PHD-Department of Foods, Nutrition & Dietetics

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Browsing PHD-Department of Foods, Nutrition & Dietetics by Subject "Kenya"

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    Effect of Moringa-Finger Millet Porridge Consumption on Protein and Vitamin A Status of Cerebral Palsy Children in Nairobi City County, Kenya
    (2022) Malla, Janet Kajuju; Sophie Ochola; Irene Ogada
    Malnutrition, secondary to feeding dysfunctions is common in children suffering from Cerebral Palsy (CP) and is associated with inadequate protein intake which is consequently linked with vitamin A deficiency. A diet that is both nutrient-dense and easy to chew and swallow is necessary to improve the protein and vitamin A status of these children. Previous studies have reported the potential of Moringa oleifera leaf powder in alleviating nutritional deficiencies. The purpose of this study was to find out the effect of M. oleifera consumption on the protein and vitamin A status of children with CP. Phase one involved the development, nutrient analysis and sensory evaluation of a fermented finger millet porridge fortified with M. oleifera leaf powder for the intervention. The second phase was a randomized clinical controlled trial with a sample of 113 children with CP randomly allocated to 2 study groups (intervention and control) on a 1:1 ratio. Participants in the control group were fed on fermented finger millet porridge while those in the intervention group received the fortified porridge daily for 3 months. Data collection was done by interviewing caregivers on socio-economic and demographic characteristics and dietary intake of children with CP. Nutrisurvey was used to determine the nutrient intakes of the study children which were compared against RDA values. Anthropometric measurements of children (weight and height) were also taken. The nutritional status of the children was expressed in terms serum albumin and retinol levels as well as BMI-for-age Z-scores and interpreted using WHO Child Growth Standards (2006). The Statistical Package for Social Sciences (SPSS) was used for data analysis. Relationships between categorical variables were determined using Chi-square tests while independent t-test was used to compare continuous variables. The significance level was set at p≤0.05. Results indicated that M. oleifera leaf powder had significantly high content of Protein and b-carotene which were target nutrient components for fortification of the fermented millet flour. M. oleifera fortified porridge was significantly more organoleptically acceptable than the non- fortified porridge [t (52) = 2.994; p = 0.004]. At baseline, the serum albumin levels for both groups were lower than the normal range of 3.5-5.0g/dl i.e. (3.067g/dl for intervention and 3.186g/dl for control), representing general protein deficiency. Serum retinol levels for both groups were also below the cut off values of 0.7 μmol/L i.e 0.471 μmol/L for intervention and 0.468 μmol/L for control). At end line, significant differences were observed between the control and intervention study groups respectively in the levels of serum retinol (0.471+0.03 and 0.714+0.03 μmol/L, p<0.001), serum albumin (3.198±0.06 and 3.523±0.07 g/dL, p=0.001). The BMI-for-age Z-scores between the two study groups were significantly different at end line (p=0.037) with fewer children in the intervention group found to be underweight at end line. The consumption of M. oleifera fortified porridge highly significantly improved the serum retinol and albumin levels and also the BMI-for –age Z-scores in the children in the intervention group. The study thus confirms that M. oleifera has potential of being used as suitable natural fortificant for foods consumed by children with CP in order to improve their nutritional status.
