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Mgongo M, Ickes SB, Leyaro BJ, Mboya IB, Grounds S, Seiger ER, Hashim TH, Conklin JL, Kimani-Murage EW, Martin SL. Early Infant Feeding Practices among Women Engaged in Paid Work in Africa: A Systematic Scoping Review. Adv Nutr 2024; 15:100179. [PMID: 38246350 PMCID: PMC10877690 DOI: 10.1016/j.advnut.2024.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/05/2024] [Accepted: 01/14/2024] [Indexed: 01/23/2024] Open
Abstract
Around the world, paid work without appropriate structural support is a key barrier to optimal breastfeeding practices. To better protect, promote, and support optimal breastfeeding practices among working women in Africa, this scoping review sought to understand how paid work influences infant feeding practices in the first 6 mo of life and what support women need to manage work and optimal infant feeding practices. We systematically searched PubMed, Scopus, Global Health, and CINAHL Plus, screened 2436 abstracts, and reviewed 322 full-text articles using Covidence for review and charting. We identified 203 articles that met the inclusion criteria. We identified 32 quantitative, 10 qualitative, 3 mixed-methods, and 2 review articles that focused on examining the relationship between work and breastfeeding, and 109 quantitative, 22 qualitative, 21 mixed-methods, and 4 review articles that included work as part of broader breastfeeding research but did not focus on work. Most studies reported a significant negative association between work and exclusive breastfeeding. Three major domains were reported in the qualitative studies: challenges to managing work and infant feeding, receiving support from employers and family members/caregivers, and strategies for feeding infants when the mother is working. Reviewed studies proposed recommendations to increase support for breastfeeding through changes to policies and support within worksites, the health system, and childcare; however, evidence of previously implemented policies or programs is limited. We recommend more consistent definitions and measurement of women's work. Future research is needed on the impact of implementing various strategies and benefits for breastfeeding at workplaces, as well as efforts to support breastfeeding among informal workers.
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Affiliation(s)
- Melina Mgongo
- Institute of Public Health, Department of Community and Global Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania; Better Health for the African Mother and Child, Moshi, Tanzania.
| | - Scott B Ickes
- Department of Biological and Health Sciences, Wheaton College, Wheaton, IL, United States; Kenya Medical Research Institute, Nairobi, Kenya; Program in Nutritional Sciences, and Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States; Department of Kinesiology and Health Sciences, William and Mary, WIlliamsburg, VA, United States
| | - Beatrice J Leyaro
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Innocent B Mboya
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania; Department of Translational Medicine, Lund University, Malmo, Sweden
| | - Samantha Grounds
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Emily R Seiger
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tamara H Hashim
- Institute of Public Health, Department of Community and Global Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Jamie L Conklin
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Nampijja M, Langat N, Oloo L, Okelo K, Muendo R, Kiyeng M, Amboka P, Abboah-Offei M, Ray A, Kitsao-Wekulo P, Kimani-Murage EW, Elsey H. Predictors of quality of childcare centers in low-income settings: findings from a cross-sectional study in two Nairobi slums. Front Public Health 2023; 11:1163491. [PMID: 38026308 PMCID: PMC10644197 DOI: 10.3389/fpubh.2023.1163491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Background Rapid urbanization and increased women's involvement in paid work have contributed to the upsurge of informal childcare centers, especially in low-income settings where quality is a major issue. However, there are limited data on the factors associated with the quality of childcare centers in informal settlements in Africa. Methods We conducted a quantitative observation and questionnaire survey of 66 childcare centers to identify the factors associated with the quality of childcare services in two informal settlements (Korogocho and Viwandani) in Nairobi. The quality of the centers (outcome variable) was assessed using a locally developed tool. Data on center characteristics including type, size, location, length of operation, charges, and number of staff were collected. Center providers' knowledge, attitude, and practices (KAP) in childcare were assessed through a questionnaire, focusing on nurturing care and business management. Data were described using means and standard deviation or frequencies and percentages. Associations between quality center score (outcome variable) and other variables were examined using multivariable linear regression to identify potential predictors of the quality of the center environment. Findings A total of 129 childcare centers were identified and categorized as home-based (n = 45), center-based (n = 14), school-based (n = 61), and church-based (n = 9). The number of home-based centers was particularly high in Viwandani (n = 40; 52%). Only 9% of home-based centers reported any external support and 20% had any training on early childhood development. Of the 129 centers, 66 had complete detailed assessment of predictors of quality reported here. Unadjusted linear regressions revealed associations between quality of childcare center and center providers' education level, type of center, support received, caregiver-child ratio, number of children in the center, and center providers' KAP score (p < 0.05). However, in the multivariable regression, only higher levels of center provider KAP (β = 0.51; 95% CI: 0.18, 0.84; p = 0.003) and center type (β = 8.68; 95% CI: 2.32, 15.04; p = 0.008) were significantly associated with center quality score. Implication Our results show that center providers' knowledge and practices are a major driver of the quality of childcare centers in informal settlements in Nairobi. Interventions for improving the quality of childcare services in such settings should invest in equipping center providers with the necessary knowledge and skills through training and supportive supervision.
