Examining the complex dynamics influencing acute malnutrition in Turkana and Samburu counties: Study protocol.

Acute malnutrition in children under 5 years is persistent in Eastern Africa's arid and semiarid lands. This study aimed to identify the drivers of acute malnutrition in Turkana and Samburu counties, Kenya. This was a population-based longitudinal mixed-methods observational study. Qualitative and quantitative data were collected at Wave 1, but only quantitative data were collected during follow-up. Participants were a representative sample of children and their primary caregivers from households with children under 3 years at Wave 1. Anthropometric measurements of all children under 5 years in the sampled households were taken at Wave 1 (May to July 2021), and one child under 3 years was randomly selected for follow-up about every 4 months over 2 years for six data collection waves. The study also collected data on sociodemographics; child feeding practices and morbidity; household water and food insecurity; shocks; coping strategies, social safety nets and economic safeguards; water, sanitation and hygiene; women's decision-making and food consumption. Qualitative data were collected through community dialogues, focus group discussions, in-depth interviews, photovoice and key informant interviews with mothers and fathers with children under 5 years, community leaders, county officials and staff of nongovernmental organisations. Data collection is complete and analysis is ongoing. The analysis includes thematic analysis of qualitative data and descriptive and multi-variable regression analyses of quantitative data.

Communities and employers show a high level of preparedness in supporting working mothers to combine breastfeeding with work in rural Kenya.

Community Readiness Model (CRM) through pragmatic mixed methods design, combining quantitative CRM survey with qualitative data, was used to assess the level of preparedness and readiness among local leaders, employers and community members in supporting working mothers to combine breastfeeding with work. The study was conducted in one of the tea state farms in Kericho County of Kenya. A total of 17 purposively selected men (fathers), lactating mothers, peer educators, health professionals (doctors, nurses and nutritionists), tea plantation managers and grandmothers were interviewed. The CRM that has six different dimensions was applied to determine the stage of readiness to support working mothers to combine breastfeeding with work. Community Readiness Score (CRS) was calculated descriptively as mean ± standard deviation (SD). Thematic analysis using NVIVO software was used to analyse qualitative data. We found that the mean (±SD) CRS was 7.3 (1.9), which corresponded to the third highest level of the nine stages or the 'stabilization' stage of community readiness. Dimensionally, the mean CRS was the highest (8.3 ± 1.9) for leadership followed by community efforts (7.5 ± 2.1), whereas the lowest CRS was observed for knowledge of efforts (6.6 ± 2.3) and availability of resources (6.6 ± 1.9). In conclusion, high level of readiness to support working women to combine work with breastfeeding with suboptimal knowledge of efforts and availability of resources was observed in the area. Future interventions should focus on enabling the community to feel more comfortable and creating detailed and refined knowledge on combining breastfeeding with work.

Community perceptions towards the new role of traditional birth attendants as birth companions and nutrition advocates in Kakamega County, Kenya.

Delivery with skilled birth attendants is important for reducing maternal mortality in developing countries. However, traditional birth attendants (TBAs) are abundant in such settings, managing deliveries without the skills and resources necessary to prevent mortality in this situations. Interventions that have been proposed to mitigate the situation include redefining the role of TBAs to nutrition advocates and birth companions for pregnant women to health facilities. We thus explored community perceptions on these new roles of TBAs, as birth companions and nutrition advocates, and their influence on health facility deliveries in Kakamega County, Kenya. Qualitative data was collected through key informant interviews with health workers and focus group discussions with lactating mothers, pregnant women, husbands, community leaders, community health volunteers, and TBA. Content analysis was conducted; data was organized into subthemes and conclusions made from each subtheme using Atlas.ti software. TBAs adopted their birth companion role as the majority offered companionship to mothers delivering at health facilities. Mothers were happy with this role as TBAs continued providing companionship even after delivery. The community members were happy with the new role of TBAs and reported increased deliveries at the health facilities. In contrast, TBAs did not adopt the nutrition advocacy role sufficiently. We found that redefining the role of the TBAs into birth companions to support facility-based delivery is thus feasible and acceptable. Nutrition advocacy by the TBAs should be strengthened to maximize on the opportunity provided by the close association between TBAs and mothers and the community.

Wealth and obesity in pre-adolescents and their guardians: A first step in explaining non-communicable disease-related behaviour in two areas of Nairobi City County.

The prevalence of non-communicable diseases is increasing in lower-middle-income countries as these countries transition to unhealthy lifestyles. The transition is mostly predominant in urban areas. We assessed the association between wealth and obesity in two sub-counties in Nairobi City County, Kenya, in the context of family and poverty. This cross-sectional study was conducted among of 9-14 years old pre-adolescents and their guardians living in low- (Embakasi) and middle-income (Langata) sub-counties. The sociodemographic characteristics were collected using a validated questionnaire. Weight, height, mid-upper arm circumference, and waist circumference were measured using standard approved protocols. Socioeconomic characteristics of the residential sites were accessed using Wealth Index, created by using Principal Component Analysis. Statistical analyses were done by analysis of variance (continuous variables, comparison of areas) and with logistic and linear regression models.A total of 149 households, response rate of 93%, participated, 72 from Embakasi and 77 from Langata. Most of the participants residing in Embakasi belonged to the lower income and education groups whereas participants residing in Langata belonged to the higher income and education groups. About 30% of the pre-adolescent participants in Langata were overweight, compared to 6% in Embakasi (p<0.001). In contrast, the prevalence of adults (mostly mothers) with overweight and obesity was high (65%) in both study areas. Wealth (ß = 0.01; SE 0.0; p = 0.003) and income (ß = 0.29; SE 0.11; p = 0.009) predicted higher BMI z-score in pre-adolescents. In, pre-adolescent overweight was already highly prevalent in the middle-income area, while the proportion of women with overweight/obesity was high in the low-income area. These results suggest that a lifestyle promoting obesity is high regardless of socioeconomic status and wealth in Kenya. This provides a strong justification for promoting healthy lifestyles across all socio-economic classes.

Wealth and Sedentary Time Are Associated With Dietary Patterns Among Preadolescents in Nairobi City, Kenya.

OBJECTIVE: The study aimed to compare dietary patterns in preadolescents in urban areas with different physical activity and socioeconomic profiles in Nairobi, Kenya. DESIGN: Cross-sectional. PARTICIPANTS: Preadolescents aged 9-14 years (n = 149) living in low- or middle-income areas in Nairobi. VARIABLES MEASURED: Sociodemographic characteristics were collected using a validated questionnaire. Weight and height were measured. Diet was assessed using a food frequency questionnaire and physical activity by accelerometer. ANALYSIS: Dietary patterns (DP) were formed through principal component analysis. Associations of age, sex, parental education, wealth, body mass index, physical activity, and sedentary time with DPs were analyzed with linear regression. RESULTS: Three DPs explained 36% of the total variance in food consumption: (1) snacks, fast food, and meat; (2) dairy products and plant protein; and (3) vegetables and refined grains. Higher wealth was associated with higher scores of the first DP (P < 0.05). CONCLUSIONS AND IMPLICATIONS: Consumption of foods often deemed unhealthy (eg, snacks and fast food) was more frequent among preadolescents whose families were wealthier. Interventions that seek ways to promote healthy lifestyles among families residing in urban areas of Kenya are warranted.