MST-Department of Foods, Nutrition & Dietetics

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Adherence to Dietary Recommendations in the Management of Type 2 Diabetic Patients Attending Diabetic Clinic at Nyahururu County Referral Hospital, Kenya
(Kenyatta University, 2024-02) Muketha, Maureen Karimi
Type 2 Diabetes is among the biggest contributors of deaths and morbidity worldwide. It’s also increasing steadily, and if not controlled, it will soon become an epidemic due to an increase in the ageing population and the number of obesity cases worldwide. This aggravates the existing burden on health systems especially in developing nations. Screening and diagnosis are based on clinical guidelines that encompass both clinical and laboratory parameters. There is presently no cure for the disease. However, adherence to dietary recommendations as advised by health care workers has proven to be a game changer in its management. Hence, the current study sets to unravel adherence to dietary recommendations in the management of Type 2 diabetic patients at Nyahururu County Referral Hospital. Blood glucose level was used in order to determine if the patient has adhered to dietary recommendations. The study was conducted between November 2022 and January 2023; and it adopted a cross sectional analytical design using the Perceived Dietary Adherence Questionnaire to collect information on the socio-demographic characteristics, behavioural characteristics, dietary diversity, adherence to dietary recommendations and the level of dietary awareness. The study also utilised Focus Group Discussions (FGDs) and Key Informant interviews (KIIs) to collect complementary qualitative data. Systematic random sampling was applied in the 152 participants; who attended the diabetic clinic at Nyahururu County Referral Hospital. The information and data collected was entered into SPSS Version 21.0 and analysed. Qualitative data was transcribed coded and analysed to bring out the emerging themes. The study found that the social demographic factors, behavioural characteristics and awareness influenced adherence to dietary recommendation among the diabetics’ patients attending Nyahururu diabetic clinic at Nyahururu County Referral Hospital. Analysis of the respondent BMI was classified under 4 categories of underweight, normal, overweight and obese. Most of the respondents had a normal BMI (55.3%), overweight (28.4%), obese (7.4%) while (9.2%) were underweight. It was also observed 91.5% of the respondents had fasting blood glucose of more than 7.0mmol/l or higher glucose levels at the time of this study. This means that most of the respondents had high and uncontrolled blood sugar levels. The mean energy intake per day was 2291.4±125.6 kcal for men and 2193.7±164.3 kcal for female. The patients’ demographic characteristics influenced the level of adherence to dietary recommendation among the diabetics’ patients attending Nyahururu diabetic clinic at Nyahururu County Referral Hospital. There existed a statistically important association between gender, income, level of education, marital status and the level of awareness with the diabetic patients’ adherence to dietary recommendations at α=0.05. On the other side, age was not found to have insignificant influence on the participants’ adherence to dietary recommendations at α=0.05. There also existed a statistically significant association between Physical exercise, smoking as well as presence of other disease and diabetic patients’ adherence to dietary recommendations at α=0.05. Taking alcohol, family diabetics history, duration lived with diabetes and self- care did not significantly influence participants’ adherence to dietary recommendations at α=0.05. The intervention should be based on gender, education status, marital status and income; the average sugar level in mean was higher than the sugar level in women thus implies that men had low observance of recommended dietary than female. The study recommends emphasis on the observations of physical exercise, smoking and presence of other disease. The Ministry of Health and stakeholders should emphasize regular community sensitization of communities on the dietary recommendations for diabetic patients through continuous nutrition advocacy.
Agricultural Commercialization of Staple Foods, Household Food Security and Nutrition Status of Children Aged 6-59 Months in Tharaka-Nithi County, Kenya
(Kenyatta University, 2022) Gitari, Janice Gatakaa; Peter Chege; Ann Munyaka
Globally, the number of undernourished people rose to above820 million in 2018. Kenya ranked 125th out of 157 countries in progress toward meeting the Sustainable Development Goals in 2017. Among the thirteen counties in the eastern and central regions of Kenya, Tharaka-Nithi County ranked second on stunting levels at 32%. Studies have shown large variations in food security implications caused by commercialization of agriculture hence need for further research to generate conclusive results. Thus, this study sought to assess the effect of agricultural commercialization of staples and household food security on nutrition status of children aged 6-59 months in Tharaka-Nithi County. The study adopted a cross-sectional analytical study design. Purposive sampling was used to select Mukothima ward. Proportionate to sizes sampling was used to select the number of households while systematic sampling was used to select the households with under-fives in each of the sub-locations to generate 374 children-caregiver pairs. Researcher administered structured questionnaires, key informant interview and focus group discussion guides were used to collect data. Data was entered into SPSS version 20.0 for analysis. Nutri-Survey and ENA for SMART were used to analyse 24-hour recall and anthropometric data respectively. Chi-square tests were run to test associations among categorical data variables. Qualitative data was organized into themes for analysis. The mean household size was 4.28 ± 1.404 with 85.2 %, of the households being headed by youthful men. 52.5% of the subjects relied on food crops’ sale as their main income source with65.3% being high level participants of agricultural commercialization. The mean Household Dietary Diversity Score was 5.32± 1.06. Based on Household Food Insecurity Access Score, 35.51% of the households were food secure. The mean number of meals eaten by the households in the day preceding the study was 2.94 ±0.926 with the main food source being purchases. Further, the mean energy and selected nutrient intakes of the under-fives in the study were adequate except for Zinc and Vitamin A. The prevalence of underweight based on WAZ-scores was 17.2 % while the GAM based on WHZ-scores was at 5.4 %. 33.6 % of the under-fives in the study were stunted. Significant positive associations were observed between: agricultural commercialization and income (Chi-square=23; P value =0.021); agricultural commercialization and occupation (Chi-square=23; P value =0.007); Income and HDDS (r=0.71; P value =0.035); agricultural commercialization and HDDS (P value =0.001); agricultural commercialization and nutrition status of the under-fives (P value =0.0041) and HDDS and nutrition status of the under-fives (r=0.78; P value =0.003). This study demonstrated that households which practice Agricultural Commercialization to a larger extent generated income which enabled them to purchase various foods in addition to their own produce thus achieving adequate nutrient intakes resulting to better nutrition outcomes. Thus, Tharaka-Nithi County Government should domesticate the Food Crops Act of 2013 which regulates food crop production activities. The County Government of Tharaka-Nithi and other partners should intensify adoption of sustainable nutrition interventions that will address the high levels of stunting among under-fives as revealed by the study results. A longitudinal study is recommended to further explore the relationships between agricultural commercialization and food security given their multi-dimensional nature.
