Effect of using mobile phone communication on dietary management of Type 2 Diabetes Mellitus patients in Kenya.

Purpose: Advancements in management of non-communicable diseases using regular reminders on lifestyle and dietary behaviors have been effectively achieved using mobile phones. This study evaluates the effects of regular communication using a mobile phone on dietary management of Type 2 Diabetes Mellitus (T2DM) among patients attending Kitui County Referral Hospital (KCRH) in Kenya. Methods: Pre/post-study design among eligible and consenting T2DM patients visiting KCRH was used for this study. One hundred and thirty-eight T2DM patients were enrolled; 67 in the intervention group (IG) and 71 in the control group (CG). The IG received regular reminders on key dietary practices through their mobile phones for six months while the CG did not. The Net Effect of Intervention (NEI) and bivariate logistic regression were used to determine the impact of mobile phone communication intervention at p < 0.05. SPSS version 24 was used to analyze the data. Results: The results revealed an increase of respondents who adhered to the meal plan in the IG from 47.8% to 59.7% compared to a decrease from 49.3% to 45.1% in CG with corresponding NEI increasing (16.1%) significantly (p < 0.05). The proportion of respondents with an increased frequency of meals increased from 41.8 to 47.8% in the IG compared to a reduction from 52.1% to 45.1% in the CG with corresponding NEI increasing (13.0%) significantly (p < 0.05). Conclusion: Regular reminders on lifestyle and dietary behaviors using mobile phone communication improved adherence to dietary practices such as meal planning and frequency of meals in the management of T2DM.

Exploring the Status of Preference, Utilization Practices, and Challenges to Consumption of Amaranth in Kenya and Tanzania.

African leafy vegetables such as amaranth have been utilized since time immemorial both as food and as medicine. These vegetables grew naturally in most rural environments, but currently most of them are cultivated both for home consumption and for sale. The aim of this study was to identify the most preferred amaranth species and cooking and utilization practices, as well as the beliefs and attitudes that encourage or discourage use of this vegetable. The study was carried out in seven counties of Kenya and in three regions in Tanzania. Twenty Focus Group Discussions (FGDs) with members of the community and twenty Key Informant Interviews (KIIs) with agricultural and nutrition officers were conducted in the study areas to obtain information on preferred varieties, sources of amaranth vegetables, common cooking methods, alternative uses, beliefs and taboos surrounding amaranth consumption, and the challenges experienced in production and consumption. The findings of the study showed that amaranth is one of the most commonly consumed indigenous vegetables in Kenya and Tanzania. The preference for varieties and cooking habits differs depending on the community and individuals. Amaranthus dubius and Amaranthus blitum were most common in Kenya, while Amaranthus dubius and Amaranthus hypochondriacus were most common in Tanzania. Most people consumed these vegetables because they were affordable and available or because of circumstance of lacking other foods. Regarding cooking, final taste was mostly considered rather than nutritional attribute. Several alternative uses of amaranth such as uses as medicine and livestock feed were also reported, as well as some beliefs and taboos surrounding the vegetable. Training on nutritional attributes and promotion of food preparation practices that ensure maximum nutrient benefits from amaranth is needed at the community level to realize the nutritional importance of the vegetables. Hands-on training and demonstrations were the most preferred modes of passing information.

Health providers´ knowledge on maternal and newborn care: implications on health systems strengthening in Vihiga County, Kenya.

INTRODUCTION: pregnant women need access to skilled attendance at birth and emergency obstetric care (EmOC) to avert maternal deaths. While poor EmOC services may explain the high maternal mortality, inadequate knowledge of providers is also part of the problem. This forms the basis of this paper, in a setting where 50.2% of women deliver in a health facility but maternal mortality remains high at 531/100,000 live births, compared to the national average of 362/100,000 in Kenya. METHODS: a facility based cross-sectional survey was conducted in 2018 with a set of knowledge questions extracted from the averting maternal death and disability toolkit. Providers knowledge for maternal and newborn health (MNH) was assessed by interviewing nurses on duty in the maternity units. Data were entered in Ms Access and exported to R version 3.6.2 for descriptive and logistic regression analysis. Ethical clearance was obtained from Kenya Medical Research Unit. RESULTS: a total of 55 nurses were interviewed. Majority (71%) of the respondents were diploma nurses. The overall knowledge score for MNH among the providers was adequate with a score of (64%). Generally, the midwives and higher diploma nurses consistently scored higher than diploma nurses in all the topic areas of MNH. In the mixed linear regression, determinants of knowledge score were seen in provider-level variables. CONCLUSION: overall, the providers scores were higher on intrapartum and newborn care compared to scores on care for complications. We conclude that in-service training on EmOC to providers is critical to reduction of maternal mortality.

