% CI: -26.5, -13.5) and significantly higher for CSB-sprinkle-MMNZn (β=5.9 μg/dL; 95% CI: 0.5, 11.3). No significant difference was observed between CSB-sprinkle-ZN and control group (β=-2.1; 95% CI: -8.3; 4.2). Conventional fortification was not bioequivalent to MNPs in improving serum Zn levels (t-tests 95% CI: -2.2; 8.9 p>0.05). Kaplan Meier disease-free survival was not significantly different among study groups (log rank test; p>0.05). Change in appetite scores was not significantly different among study groups (mixed effects linear regression; p>0.05). In vitro Zn bio-accessibility in MNPs (26.05%) was not significantly different from control (24.07%) (t-test; p=0.7). MNPs were more effective in improving Zn status of malnourished children compared to conventional fortification and are therefore recommended for food supplementation programmes targeting urban poor. Further research on processing technologies to improve micronutrient bioavailability in CSB and on optimal home fortification for improved health outcomes is needed.
Impact of spirulina corn soya blend on protein energy malnourished and iron deficient children aged 6-23 months in Ndhiwa sub-county-Kenya.
(Kenyatta University, 2016-12) Othoo, Dorothy Apondi
Protein Energy Malnutrition (PEM) and iron deficiency Anemia (IDA) affect children below five years globally. Studies in Kenya show levels of stunting (26%), wasting (4%), underweight (11%) and low iron intakes (7%) among children aged 6-23 months. These children are at critical period of rapid growth marked by malnutrition which can be irreversible if not effectively addressed. The standard CSB to manage PEM is inadequate in energy and micronutrients. Spirulina powder is richer in proteins and iron than soya bean and if used to fortify CSB would provide a more energy dense and iron rich flour than standard CSB. The SCSB can be produced locally by households to ensure nutritious consumption for under-nourished children than CSB. The objective of the study was to determine impact of SCSB on PEM and IDA among children aged 6-23 months in Ndhiwa Sub-County through a randomized controlled trial. A total of 240 children with PEM and IDA were accessed at Ndhiwa Sub-County Hospital and randomly assigned to two experimental groups (EG1 received SCSB while EG2 received standard CSB) and one control group who did not receive any treatment during the intervention. Data was collected using a questionnaire and a Focus Group Discussion (FGD) guide. PEM was assessed using the following indicators; plasma Retinol Binding Protein, WHZ and WAZ scores while iron status assessed based on Hematocrit levels. Relative Risk, Difference in Difference and Log-rank tests were used to compare impact of SCSB and standard CSB on PEM and IDA while logistic regression used to identify predictors of plasma RBP, Hct levels, WHZ and WAZ. At baseline, assessment of plasma RBP and Hct levels was done. In addition nutrient content analysis of spirulina powder, SCSB, CSB and maize flours was done for carbohydrates, proteins, fats and iron, and production of SCSB and CSB flours used in the intervention. Intervention was done for 6 months and involved daily consumption of 100g SCSB and CSB flours while doing assessments of key variables up to six months. The SCSB was significantly higher in energy (5.4±0.1Kcal/100g vs 2.9±0.7 and 2.8±0.3, p=0.036), protein (20.84±0.2 vs 15.47±0.2 and 0.06±0.1, p=0.043) and iron (15.32±0.2 vs 6.15±0.3 and 0.81±0.2, p=0.043) than CSB and maize meal. The children who consumed SCSB significantly improved in RBP status (RR:3.07;CI:2.62-2.72,p=0.004 and RR:4.06;CI:3.63-3.76,p=0.0001), Hct status (RR: 3.15;CI:1.91-2.07,p=0.002 and RR:4.07;CI:3.66-3.79,p<0.0001), wasting (RR:3.10;CI:0.001-0.48,p=0.0001 and RR:4.08;CI:3.37-3.58,p=0.0001) and underweight (RR: 3.16;CI:3.58-3.91,p=0.0001 and RR:4.18;CI:3.05-3.27,p=0.0001) compared to children who consumed CSB and those in control group. The children who consumed SCSB had faster recovery from PEM and IDA compared to children who consumed CSB and children in control group. The breast fed children consuming SCSB were significantly meeting RDAs for energy (913.8±149Kcal vs 727.8±125 and 654±114,p=0.011 ), protein (15.2±8g vs 8.9±3 and 8.2±2, p=0.004) and iron (15.9±0.3mg vs 6.0±0.7 and 4.3±0.8, p=0.004) as well as non-breastfed; energy (832±116Kcal vs 781±93 and 652±102, p=0.022), protein (19.9±8 vs 8.3±3 and 6.2±4, p=0.001) and iron (15.9±0.1 vs 7.1±0.2 and 4.9±0.6, p=0.002) compared to children who consumed CSB and those in control group. There were no significant difference in the acceptability attributes of mothers/caregivers of children who consumed both SCSB and CSB porridges (chisquare: p>0.005). The SCSB had a significantly higher impact on PEM and iron deficiency than standard CSB and control group. The use of spirulina powder as a fortifier for commonly consumed cereals in Kenyan communities is recommended.

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