Antioxidant Retention Acceptability in Solar-Dried Mushrooms and Acceptability of Mushroom Millet Porridge Blend among HIV Patients in Nakuru County Referral Hospital, Kenya
(Kenyatta University, 2023-11) Masiko, Bosire Miriam; Ann Munyuka; Juliana Kiio
Th_e rolg of mushrooms in preventing and treating illness and promoting quality of life has gained increased awareness especially due to their high antioxidant content. Antioxidants are necessary for body protection against oxidative stress especially among people with lowered immune system, such as People Living with HIV/AIDS (PLWHAs). There are limited options ot: nutritional therapeutic foods available for use by PLWHAs. Millet is an Under}mllze.d indigenous crop in Kenya whose nutrient profile can be improved through blt_ndm.g with other foods. The purpose of this study was to establish the antioxidant (Vltamm E, Vitamin C, B-carotene and Total Phenolic Content) concentration and retention in fresh' .and solar-dried oyster mushrooms (Pleurotus ostreatus) and assess the acceptability of finger millet (Eleusine Coracana) porridge enriched with oyster mushroom among PLWHASs. The study adopted an experimental design with fresh mushrooms and pure millet flour as the control samples and mushroom enriched millet flour as the experimental samples. Fresh mushrooms were purchased in Juja sub-county, Kenya, transported using cool boxes and refrigerated at 4°C in the Kenyatta University food chemistry laboratory. Millet samples were purchased from markets within Nairobi County, Kenya and transported and stored in hermetic bags. B-carotene and Total Phenolic Content of mushrooms and millet were analyzed using UV-VIS spectrophotometry at 450nm and 765nm respectively. Vitamin C and Vitamin E content were analyzed using reverse-phase high Pressure liquid chromatography (HPLC). Sensory acceptability of mushroom-millet porridge was determined using a S-point hedonic scale questionnaire administered to 30 randomly selected participants (PLWHAs) from Nakuru County Referral Hospital. Independent T-tests and Analysis of Variance (ANOVA) were used to analyze nutrient content and sensory scores. The antioxidant nutrient content of fresh and solar dried mushrooms were: B-carotene- 13.73 + 0.02 mg/100g dw, 1.21 + 0.00 mg/100g dw ; Vitamin E- 23.23 + 2.12 mg/100g dw, 0.96 + 1.18 mg/100g dw; Vitamin C 37.25 + 0.32 mg/100g dw, 5.60 + 0.12 mg/100g dw and TPC 36.48 + 1.50 mg/100g dw, 21.55 + 0.24 mg/100g dw respectively. Blanching the mushrooms before solar drying increased the retention rate of the nutrient antioxidants in the solar dried mushrooms. There was a significant difference in the antioxidant content of fresh mushroom and solar dried mushrooms in all the tested nutrients (p < 0.05). Enriching millet flour with mushroom powder significantly increased p-carotene, Vitamin C and TPC concentrations (p < 0.05). There were significant differences between control porridge and mushroom enriched millet porridges on all sensory attributes apart from color (p < 0.05). The unblanched mushroom: millet porridge (60:40) blend was rated the poorest (2.97 + 1.47) in all the sensory attributes. This study’s findings demonstrate that oyster mushrooms are rich in antioxidants. However, solar drying the mushrooms without blanching significantly lowers the levels of the antioxidants. This study established that porridge made from millet flour enriched with mushroom is rich in -carotene, Vitamin C and TPC; and is acceptable among PLWHAs. The consumption of porridge made from millet-mushroom blended flour should be promoted among PLWHAs not only because of protein content but also because of antioxidant content. Findings from this study are relevant to nutritionists, farmers, and policy makers as it shows the potential of mushrooms in enhancing diets, promoting health and income generation.
Antioxidant Retention in Solar-Dried Mushrooms and Acceptability of Mushroom Millet Porridge Blend among HIV Patients in Nakuru County Referral Hospital, Kenya
(Kenyatta University, 2023) Bosire, Miriam Masiko; Ann Munyaka; Juliana Kiio
The role of mushrooms in preventing and treating illness and promoting quality of life has gained increased awareness especially due to their high antioxidant content. Antioxidants are necessary for body protection against oxidative stress especially among people with lowered immune system, such as People Living with HIV/AIDS (PLWHAs). There are limited options of nutritional therapeutic foods available for use by PLWHAs. Millet is an underutilized indigenous crop in Kenya whose nutrient profile can be improved through blending with other foods. The purpose of this study was to establish the antioxidant (Vitamin E, Vitamin C, β-carotene and Total Phenolic Content) concentration and retention in fresh and solar-dried oyster mushrooms (Pleurotus ostreatus) and assess the acceptability of finger millet (Eleusine Coracana) porridge enriched with oyster mushroom among PLWHAs. The study adopted an experimental design with fresh mushrooms and pure millet flour as the control samples and mushroom enriched millet flour as the experimental samples. Fresh mushrooms were purchased in Juja sub-county, Kenya, transported using cool boxes and refrigerated at 4ºC in the Kenyatta University food chemistry laboratory. Millet samples were purchased from markets within Nairobi County, Kenya and transported and stored in hermetic bags. β-carotene and Total Phenolic Content of mushrooms and millet were analyzed using UV-VIS spectrophotometry at 450nm and 765nm respectively. Vitamin C and Vitamin E content were analyzed using reverse-phase high Pressure liquid chromatography (HPLC). Sensory acceptability of mushroom-millet porridge was determined using a 5-point hedonic scale questionnaire administered to 30 randomly selected participants (PLWHAs) from Nakuru County Referral Hospital. Independent T-tests and Analysis of Variance (ANOVA) were used to analyze nutrient content and sensory scores. The antioxidant nutrient content of fresh and solar dried mushrooms were: β-carotene- 13.73 ± 0.02 mg/100g dw, 1.21 ± 0.00 mg/100g dw ; Vitamin E- 23.23 ± 2.12 mg/100g dw, 0.96 ± 1.18 mg/100g dw; Vitamin C 37.25 ± 0.32 mg/100g dw, 5.60 ± 0.12 mg/100g dw and TPC 36.48 ± 1.50 mg/100g dw, 21.55 ± 0.24 mg/100g dw respectively. Blanching the mushrooms before solar drying increased the retention rate of the nutrient antioxidants in the solar dried mushrooms. There was a significant difference in the antioxidant content of fresh mushroom and solar dried mushrooms in all the tested nutrients (p ≤ 0.05). Enriching millet flour with mushroom powder significantly increased β-carotene, Vitamin C and TPC concentrations (p ≤ 0.05). There were significant differences between control porridge and mushroom enriched millet porridges on all sensory attributes apart from color (p ≤ 0.05). The unblanched mushroom: millet porridge (60:40) blend was rated the poorest (2.97 ± 1.47) in all the sensory attributes. This study’s findings demonstrate that oyster mushrooms are rich in antioxidants. However, solar drying the mushrooms without blanching significantly lowers the levels of the antioxidants. This study established that porridge made from millet flour enriched with mushroom is rich in β-carotene, Vitamin C and TPC; and is acceptable among PLWHAs. The consumption of porridge made from millet-mushroom blended flour should be promoted among PLWHAs not only because of protein content but also because of antioxidant content. Findings from this study are relevant to nutritionists, farmers, and policy makers as it shows the potential of mushrooms in enhancing diets, promoting health and income generation.
Arm-span/height correlation in the Luo community-a tool to improve admission criteria based on BMI for Nutritional Rehabilitation HIV Programs
(2012-11-07) Ngetich, Kiprono Weldon; Wagah, Margaret; Rombo, G. O.; Wagah, Akinyi Margaret
Body mass index (BMI) is one of the main criteria used during targeting for therapeutic feeding. For bed ridden HIV-positive people, height cannot be accurately taken because they cannot stand straight due to gross muscle weakness resulting in inaccurate BMl calculation. Arm span has been shown to correlate with height and is not affected by sickness or aging but varies with ethnicity. This study was to explore the correlation between arm span/demi span and height among the Luo community so as to come up with a correlation equation that can be used to approximate the height of bedridden Hl V positive people. A cross sectional study was done and the main objective was to determine the correlation between arm span and height among the Luo community. The study location was Homabay MSF HIV clinic with the sample size of 500 Luo adults between the age IS and 60 years. At the study site, anthropometric measurements were taken using the standard techniques. Partial correlation between arm span/demi arm span and height with control of sex was done. Stepwise forward analysis was done to enable construction of a correlation equation that best estimate height from arm span. Bland-Altman assessment of agreement was done to check the difference in the use of either predicted height from arm span or demi arm span to calculate BMI. Scatter plot diagrams were used to show the correlation between arm span/demi span and height. Tables showing anthropometric characteristics of the sample, arm span! demi span and height correlation by sex, prediction models, partial correlation between MUAC and BMl, sex specific regression equation relating arm span/demi span and height and BMI-as cut offs equivalent to BMI-height cut offs for classifying nutritional status among adults were used to present data. The study found that there were differences in all variables between males and females from the Luo community. There was a high arm span/demi span with height correlation (0.S6) in both sexes among the Luo community. Arm span alone accounted for 83.6% of the variability in height with sex and age having no impact on the variability. The prediction equations for estimating height are: H eight=O. 71 (arm span)+40.S6 and Height=I.44(demi arm span)+43.2S. Partial correlation between BMl-asIBMI-ht with MUAC (controlled by sex) showed the lowest (0.57) and the highest (0.65) correlations respectively. In conclusion, the height estimated from arm span can be used to calculate BMI as a way of improving admission criteria for therapeutic feeding programs for the HIV positive adults in the Luo community. More research is recommended to determine the trend in other communities in Kenya and other African countries where there is high HIV prevalence.
