High levels of undernutrition, particularly stunting, have persisted in Kenya, like in other developing countries. The relationship betweeen vitamin A supplementation and growth of children in Kenya has not been established, while there are context-specific variations on the relationship. This study explores this relationship in the Kenyan context. […]
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Comparing self-rating health responses across individuals and cultures is misleading due to different reporting behaviors. Anchoring vignettes is a technique that allows identifying and adjusting selfrating responses for reporting heterogeneity (RH).This article aims to test two crucial assumptions of vignette equivalence (VE) and response consistency (RC) that are required to be met before vignettes can be used to adjust self-rating responses for RH. Design:We used self-ratings, vignettes, and objective measures covering domains of mobility and cognition from theWHOstudy on global AGEing and adult health, administered to older adults aged 50 years and above from eight low- and middle-income countries in Africa and Asia. For VE, we specified a hierarchical ordered probit (HOPIT) model to test for equality of perceived vignette locations. For RC, we tested for equality of thresholds that are used to rate vignettes with thresholds derived from objective measures and used to rate their own health function. […]
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It has been almost a decade since HIV was declared a national disaster in Kenya. Antiretroviral therapy (ART) provision has been a mainstay of HIV treatment efforts globally. In Kenya, the government started ART provision in 2003 with significantly scale-up after 2006. This study aims to demonstrate changes in populationlevel HIV mortality in two high HIV prevalence slums in Nairobi with respect to the initiation and subsequent scale-up of the national ART program. […]
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Background
The World Health Organisation (WHO) recommends exclusive breastfeeding during the first six months of life for optimal growth, development and health. Breastfeeding should continue up to two years or more and nutritionally adequate, safe, and appropriately-fed complementary foods should be introduced at the age of six months to meet the evolving needs of the growing infant. Little evidence exists on breastfeeding and infant feeding practices in urban slums in sub-Saharan Africa. Our aim was to assess breastfeeding and infant feeding practices in Nairobi slums with reference to WHO recommendations.
Methods
Data from a longitudinal study conducted in two Nairobi slums are used. The study used information on the first year of life of 4299 children born between September 2006 and January 2010. All women who gave birth during this period were interviewed on breastfeeding and complementary feeding practices at recruitment and this information was updated twice, at four-monthly intervals. Cox proportional hazard analysis was used to determine factors associated with cessation of breastfeeding in infancy and early introduction of complementary foods.
Results:
There was universal breastfeeding with almost all children (99%) having ever been breastfed. However, more than a third (37%) were not breastfed in the first hour following delivery, and 40% were given something to drink other than the mothers’ breast milk within 3 days after delivery. About 85% of infants were still breastfeeding by the end of the 11th month. Exclusive breastfeeding for the first six months was rare as only about 2% of infants were exclusively breastfed for six months. Factors associated with sub-optimal infant breastfeeding and feeding practices in these settings include child’s sex; perceived size at birth; mother’s marital status, ethnicity; education level; family planning (pregnancy desirability); health seeking behaviour (place of delivery) and; neighbourhood (slum of residence).
