Assessment of consumers' preference for orange-fleshed sweet potato puree chapati: a case of rural and urban consumers in Kenya.

BACKGROUND: Orange-fleshed sweet potato (OFSP) is bio-fortified with vitamin A precursors through breeding and is thus ideal for combating vitamin A deficiency (VAD). One of the potential mechanisms to promote the consumption of OFSP is to enhance its availability through processing into products with a longer shelf life and more desirable to consumers. However, very few farmers and agro-processors practice value addition due to market uncertainties; there is little information on market availability for OFSP products. This study examined consumers' preference for OFSP puree chapati in rural and urban areas of Kenya, using the contingent valuation method. Data was collected from a random sample of 411 sweet potato consumers and a double-bounded logit model was applied to analyze consumers' willingness to pay (WTP) for OFSP puree chapati. RESULTS: Consumers were willing to pay a price of Kenya shillings (KES) 19 (USD 0.14) and 35 (USD 0.26) for OFSP puree chapati in Homa Bay and Nairobi counties, respectively. The presence of children under 5 years in a household, consumers' awareness of OFSP products and benefits of consuming OFSP, and level of education had a positive and significant influence on WTP for OFSP puree chapati in both regions. CONCLUSION: The study demonstrated that consumers exhibited a positive preference for OFSP puree chapati. In order to increase the consumption of OFSP and its value-added products, it is important to promote consumer awareness of OFSP puree chapati and other such nutritious products through cooking demonstrations and other nudging approaches using attractive illustrations and social media platforms that engage mothers and care-givers of children under 5 years old as well as the youth. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Targeting market segment needs with public-good crop breeding investments: A case study with potato and sweetpotato focused on poverty alleviation, nutrition and gender.

Crop breeding programs have often focused on the release of new varieties that target yield improvement to achieve food security and reduce poverty. While continued investments in this objective are justified, there is a need for breeding programs to be increasingly more demand-driven and responsive to the changing customer preferences and population dynamics. This paper analyses the responsiveness of global potato and sweetpotato breeding programs pursued by the International Potato Center (CIP) and its partners to three major development indicators: poverty, malnutrition and gender. The study followed a seed product market segmentation blueprint developed by the Excellence in Breeding platform (EiB) to identify, describe, and estimate the sizes of the market segments at subregional levels. We then estimated the potential poverty and nutrition impacts of investments in the respective market segments. Further, we employed the G+ tools involving multidisciplinary workshops to evaluate the gender-responsiveness of the breeding programs. Our analysis reveals that future investments in breeding programs will achieve greater impacts by developing varieties for market segments and pipelines that have more poor rural people, high stunting rates among children, anemia prevalence among women of reproductive age, and where there is high vitamin A deficiency. In addition, breeding strategies that reduce gender inequality and enhance appropriate change of gender roles (hence gender transformative) are also required.

Using preschoolers to improve caregivers' knowledge, attitude, and practices relating to biofortified crops: Evidence from a randomized nutrition education trial in Kenya.

This 2018 randomized controlled trial examined the role behavioral nudges can play in improving caregivers' knowledge, attitude, and practices (KAP) relating to biofortified orange-fleshed sweetpotato (OFSP). The experiment involved 431 preschooler-caregiver pairs in 15 villages. The preschoolers were enrolled in public-run Early Childhood Development and Education (ECDE) centers in the respective villages. Caregivers were first exposed to the routine OFSP promotion activities in the area - invited to cooking demonstration workshops and issued with free OFSP vines to plant. A baseline survey followed. Next, the 15 villages were randomized into four study groups (a control and three treatments). The interventions were deployed for 30 days as follows: Treatment 1 - preschoolers issued OFSP-branded exercise books, class posters, and poems; Treatment 2 - caregivers received phone-mediated text messages; and Treatment 3 - received the full suite of interventions. This study analyzed the endline and baseline data and finds that, in general, changes in KAP scores were negatively associated with control group (p = .005) and positively associated with Treatment 3 (p = .02). Specifically, Treatment 3 significantly increased caregivers' knowledge of OFSP production, consumption, and vitamin A. Treatment 2 significantly improved their attitude too. It concludes that an integrated complementary nutrition education approach targeting preschooler-caregiver pairs is more effective in increasing knowledge of cultivation and consumption of OFSP. It discusses the implications for the design of more effective nutrition programs targeting households with preschoolers to accelerate the fight against vitamin A deficiency (VAD).

The Role of Targeted Nutrition Education of Preschoolers and Caregivers on Sustained Consumption of Biofortified Orange-Fleshed Sweetpotato in Kenya.