Assessment of complementary feeding practices and nutritional status among children in Athi-River, Machakos District, Kenya
(2011-11-03) Chelimo, Florence L.; Kuria, E. N.; Rombo, G. O.
Complementary feeding involves feeding infants and young children with semi-solid and solid foods in addition to breast milk to ensure adequate nutrition Mother's or principal caregiver's practices however determine the success of complementary feeding. This is affected by many socio-economic and socio cultural factors among others. A descriptive survey study on the complementary feeding practices and the nutritional status of children aged 6 to 24 months was carried out in Athi-river Division of Machakos District, a district that has continually reported high cases of childhood malnutrition. Athi-river is an industrial town in the district and therefore mothers move from other areas to Athiriver in search of employment. The major objective was to assess the complementary feeding practices and the nutritional status of children. A sample of 132 mothers and their children were randomly selected to form the study sample. Data were collected using an interview schedule, anthropometry, focus group discussions, observations and laboratory analysis. The data were analyzed using SPSS, Nutri-survey, Epi-info computer packages and expressed in descriptive and inferential statistics. A P- value of <0.05 was considered significant. Pearson Product Moment Correlation (PPMC) was used to determine the magnitude and direction of the relationship between complementary feeding practices and the nutritional status of the children. Multiple regression was used to determine whether the various complementary feeding practices predict the nutritional status. About half of the respondents (49.2%) were aged between 19 - 25 years while 61.4% and 69.7% of them had primary school education and were casual labourers respectively. Slightly less than half of the respondents (41.7%) left their children with neighbours when they went to work. Although, majority of the study children (77.7%) were being breastfed at the time of the study, exclusive breastfeeding was only done for at most 2 months of life, hence complementary foods were introduced at an early age than the recommended. Slightly more than two thirds (69.2%) of the mothers did not use commercial foods, which are fortified. Majority of the respondents (78.8%) used feeding bottles instead of the recommended cup or bowl and spoon. All the mothers did not sterilize the feeding equipment. Slightly more than half (51.5%) of the mothers did not treat the water they use to prepare the child's food. Majority of the children did not consume adequate amounts of nutrients such as vitamin A (77.2%), vitamin 132 (85.6%), B3 (85.7%), 136 (60.6%), B12 (73.5%), Magnesium (98.4%), zinc (79.6%) and selenium (73.5%). More than half of the children did not also consume vegetables (82.6%), fruits (64.5%) and animal products (59.1%) regularly as recommended. Financial constraints limited the complementary feeding of the children. The proportion of the 6 to 24 months old children that was stunted, wasted and underweight was 25.0%, 24.9% and 19.7% respectively. Majority of the children (72.8%) had been ill for the past two weeks. The number of meals consumed and amount of kilocalories taken were found to affect the nutritional status of children significantly. The number of meals consumed per day, amount of kilocalories and income earned were found to contribute to 21.0% of the children's nutritional status. It was recommended that mothers be empowered and educated on complementary feeding practices.
Assessment of Infant and Young Child Feeding and Nutritional Status of Children 0-23 Months among Ilchamus Pastoralists in Baringo County, Kenya
(Kenyatta University, 2024-04) Rotich, Joyline J.
World Health Organization defines feeding practices of infants and young children as breastfeeding instantly after delivery and continuing exclusively for six months. Complementary feeding gradually from seven months with breastmilk till two years. Caregivers adhere to adequate infant and young child feeding practices to minimize child undernutrition. However, this is not always the case among the Ilchamus pastoralist community who live in the arid and semi-arid regions of Baringo County, facing challenges such as food insecurity and cattle theft. High prevalence of stunting (28.1%) and underweight (4.7%) have been reported among the community despite efforts to alleviate malnutrition in the area. Unfortunately, there is limited research on the feeding practices of children aged zero to twenty-three months in this community, resulting in a scarcity of information. Consequently, this study investigated the feeding patterns and nutritional status of children zero to twenty-three months among the Ilchamus pastoralists of Baringo County, Kenya. The researcher involved 206 caregivers with children zero to twenty-three months. A cross-sectional analytical study design was adopted. A multi-stage selection strategy was used to arrive at the study sample. Wards and locations were purposively selected. While proportionate selection for villages and households. The study was accomplished in Mukutani and Ilchamus Wards, Baringo County, Kenya. A structured questionnaire was utilized to gather descriptive data. The Statistical Packages for Social Sciences (SPSS) version 22 aided in data analysis. Nutritional status was determined by the mid-upper arm circumference, Weight-for-height, and Weight-for-age Z-score based on World Health Organization cut-offs. Descriptive statistics of infant and childcare characteristics were done using percentages and frequencies while association shown by chi-square and spearman’s correlation significant at p<0.05. Most caregivers had a primary level of education, 154(60.2%), and only seven (2.7%) had tertiary training. About 150(58.6%) were unemployed, and the majority, 142(55.5%), had an income of Ksh 5000- 10,000. About 207(80.9%) were married while 46(16.0%) were single. The prevalence of exclusive breastfeeding was 180 (70.3%), with 181(70.7%) initiating breasting within an hour after birth. About 35(13.7%) introduced other foods before age six. Minimum dietary diversity was at 3.8% for ages 6-8 months, 4.9% for 9-11 months, 8.2% for ages 12-17 months, and 9.2% among ages 18-23 months, and minimum meal frequency was three times a day. Prevalence of Wasting was at 35.6%, stunting (41.6%), and underweight (35.2%). The number of household members and household income are significantly associated with wasting (p<0.05). IYCF practices indicated a significant association with wasting (p<0.05). Stunting also showed a significant link between household members showed a significant association with stunting (p<0.05). In addition, household head, number of people in the household, and occupation of the household head showed a significant statistical association with underweight (p<0.05). Low uptake of optimal children's feeding practices contributes to their poor health and Nutritional status. The findings provide evidence of the importance of ensuring adequate feeding practices among Infants and young children to alleviate malnutrition. Thus, Baringo County and the National Government Ministry of Health in Kenya should enhance programs to improve nutrition education to advance maternal and child health.