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Affiliation(s)
| | - Nelson Langat
- African Population and Health Research Centre, Nairobi, Kenya
| | - Linda Oloo
- African Population and Health Research Centre, Nairobi, Kenya
| | - Kenneth Okelo
- African Population and Health Research Centre, Nairobi, Kenya
| | - Ruth Muendo
- African Population and Health Research Centre, Nairobi, Kenya
| | | | - Patrick Amboka
- African Population and Health Research Centre, Nairobi, Kenya
| | - Mary Abboah-Offei
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
- Department of Health Sciences, University of York, York, United Kingdom
| | - Anna Ray
- Department of Health Sciences, University of York, York, United Kingdom
| | | | | | - Helen Elsey
- Department of Health Sciences, University of York, York, United Kingdom
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Wambui E, Nampijja M, Okelo KO, Muendo R, Onyango S, Kimani-Murage EW, Kitsao-Wekulo P. Perceptions of the influence of a mobile phone-based messaging platform on caregiver ECD knowledge, attitudes and practices: a qualitative exploration in an informal settlement in Nairobi. BMC Prim Care 2023; 24:187. [PMID: 37710157 PMCID: PMC10502968 DOI: 10.1186/s12875-023-02127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/16/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Programs supporting initiatives for children younger than three years are inadequate and not accessible to many families, particularly in resource-limited settings. Many primary caregivers have little knowledge on how to monitor the development of their children or the importance of engaging children in stimulative activities during the course of early development. Health system limitations make it difficult for health workers to educate and demonstrate stimulative engagement to caregivers. The massive use of technology can be used to facilitate access to growth and development programs for children. We developed and implemented a mobile phone technology to help caregivers monitor and stimulate their children's development in real-time. This study explored the influence that this intervention had on the caregivers' early child development (ECD) knowledge, attitudes and practices. METHODS In this qualitative cross-sectional study, we conducted interviews through eight (8) focus group discussions, three (3) key informant interviews and 9 indepth interviews among a total of 111 participants including primary caregivers (n = 87), community health volunteers (CHVs) (n = 21) health managers and workers (n = 3) to determine their attitudes and experience with the intervention with regards to improving their KAP. Interviews were audio-recorded, transcribed, and analyzed thematically. RESULTS Caregivers and CHVs reported that the intervention had provided them with new knowledge that positively influenced their ECD caregiving attitudes and practices. CHVs and health workers and managers reported that the intervention had provided caregivers with confidence in caring for their children while increasing their knowledge on how to monitor and stimulate their children's development. CONCLUSION Mobile phone technology can be effectively used to enhance caregivers' knowledge of ECD and enable them to monitor and support their children's development in real-time. TRIAL REGISTRATION The trial was registered with the Pan African Clinical Trial Registry ( www.pactr.org ) database (ID number: PACTR201905787868050 Date: 6/05/2019.
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Affiliation(s)
- Elizabeth Wambui
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya.