BACKGROUND: Persistent prevalence of high malnutrition in poor households in developing countries calls for enhancement of cost-effective nutrition interventions among the vulnerable groups. One responsive way is to promote regular consumption of home-grown biofortified foods, particularly in the micronutrient-deficient groups. Previous nutrition interventions have targeted adults with behavior change education, but have rarely explored the potential of nutrition education of preschoolers as change agents. OBJECTIVES: This study sought to assess the effect of nutrition education targeting preschool children and their caregivers on their consumption of vitamin A-biofortified orange-fleshed sweetpotato (OFSP) in rural farm households in Homa Bay County, Kenya. METHODS: A total of 431 preschooler-caregiver pairs from 15 village-level clusters were recruited into a randomized controlled trial. The sample was randomized into 1 control (3 villages) and 3 treatment groups (4 villages each). Treatments involved channeling nutrition education to preschoolers through their learning materials (preschooler treatment); the caregivers through their mobile phones (caregiver treatment); and to both preschoolers and their caregivers simultaneously (integrated treatment). Baseline and follow-up household-level surveys were conducted with the caregivers, and consumption data were collected from the preschoolers using a child dietary diversity register. Class teachers sought 24-h consumption recalls of the preschoolers for 19 consecutive schooldays. RESULTS: The results of a zero-inflated Poisson regression showed that the phone-mediated and multichanneled nutrition education approaches significantly increased the number of days of OFSP consumption. The integrated nutrition education approach significantly increased the preschoolers' likelihood to consume OFSP, number of OFSP consumption days, and likelihood to consume it more than once per week by 11%, 77%, and 20%, respectively. CONCLUSIONS: Nutrition education through OFSP-branded preschoolers' learning materials and phone-mediated messages provides effective nudges to the caregivers to feed their preschoolers regularly with OFSP. This could have implications for realizing sustainable nutrition programs in biofortified crop-growing areas.

Do Nutrition Education Approaches With Preschoolers and Their Caregivers Influence Retention of Biofortified Orange-Fleshed Sweet Potato on Farms? Evidence From Homa Bay County, Kenya.

BACKGROUND: Biofortified staples have been promoted widely in sub-Saharan Africa to combat micronutrient deficiencies. Contemporary projects are increasingly using elementary schools to target households with these foods. OBJECTIVE: This study assessed the effects of integrated nutrition education approaches, targeting preschoolers and their caregivers, on retention of orange-fleshed sweet potato (OFSP) on farms in the second season after lapse of free vine dissemination initiatives. METHODS: Rural farming households, with preschoolers and no prior engagement with OFSP, were targeted. A multistage sample of 431 preschooler-caregiver pairs was recruited for a cluster-randomized controlled trial. After issuing routine OFSP promotion activities, 15 village-level clusters of the pairs were randomized into 1 control group (3 villages) and 3 treatment arms (4 villages each) for the interventions. Baseline and follow-up household-level survey data were collected from the caregivers. The interventions included: (1) OFSP-branded exercise books, posters, and a poem to preschoolers only; (2) OFSP-oriented mobile phone mediated text messages to caregivers only; and (3) both 1 and 2 provided to individual households concurrently. Interventions 1 and 2 were single-channeled, while 3 was multichanneled. We estimated the intention-to-treat (ITT) and treatment-on-the-treated (TOT) effects using a binary logit model and a special regressor method, respectively. RESULTS: Only the multi-channeled nutrition education approach had significant effects (ITT = 0.167, P = .001; TOT = .243, P = .007) on the caregivers' likelihood to retain OFSP on their farms. CONCLUSIONS: The finding implies that multi-channeled agriculture nutrition education interventions through Early Childhood Development institutions can be effective in ensuring sustainable adoption of OFSP.

Technical efficiency and technology gaps of sorghum plots in Uganda: A gendered stochastic metafrontier analysis.

Sorghum plot managers in different locations have varying levels of resource endowment that in turn influence technical efficiency (TE). Therefore, plot managers operate at different levels of technology. The present study applied a stochastic metafrontier approach to assess TE and technology gaps of female, male and jointly-managed sorghum plots. A two limit-Tobit model was subsequently applied to assess determinants of TE. Results indicate that male-managed sorghum plots had the highest metafrontier technical efficiencies (MTEs) (61%, 56% and 15%) and technology gap ratios (TGRs) (98%, 92% and 20%) for Lira, Serere and Kumi districts, respectively compared to female and jointly managed plots. However, jointly managed plots had higher TE and TGRs compared to female plot managers but lower than those of the male-managed plots. Age, distance to plot and farmer group membership influenced TE positively while household size, years of farming sorghum and access to credit had negative effects on efficiency.

The contribution of extensive chicken production systems and practices to Newcastle disease outbreaks in Kenya.