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    Effect of Nutrition and Physical Activity Education Intervention on Weight Management among Adolescents in Secondary Schools in Uasin Gishu County, Kenya
    (Kenyatta University, 2021) Munyao, Florence Wandia; Sophie Ochola; Irene Ogada
    Health-related behaviors and attitudes, such as unhealthy eating habits and physical inactivity have been identified as key causative factors of overweight and obesity. Studies to evaluate school-focused interventions on weight management in adolescents in Kenya are limited. The purpose of this study was to determine the effect of a school-focused nutrition and physical activity education intervention on the knowledge, attitudes, dietary patterns and physical activity patterns in relation to body weight among adolescent students 15-18 years old attending day schools in Kenya. This was a Cluster Randomized Controlled Trial in which 4 schools were randomly placed into 2 study groups. Students were randomly assigned to the study groups; 111 per group. The intervention group received 8 lessons each of nutrition education and physical activity education on a weekly basis. Students in the control group received no nutrition and physical activity education lessons from the research team. Data was collected using self-administered questionnaires at baseline, 8 weeks and 6 months post intervention. Key informant interviews were conducted to collect qualitative data. Major dietary patterns were derived from a principal component analysis of reported intake from a Food Frequency Questionnaire. Data was analyzed by use of statistical package for social sciences (SPSS) version 21 for descriptive and inferential statistics. Nutrition and physical activity education resulted in significantly higher improvement in mean knowledge scores in intervention group compared to the control group (T-test: 2.269; p=0.024) at 6 months post intervention. The difference in knowledge change (difference in difference) in the intervention group was significantly higher than the difference in the control group (DID of 0.43; p<0.001). The students mean attitude scores were significantly different at 6 months post intervention (T-test:-6.47; p<0.001). The principal component mean of the healthy dietary pattern was significantly higher in the intervention group compared to the control group (T-test: 1.814; p=0.042). The intensity and levels of physical activity improved in the intervention group as compared to the control group at 8 weeks and 6 months post intervention. Metabolic Equivalent for Task (MET) scores were significantly higher in the intervention group (T-test: -2.36; p=0.019) at 6 months post intervention as compared to the control group. The intervention group had a significantly lower waist circumference at 8 weeks post intervention compared to the control group (T-test: 3.229; p =0.001), but the mean BMI for age Z scores were not significantly different at the same time period (T-test: -0.357; p=0.720), between the study groups. The intervention group had lower mean waist circumference and lower mean BMI for age Z scores in contrast to the control group, at 6 months post intervention. Significant changes in the mean scores of waist circumference (Difference in Difference (DID) of 1.16; p<0.001) and mean BMI for age z scores (DID of 0.66; p<0.001) were noted when baseline and end line mean scores were compared. School focused physical activity and nutrition education can be effective in managing weight among adolescent students and should therefore be encouraged.
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    Effect of Umbilical Cord Clamping Time on Nutrition Status of Infants: A Randomized-Controlled Trial in Longisa Hospital, Bomet County, Kenya
    (Kenyatta University, 2019-10) Bor, Kipkorir Wesley
    Although most studies document the benefit of delaying umbilical cord clamping in relation to improved haemoglobin levels, few of those studies have been done in low resource settings. Standard routine practice in most facilities is generally clamping umblical cord in less than 60 seconds. This study therefore sought to establish the effects of umbilical cord clamping time on infant nutritional status at 6 months at Longisa County Referral Hospital through randomized controlled trial design. Sample size of n=204 of mother-infant pair was enrolled in both control and experimental group of the study. The experimental group involved clamping the umbilical cord between 3-5 minutes after delivery while the control group was clamped as per the standard routine practice in the facility. Infant’s blood sample was drawn and haemoglobin was assessed at birth, 6 weeks and 6 months. Ballard maturity assessment score was used to assess infant gestational age at birth. Weight was measured using SECA 354 and length was assed using SECA 210 length Matt. Mother -infant socio demographic characteristics collected using a validated questionnaire. A standard Pre-test questionnaire based on WHO 2014 guidelines was used to measure health workers knowledge on the umbilical cord clamping time. Data was analysed using Stata version 15.1 and Microsoft Office Excel 2007. Mother-infant socio-demographic characteristics by the study group was compared using Pearson chi-square (p < 0.05; 95% CI). Health workers’ knowledge was analysed results presented in percentage. Third trimester maternal haemoglobin was collected in mother child booklet and analysed using Pearson chi-square. Infant haemoglobin levels at birth, 6 weeks and 6 months by study group was analysed using Pearson chi-square. The relationship between maternal and infant haemoglobin status was assessed using Pearson correlation coefficient determinant. The effect of umbilical cord clamping on infant nutritional status and haemoglobin was tested using student t-test. Predictors of infant Nutritional status at six (6) months were established using binary logistic regression model. The results are based on two-tailed tests at 95% confidence interval and a p-value p < 0.05 was used as the criterion for significance. Results were: Mean age of mothers of infants enrolled into the study was (22.73 ± 1.9; p<0.05); about 50% of health workers knew that delaying umbilical cord clamping is beneficial to the infant. Approximately 69% of health workers believe that delaying umbilical cord camping increases the HIV infection. Control group: Mean weight: at birth 2.89kgs (95% CI, 2.81-2.97), 4.81 (95% CI (4.68-4.94) at 6 weeks and 7.41kgs (95% CI, 7.28-7.54) at 6 months. Mean haemoglobin at birth was 18.72g/dl (95% CI, 18.19-19.25), 10.85g/dl (95% CI (10.58-11.12) at 6 weeks and 11.10g/dl (95% CI, 14.26-15.52) at 6 months. Experimental group: Mean weight at birth 2.93kgs, 5.22 (95% CI, 4.99-5.22) and 8.51 at 6 months ((95% CI, 8.40-8.60; p<0.05). Mean haemoglobin: Birth 19.67g/dl, (95% CI, 19.25-20.09), 11.72(95% CI, 11.45-11.99) and 12.22g/dl (11.95-12.49 at 6 months ((95% CI, 8.40-8.60; p<0.05). Predictor of infant nutritional status at 6 months were weight (OR14.90, p<0.05; 95% CI: 7.25-30.00) and infant haemoglobin (OR1.64, p<0.05; 95% CI: 1.3-2.07). The study concluded that delaying the umbilical cord clamping improved infant Nutritional status and haemoglobin. Setting optimal time to clamp the umblical cord is important for Kenyan health facilities.