| | - Margaret Nampijja
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - Kenneth Odhiambo Okelo
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - Ruth Muendo
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - Silas Onyango
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - Elizabeth W Kimani-Murage
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - Patricia Kitsao-Wekulo
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
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Hughes RC, Muendo R, Bhopal SS, Onyango S, Kimani-Murage EW, Kirkwood BR, Hill Z, Kitsao-Wekulo P. Parental experiences of childcare in an informal urban settlement: qualitative interview findings from the Nairobi Early Childcare in Slums (NECS) project. BMJ Open 2023; 13:e071627. [PMID: 37105687 PMCID: PMC10152052 DOI: 10.1136/bmjopen-2023-071627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES To gain an in-depth understanding of parent/carers' perspectives on, and decision-making about, early childhood care in general, and paid childcare specifically, in informal settlements in Nairobi. DESIGN In-depth telephone interviews, conducted using a topic guide, were analysed through a combination of deductive and inductive thematic analysis and regular reflexivity meetings. We explored parents' childcare needs and experiences over time, and their perspectives on the provision of paid childcare in the slums. SETTING Three informal settlements or slums in Nairobi: Kibera; Kawangware; and Mukuru-Viwandani. PARTICIPANTS A purposively selected sample of 21 parental and non-parental carers of children aged under 5 years who were currently living in three Nairobi slums, including men and women, and users and non-users of paid childcare. RESULTS Childcare is complex, with a plurality of approaches being used. Common strategies include family member provided care (often but not exclusively by mothers, at home or at a place of work), paid childcare and informal or ad hoc arrangements with neighbours. Childcare decision-making in these settings is constrained by economics and the broader context of living in the slum. Paid childcare is frequently used, but is widely understood to be lacking in quality, especially for the poorest. Quality of childcare is understood to comprise a combination of structural factors, such as the physical space, play and learning resources and processes such as interactions between the care provider and children or parents. CONCLUSIONS These findings suggest a need, and opportunity, to improve early childhood care in slums. Understanding parental perspectives on both the deficiencies and valued features of childcare is likely to be vital to informing efforts to improve childcare in these settings.
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Affiliation(s)
- Robert C Hughes
- Maternal & Child Health Intervention Research Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth Muendo
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Sunil S Bhopal
- Maternal & Child Health Intervention Research Group, London School of Hygiene & Tropical Medicine, London, UK
- Newcastle upon Tyne, Population Health Sciences Institute, Newcastle upon Tyne, UK
| | - Silas Onyango
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | | | - Betty R Kirkwood
- Maternal & Child Health Intervention Research Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Zelee Hill
- Institute for Global Health, University College London, London, UK
| | - Patricia Kitsao-Wekulo
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
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Nyamasege CK, Kimani-Murage EW, Imungi JK, Kaindi DWM, Wagatsuma Y. Risks of Anaemia Among Pre-School Children Following Maternal Nutrition Education and Counselling in Urban Informal Settlements of Nairobi, Kenya. Community Health Equity Res Policy 2023; 43:265-274. [PMID: 34096381 DOI: 10.1177/0272684x211022584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Slum environment may pose risk to child health and nutrition. This study assessed the risks of anemia among under five-year-old children, five years after implementing a nutrition education and counseling intervention in two urban slums in Nairobi, Kenya. A cross-sectional study was conducted in May 2018 as a follow-up of a randomized controlled study carried out between 2012-2015. A trained nurse measured hemoglobin levels of 438 children from households which participated in the initial study. Multivariate logistic regression was conducted to identify risks of anemia. The mean (+SD) age of the children was 55.9 (5.3) months and mean (+SD) hemoglobin was 10.7 (1.5) g/dL. Anemia prevalence was 59.8%, 33.9% had mild, 24.7% moderate, and 1.2% severe anemia. Absence of home toilet (AOR = 3.31; 95% CI, 1.20-9.09), household which paid to use a toilet facility (AOR = 1.86; 95% CI, 1.12-3.08), child's frequency of eating colored fruits and vegetables (AOR = 0.28; 95% CI, 0.08-0.96), meat and meat products (AOR = 0.31; 95% CI, 0.23-6.01), number of meals a child aged <15years ate a day preceding the study (AOR = 1.49; 95% CI, 1.14-1.98), and a mother who had a history of anemia (AOR = 2.89; 95% CI, 1.22-12.01), were factors significantly associated with child's anemia status. The environment of urban informal settings influences child anemia status. Further studies with interventions are therefore required in order to improve sanitation facilities and access to meats, fruits, and vegetables in urban slums through innovative kitchen gardens and small animal husbandry.