Conclusions
The study indicates poor adherence to WHO recommendations for breastfeeding and infant feeding practices. Interventions and further research should pay attention to factors such as cultural practices, access to and utilization of health care facilities, child feeding education, and family planning. […]
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Routine vaccination programmes have led to substantial declines in the incidence of most of the target diseases. In these circumstances, vaccine effects beyond those on the target diseases may become evident. Several studies have suggested that certain vaccines may influence mortality in low income settings in ways that cannot be attributed to effects on target diseases. Trials of such ‘non-specific’ effects are difficult if not impossible to organise; and observational studies of them are prone to serious confounding, because those who do or do not receive vaccines are likely to differ in many ways, some of which relate to their subsequent risk of early death, independent of vaccination. They are also prone to other biases, including the selective loss of vaccination records for children who die. We review these potential sources of bias and suggest what and how data may be collected to optimise the validity of such studies. […]
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We review sources of bias which can affect non-randomized cohort studies of non-specific effects of vaccines on child mortality. Using examples from the literature on non-specific effects, we describe different sources of selection and information bias, and, where possible, outline analysis strategies to mitigate or eliminate such biases. […]
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Maternal mortality in Sub-Saharan Africa remains a challenge with estimates exceeding 1,000 maternal deaths per 100,000 live births in some countries. Successful prevention of maternal deaths hinges on adequate and quality emergency obstetric care. In addition to skilled personnel, there is need for a supportive environment in terms of essential drugs and supplies, equipment, and a referral system. Many household surveys report a reasonably high proportion of women delivering in health facilities. However, the quality and adequacy of facilities and personnel are often not assessed. The three delay model; 1) delay in making the decision to seek care; 2) delay in reaching an appropriate obstetric facility; and 3) delay in receiving appropriate care once at the facility guided this project. This paper examines aspects of the third delay by assessing quality of emergency obstetric care in terms of staffing, skills equipment and supplies. […]
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Current estimates of maternal mortality ratios in Kenya are at least as high as 560 deaths per 100,000 live births. Given the pervasive poverty and lack of quality health services in slum areas, the maternal mortality situation in this setting can only be expected to be worse. With a functioning health care system, most maternal deaths are avoidable if complications are identified early. A major challenge to effective monitoring of maternal mortality in developing countries is the lack of reliable data since vital registration systems are either non-existent or under-utilized. In this paper, we estimated the burden and identified causes of maternal mortality in two slums of Nairobi City, Kenya. […]
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This paper uses longitudinal data from two informal settlements of Nairobi, Kenya to examine patterns of child growth and how these are affected by four different dimensions of poverty at the household level namely, expenditures poverty, assets poverty, food poverty, and subjective poverty. The descriptive results show a grim picture, with the prevalence of overall stunting reaching nearly 60% in the age group 15–17 months and remaining almost constant thereafter. There is a strong association between food poverty and stunting among children aged 6–11 months (po0.01), while asset poverty and subjective poverty have stronger relationships (po0.01) with under nutrition at older age (24 months or older for asset poverty, and 12 months or older for subjective poverty). The effect of expenditure poverty does not reach statistical significant in any age group. These findings shed light on the degree of vulnerability of urban poor infants and children and on the influences of various aspects of poverty measures. […]
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Objectives:
To assess the prevalence, awareness, treatment and control of diabetes and to examine the relationship of obesity with raised blood glucose in the slums of Nairobi, Kenya.
Methods:
We used data from a cross-sectional population-based survey, conducted in 2008-2009, involving a random sample of 5190 (2794 men and 2396 women) adults aged ≥18 years living in two slums – Korogocho and Viwandani – in Nairobi.
Results:
The prevalence (weighted by sampling and response rates) of diabetes was 4.8% (95%CI 4.0-5.7) in women and 4.0% (95%CI 3.3-4.7) in men. Less than a quarter of those found to have diabetes were aware of their condition among which just over half of men and three-quarters of women reported being on any treatment in the 12 months preceding the survey. Overall, fewer than 5% of all people with diabetes had their blood sugar under control. Obesity and overweight were significantly associated with increased odds (1.7, 95%CI 1.1-2.6) of raised blood glucose only among women while adjusting for important covariates.
Conclusion:
The prevalence of diabetes in this impoverished population is moderately high, while the levels of awareness, treatment and control are quite low. In this population, obesity is an important risk factor for raised blood glucose particularly among women. Prevention and control strategies that target modifiable risk factors for diabetes and increase access to treatment and control in such disadvantaged settings are urgently needed. […]
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PAMANECH – The Partnership for Maternal, Newborn and Child Health […]
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This Global Nutrition Report is the first in an annual series. It tracks worldwide progress in improving nutrition status, identifies bottlenecks to change, highlights opportunities for action, and contributes to strengthened nutrition accountability. The report series was created through a commitment of the signatories of the Nutrition for Growth Summit in 2013. It is supported by a wide-ranging group of stakeholders and delivered by an Independent Group of Experts in partnership with a large number of external contributors. […]
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The role of socio-cultural factors such as religion and ethnicity in aiding or hampering family planning (FP) uptake in rural Western Kenya, a region with persistently high fertility rates, is not well established. We explored whether attitudes towards FP can be attributed to religious affiliation and/or ethnicity among women in the region. Findings show that religion and ethnicity have no impact; the most significant factors are level of education and knowledge about the benefits of FP for the mother. FP interventions ought to include strategies aimed at enhancing women’s knowledge about the positive impacts of family planning. […]
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What’s so Great about Exclusive Breastfeeding?