An assessment of service quality as perceived by customers in five star restaurants in Nairobi, Kenya
(Kenyatta University, 2008-06) Opondo, Josephine Atieno
The tenet of this study is that despite hospitality staff claiming to offer quality services many customers' expectations are not met. Staff tend to focus on tangible elements of the products in their role as service providers. Service providers should regularly monitor service quality and customer satisfaction in an attempt to improve customer retention. Inappropriate or inadequate treatment can result in customer dissatisfaction. The purpose of the study was to assess various quality aspects of service as perceived by the customers in five star restaurants in Nairobi. The study aimed at determining the difference in attitudes and expectations of both customers and service providers. A descriptive survey design was used to evaluate service quality as perceived by customers in selected five star restaurants in Nairobi. This design enabled the researcher to gather information, summarize, present and interpret information for the purpose of clarification The study was restricted to three, five star restaurants in Nairobi, namely: A, B and C.The letters have been used for anonymity reasons. Simplerandom method was used to select three restaurants from the classification of hotels andi~sta'urants. Convenient sampling and stratified methods were used to select subjects for the study. Customers from each of the three restaurants were conveniently selected (A 125, B 120 and C 40). Three restaurant managers < and 22 waiting staff were also interviewed. Data were collected using; rating scale, questionnaires and interview schedules. Observation forms and guest comment cards were also used. Data collected were analyzed using both descriptive and inferential statistics. The main techniques used to analyze data were the Chi-square (x2), Pearson Product- moment correlation (r), Analysis of Variance (ANOVA) and factor analysis. The result of study showed that five top ranked customer satisfaction dimensions revealed that customers were extremely satisfied with; customers' problems treated sympathetically, staff knowledgeable about products, friendliness and politeness of staff, food is fresh and there is no mix up in orders or bills. The study found that the customers were extremely satisfied with the restaurant's reliability, empathy, assurance and responsiveness. However, they were satisfied with tangibles. From this study the reseafcher concludes that; Customers are satisfied with the quality of services provided by the five star restaurants in Nairobi. The restaurants meet the requirements for five star restaurants as established in the criteria for classification of restaurants; Different restaurants provide customers with different levels of satisfaction and majority of the working staff are satisfied with the working conditions within the restaurants. Based on the study, it is recommended that a focus should be made in areas such as empathy, responsiveness and assurance so as to retain and attract more customers. Since majority of the waiting staff are dissatisfied with the pay they received, the management of the five star restaurants should review the pay of staff to ensure that the workers get their rightful dues. This can enhance the quality of service they deliver to customers.
Assessment of Sodium Levels of Processed and Packaged Food Products from Selected Supermarkets in Nairobi and Kiambu Counties, Kenya
(Kenyatta University, 2022) Kibet, Alex; Judith Kimiywe; Rhoda Ndanuko
Excessive intake of sodium can lead to serious health problems and complications overtime. Of special interest is high blood pressure, which is a major risk factor for heart diseases and stroke. This is attributed to the massive intake of ultra-processed foods that possess high energy, fats and above all added salts. This study presents an assessment of sodium content in a selection of food groups as reported on the nutrient information panels and compared with the international standards, notably, the United Kingdom food standard agency (UKFSA) 2017 salt benchmark targets. A cross sectional research design was employed in carrying out this study. Purposive sampling technique was used in selection of five suitable supermarkets stores in Nairobi and Kiambu counties. Supermarkets with more branches that translated to a bigger market share, wider aisles and distributed across the low, middle and high-income residential areas of both counties were suitable. Similarly, four food groups (sauces and spreads, meat products, snack foods and cereal products) basing from other related studies were also selected purposively. The data was collected using FoodSwitch data collector mobile app developed by The George Institute for Global Health, Australia. The app was used to scan the product bar code and captured images of the front and back of the package, product name, ingredients details, manufacturer, brand name and the nutritional information. These images were uploaded into a cloud-based content management system, from where label information could be coded into a database. The study sample was later obtained by applying stratified random sampling technique where the database population was sub-divided into various food groups/strata and a random sub-sample from each selected food group obtained. This was then pooled to make up the required sample of 422 food products. The data was then extracted and exported into SPSS Version 23. Descriptive statistics including the average sodium content together with their standard deviations were computed at each food group as well as their respective food categories. To test for significance differences in average sodium content, the One-way ANOVA was applied followed by Games-Howell Post Hoc Tests. Statistical significance was set at p<0.05. The study found that sauces and spreads had the highest level of sodium content with 1919.81mg/100g, followed by meat products, snack foods and finally cereal products (567.03mg/100g, 551.29mg/100g and 276.10mg/100g respectively). There was a statistically significant differences in the mean sodium content between the four food groups as determined by One-Way ANOVA, [F (3,418) =32.87, P<0.001]. Games-Howell post hoc test revealed that the level of sodium was significantly higher in sauces and spreads (1919.81±2426.91mg/100g, P<0.001) compared to snack foods (551.29±342.75mg/100, P<0.001), cereal products (276.01± 357.04mg/100g, P<0.001) as well as meat products (567.03±403.95mg/100g, P<0.001). In the same way, snack foods had significantly higher levels of sodium than cereal products, (P<0.001). However, there was no statistically significant difference in sodium levels between snack foods and meat products (P=0.995). Overall, 36% of the products that were assessed across the four food groups had sodium levels that exceeded the UKFSA 2017 maximum salt benchmark targets, with all the food groups exhibiting wide ranges between the products with the most and the least sodium content. Frequent monitoring of these food groups and their respective categories by regulatory bodies is of extreme importance in enhancement of consumer safety. Moreover, there is a high potential of reducing sodium levels in most processed foods in Kenya as evidenced by variation of sodium content within the four food groups.
An assessment of the adequacy of school meals in meeting the nutritional requirements of girls in boarding secondary schools in Nairobi
(2012-01-31) Buluku, Elizabeth A
Proper nutrition implies receiving adequate foods and to convey the nutrients required for optimal growth and development of individuals. In boarding institutions, meals must cover all the students' requirements for nutrients in order to sustain a vigorous and healthy life. In situations where no regulator mechanisms exist to ensure adherence to minimum dietary requirements are met as it is in the Kenyan boarding learning institutions, the risk of inadequate intakes is high. This is especially so among adolescent girls whose dietary requirements are markedly increased. The purpose of this study was therefore to assess the dietary practices of girls in boarding schools in Nairobi and to determine the adequacy of meals in their schools. A descriptive cross-sectional survey was used in the study. Data were collected using self-administered questionnaires for students and interview schedules for headmistresses and cateresses. A bathroom scale and a height board were used to collect anthropometric data. A combination of probability and non-probability sampling procedures were used. Descriptive statistics (frequencies, percentages and means) and inferential statistics (ANOVA, chi-square and t-tests) were used to summarize data and to test for differences between groups respectively. All schools sampled provided at least 3 meals a day, that is breakfast, lunch and supper. Mid-morning and afternoon tea/coffee were provided in only two schools. Except for energy the school meals did not meet the Recommended Dietary Allowances (RDA) for protein (44g), calcium (650mg), iron (15mg) and vitamin A (800ugRE). The most deficient nutrient in the school meals provided was calcium. The major factor considered in the planning of meals is the amount of money available. A majority (78%) of the students generally had negative attitudes towards school meals. The reasons for this included poor preparation and cooking of school meals, limited variety, and flavour. Snacking was common with as many as 76% of the students engaging in it. Biscuits were the most consumed snack. A majority of the students snacked to satisfy hunger, implying that school meals were inadequate in quantity. Students' suggestion for improvement of school meals included increased meal portions, a widening of meal item varieties and improvement of flavour. The nutritional status of the students based on the Body Mass Index (BMI) indicated that majority (65%) of the students were well nourished as they fell within the optimum range (18.5-25.0). Three per cent of the students were severely underweight while 4% were obese. Significant differences were observed between energy (x2 = 271.339), calcium (x2 = 745.675) and vitamin A (x2 = 384.867) provided in the school meals and the RDA at p < 0.05. Apart from energy, there was no significant differences among the school meals provided for protein (x2 = 1.890) calcium (x2=5.496), iron (x2=0.925) at p > 0.05. The hypothesis that there is no significant difference in attitudes towards school meals among students in different forms was accepted while the hypothesis that there is no significant difference in attitudes towards school meals among students was rejected. The study concluded that school meals in girls' boarding schools in Nairobi are inadequate in quantities of nutrients provided in relation to RDA for protein, calcium, iron and vitamin A. The study recommends nutritional education for meal planners in boarding institutions and the formation of a regulatory body to ensure adherence to the minimum dietary requirements of students. Further research in similar institutions in different set-ups should be done.