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Affiliation(s)
- Carolyn Kemunto Nyamasege
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan.,Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Elizabeth W Kimani-Murage
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Japan.,Department of Maternal and Child Wellbeing, African Population and Health Research Center, Nairobi, Kenya
| | | | | | - Yukiko Wagatsuma
- Department of Food Science, Nutrition and Technology, University of Nairobi, Kenya
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Wanjohi MN, Pradeilles R, Asiki G, Holdsworth M, Kimani-Murage EW, Muthuri SK, Irache A, Laar A, Zotor F, Tandoh A, Klomegah S, Graham F, Osei-Kwasi HA, Green MA, Coleman N, Mensah K, Akparibo R, Aryeteey R, Rousham EK, Bricas N, Bohr M, Griffiths P. Community perceptions on the factors in the social food environment that influence dietary behaviour in cities of Kenya and Ghana: a Photovoice study. Public Health Nutr 2022; 26:1-13. [PMID: 36305344 PMCID: PMC9989710 DOI: 10.1017/s1368980022002270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/08/2022] [Accepted: 10/04/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To explore communities' perspectives on the factors in the social food environment that influence dietary behaviours in African cities. DESIGN A qualitative study using participatory photography (Photovoice). Participants took and discussed photographs representing factors in the social food environment that influence their dietary behaviours. Follow-up in-depth interviews allowed participants to tell the 'stories' of their photographs. Thematic analysis was conducted, using data-driven and theory-driven (based on the socio-ecological model) approaches. SETTING Three low-income areas of Nairobi (n 48) in Kenya and Accra (n 62) and Ho (n 32) in Ghana. PARTICIPANTS Adolescents and adults, male and female aged ≥13 years. RESULTS The 'people' who were most commonly reported as influencers of dietary behaviours within the social food environment included family members, friends, health workers and food vendors. They mainly influenced food purchase, preparation and consumption, through (1) considerations for family members' food preferences, (2) considerations for family members' health and nutrition needs, (3) social support by family and friends, (4) provision of nutritional advice and modelling food behaviour by parents and health professionals, (5) food vendors' services and social qualities. CONCLUSIONS The family presents an opportunity for promoting healthy dietary behaviours among family members. Peer groups could be harnessed to promote healthy dietary behaviours among adolescents and youth. Empowering food vendors to provide healthier and safer food options could enhance healthier food sourcing, purchasing and consumption in African low-income urban communities.
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Affiliation(s)
- Milkah N Wanjohi
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, P.O Box 01787-00100, Nairobi, Kenya
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, Loughborough, UK
| | - Gershim Asiki
- Health and Systems for Health Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-food systems), (Université Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institute Agro, IRD), Montpellier, France
| | - Elizabeth W Kimani-Murage
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, P.O Box 01787-00100, Nairobi, Kenya
| | - Stella K Muthuri
- Population Dynamics and Reproductive Health Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Ana Irache
- Warwick Center for Applied Health Research and Delivery, Warwick Medical School, University of Warwick, Coventry, UK
| | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Francis Zotor
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Akua Tandoh
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Senam Klomegah
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Fiona Graham
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Mark A Green
- Department of Geography & Planning, University of Liverpool, Liverpool, UK
| | - Nathaniel Coleman
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle Bu, Accra, Ghana
| | - Kobby Mensah
- Department of Marketing and Entrepreneurship, University of Ghana Business School, Legon, Accra, Ghana
| | - Robert Akparibo
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Richmond Aryeteey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Emily K Rousham
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, Loughborough, UK
| | - Nicolas Bricas
- French Agricultural Research Centre for International Development (CIRAD), Montpellier Cedex 5, France
| | - Marco Bohr
- School of Art and Design, Nottingham Trent University, Nottingham, UK
| | - Paula Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, Loughborough, UK
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7