Breastfeeding is the most natural way to feed newborn babies, yet millions of babies are not breastfed adequately. UNICEF and WHO recommendations for infant feeding during the first two years of life include (WHO 2003):
- Immediate initiation of breastfeeding after birth
- Exclusive breastfeeding for first six months
- Sustained breastfeeding for two years or beyond with appropriate complementary feeding from six months This breastfeeding practice is critical for child growth, development and survival.
It reduces infections and mortality in children, improves mental and motor development, and protects against obesity and metabolic diseases and premature deaths later in the life course (Black et al 2013, Lanigan and Singal 2009, Black et al. 2008, Victora et al. 2008, Grantham-McGregor et al 2007).
But how does Breastfeeding Provide all these Benefits?
Human breast milk uniquely benefits the baby. It contains various components including bioactive proteins that are lacking or are in lower quantities in other milk substitutes such as cow milk. These components offer various benefits to the baby including enzyme activities, antimicrobial effects, enhanced nutrient absorption and growth stimulation. It also contains milk fat globule membranes (MFGM), which may explain the difference in infection levels and cognitive development between breastfed and formula fed children. While some studies have found no consistent difference in adiposity between formula-fed and breastfed infants in the first six months of life, others have found that breastfed infants may gain more fat in the first six months of life but gain more fat-free mass after six months, which reduces the risk of obesity later in life (Ziegler 2006, Lonnerdal 2010). […]
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Breastfeeding is an effective method of ensuring child health and survival. World Health Organization (WHO) recommends exclusive breastfeeding during the first 6 months of life as a source of nourishment for infants and young children (1). In-order to meet the infant’s needs for growth, health and development, breastfeeding should continue for at-least 2 years of life combined with appropriate complementary feeding that is introduced at 6 months. It is estimated that 1.4 million child-lives could be saved by improving breastfeeding practices (2). The rates of breastfeeding are generally high in Kenya with a reported 97% of children ever breastfed while initiation of breastfeeding is 86% within one day of birth (3). However, exclusive breastfeeding rates are still very low in the country estimated at only 32% of children age 6 months (3). Exclusive breastfeeding rates vary widely across the country with even lower rates of up to 2% reported in informal settlements in Nairobi (4). The main reasons given for discontinued breastfeeding and early introduction of complementary feeding includes mother’s retuning to work, not having enough breast-milk and advice by health professionals (5). The Baby Friendly Community Initiative (BFCI) has been recommended as an appropriate method of promoting and supporting breastfeeding at community level (6).
Breastfeeding is a complex process governed by psychological and physiological factors which are influenced by a wide spectrum of environmental, social and cultural factors (7). These factors have been summarised by Ochola (8) in a schematic illustration shown on Figure 1. Ochola, (8) argues that maternal psychological and physiological factors are affected by maternal socio-economic and demographic factors, contextual factors such as place of delivery, cultural factors and infant characteristics. The maternal psychological and physiological factors in-turn directly affects exclusive breastfeeding practices (Figure 1). This complexity of factors influencing breastfeeding practices requires a tactical approach in-order to increase the uptake of appropriate breastfeeding practices for optimal child growth.
Several models have been tested for promoting exclusive breastfeeding in Kenya. This review will highlight three main ones namely, the counselling of mothers and peer counsellors, Baby Friendly Hospital Initiative (BFHI), and the Baby Friendly Community Initiative (BFCI). […]
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Introduction
A new Initiative Baby Friendly Community Initiative (BFCI) is being developed to serve as a model for improving infant feeding practices in the community health services in Kenya. The aim is to provide women with a comprehensive support system to improve maternal nutrition and breast feeding practices at community level. To inform the implementation of the BFCI package, participatory action research involving focus group discussions and interviews with mothers, community leaders and other members of the community and health care professionals have been conducted. Further, a study trip was undertaken to Cambodia which has had success in its implementation of BFCI so that lessons that will inform its implementation could be learnt.
Purpose of the visit
The purpose of the visit was to learn on the implementation of Baby Friendly Community Initiative by the Kingdom of Cambodia and learn the success stories.