Effect of a nutrition education programme on the metabolic syndrome in type 2 diabetes mellitus patients at a level 5 Hospital in Kenya: "a randomized controlled trial".

BACKGROUND: Type 2 diabetes mellitus (T2D), is a life-threatening condition of global public health concern. It worsens in the presence of the metabolic syndrome (MetS), a complex disorder characterized by co-occurrence of at least three of such factors as hypertension, obesity, dyslipidemia and insulin resistance. However, lifestyle interventions reduce the risk of both MetS and T2D, and nutrition education can empower individuals on the appropriate, lifestyle changes. The aim of the current study was to evaluate the effect of a nutrition education programme, with and without inclusion of peer to peer support, on MetS in T2D patients. METHODS: This was a randomized controlled trial with two intervention groups and one control. One of the intervention groups involved a nutrition education programme with peer-to-peer support (NEP); the other involved only the education program, while the control received standard care. Each group had 51 participants. The nutrition education programme was conducted for 2 h per week for 8 weeks. In addition, the NEP had weekly peer-to-peer interactions for 8 weeks. All groups had follow-up sessions for 6 months. Data on MetS risk factors as well as food intake patterns and physical activity levels were taken at baseline and at different time points during the study. Analysis of Co-variance and regression were used in the analysis. RESULTS: The MetS prevalence improved in the NEP (90 to 52%) and NE (86 to 69%), while it worsened in C (88 to 91%). There was improvement in the mean values of the anthropometric parameters in the NEP and NE which worsened in the control group. There was a general improvement in mean values of blood lipids, fasting blood glucose and HbA1c in all the groups, with NEP showing the greatest improvements, followed by NE, except for triglycerides and HDL where the control group had better improvement than the NE. Changes in the anthropometric and metabolic indicators mirrored the changes in food intake patterns and physical activity, where the greatest improvements occurred in the NEP. CONCLUSIONS: Nutrition education with inclusion of peer to peer support was of clinical benefit in improving metabolic outcomes and reducing MetS in T2DM patients. TRIAL REGISTRATION: The study has been registered retrospectively by Pan African Clinical Trial Registry; Registration No: PACTR201910518676391.

Food Fortification: The Level of Awareness among Kenyan Consumers.

More than half of the morbidity and mortality cases among children in Kenya are as a result of micronutrient deficiencies (MNDs). Food fortification is considered by the Government of Kenya as a feasible strategy for addressing MNDs. Worldwide, fortification has been proven to be effective since it does not require any change in dietary habits. Success of large-scale food fortification however may depend on consumer awareness of the fortification benefits. A cross-sectional study was conducted in 13 counties to collect information on fortification awareness using structured questionnaires. 1435 respondents were selected using the Lot Quality Assurance Sampling method. Data were analyzed using Stata version 14.0 and statistical significance p < 0.05. The study participants were described using descriptive statistics. The association of sociodemographic characteristics and awareness of fortification was performed using binary logistic regression analysis. The median age of the study participants was 35 years. Only 28% of the respondents were aware of the term "fortification." Of the respondents, about 27% heard of food fortification through radio. Vernacular radio emerged as the most preferred channel for communicating fortification information among 24.9% of the respondents. Although awareness of vitamins (32%) and minerals (1.5%) was limited, most (76%) respondents reported of existence of health risks for lacking micronutrients. Awareness of food fortification was significantly associated with respondents' occupation (p < 0.001), household size (p=0.012), education levels (p < 0.001), and age (p=0.025). There is need for a wider use of broadcast media sources to modify information and education materials to promote fortification awareness among Kenyan consumers.