Assessment of the Factors Affecting Performance and Management of Banqueting Services in Five-Star Hotels in Nairobi, Kenya.
(2011-12-13) Maranga, V. N.
Traditional revenue sources in hotels are threatened by both the reduction in tourist turnover and unexploited domestic market. The sub-optimal performance of banquet services as revenue centres in hotels have, however, been attributed to a combination of factors including inadequate seating capacity, theft, overcrowded venues, insecurity, insufficient equipment, unattractive changes, exodus of customers to lower star hotels and lack of effective management. The objectives of this study were to: - (1.) assess the revenue contribution from banqueting services, (2.) determine factors affecting banqueting services, (3.) identify problems faced by managers in banqueting management, and (4.) determine management operations of banqueting services by 5 star hotels. Data for this study were gathered through, interview schedules, questionnaires, observation checklists and secondary documents from sampled establishments. Both random and purposive sampling procedures were used to identify ninety-eight respondents in Nairobi. Correlation analysis was used to test relationships between variables. The results indicated a significant variations of revenue derived from banquet services, with highest being 68% and lowest 20%. The total revenue generated from banqueting services was Kshs.404, 114,769.00 (million) in the year 2004. Results showed multiple bookings in one day, with corporate clients spending over Ksh. 500,000.00 in one function. There were differences in the number of mean guests attending the banquets between hotels and within hotels (p-value =0.07). A majority of hotels (79%) recruited casual staff with a ratio 2:1 to permanent staff. This reflected a notable dependence on casual staff and yet no established scheme existed for casuals incase of accidents. These findings indicated a worrisome and questionable ability of the casual staff to offer effective and successful service as no formal briefings are given prior to the start of service. Though there is erratic demand for banquets, 64% experienced a large turnover between the months of September and December. A logistic regression was used to assess the relationships between the independent and dependent variable. Results (p-value =12.504) indicated that large turnover of clients is dependant on seasonality. The prices charged (p-value= 9.32) were not proportionate to portion sizes served. Although insecurity has increased due to rising crime rates, hotels have a legal duty to provide "reasonable care" for the protection of guests and staff. Theft (5%) was found to have a very low effect on banqueting performance due to the busy environment of food and beverage and complexity. Although pilferage was found to be minimal at 2%, it was higher in alcoholic beverages than in food. Determinants of optimal revenue include; bargaining power of clients, client loyalty, sufficient capacity and spacious venue. Other factors influencing the service are converting restaurants into banquet halls during the day and the same into restaurants at night. Some hotels tactfully use yield management in low season. The hotel industry needs to diversify and improve banquet products and services, monitor the security of the guests and identify training needs of both the casual and permanent staff. Conclusively, banqueting services are a significant source of revenue as they contributed enormous income to the Hospitality sector.
Association between Household Food Security and Infant Feeding Practices in Urban Informal Settlements in Nairobi County, Kenya
(Kenyatta University, 2021) Njoki, Macharia Teresia; Sophie Ochola; Elizabeth Kimani
Despite various strategies to reduce child malnutrition and death, millions of children under five years of age die every year due to preventable causes. Appropriate infant and young child feeding (IYCF) practices play a major role in the healthy growth and development of children and helps reduce malnutrition and mortality. Studies in the urban informal settlements show widespread inappropriate infant and young child feeding (IYCF) practices and high rates of food insecurity. These together with the unique challenges with regards to child survival in these settings has led to widespread and persistent under-nutrition rates. This study assessed the association between household food security and IYCF practices in two urban informal settlements in Nairobi, Kenya. The study adopted a longitudinal study design that involved a census sample of 1500 children less than 12 months of age and their mothers aged between 14-49 years. A researcher-administered questionnaire was used to collect data on IYCF; household food security; and maternal demographic and socio-economic characteristics. Logistic regression was used to determine the association between food insecurity and IYFC practices. The findings showed high household food insecurity as only 19.5% of the households were food secure. Breastfeeding practices were comparable to the national rates as most of the children (84.2%) had been initiated to breastfeeding within one-hour of birth and were exclusive breastfed (60.4%). However, infant feeding practices were inappropriate as only 41% of the children attained a minimum dietary diversity; 76% attained minimum meal frequency and 27% attained minimum acceptable diet. With the exception of the minimum meal frequency, adjusted logistic regression findings showed that infants living in food secure households were significantly more likely to achieve appropriate infant feeding practices than those in food insecure households: minimum meal frequency (AOR 1.26, p= 0.530); minimum dietary diversity (AOR 1.84, p= 0.046) and minimum acceptable diet (AOR 2.35, p= 0.008). The findings of this study add to the body of knowledge by demonstrating an association between household food security and infant feeding practices in low-income settings. The findings imply that interventions aimed at improving infant feeding practices and ultimately nutritional status should consider a holistic approach to include improving household food security. The findings of this study provides evidenced-based information useful in decision making by programmes whose aim is to improve the nutrition status of children amongst the urban poor.
Association between Paternal Illicit Alcohol Consumption, Complementary Feeding and Nutrition Status of Children Aged 6-23 Months in Kirinyaga County, Kenya
(Kenyatta University, 2018-06) Mwangi, Terry Wangui
The use of illicit alcohol has increased in Kenya. Illicit alcohol is cheap, readily available and stored under unhygienic conditions despite the Alcoholic and Drinks Act (ADA) of 2010, which seeks to protect drinker‟s health and control drinking hours. In Kenya there has been an increase in illicit alcohol consumption from 3.8% in 2007 to 4.2% in 2012. Excessive use of illicit alcohol can result in sub-optimal infant and young child feeding (IYCF) as resources may be directed to illicit alcohol purchases thus limiting those directed to food. There is limited evidence on the relationship between paternal consumption of illicit alcohol in relation to complementary feeding practices and nutrition status. The study therefore investigated association between paternal illicit alcohol consumption, complementary feeding and nutrition status of children aged 6-23 months in Mwea-East Sub-County, Kirinyaga County. The study adopted a cross-sectional analytical design with a sample of 239 fathers/caregivers with children 6-23 months of age. Simple random sampling technique was used to select households with children 6-23 months of age in which fathers consumed illicit alcohol. Data was collected using both qualitative and quantitative methods. Weight and length measurements were used to assess the nutrition status based on weight and length indices. Overall, under nutrition was high among children: Wasting (6.1%, 95% CI 4.8-7.0); stunting (12.6% 95 CI 8.9-17.5) and underweight (10.4% 95% CI 7.1-15.1) respectively. The minimum meal frequency was attained by 93.5%, minimum dietary diversity was attained by (86.1%), while minimum acceptable diet was attained by 85.2%. Data on anthropometry was analyzed using ENA for SMART software version 2010 then exported to SPSS version 22 for cross analysis with other variables, while Nutri survey was used for dietary data. The World Health Organization growth standards and z-score cut off points were used to establish nutrition status of the children. Descriptive statistics were used to describe socio-economic, socio-demographic characteristics and complementary feeding practices of the study population. The study found that 86.1% of the households were male headed, 71.7% were casual workers while father‟s food expenditure per day was low. Chi-square was used to test for association between categorical variables such as nutrition status and mode of feeding. Statistical significance was set at p< 0.05. There was an association between food expenditure and dietary diversity (p<0.001), meal frequency (p<0.001) and minimum acceptable diet (p<0.002). Qualitative data was transcribed, coded and categorized to generate emerging themes. Key Informant Interviews were analyzed using content analysis. The study findings may be useful to stakeholders such as National Agency for the Campaign against Drug Abuse (NACADA), Ministry of Health (MOH), Kenya Bureau of Standards (KEBS), families that have members who consume illicit alcohol and other agencies. Nutrition messages on Infant and Young Child Feeding should be emphasized especially on dietary diversity and meal frequency.