Baby Friendly Community Initiative Study -methods used
- Presentation
- National Nutrition Programme
- Provincial Health Department Bottonbang Province
- Provincial Health Department Oddormeachey Province
- Partners MJP, FAO, MALIS, MALTISER International
- Visit to the facility to observe implementation of BFHI
- Visit to the community to learn implementation of BFCI
- Interviews with specific groups
- Mother Support Groups (BFCI Volunteers)
- Individual Mothers
- Post natal mothers
- Farmer Groups
- Mother Child Pair Group (Mothers who have benefited from BFCI)
[…]
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Cardiovascular diseases (CVD) are the main cause of morbidity and mortality worldwide. As prevention and treatment of CVD often requires active screening and lifelong follow up it is a challenge for health systems both in high-income and low and middle-income countries to deliver adequate care to those in need, with efficient use of resources. We developed a health service model for primary prevention of CVD suitable for implementation in the Nairobi slums, based on best practices from public health and the private sectors. The model consists of four key intervention elements focusing on increasing awareness, incentives for promoting access to screening and treatment, and improvement of long-term adherence to prescribed medications. More than 5,000 slum dwellers aged ≥35 years and above have been screened in the study resulting in more than 1000 diagnosed with hypertension and referred to the clinic.
Some marginalized groups in high-income countries like African migrants in the Netherlands also have low rates of awareness, treatment and control of hypertension as the slum population in Nairobi. The parallel between both groups is that they have a combination of risky lifestyle, are prone to chronic diseases such as hypertension, have limited knowledge about hypertension and its complications, and a tendency to stay away from clinics partly due to cultural beliefs in alternative forms of treatment, and lack of trust in health providers. Based on these similarities it was suggested by several policy-makers that the model from Nairobi can be applied to other vulnerable populations such as African migrants in high-income countries. The model can be contextualized to the local situation by adapting the key steps of the model to the local settings.
The involvement and support of African communities’ infrastructures and health care staff is crucial, and the most important enabler for successful implementation of the model in migrant communities in high-income countries. Once these stakeholders have expressed their interest, the impact of the adapted intervention can be measured through an implementation research approach including collection of costs from health care providers’ perspective and health effects in the target population, similar to the study design for Nairobi.
Keywords:
Reverse innovation, Hypertension, Prevention, Treatment, Slums, Kenya, African migrants […]
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Abstract
Background:
The World Health Organization recommends Bacillus Calmette-Guérin (BCG) vaccination against tuberculosis be given at birth. However, in many developing countries, pre-term and low birth weight infants get vaccinated only after they gain the desired weight. In Kenya, the ministry of health recommends pre-term and low birth weight infants to be immunized at the time of discharge from hospital irrespective of their weight. This paper seeks to understand the effects of birth weight on timing of BCG vaccine.
Methods:
The study was conducted in two Nairobi urban informal settlements, Korogocho and Viwandani which hosts the Nairobi Urban Health and Demographic Surveillance system. All infants born in the study area since September 2006 were included in the study. Data on immunization history and birth weight of the infant were recorded from child’s clinic card. Follow up visits were done every four months to update immunization status of the child. A total of 3,602 infants were included in this analysis. Log normal accelerated failure time parametric model was used to assess the association between low birth weight infants and time to BCG immunization.
Results:
In total, 229 (6.4%) infants were low birth weight. About 16.6% of the low birth weight infants weighed less than 2000 grams and 83.4% weighed between 2000 and 2490 grams. Results showed that, 60% of the low birth weight infants received BCG vaccine after more than five weeks of life. Private health facilities were less likely to administer a BCG vaccine on time compared to public health facilities. The effects of low birth weight on females was 0.60 and 0.97-times that of males for infants weighing 2000–2499 grams and for infants weighing <2000 grams respectively. The effect of low birth weight among infants born in public health facilities was 1.52 and 3.94-times that of infants delivered in private health facilities for infants weighing 2000–2499 grams and those weighing < 2000 grams respectively.
Conclusion:
Low birth weight infants received BCG immunization late compared to normal birth weight infants. Low birth weight infants delivered in public health facilities were more likely to be immunized much later compared to private health facilities.
Keywords:
Bacillus Calmette-Guérin, Low birth weight, Immunization […]
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Food and nutrition security exists when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life. […]
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This report summarizes the findings of the Nigerian component of a multi-country research project entitled Analysis of Non-communicable Diseases Prevention Policies in Africa (ANPPA). […]
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