Moisture sorption isotherm and shelf life prediction of complementary food based on amaranth-sorghum grains.

The quantity and quality of complementary foods is one of the contributing factors to childhood under nutrition. Complementary food based on amaranth and sorghum grains was formulated. It was deemed to be superior nutritionally to the commonly used complementary foods in Kenya. Knowledge on storage and packaging is important for a long shelf life of the product to be achieved. Water activity and moisture content are key indicators of the stability of dried foods. To establish the proper storage conditions of the product, moisture sorption isotherms at 25 °C, 30 °C and 35 °C were determined over water activity range of 0.11-0.97 and data fitted with six sorption models. Water vapour permeability of common packaging materials was also determined at 25 °C and 35 °C and the data was used to predict the product's shelf life. The product exhibited type two sorption isotherm according to Brunner classification an indication of monolayer-multilayer sorption behavior. The critical storage moisture content of the complementary food corresponding to 0.6 water activity a point of microbiological stability was found to be 7.5%. Based on Heiss-Eichner model, a shelf life of 1423 days at 25 °C can be achieved with product initial moisture content of 5 g/100 g and packaged in 110 µm thick aluminum pouch. The shelf life of the product was shortened two to three fold at 35 °C in comparison to storage at 25 °C.

Thyroglobulin Is Markedly Elevated in 6- to 24-Month-Old Infants at Both Low and High Iodine Intakes and Suggests a Narrow Optimal Iodine Intake Range.

BACKGROUND: In areas with incomplete salt iodization coverage, infants and children aged 6-24 months weaning from breast milk and receiving complementary foods are at risk of iodine deficiency. However, few data exist on the risk of excessive iodine intake in this age group. Thyroglobulin (Tg) is a sensitive marker of iodine intake in school-age children and adults and may be used to estimate the optimal iodine intake range in infancy. The aim of this study was to assess the association of low and high iodine intakes with Tg and thyroid function in weaning infants. METHODS: This multicenter cross-sectional study recruited infants aged 6-24 months (n = 1543; Mage = 12.2 ± 4.6 months) receiving breast milk with complementary foods, from seven countries in areas with previously documented deficient, sufficient, or excessive iodine intake in schoolchildren or pregnant women. Urinary iodine concentration (UIC) and Tg, total thyroxine, and thyrotropin were measured using dried blood spot testing. RESULTS: Median UIC ranged from 48 µg/L (interquartile range 31-79 µg/L) to 552 µg/L (interquartile range 272-987 µg/L) across the study sites. Median Tg using dried blood spot testing was high (>50 µg/L) at estimated habitual iodine intakes <50 µg/day and >230 µg/day. Prevalence of overt thyroid disorders was low (<3%). Yet, subclinical hyperthyroidism was observed in the countries with the lowest iodine intake. CONCLUSIONS: Tg is a sensitive biomarker of iodine intake in 6- to 24-month-old infants and follows a U-shaped relationship with iodine intake, suggesting a relatively narrow optimal intake range. Infants with low iodine intake may be at increased risk of subclinical thyroid dysfunction. In population monitoring of iodine deficiency or excess, assessment of iodine status using UIC and Tg may be valuable in this young age group.

Effect of Excess Iodine Intake from Iodized Salt and/or Groundwater Iodine on Thyroid Function in Nonpregnant and Pregnant Women, Infants, and Children: A Multicenter Study in East Africa.