Blood Pressure and its Associated Risk Factors among Staff at Uasin Gishu Level 5 Hospital, Uasin Gishu County, Kenya
(Kenyatta University, 2020-08) Sum, Jepchumba Rael
High blood pressure continues to be a global public health issue and attention needs to be given to primary preventive measures especially among health practitioners who are a channel to the entire population. Modifiable risk factors for hypertension include overweight and obesity, low consumption of fruits/vegetables, physical inactivity, occupational stress, smoking and excess alcohol consumption. The prevalence of hypertension among health workers in other countries outside and within Africa ranges between 10%-33% while Kenya is between 18.4-32.6% among various community populations but there is no specific data on the prevalence of hypertension among health workers in Uasin Gishu County. This study aimed at determining blood pressure and its associated risk factors among staff at Uasin Gishu level 5 Hospital, Uasin-Gishu County. A cross-sectional analytical study was conducted on a convenient sample of 136 respondents at Uasin Gishu hospital since it is the largest hospital in Uasin Gishu County. Pretested and validated tools were used. A structured questionnaire was used to collect data on socio-demographic characteristics and behavioural factors. 24-hour dietary recall and dietary diversity score were used to collect data on dietary practices. Data on physical activity levels of respondents was collected using the Global physical activity questionnaire. Anthropometric parameters namely weight, height and waist hip ratio were used to determine the nutritional status which was described using World Health Organization classification on Body Mass Index (BMI) and waist hip ratio (WHR). 24hr dietary recall data were analyzed using Nutri-survey. Demographic and socio-economic factors, behavioural factors, occupational stress, dietary practices, nutritional status and physical activity level were analyzed using descriptive statistics. Pearson correlation test was used to determine the relationship between variables, chi-square for the association. A p-value of <0.05 was used as a criterion for statistical significance. The mean age of the hospital staff was 36.96±9.96 years. Prevalence of high blood pressure was 22.6% with the most prevalent risk factors being central obesity (66.9%), BMI above 24.9kg/m2 (63.4%), occupational stress (23%) and physical inactivity at 14%. High dietary cholesterol intake of 219mg which is above RDI of 200mg was observed in female respondents. A Majority (80.1%) had medium dietary diversity score. Dietary intake of key micronutrients such as potassium, calcium in women and vitamin C in males were below the recommended dietary intake. Gender was associated with BMI (p-value = 0.007) and physical activity level (p-value = < 0.001). Factors related to BP were BMI (p-value= 0.011), WHR (p-value= 0.002), age (p-value = < 0.001), education (p-value= 0.016) and household size (p-value= 0.004). Socio-demographic and nutritional status of Uasin Gishu hospital staff influenced their BP levels. Based on findings from this study, respondents should be informed on their nutritional status and blood pressure levels and its associated risk factors. County health administration may find the results from this study useful to help come up with interventions to curb risk factors among their staff. Ministry of Health and other relevant stakeholders such as Kenya Cardiac Society, International Society of hypertension and MoH involved in the prevention and management of hypertension may find this information useful for guiding policy and meeting global targets and goals.
Childcare practices, morbidity status and nutrition status of preschool children (24-59 months) living in orphanages in Kwale County, Kenya
(Kenyatta University, 2018-03) Moyo, Burhaan Bakari
ABSTRACT High adult mortality due to various causes like HIV and AIDS has led to an upward trend of the number of orphans and vulnerable children. Extended family networks have taken the responsibility of caring for these children but lack of adequate resources for their care has forced the caretakers of these children to take them to orphanages. As a consequence to the ever-increasing number of orphans, there has been mushrooming of orphanages in the country. Appropriate childcare practices have substantial consequences for growth, development and survival of infants and children. However, due to lack of adequate resources, children living in institutions are faced with practical challenges in being provided for their basic necessities including nutritious food and clothing. Most studies that have been carried out in Kenya have focused on children below five years who are under the care of their parents. Studies conducted in orphanages have concentrated on children above five years. Thus there is minimal information on childcare practices, morbidity status and nutrition status of preschool children living in orphanages. The purpose of this study was to determine the childcare practices, morbidity status and nutrition status of preschool children 24-59 months of age living in orphanages in Kwale County, Kenya. A cross-sectional analytical study was conducted on a comprehensive sample of 162 children and 45 caregivers, drawn from a sample of 14 out of the 21 orphanages in Kwale County, Kenya. Data collection tools included; a structured researcher-administered questionnaire for caregivers, Key informant interview (KII) guide and observation checklist. The data collected was analysed using Statistical Package for Social Sciences (SPSS) version 20.0 and anthropometric data of the children analysed using ENA for SMART (2011). WHO standards (2006) were used in interpretation of anthropometric data. More than a third (36.4%) of children were either single or double orphans. The rest (63.6%) were not orphans. The mean (SD) duration of stay in orphanages was 35.22+13.54 months. Majority (84.0%) of children had favourable caregiver to child ratio while a small proportion (16.0%) had unfavourable caregiver to child ratio. Supper provided a significant proportion (35.1%) of daily energy intake than both lunch (34.7%) and breakfast (11.4%). In terms of nutrition status: 15.4% of the children were stunted, 8.6% were underweight and 3.7% were wasted. Boys were more stunted, underweight and wasted compared to the girls (chi-square test; p < 0.05). A small proportion (6.8%) of children suffered from upper respiratory tract infection, 10.5% suffered from malaria and 0.6% from measles. Childcare (dietary) practices were associated with underweight (chi-square test; p < 0.001) and stunting (chi-square test; p < 0.001). Children who had been ill based on a two week morbidity recall were likely to be stunted (chi-square test; p < 0.001), underweight (chi-square test; p < 0.001) and wasted (chi-square test; p = 0.020). Institutional characteristics (caregivers trained on childcare) were associated with underweight (chi-square test; p < 0.001), wasting (chi-square test; p = 0.012) and stunting (chi-square test; p < 0.001). Duration of stay of the children in the orphanages was positively associated with underweight (p < 0.001) and stunting (p < 0.001). The results of this study can therefore be used to formulate and/or strengthen strategies or systems that address the needs of children in orphanages in Kenya and other developing countries. The government should ensure that registered orphanages have adequate resources to take care of children in orphanages. The orphanages should also encourage research activities to improve conditions in the orphanages.