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    Impact of Maternal Dietary Intake on Breast Milk Composition and Infant Nutrition Status Among Lactating Women in Nyeri County, Kenya
    (Kenyatta University, 2020-08) Kiboi, Willy Kahanya
    Exclusive breastfeeding for the first six months of life, with continued breastfeeding up to 2 years after the introduction of complementary feeds, is considered as the standard norm for infant feeding. Although the benefits of breastfeeding have long been known, studies on the composition of human milk are still ongoing. Considering that breast milk is the sole source of the nutrition for the infant in the first six months of life, it is essential to have accurate and up to date data on its composition. The composition of human milk could vary according to many maternal factors such as diet, nutritional status, genetics and environmental exposures, among other factors. The amount of variability in human milk composition that could be attributed to maternal dietary intake remains largely unknown. In Africa, particularly in Kenya, there is scanty information available on the nutrient composition of breast milk and the factors that affect its composition. This study therefore investigated the association between maternal dietary intake with breast milk nutrient composition and their effect on the nutrition status of the infant (under six months). The longitudinal study was conducted in Nyeri County, Kenya. Participants included lactating mothers with infants under six months. The lactating mothers’ dietary intake, nutrition status (BMI, MUAC and serum micronutrients) and that of their infants (recumbent length and weight) were assessed. Additionally, breast milk samples were collected and analyzed for selected nutrient content and correlated with both maternal dietary intake and the infant’s nutritional status. The breast milk samples were analysed for energy, macronutrients and selected micronutrients (vitamin A, calcium, magnesium, zinc and iron). All the measurements were done at two time points (first and the fifth month of lactation) among a comprehensive sample of 104 mother-child dyads. Significant changes in the mean nutrient composition were noted between the first and fifth month of lactation (protein-0.96 g/dL and 0.85 g/dL, p = 0.03; vitamin A-22.48 and 31.61 μg/dL, p value, p < 0.001; iron-0.39 mg/L and 0.47 mg/L, p = 0.02). There was statistically significant (p < 0.05) relationship between mother energy intake with milk lactose (r = 0.30); carbohydrate intake with milk true proteins (r = 0.24); protein intake with milk true protein (r = 0.44) and milk iron (r = 0.31); fat intake with milk energy (r = 0.29), milk true protein (r = 0.40) and milk fat (r = 0.35); percent of energy from fat with milk energy (r = 0.39) and milk fat (r = 0.45). Furthermore, vitamin A intake with milk retinol (r = 0.56), calcium intake with milk zinc (r = -0.32) and iron (r = -0.27), zinc and iron (r = -0.26). For maternal nutrition status, hemoglobin (Hb) was correlated with both milk energy (r = 0.30) and true protein (r = 0.44). Serum retinol, magnesium and iron were correlated with milk retinol (r = 0.34), magnesium (r = 0.29) and iron (r = 0.33), respectively. Association between breast milk nutrient composition and infant nutrition status revealed that the milk true protein (r = 0.58) and retinol (r = 0.32) were positively correlated with weight for age and MUAC (r = 0.31) of the infant. Weight for length was also positively correlated with milk lactose (r = 0.47). No relationship was found between other maternal factors (age, parity, child sex and mode of delivery) and any of the selected breast milk nutrient content (p > 0.05). The study observes that breast milk nutrient composition is variable over the course of lactation. Further, both maternal dietary intake and nutrition status (serum micronutrient status) are associated with the nutrient composition of human milk. Moreover, breast milk nutrient composition is related to the infant nutrition status. Promoting adequate nutrient intake and optimal maternal nutritional status during lactation is essential to ensure adequate child growth and development.