BACKGROUND: Acute excess iodine intake can damage the thyroid, but the effects of chronic excess iodine intake are uncertain. Few data exist for pregnant and lactating women and infants exposed to excessive iodine intake. METHODS: This was a multicenter cross-sectional study. At study sites in rural Kenya and urban Tanzania previously reporting iodine excess in children, urinary iodine concentration (UIC), thyrotropin, total thyroxine, and thyroglobulin (Tg) were measured in school-age children (SAC), women of reproductive age, pregnant (PW) and lactating women, and breast-feeding and weaning infants. In a national study in Djibouti, UIC was measured in SAC and PW. At all sites, daily iodine intake was estimated based on UIC, and iodine concentration was measured in household salt and drinking water. RESULTS: The total sample size was 4636: 1390, 2048, and 1198 subjects from Kenya, Tanzania, and Djibouti, respectively. In Kenya and Tanzania: (i) median UIC was well above thresholds for adequate iodine nutrition in all groups and exceeded the threshold for excess iodine intake in SAC; (ii) iodine concentrations >40 mg of iodine/kg were found in approximately 55% of household salt samples; (iii) iodine concentrations ≥10 µg/L were detected in 9% of drinking water samples; (iv) Tg was elevated in all population groups, but the prevalence of thyroid disorders was negligible, except that 5-12% of women of reproductive age had subclinical hyperthyroidism and 10-15% of PW were hypothyroxinemic. In Djibouti: (i) the median UIC was 335 µg/L (interquartile range [IQR] = 216-493 µg/L) in SAC and 265 µg/L (IQR = 168-449 µg/L) in PW; (ii) only 1.6% of Djibouti salt samples (n = 1200) were adequately iodized (>15 mg/kg); (iii) the median iodine concentration in drinking water was 92 µg/L (IQR = 37-158 µg/L; n = 77). In all countries, UIC was not significantly correlated with salt or water iodine concentrations. CONCLUSIONS: Although iodine intake was excessive and Tg concentrations were elevated, there was little impact on thyroid function. Chronic excess iodine intake thus appears to be well tolerated by women, infants, and children. However, such high iodine intake is unnecessary and should be avoided. Careful evaluation of contributions from both iodized salt and groundwater iodine is recommended before any review of iodization policy is considered.

Development of a nutrient-dense complementary food using amaranth-sorghum grains.

Thin porridge from cereals and starchy tubers is a common complementary food in Sub Saharan Africa. It may be high in antinutrients, low in energy, and nutrient density hence inadequate in providing infants' high energy and nutrients requirements per unit body weight. Consequently, undernourishment levels among children under 5 years are high. Therefore, there is need to avail nutrient-dense complementary foods especially for children in low-resource settings. The study was aimed at developing a nutrient-dense complementary food from amaranth and sorghum grains. Amaranth grain, a pseudocereal, though rarely used as a complementary food in Kenya has a higher nutritional quality than other staples. Plant-based foods are known to have high levels of antinutrients. Steeping and germination were used to reduce the levels of antinutrients and enhance the bioavailability of minerals in the grains. Various steeped and germinated amaranth and sorghum grains formulations were made to find the ratio with the highest nutrient content and lowest antinutrient levels. The 90% amaranth-sorghum grains formulation had significantly (F = 32.133, P < 0.05) higher energy (5 kcal per g on dry weight basis) than the other formulations and a protein content of 14.4%. This is higher than the estimated protein needs from complementary foods even for a 12-23 months child of low breast milk intake (9.1 g/d). Antinutrients could not be detected which could imply enhanced nutrient bioavailability. Therefore, a nutrient-dense complementary food product was developed from steeped and germinated amaranth and sorghum grains with 90% amaranth grain. In ready to eat form, it would give an energy content of 1.7 kcal per g (dilution of 1:2 amaranth-sorghum flour to water) and 1.2 kcal per g (dilution of 1:4 amaranth-sorghum flour to water). It can be used as a nutrient-dense complementary food and for other vulnerable groups.

Folate deficiency and utilization of folic acid fortified flour among pregnant women attending antenatal clinic at Pumwani Maternity Hospital, Kenya, 2015.

