Health and nutrition knowledge, attitudes and practices of pregnant women attending and not-attending ANC clinics in Western Kenya: a cross-sectional analysis.

BACKGROUND: Antenatal care (ANC) is a key strategy to decreasing maternal mortality in low-resource settings. ANC clinics provide resources to improve nutrition and health knowledge and promote preventive health practices. We sought to compare the knowledge, attitude and practices (KAP) among women seeking and not-seeking ANC in rural Kenya. METHODS: Data from a community-based cross-sectional survey conducted in Western Province, Kenya were used. Nutrition knowledge (NKS), health knowledge (HKS), attitude score (AS), and dietary diversity score (DDS) were constructed indices. χ2 test and Student's t-test were used to compare proportions and means, respectively, to assess the difference in KAP among pregnant women attending and not-attending ANC clinics. Multiple regression analyses were used to assess the impact of the number of ANC visits (none, <4, ≥4) on knowledge and practice scores, adjusting for maternal socio-demographic confounders, such as age, gestational age, education level and household wealth index. RESULTS: Among the 979 pregnant women in the survey, 59% had attended ANC clinics while 39% had not. The mean (±SD) NKS was 4.6 (1.9) out of 11, HKS was 6.2 (1.7) out of 12, DDS was 4.9 (1.4) out of 12, and AS was 7.4 (2.2) out of 10. Nutrition knowledge, attitudes, and DDS were not significantly different between ANC clinic attending and non-attending women. Among women who attended ANC clinics, 82.6% received malaria and/or antihelmintic treatment, compared to 29.6% of ANC clinic non-attendees. Higher number of ANC clinic visits and higher maternal education level were significantly positively associated with maternal health knowledge. CONCLUSIONS: Substantial opportunities exist for antenatal KAP improvement among women in Western Kenya, some of which could occur with greater ANC attendance. Further research is needed to understand multi-level factors that may affect maternal knowledge and practices.

Effect of an improved local ingredient-based complementary food fortified or not with iron and selected multiple micronutrients on Hb concentration.

OBJECTIVE: To assess the effect of an improved local ingredient-based gruel fortified or not with selected multiple micronutrients (MM) on Hb concentration of young children. DESIGN: In a nutrition centre that we opened in their villages, children received either MM supplement (containing iron, zinc, vitamin A, vitamin C and iodine) with the improved gruel (MMGG) or the improved gruel only (GG), twice daily, 6 d/week, for 6 months. We assessed baseline and endpoint Hb concentration and anthropometric indices. SETTING: Kongoussi, a rural and poor district of Burkina Faso. SUBJECTS: In a community-based trial, we randomly assigned 131 children aged 6-23 months with Hb concentrations in the range of 80-109 g/l into two groups. RESULTS: The groups did not differ significantly at baseline. Mean baseline Hb concentration was 89·2 (sd 6·5) g/l and 90·3 (sd 8·4) g/l in the GG and the MMGG, respectively (P = 0·42). It increased to 104·1 (sd 11·4) g/l in the GG (P < 0·001) and 107·6 (sd 14·7) g/l in the MMGG (P < 0·001). The between-group difference of 3·5 (95 % CI -1·0, 8·1) g/l in mean (sd) endpoint Hb concentration was not significant (P = 0·13). The endpoint anthropometric indices were not different between the groups. CONCLUSIONS: This MM supplement had no additional effect on Hb concentration. Thorough studies are needed to evaluate the actual efficacy of the gruel before its introduction into household routine.

Development of an improved local-ingredient-based complementary food and technology transfer to rural housewives.

BACKGROUND: Food technology transfer to rural households, based on local ingredients, is a relevant and sustainable strategy to ensure better nutrition of young children. Objective. To develop an improved mush based on local ingredients and evaluate the potential for transferring its technology to rural housewives. METHODS: We developed a flour-based food using Alicom software and performed laboratory trials to evaluate its actual nutritional quality. Then we recruited housewives from each of the 27 project villages and trained them in flour production and mush preparation twice daily, 6 days a week, for 26 weeks. Mush was sampled during the training session and at weeks 4, 12, and 22 and evaluated for actual flow distance and dry matter content, which served to estimate energy density and iron and zinc contents. RESULTS: The laboratory trials reported average energy densities of 103 kcal/l00 g, iron contents of 2.6 mg/100 kcal, and zinc contents of 1.2 mg/100 kcal. The average (+/- SD) energy densities of the mush samples obtained during the training session and at weeks 4, 12, and 22 were 103.0 +/- 5.6, 103.3 +/- 5.2, 107.9 +/- 11.5, and 101.3 +/- 8.7 kcal/100 g, respectively. The average iron contents were 2.3 +/- 0.5, 2.3 +/- 0.5, 2.6 +/- 0.3, and 1.8 +/- 0.8 mg/ 100 kcal, respectively, and the average zinc contents were 1.6 +/- 0.1, 1.6 +/- 0.1, 1.7 +/- 0.1, and 1.6 +/- 0.2 mg/100 kcal. CONCLUSIONS: Developing a suitable complementary food from local ingredients and educating households in nutrition and use of local products are feasible. Such education should come with measures aimed at improving the accessibility of some ingredients to ensure feasibility and sustainability.

A local-ingredient-based, processed flour to improve the energy, iron and zinc intakes of young children: a community-based intervention.