Newcastle disease (ND) poses a challenge especially for farmers rearing indigenous chicken under the extensive system. This is due to the lack of uniformity in practices, favoring the introduction and spread of the disease. This is worsened by the lack of information on how management practices contribute to the spread of ND. The current study assessed the role of extensive chicken production systems and management practices on the frequency of ND outbreaks in Kenya using a Poisson regression model (PRM) on primary survey data from 332 farmers in Kakamega and Machakos counties. Descriptive results showed a low access to institutional support services like extension, training, credit, and vaccination services for both male and female farmers. Results from the PRM analysis show that flock size, isolated and confined housing, multi-aged flock mixture, screening of birds, access to ND vaccination, ND awareness, distance to agro-veterinary service providers, and access to animal health training and extension services had significant effects on the frequency of ND outbreaks. The findings underscore the need for innovative extension approaches that facilitate the use of information communication technologies to create more awareness on disease detection and mitigation measures. Use of farmer groups as innovation platforms for enhanced skill sharing and as key peer monitoring channels would also improve compliance with prescribed disease control methods. Further, there is a need for partnerships between local-level county governments, vaccine producers, and agro-veterinary service providers to ensure the development of low-cost vaccines and requisite storage facilities, and their timely delivery to the male and female resource-poor smallholder extensive chicken farmers.

Assessment of local stakeholders' preferences for foreign land lease design attributes in Kenya: A participatory choice-based survey approach.

Global land acquisition and lease investments in developing countries by foreign companies have elicited a lot of controversy and interest in recent literature. Well-structured foreign land leases and investments might offer development benefits to the host countries including opportunities for employment, provision of capital for improvement of infrastructure and stabilization of food prices. However, most foreign land lease deals in Africa are often characterized by secret negotiations and lack of local stakeholder consultations. Consequently, the land deals often result in displacement of land owners and loss of their customary land rights such as grazing and fuel wood access rights. The situation is exacerbated by relatively low monetary compensation offered to the land owners by the foreign investors. In recent years, numerous protests by the excluded stakeholders have resulted to considerable loss of investments and disruption of livelihoods. Against this backdrop, the present study analyzed local community members' preferences for foreign land lease design attributes in coastal Kenya using choice experiment survey data from a random sample of 200 respondents. Results showed that respondents prefer varying payment levels in order to allow design of leases that incorporate the following attributes: short lease duration (up to 15 years); renewable leases after joint negotiations and; provision of formal employment to land owners' household members. These insights should be incorporated in the design of foreign land leases to promote harmony between land owners and leasers.

Sequelae and Other Conditions in Ebola Virus Disease Survivors, Sierra Leone, 2015.

We rapidly assessed the health of Ebola virus disease (EVD) survivors in Kenema, Sierra Leone, by reviewing medical charts of all patients attending the Survivor Clinic of Kenema Government Hospital. Data were abstracted on signs and symptoms at every attendance. As of November 2015, a total of 621 attendances by 115 survivors with laboratory-confirmed EVD were made to the Survivor Clinic. Most (60.9%) survivors were women. Survivors' median age was 28 years (range 0.25-70 years). Survivors attended the clinic a median of 5 times (range 1-21 times) each, and the median time from EVD discharge to attendance was 261 days (range 4-504 days). The most commonly reported signs and symptoms among the 621 attendances were headache (63.1%), fever (61.7%), and myalgia (43.3%). Because health needs of EVD survivors are complex, rapid chart reviews at survivor clinics should be repeated regularly to assess the extent of illness and prioritize service delivery.

Malnutrition and Childhood Disability in Turkana, Kenya: Results from a Case-Control Study.

BACKGROUND: Children with disabilities may be particularly vulnerable to malnutrition, as a result of exclusions and feeding difficulties. However, there is limited evidence currently available on this subject. METHODS: A population-based case-control study was conducted in Turkana County, Kenya, between July and August 2013. Key informants in the community identified children aged 6 months to 10 years who they believed may have a disability. These children were screened by a questionnaire (UNICEF-Washington Group) and assessed by a paediatrician to confirm whether they had a disability and the type. Two controls without disabilities were selected per case: A sibling control (sibling nearest in age) and a neighbourhood control (nearest neighbour within one year of age). The caregiver completed a questionnaire on behalf of the child (e.g. information on feeding, poverty, illness, education), and anthropometric measures were taken. We undertook multivariable logistic and linear regression analyses to estimate the relationship between disability and malnutrition. RESULTS: The study included 311 cases with disabilities, 196 sibling controls and 300 neighbour controls. Children with disabilities were more likely to report a range of feeding difficulties. They were 1.6-2.9 times more likely to have malnutrition in comparison to neighbour controls or family controls, including general malnutrition (low weight for age), stunting (low height for age), low body mass index (BMI) or low mid upper arm circumference (MUAC) for age. Children with disabilities were almost twice as likely to have wasting (low weight for height) in comparison to neighbour controls (OR = 1.9, 95% CI 1.1-3.2), but this difference was not apparent compared with siblings (OR = 1.5, 95% CI 0.8-2.7). Children with disabilities also faced other exclusions. For instance those aged 5+ were much more likely not to attend school than neighbour controls (OR = 8.5, 95% CI 4.3-16.9). CONCLUSIONS: Children with disabilities were particularly vulnerable to malnutrition, even within this area of food insecurity and widespread malnutrition. Efforts need to be made to include children with disabilities within food supplementation programmes, and school based programmes alone may be inadequate to meet this need. Exclusion of children with disabilities from education is also a priority area to be addressed.