INTRODUCTION: in 2012, the Government of Kenya amended the Food, Drug and Chemical Substances Act to make the fortification of maize and wheat flour with folic acid mandatory. We assessed folate deficiency, awareness and use of folic acid fortified flour among pregnant women receiving antenatal care (ANC) at a clinic at Pumwani Maternity Hospital, Kenya, 2015. METHODS: we conducted a cross-sectional survey at Pumwani Maternity Hospital between October and November 2014. We enrolled pregnant women who received ANC and interviewed them using a semi-structured questionnaire after obtaining informed consent. Blood samples were collected from all study participants and serum folate level was analyzed by electrochemiluminescence immunoassay. Folate deficiency was defined as serum folate of < 10nmols/L and borderline folate deficiency was defined as serum folate of between 10nmols/L and 15nmols/L. RESULTS: among the 247 study participants, two (1%) had folate deficiency. One hundred and seventy-nine (73.4%) had heard about folic acid, but only 56 (23%) had heard about folic acid fortified flour. Overall, 198 (80%) study participants consumed fortified brands of maize flour and 205 (84%) consumed fortified brands of wheat flour; only four (2%) and two (1%) of study participants consumed specific brands of maize and wheat flour respectively because they were fortified. CONCLUSION: the prevalence of folate deficiency was low and this may have been because of the availability of fortification programs. Although there was limited knowledge of fortified flour, utilization was high. The Kenyan Ministry of Health should enforce implementation of the legislation on maize flour and wheat flour fortification by all milling industries.

Enteric pathogens and factors associated with acute bloody diarrhoea, Kenya.

BACKGROUND: Shigellosis is the major cause of bloody diarrhoea worldwide and is endemic in most developing countries. In Kenya, bloody diarrhoea is reported weekly as part of priority diseases under Integrated Disease Surveillance and Response System (IDSR) in the Ministry of Health. METHODS: We conducted a case control study with 805 participants (284 cases and 521 controls) between January and December 2012 in Kilifi and Nairobi Counties. Kilifi County is largely a rural population whereas Nairobi County is largely urban. A case was defined as a person of any age who presented to outpatient clinic with acute diarrhoea with visible blood in the stool in six selected health facilities in the two counties within the study period. A control was defined as a healthy person of similar age group and sex with the case and lived in the neighbourhood of the case. RESULTS: The main presenting clinical features for bloody diarrhoea cases were; abdominal pain (69 %), mucous in stool (61 %), abdominal discomfort (54 %) and anorexia (50 %). Pathogen isolation rate was 40.5 % with bacterial and protozoal pathogens accounting for 28.2 % and 12.3 % respectively. Shigella was the most prevalent bacterial pathogen isolated in 23.6 % of the cases while Entamoeba histolytica was the most prevalent protozoal pathogen isolated in 10.2 % of the cases. On binary logistic regression, three variables were found to be independently and significantly associated with acute bloody diarrhoea at 5 % significance level; storage of drinking water separate from water for other use (OR = 0.41, 95 % CI 0.20-0.87, p = 0.021), washing hands after last defecation (OR = 0.24, 95 % CI 0.08-.076, p = 0.015) and presence of coliforms in main source water (OR = 2.56, CI 1.21-5.4, p = 0.014). Rainfall and temperature had strong positive correlation with bloody diarrhoea. CONCLUSION: The main etiologic agents for bloody diarrhoea were Shigella and E. histolytica. Good personal hygiene practices such as washing hands after defecation and storing drinking water separate from water for other use were found to be the key protective factors for the disease while presence of coliform in main water source was found to be a risk factor. Implementation of water, sanitation and hygiene (WASH) interventions is therefore key in prevention and control of bloody diarrhoea.

Consumer evaluation of food with nutritional benefits: a systematic review and narrative synthesis.

As a consequence of the growing interest in, and development of, various types of food with nutritional benefits, the modern consumer views their kitchen cabinet more and more as a medicine cabinet. Given that consumer evaluation of food is considered key to the successful production, marketing and finally consumption of food, a procedure commonly used in medical fields was employed to systematically review and summarize evidence of consumer evaluation studies on nutritious foods. The focus is primarily on consumer understanding of nutritious food and the underlying determinants of consumer evaluation. Our results highlight four groups of key determinants: (1) nutrition knowledge and information; (2) attitudes, beliefs, perceptions and behavioural determinants; (3) price, process and product characteristics; and (4) socio-demographics. The findings also point to the importance of understanding consumer acceptance as one many concepts in the consumer evaluation process, and provide support for developing appropriate strategies for improving health and well-being of consumers.