The present study was undertaken to determine the actual amounts of mush consumed and energy iron and zinc intakes of, and to investigate the attendance rate among, children aged 6-23 months due to an improved mush intervention. A cohort of 208 children from 27 villages was followed up for 6 months. Twice a day, 6 days/week, each mother took her child to the nutrition centre we had opened in her village to receive the mush and fed it to her child. Amounts consumed were 15, 21 and 33 g/kg body weight/meal for children aged 6-8, 9-11 and 12-23 months respectively. The average (standard deviation) attendance rate was 68.0% (25.6%). The median (range) daily intakes from the mush were 213 (25-373) kcal, 5.3 (0.6-9.3) mg, and 2.3 (0.3-4.1) mg for energy, iron and zinc, respectively. This flour and mush production should enter the routines of individual households, supported by a large-scale programme of nutrition education.

Effect of iron or multiple micronutrient supplements on the prevalence of anaemia among anaemic young children of a malaria-endemic area: a randomized double-blind trial.

OBJECTIVE: To assess the effect of supplementation with iron or multiple micronutrients (MM) on the prevalence of anaemia in a malaria-endemic area. METHODS: A community-based randomized double-blind trial was conducted in rural Burkina Faso, including children aged 6-23 months with haemoglobin (Hb) concentrations of 70-109 g/l who were randomized into an iron group (Fe, n = 96), an iron and zinc group (IZ, n = 100) or an MM group (MM, n = 100), 5 days/week for 6 months. All children were provided with insecticide-treated bednets; those who had a Plasmodium falciparum (PF) positive-smear at baseline and/or at each monthly checking received antimalarial therapy. RESULTS: The mean (SD) endpoint Hb concentration was higher in the MM group [113.2 (13.6) g/l] than in the IZ group [106.3 (15.6) g/l] and the Fe group [107.1 (12.9) g/l] (P = 0.001). Children in the MM group were more likely to recover from anaemia than those in the Fe group [prevalence rate ratios, PRR (95% confidence interval, CI) = 1.62 (1.22-2.15), P < 0.001]. The IZ group did not differ from the Fe group [PRR (95% CI) = 0.94 (0.65-1.35), P = 0.72]. None of the interactions on the effect of supplementation of baseline age (0.13), or baseline height-for-age z-score (P = 0.33), or incident PF parasitemia (P = 0.99), was significant. CONCLUSION: In this malaria-endemic area, in combination with malaria management, the MM supplement was more efficacious than the Fe supplement and the IZ supplement for reducing anaemia. Further investigation into limiting factors and amounts of micronutrients that would be more efficacious for reducing anaemia is recommended.

Moderate-to-severe anaemia due to afebrile Plasmodium falciparum infection in children aged 6-23 months from the rural district of Kongoussi, Burkina Faso.

A population-based cross-sectional study was conducted to investigate the association of haemoglobin concentration and moderate-to-severe anaemia with afebrile Plasmodium falciparum (PF) infection in 456 rural children aged 6-23 months. Capillary blood was obtained for haemoglobin concentration measurement by HemoCue and malaria detection by blood smear microscopy. Anaemia was noted in 444 (97.4%) children with 194 (42.5%) being moderate-to-severe anaemia. PF infection was noted in 240 (52.6%) children with 117 (25.6%) being afebrile and 123 (27.0%) being febrile. Children with afebrile and those with febrile PF infection were more likely to have moderate-to-severe anaemia than children who were PF-free, with odds ratio (95% confidence interval) of 1.86 (1.07-3.23), p = 0.028 and 2.40 (1.29-4.48), p < 0.001, respectively. These results underline the high burden of both anaemia and PF infection in this population. Strategies aiming at controlling malarial anaemia and based on malaria case-treatment should consider both febrile and afebrile PF infection to allow for a better impact.

Socio-spatial disparities of obesity among adults in the urban setting of Ouagadougou, Burkina Faso.

OBJECTIVES: To document the prevalence and the socio-spatial variations of obesity and to identify individual and household characteristics, lifestyles and dietary practices contributing to obesity and its socio-spatial distribution. DESIGN: Population-based cross-sectional survey. We selected 1,570 households from four strata characterised as unstructured and low building-density (ULBD), unstructured and high building-density (UHBD), structured and low building-density (SLBD) and structured and high building-density (SHBD) areas. Structured areas are those that were allotted by the township authority (cadastral services), with public services; unstructured areas refer to those developed with no cadastral organisation. SETTING: Ouagadougou, the capital city of Burkina Faso. SUBJECTS: BMI was calculated in 2022 adults aged 35 years and above who were classified as obese when their BMI was >or=30 kg/m2. Obesity was investigated in relation to household and individual characteristics, lifestyles and dietary practices; adjusted odds ratios with 95 % confidence intervals were derived from a logistic regression model. RESULTS: The overall prevalence of obesity was 14.7 % (males 5.5 % and females 21.9 %). Age, gender, household equipment index, usual transport with motor vehicles and micronutrient-rich food consumption were associated with obesity. After adjustment for these factors, obesity remained associated with the area of residence: residents from SHBD areas were more likely to be obese than those from ULBD areas (OR = 1.41; 95 % CI 2.59,4.76). CONCLUSIONS: Obesity in Ouagadougou is a preoccupant problem that calls for more consideration. Thorough investigation is needed to assess the environmental factors that contribute to the socio-spatial disparity of obesity.