Childcare Practices,Nutrition Status and Morbidity Prevalence of Underfives Among Internally Displaced Persons in Kieni Forest, Gatundu District
(2013-03-22) Kihagi, Wothaya Grace
Undernutrition in children continues to be a major challenge globally and in developing countries. In Kenya, the burden of undernutrition is being felt and nutrition status' trends have been deteriorating. Likewise, underfive mortality rates are increasing due to poor childcare practices resulting from unsuitable infant and young child feeding practices and inappropriate health care practices. People living in Internally Displaced Persons (lOPs) Camps are faced with practical challenges which hinder good childcare practices yet the Kenyan Government and other agencies find it hard to provide minimum standards of water, food, shelter and health services as stipulated in the Humanitarian charter. The aim of the study was to. determine the demographic and socioeconomic characteristics of households as well'iaschildcare practices among IDPs in Kieni Forest. Assessment of morbidity and nutrition status of underfives was done. A cross-sectional analytical design was used to investigate the relationship between childcare practices, morbidity prevalence and nutrition of underfives. The study site was purposively selected and a comprehensive sample of 168 children used for the study. Data was collected using structured questionnaire, an interview schedule guide, observation checklists and Focus Group Discussions Guides. The Statistical Package for Social Sciences (SPSS) version 11.5 was used to analyze data while ENA for SMART (2010) analyzed anthropometric data. Chi-square test was used to describe the relationship between categorical variables while Pearson product moment described the relationship of non categorical variables. Multiple regression was used to predict nutrition outcome of underfives in Kieni. The mean number of underfive per household was 1.5±0.6 while household size was 4.6± 1.2. About 60 % of the caregivers were married while 18.5% were separated. The main occupation (65.5%) of the caregivers was casual labour. Majority (70%) of the households earned below Kshs 4QQOper month. Mothers were the principal caregivers (88.7%) though use of informal daycare centres (27%) was common. Children in custody of minors were 10.3% while significant proportion of children (34.2%) was unattended. Children were universally breastfed .at birth with 65.1% initiated to breastmilk within recommended first hour of life while bottle feeding rates were 73%. Only 28% of the children achieved minimum dietary diversity. Morbidity prevalence was 71% with Acute Respiratory Infections (63.1%), Malaria, (23.2%), skin diseases (14.3%) and diarrhoea (11.3%) as major diseases yet only of half of caregivers sought treatment timely. The prevalence of wasting was 2.6%, underweight 14.9% and stunting at 35.9%. Stunting was higher than national rates and in girls than in boys (38.3% vs. 33.3%) though the difference was insignificant (p>0.05). Dietary diversity and deworming were significantly (p < 0.05) related to nutrition status (underweight) of underfives. The predictors of nutrition status of children were deworming [OR, 5.43, P=0.003] and household income [OR, 1.0, P=O.OII]. Overall, care practices and complementary feeding practices were inadequate while sanitation was poor. Thus, public health measures should be promptly addressed alongside continuous community outreaches to enhance accessibility of health services and promotion of health. Similar research should be replicated in other sites especially on efficacy of nutrition services in care centres.
A Comparative Study of Nutritional Status of Orphans Participating and not Participating in School Feeding Programmes in Kariobangi, Kenya
(2013-10-16) Arimi, Kinanu Caroline
The Millennium Development Goals highlights Malnutrition as one of the pnonty development issues under its framework of which malnutrition remains an important public health concern in the developing world especially Kenya (MDGs, 2008). Nutritional status and nutritional food security are a priority as malnutrition is a risk factor for morbidity and mortality, poor cognitive development and reduced productivity (Black, Allen, Bhutta, et al., 2008; Grantham-McGregor, Cheung, Cueto, et al., 2007). The aim of the study was to compare the nutritional status of orphans participating in a school feeding programme and that of orphans not participating in such a programme. The study was a cross-sectional comparative survey carried out in Kariobangi location, Korogocho slum. The population under investigation comprised of 7 schools in Kariobangi location, 3 of which were in the school feeding programme and 4 of which were not. A sample size of 160 orphans aged between 5 to 10 years was determined. Sampling techniques were a combination of purposive sampling and simple random sampling techniques. The research instrument was a questionnaire and an interview schedule. Data was analysed using SPSS, nutrisurvey and anthro plus computer packages. The dependent variable was nutritional status measured by indexes, height for age, BMI for age, and underweight. The findings of the study revealed that school feeding programme had a higher proportion of malnourished children (underweight 20.3%, low Body mass Index for age 16.5% and stunting 19.2%) than the non school feeding programme (underweight 5%, Low Body Mass Index for age 10%, and stunting 20%) although only the low BMI for age was significantly different for the two groups at P<0.05. Calorific intake was inadequate in many of the orphans in both groups but more orphans in the non school feeding group were meeting the recommended dietary allowances for most nutrients compared to those in the school feeding group. Majority of school feeding programme group (61.4%) consumed foods of medium dietary diversity score while majority of non-school feeding programme (61%) consumed foods of high dietary diversity score.( significant at P<0.05).The levels of morbidity in terms of cold/cough and fever were significantly higher in non-school feeding programme compared to the school feeding programme. Multiple logistic regression analysis showed that orphans who stayed for a short time without their mothers were less likely to be underweight in the school feeding programme (OR: 0.78 CI 0.64- 0.94 P=O.013) and stunted in the non- school feeding programme (OR=0.72 CI 0.59-0.58 P= 0.00) than those who had stayed for a long time. In terms of low body mass index for age, orphans in the school feeding programme who consumed diets of few food groups were significantly thinner compared to those who had consumed foods of many food groups.(OR= 2.15 CI 1.04-61.32 p=0.046). The study recommended diversification of food within the schools offering feeding programmes through urban farming of vegetables and poultry within the school compound. The Ministry of Education and partners like WFP and others NGOs with interest in school going children need to enlarge the scope of school feeding programme in Kariobangi. It is also necessary to carry out a longitudinal study on the impact of school feeding programmes on orphans
Comparison between Magnesium Supplement and Ibuprofen as Treatments of Primary Dysmenorrhea and Dietary Intake of School Going Girls in Machakos, Kenya: Randomized Trial
(2014-02-24) Gogi, Julie; Kimiywe, Judith; Okello-Agina, Bonventure Michael
Primary dysmenorrhea refers to painful menstrual cramps accompanied with diarrhea, nausea and vomiting, mood swings and headache. This condition is a leading cause of recurrent class absenteeism with 80.2% of adolescent girls affected in Kenya. The adolescent might not be able to achieve the supplemental dosage (500-1000 mg) for magnesium no matter how much foods rich in magnesium she takes especially during menstruation when she is experiencing nausea and vomiting. Besides, the conventional treatment methods have a failure rate and have often been abused. This study therefore sought to find out nutritional alternatives to treatments of primary dysmenorrhea. The study adopted a randomized trial design with an aim to compare Magnesium supplements and Ibuprofen as treatments on the duration, intensity of menstrual pain, frequency of systemic symptoms, interference on daily activities and the side effects of the two treatments among adolescent girls in Machakos District. Data was cleaned, coded and entered using social statistical package for social sciences. Median, IQR, percentages, chi-square tests, Mann-whitney U, spearman’s correlation and Odds ratio (α = 0.05) were used for analysis. Findings show that at baseline, those who had pain for a shorter time (1/2 day) were 31% and 30% in magnesium and ibuprofen group respectively. After the second treatment more girls had pain for half a day (85%) in magnesium group and (78%) in ibuprofen group than for 2 days or more (7%) in magnesium group and (8%) in ibuprofen group. At baseline 32% and 40% of adolescents had severe pain in magnesium and ibuprofen group respectively, but due to the effect of the treatments, only 6% and 10% presented with severe pains after the second treatment. At baseline, more than half of the girls were able to do their daily activities in magnesium (62%) and ibuprofen group (64%). After the second treatment, almost all (97%) of the adolescents studied were able to do their daily activities in the two treatment groups. There was a positive improvement after the second treatment for the adolescents who had symptoms of primary dysmenorrhea at baseline. Magnesium had no side effects while Ibuprofen had minor side effects on the girls. The adolescent girls who reported not having taken breakfast everyday had a 2.13 increased likelihood to have severe menstrual pain compared to those who did not take breakfast (OR=2.13;95% CI:0.42-31.57;P=0.002). The respondents who took 3-4 cups of coffee and or black tea and or chocolate beverages had a 1.31 increased likelihood to have severe menstrual pain compared to those who rarely or did not take (OR=1.31; 95% CI: 0.49-3.4; P=0.002). Towards the days of their menses, adolescent girls felt the urge to take sweets, chocolate or juggery. In addition, a regression of the urge to take sweet food was very significant at P=0.003. The odds of having a person who is has severe pains to have the urge to eat sweet foods towards their menstruation was 2.56 times higher than the person who did not have severe pain (that is those who either have moderate or no pain). There is no significant difference in Magnesium and Ibuprofen as treatments of primary dysmenorrhea, Magnesium can therefore be used as a nutrition alternative in the management of period pains.