Modelling protection behaviour towards micronutrient deficiencies: Case of iodine biofortified vegetable legumes as health intervention for school-going children.

BACKGROUND/OBJECTIVES: Despite successes recorded in combating iodine deficiency, more than 2 billion people are still at risk of iodine deficiency disorders. Rural landlocked and mountainous areas of developing countries are the hardest hit, hence the need to explore and advance novel strategies such as biofortification. SUBJECTS/METHODS: We evaluated adoption, purchase, and consumption of iodine biofortified vegetable legumes (IBVL) using the theory of protection motivations (PMT) integrated with an economic valuation technique. A total of 1,200 participants from three land-locked locations in East Africa were recruited via multi-stage cluster sampling, and data were collected using two, slightly distinct, questionnaires incorporating PMT constructs. The survey also elicited preferences for iodine biofortified foods when offered at a premium or discount. Determinants of protection motivations and preferences for iodine biofortified foods were assessed using path analysis modelling and two-limit Tobit regression, respectively. RESULTS: Knowledge of iodine, iodine-health link, salt iodization, and biofortification was very low, albeit lower at the household level. Iodine and biofortification were not recognized as nutrient and novel approaches, respectively. On the other hand, severity, fear, occupation, knowledge, iodine status, household composition, and self-efficacy predicted the intention to consume biofortified foods at the household level; only vulnerability, self-efficacy, and location were the most crucial elements at the school level. In addition, results demonstrated a positive willingness-to-pay a premium or acceptance of a lesser discount for biofortification. Furthermore, preference towards iodine biofortified foods was a function of protection motivations, severity, vulnerability, fear, response efficacy, response cost, knowledge, iodine status, gender, age. and household head. CONCLUSIONS: Results lend support for prevention of iodine deficiency in unprotected populations through biofortification; however 'threat' appraisal and socio-economic predictors are decisive in designing nutrition interventions and stimulating uptake of biofortification. In principle, the contribution is threefold: 1) Successful application of the integrated model to guide policy formulation; 2) Offer guidance to stakeholders to identify and tap niche markets; 3) stimulation of rural economic growth around school feeding programmes.

A novel framework for analysing stakeholder interest in healthy foods: A case study on iodine biofortification.

Despite the availability of novel strategies to prevent micronutrient malnutrition, such as biofortification, limited understanding of stakeholders often hampers their success. We build upon the existing literature on protection motivations (PMT) and technology acceptance (TAM) to develop an integrated PMTAM model for analyzing stakeholders' reactions, on both the supply and demand sides. Regarding the latter, the case of the iodine biofortified food chain is used to evaluate African households' interest. All model constructs, and threat appraisal in particular, are decisive in determining the uptake of biofortification, while also social demographics and own nutrition status play an important role.

Efficacy of mid-upper arm circumference in identification, follow-up and discharge of malnourished children during nutrition rehabilitation.

BACKGROUND/OBJECTIVES: Although it is crucial to identify those children likely to be treated in an appropriate nutrition rehabilitation programme and discharge them at the appropriate time, there is no golden standard for such identification. The current study examined the appropriateness of using Mid-Upper Arm Circumference for the identification, follow-up and discharge of malnourished children. We also assessed its discrepancy with the Weight-for-Height based diagnosis, the rate of recovery, and the discharge criteria of the children during nutrition rehabilitation. SUBJECTS/METHODS: The study present findings from 156 children (aged 6-59 months) attending a supplementary feeding programme at Makadara and Jericho Health Centres, Eastern District of Nairobi, Kenya. Records of age, weight, height and mid-upper arm circumference were selected at three stages of nutrition rehabilitation: admission, follow-up and discharge. The values obtained were then used to calculate z-scores as defined by WHO Anthro while estimating different diagnostic indices. RESULTS: Mid-upper arm circumference single cut-off (< 12.5 cm) was found to exhibit high values of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio at both admission and discharge. Besides, children recorded higher rate of recovery at 86 days, an average increment of 0.98 cm at the rate of 0.14mm/day, and a weight gain of 13.49gm/day, albeit higher in female than their male counterparts. Nevertheless, children admitted on basis of low MUAC had a significantly higher MUAC gain than WH at 0.19mm/day and 0.13mm/day respectively. CONCLUSIONS: Mid-upper arm circumference can be an appropriate tool for identifying malnourished children for admission to nutrition rehabilitation programs. Our results confirm the appropriateness of this tool for monitoring recovery trends and discharging the children thereafter. In principle the tool has potential to minimize nutrition rehabilitation costs, particularly in community therapeutic centres in developing countries.