Community case management of malaria: a pro-poor intervention in rural Kenya.

BACKGROUND: Access to prompt and effective treatment of malaria is a fundamental right of all populations at risk; many countries have not met the target of 60% of children treated with effective antimalarial drugs within 24 h of fever onset. While community case management of malaria is effective for increasing coverage, evidence is mixed on whether it improves equity. The objective of this study was to assess whether a community case management of a malaria programme delivered by community health workers (CHW) in two districts of Kenya improved access and equity. METHODS: Data on child fever treatment practices, malaria prevention and CHW visits was collected through cross-sectional household surveys in project communities before (December 2008) and after 1 year of intervention (December 2009). Indicators were analysed by household wealth rank (grouped into poorest [bottom 20%], poor [middle 60%] and least poor [top 20%]) and survey. RESULTS: Data were available from 763 households at baseline and 856 households at endline. At endline, access to prompt and effective malaria treatment was higher compared with baseline for all groups, with the highest proportions among the poorest (67.6%) and the poor (63.2%), and the lowest proportion among the least poor (43.4%). Corresponding data suggest this was linked to the household's interaction with a CHW as the source of advice/treatment for child fever. CONCLUSION: These findings provide evidence that in a resource-poor setting, CHWs can provide lifesaving interventions to the poorest.

Factors associated with utilization of community health workers in improving access to malaria treatment among children in Kenya.

BACKGROUND: The success of community case management in improving access to effective malaria treatment for young children relies on broad utilization of community health workers (CHWs) to diagnose and treat fever cases. A better understanding of the factors associated with CHW utilization is crucial in informing national malaria control policy and strategy in Kenya. Specifically, little is known in Kenya on the extent to which CHWs are utilized, the characteristics of families who report utilizing CHWs and whether utilization is associated with improved access to prompt and effective malaria treatment. This paper examines factors associated with utilization of CHWs in improving access to malaria treatment among children under five years of age by women caregivers in two malaria endemic districts in Kenya. METHODS: This study was conducted in 113 hard-to-reach and poor villages in Malindi and Lamu districts in the coastal region classified as having endemic transmission of malaria. A cross-sectional household survey was conducted using a standardized malaria indicator questionnaire at baseline (n=1,187) and one year later at endline assessment (n=1,374) using two-stage cluster sampling. RESULTS: There was an increase in reported utilization of CHWs as source of advice/treatment for child fevers from 2% at baseline to 35% at endline, accompanied by a decline in care-seeking from government facilities (from 67% to 48%) and other sources (26% to 2%) including shops. The most poor households and poor households reported higher utilization of CHWs at 39.4% and 37.9% respectively, compared to the least poor households (17.0%). Households in villages with less than 200 households reported higher CHWs utilization as compared to households in villages having >200 households. Prompt access to timely and effective treatment was 5.7 times higher (95% CI 3.4-9.7) when CHWs were the source of care sought. Adherence was high regardless of whether source was CHWs (73.1%) or public health facility (66.7%). CONCLUSIONS: The potential for utilization of CHWs in improving access to malaria treatment at the community level is promising. This will not only enhance access to treatment by the poorest households but also provide early and appropriate treatment to vulnerable individuals, especially those living in hard to reach areas.

Laparoscopic Trachelectomy for Cervical Stump 'Carcinoma in situ'.

A 43-year-old, who underwent a subtotal hysterectomy for postpartum hemorrhage following a normal delivery, 10 years ago, presented with a history of persistent vaginal discharge and post-coital bleeding. A pap smear reported moderate dysplasia, and a subsequent colposcopic biopsy reported severe dysplasia with crypt extension. The patient underwent a laparoscopic trachelectomy, and histology of the stump reported cervical squamous carcinoma in situ, with no microinvasion.