Comparison of Complementary Feeding and Nutrition Status between Children in Households with and those without Kitchen Gardens in Kakamega County, Kenya
(Kenyatta University, 2024-03) Naandi, Bilha
Sub-optimal feeding and nutrition among infants and young children less than 59 months old are leading causes of under nutrition in least developed countries. Recent agri nutrition interventions, focused on kitchen gardening in developing countries revealed its impact on children’s complementary feeding and nutrition status, despite insufficient empirical evidence. This study aimed at comparing nutrition status and complementary feeding of 64 children aged between 6 and 23 months in households with and 64 others without kitchen gardens in Lurambi Sub-County, Kakamega County. The study used a comparative cross-sectional and analytical research design. The findings on nutritional status were compared with WHO, 2006 Child Growth Standards. Researcher administered interviews for selected study participants households, key informants and focus group discussions. Data on IYCF, nutrition assessment and kitchen gardening was elicited and analyzed using SPSS comparing variables from households across the groups. Mothers or caregivers socio-economic, and demographic characteristics with children 6 to 23 months, revealed a significant correlation between owning kitchen garden and crops grown, all (p-values<0.05). Crop production per year, Length for Age Z-scores (LAZ), amount consumed and sold were not normally distributed as was assessed by Shapiro Wilk test and were summarized into median and inter-quartile range (IQR). Logistic regression was used to compute Odds ratios for crops grown, with kitchen gardening households being four times more likely to grow kales (OR=4.058) and three times more likely to grow both jute mallow (OR=2.524) and cow peas (OR=3.246). Their utilization was compared across the two groups. Most households without kitchen gardens did not grow micronutrient rich vegetables. ENA for SMART software was used to generate Z scores from children’s anthropometric measurements. This was interpreted using WHO (2006) Child Growth Reference, with ˂-2 and ˃+2 z-scores as cut off points for under nourished and over-nourished children respectively. Severe stunting of Length for Age Z scores (LAZ) < -3 Z score among children was higher, n=64 (20.3%) than the other n=64 (6.3%) in those without than those with kitchen gardens respectively, with statistically significant difference in stunting levels (LAZ) across the groups (Mann-Whitney Z-test; p-value= 0.011).Minimum dietary diversity was the only index that was statistically significantly different across the groups, (p-value=0.013); with 71.9% and 53.1% meeting MDD in kitchen and non-kitchen gardening households respectively. Diet among children in households without kitchen gardens was mainly consisting of cereals (maize), obtained from their farms. Socio-economic characteristics of mothers and caregivers did not determine the adoption of kitchen gardening technologies. All households should be encouraged to practice kitchen gardening. Common crops grown in kitchen gardens were kales, cowpeas and yams that were mainly utilized as food in households. It was critical to sensitize the later households to practice crop diversification both for subsistence and nutritional implications. Majority of kitchen gardening households had a high crop diversity grown, which resulted in attaining a higher children proportion having MDD. This may mean that despite households accessing arable land, mothers and caregivers need education on the health implications of feeding their children on a less diverse diet. Stunting levels of children with kitchen gardens had lower stunting levels than their counterparts. The null hypotheses that there is no significant relationship between kitchen gardening and dietary diversity as well as no significant relationship between kitchen gardening and nutrition status of index children were therefore rejected. It is recommended that non-kitchen gardening households grow bio diverse, nutrient rich crops that contribute to optimal IYCF. Organizations implementing agricultural programs should collaborate with the Ministry of Health, focus on improving household nutrition, health and food security through agri- nutrition. A longitudinal study ought to be carried out to establish how optimal complementary feeding can be achieved among the children between 6 and 23 months old using nutrition sensitive agricultural programs
Comparison of Knowledge, Attitudes and Practices on Exclusive Breastfeeding between Primiparous and Multiparous Mothers Attending Wajir District Hospital, Wajir County, Kenya
(Kenyatta University, 2016-05) Mohamed, Mahat Jimale
Exclusive breastfeeding (EBF) is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. Failure to exclusively breastfeed for six months is associated with increased risk of childhood mortality and morbidity. There is paucity of information that analyses the disparity in Knowledge, Attitudes and Practices (KAP) among primiparous and multiparous mothers. This study aimed to compare the KAP of EBF between primiparous and multiparous mothers attending Wajir County hospital, Wajir County. In a cross-sectional comparative analytical study, KAP on EBF were assessed based on structured researcher-administered questionnaires, Key Informant Interviews (KIIs) and Focus Group Discussions (FGD) for a total of 280 mothers; primiparous (n=140) and multiparous (n=140) with infants 0-5 months of age. The KIIs were conducted with the healthcare providers at Wajir District Hospital while FGDs were conducted with mothers exclusively breastfeeding and those not exclusively their babies. Data were entered and analyzed using SPSS. Descriptive statistics was used to describe the study population demographic characteristics, knowledge, attitudes and practices of both primiparous and multiparous mothers. T-test was used to test for significant differences between primiparous and multiparous for continuous data. Chi-square test and odds ratio were used to test the association between EBF and categorical variables. Statistical significance was set at p< 0.05. Qualitative data was transcribed, and common themes identified. Results showed high maternal knowledge on breastfeeding in both group mothers. The attitudes towards EBF were also positive. Nonetheless, high maternal knowledge and positive attitude did not necessarily translate into the practice of EBF. This was attributed to socio-cultural factors deeply rooted in the community that influenced infant and young child feeding practices. Overall, the prevalence of EBF was 45.5% (primiparous women 39.4% and multiparous women 49.3%) with no significant differences between the mothers. The low EBF rate may be attributed to the over 50% of mothers getting breastfeeding information from traditional birth attendants (TBAs) and family/friends/relatives compared to 38% receiving the same information from health facility. Additionally, cultural practices that propagate the early introduction of prelacteals were hindrances to EBF practices. The study established no significant relationship between maternal knowledge and EBF practice. In contrast, maternal attitude score was significantly associated with the practice of EBF. Those mothers with a positive attitude towards EBF were more likely to EBF (chi-square test; p=.001).). There was no significant relationship in maternal sources of information and parity (chi-square test; p>0.05). The study showed that infants’ age and morbidity as well as maternal morbidity and breastfeeding complications had significant negative associations with exclusive breastfeeding. There was no association between maternal socio-economic and demographic characteristics with exclusive breastfeeding. It is recommended that Ministry of Health (MOH) design effective community based programmes to improve breastfeeding practices by establishing or strengthening community-based structures (mother to mother breastfeeding support groups, community health workers, volunteers and Traditional Birth Attendants) and linking them to the health facilities for training, support and monitoring. The study also recommends MOH to maximize on the opportunities of integrating EBF campaigns with other community based interventions like community based management of severe acute malnutrition; malnutrition screening, social protection and food security programmes.

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