Stakeholder reactions toward iodine biofortified foods. An application of protection motivation theory.

OBJECTIVE/PURPOSE: To use Protection Motivation Theory (PMT) to evaluate stakeholders' intention to adopt iodine biofortified foods as an alternative means to improve children's iodine status and overall school performance. METHODS: A survey was administered with 360 parents of primary school children and 40 school heads. Protection motivation is measured through matching the cognitive processes they use to evaluate iodine deficiency (threat appraisal), as well as iodine biofortified foods to reduce the threat (coping appraisal). Data were analyzed through Robust (Cluster) regression analysis. RESULTS: Gender had a significant effect on coping appraisal for school heads, while age, education, occupation, income, household size and knowledge were significant predictors of threat, coping appraisal and/or protection motivation intention among parents. Nevertheless, in the overall protection motivation model, only two coping factors, namely self-efficacy (parents) and response cost (school heads), influenced the intention to adopt iodine biofortified foods. CONCLUSION: School feeding programs incorporating iodine biofortification should strive to increase not only consumer knowledge about iodine but also its association to apparent deficiency disorders, boost self-efficacy and ensure that the costs incurred are not perceived as barriers of adoption. The insignificant threat appraisal effects lend support for targeting future communication on biofortification upon the strategies itself, rather than on the targeted micronutrient deficiency. PMT, and coping factors in particular, seem to be valuable in assessing intentions to adopt healthy foods. Nevertheless, research is needed to improve the impacts of threat appraisal factors.

Factors associated with low birth weight among neonates born at Olkalou District Hospital, Central Region, Kenya.

INTRODUCTION: Ninety-two percent of Low Birth Weight(LBW) infants are born in developing countries, 70% in Asia and 22% in Africa. WHO and UNICEF estimate LBW in Kenya as 11% and 6%by 2009 Kenya Demographic Health Survey. The same survey estimated LBW to be 5.5% in Central Province, Kenya. Data in Olkalou hospital indicated that prevalence of LBW was high. However, factors giving rise to the problem remained unknown. METHODS: A cross-sectional analytic study was therefore conducted to estimate prevalence and distribution and determine the factors associated with LBW in the hospital. LBW was defined as birth of a live infant less than 2500 g. We collected data using a semi-structured questionnaire and review of health records. A total 327 women were randomly selected from 500 mothers. Data was managed using Epi Info 3.3.2. RESULTS: The prevalence of LBW was 12.3% (n = 40). The mean age of mothers was 25.6 ± 6.2 years. Mean birth weight was 2928 ± 533 grams. There were 51.1% (n = 165) male neonates and 48.9% (n = 158) females. The following factors were significantly associated with LBW:LBW delivery in a previous birth (OR = 4.7, 95%C.I. = 1.53-14.24), premature rapture of membranes (OR = 2.95, 95%C.I. = 1.14-7.62), premature births (OR=3.65, 95%C.I. = 1.31-10.38), and female newborn (OR = 2.32, 95%C.I. = 1.15-4.70). On logistic regression only delivery of LBW baby in a previous birth (OR = 5.07, 95%C.I. = 1.59-16.21) and female infant (OR = 3.37, 95%C.I. = 1.14-10.00)were independently associated with LBW. CONCLUSION: Prevalence of LBW in the hospital was higher than national estimates. Female infant and LBW baby in a previous birth are independent factors. Local prevention efforts are necessary to mitigate the problem. Population-based study is necessary to provide accurate estimates in the area.

Hydration properties and texture fingerprints of easy- and hard-to-cook bean varieties.

The objective of this study was to understand the factors that affect the hydration and cooking profiles of different bean varieties. During this study, nine bean varieties were classified as either easy-to-cook (ETC) or hard-to-cook (HTC) based on a subjective finger pressing test and an objective cutting test. Rose coco, Red haricot, and Zebra beans were classified as ETC, while Canadian wonder, Soya fupi, Pinto, non-nodulating, Mwezi moja, Gwaku, and New mwezi moja were HTC. The effect of different soaking (pre)-treatments on the cooking behavior and/or water absorption of whole or dehulled beans was investigated. Dehulling, soaking in high pH and monovalent salt solutions reduced the cooking time of beans, while soaking in low pH and CaCl2 solutions increased the cooking time. Moisture uptake was faster in ETC and dehulled beans. Soaking at high temperatures also increased the hydration rate. The results point to pectin-related aspects and the rate of water uptake as possible factors that influence the cooking rate of beans.

Using the unmet obstetric needs indicator to map inequities in life-saving obstetric interventions at the local health care system in Kenya.

BACKGROUND: Developing countries with high maternal mortality need to invest in indicators that not only provide information about how many women are dying, but also where, and what can be done to prevent these deaths. The unmet Obstetric Needs (UONs) concept provides this information. This concept was applied at district level in Kenya to assess how many women had UONs and where the women with unmet needs were located. METHODS: A facility based retrospective study was conducted in 2010 in Malindi District, Kenya. Data on pregnant women who underwent a major obstetric intervention (MOI) or died in facilities that provide comprehensive Emergency Obstetric Care (EmOC) services in 2008 and 2009 were collected. The difference between the number of women who experienced life threatening obstetric complications and those who received care was quantified. The main outcome measures in the study were the magnitude of UONs and their geographical distribution. RESULTS: 566 women in 2008 and 724 in 2009 underwent MOI. Of these, 185 (32.7%) in 2008 and 204 (28.1%) in 2009 were for Absolute Maternal Indications (AMI). The most common MOI was caesarean section (90%), commonly indicated by Cephalopelvic Disproportion (CPD)-narrow pelvis (27.6% in 2008; 26.1% in 2009). Based on a reference rate of 1.4%, the overall MOI for AMI rate was 1.25% in 2008 and 1.3% in 2009. In absolute terms, 22 (11%) women in 2008 and 12 (6%) in 2009, who required a life saving intervention failed to get it. Deficits in terms of unmet needs were identified in rural areas only while urban areas had rates higher than the reference rate (0.8% vs. 2.2% in 2008; 0.8% vs. 2.1% in 2009). CONCLUSIONS: The findings, if used as a proxy to maternal mortality, suggest that rural women face higher risks of dying during pregnancy and childbirth. This indicates the need to improve priority setting towards ensuring equity in access to life saving interventions for pregnant women in underserved areas.

Barriers to emergency obstetric care services: accounts of survivors of life threatening obstetric complications in Malindi District, Kenya.

INTRODUCTION: Pregnancy-related mortality and morbidity in most low and middle income countries can be reduced through early recognition of complications, prompt access to care and appropriate medical interventions following obstetric emergencies. We used the three delays framework to explore barriers to emergency obstetric care (EmOC) services by women who experienced life threatening obstetric complications in Malindi District, Kenya. METHODS: A facility-based qualitative study was conducted between November and December 2010. In-depth interviews were conducted with 30 women who experienced obstetric "near miss" at the only public hospital with capacity to provide comprehensive EmOC services in the district. RESULTS: Findings indicate that pregnant women experienced delays in making decision to seek care and in reaching an appropriate care facility. The "first" delay was due to lack of birth preparedness, including failure to identify a health facility for delivery services regardless of antenatal care and to seek care promptly despite recognition of danger signs. The "second" delay was influenced by long distance and inconvenient transport to hospital. These two delays resulted in some women arriving at the hospital too late to save the life of the unborn baby. CONCLUSION: Delays in making the decision to seek care when obstetric complications occur, combined with delays in reaching the hospital, contribute to ineffective treatment upon arrival at the hospital. Interventions to reduce maternal mortality and morbidity must adequately consider the pre-hospital challenges faced by pregnant women in order to influence decision making towards addressing the three delays.