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Joyal-Desmarais K, Stojanovic J, Kennedy EB, Enticott JC, Boucher VG, Vo H, Košir U, Lavoie KL, Bacon SL, Granana N, Losada AV, Boyle J, Shawon SR, Dawadi S, Teede H, Kautzky-Willer A, Dash A, Cornelio ME, Karsten M, Matte DL, Reichert F, Abou-Setta A, Aaron S, Alberga A, Barnett T, Barone S, Bélanger-Gravel A, Bernard S, Birch LM, Bondy S, Booij L, Da Silva RB, Bourbeau J, Burns R, Campbell T, Carlson L, Charbonneau É, Corace K, Drouin O, Ducharme F, Farhadloo M, Falk C, Fleet R, Fournier M, Garber G, Gauvin L, Gordon J, Grad R, Gupta S, Hellemans K, Herba C, Hwang H, Jedwab J, Kakinami L, Kim S, Liu J, Norris C, Pelaez S, Pilote L, Poirier P, Presseau J, Puterman E, Rash J, Ribeiro PAB, Sadatsafavi M, Chaudhuri PS, Suarthana E, Tse S, Vallis M, Caceres NB, Ortiz M, Repetto PB, Lemos-Hoyos M, Kassianos A, Rod NH, Beraneck M, Ninot G, Ditzen B, Kubiak T, Codjoe S, Kpobi L, Laar A, Skoura T, Francis DL, Devi NK, Meitei S, Nethan ST, Pinto L, Saraswathy KN, Tumu D, Lestari S, Wangge G, Byrne M, Durand H, McSharry J, Meade O, Molloy G, Noone C, Levine H, Zaidman-Zait A, Boccia S, Hoxhaj I, Paduano S, Raparelli V, Zaçe D, Aburub A, Akunga D, Ayah R, Barasa C, Godia PM, Kimani-Murage EW, Mutuku N, Mwoma T, Naanyu V, Nyamari J, Oburu H, Olenja J, Ongore D, Ziraba A, Bandawe C, Yim L, Ajuwon A, Shar NA, Usmani BA, Martínez RMB, Creed-Kanashiro H, Simão P, Rutayisire PC, Bari AZ, Vojvodic K, Nagyova I, Bantjes J, Barnes B, Coetzee B, Khagee A, Mothiba T, Roomaney R, Swartz L, Cho J, Lee MG, Berman A, Stattin NS, Fischer S, Hu D, Kara Y, Şimşek C, Üzmezoğlu B, Isunju JB, Mugisha J, Byrne-Davis L, Griffiths P, Hart J, Johnson W, Michie S, Paine N, Petherick E, Sherar L, Bilder RM, Burg M, Czajkowski S, Freedland K, Gorin SS, Holman A, Lee J, Lopez G, Naar S, Okun M, Powell L, Pressman S, Revenson T, Ruiz J, Sivaram S, Thrul J, Trudel-Fitzgerald C, Yohannes A, Navani R, Ranakombu K, Neto DH, Ben-Porat T, Dragomir A, Gagnon-Hébert A, Gemme C, Jamil M, Käfer LM, Vieira AM, Tasbih T, Woods R, Yousefi R, Roslyakova T, Priesterroth L, Edelstein S, Snir R, Uri Y, Alyami M, Sanuade C, Crescenzi O, Warkentin K, Grinko K, Angne L, Jain J, Mathur N, Mithe A, Nethan S. How well do covariates perform when adjusting for sampling bias in online COVID-19 research? Insights from multiverse analyses. Eur J Epidemiol 2022; 37:1233-1250. [PMID: 36335560 PMCID: PMC9638233 DOI: 10.1007/s10654-022-00932-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Abstract
COVID-19 research has relied heavily on convenience-based samples, which-though often necessary-are susceptible to important sampling biases. We begin with a theoretical overview and introduction to the dynamics that underlie sampling bias. We then empirically examine sampling bias in online COVID-19 surveys and evaluate the degree to which common statistical adjustments for demographic covariates successfully attenuate such bias. This registered study analysed responses to identical questions from three convenience and three largely representative samples (total N = 13,731) collected online in Canada within the International COVID-19 Awareness and Responses Evaluation Study ( www.icarestudy.com ). We compared samples on 11 behavioural and psychological outcomes (e.g., adherence to COVID-19 prevention measures, vaccine intentions) across three time points and employed multiverse-style analyses to examine how 512 combinations of demographic covariates (e.g., sex, age, education, income, ethnicity) impacted sampling discrepancies on these outcomes. Significant discrepancies emerged between samples on 73% of outcomes. Participants in the convenience samples held more positive thoughts towards and engaged in more COVID-19 prevention behaviours. Covariates attenuated sampling differences in only 55% of cases and increased differences in 45%. No covariate performed reliably well. Our results suggest that online convenience samples may display more positive dispositions towards COVID-19 prevention behaviours being studied than would samples drawn using more representative means. Adjusting results for demographic covariates frequently increased rather than decreased bias, suggesting that researchers should be cautious when interpreting adjusted findings. Using multiverse-style analyses as extended sensitivity analyses is recommended.
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Affiliation(s)
- Keven Joyal-Desmarais
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street West, Montreal, QC H4B 1R6 Canada ,Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Canada
| | - Jovana Stojanovic
- Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Canada ,Canadian Agency for Drugs and Technologies in Health, Ottawa, Canada
| | - Eric B. Kennedy
- Disaster and Emergency Management, York University, Toronto, Canada
| | - Joanne C. Enticott
- Department of General Practice, Monash University, Melbourne, Australia ,Monash Partners, Advanced Health Research and Translation Centre, Melbourne, Australia
| | | | - Hung Vo
- Austin Health, Victoria, Australia
| | - Urška Košir
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street West, Montreal, QC H4B 1R6 Canada ,Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Canada
| | - Kim L. Lavoie
- Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Canada ,Département de Psychologie, Université du Québec à Montréal, Montreal, Canada
| | - Simon L. Bacon
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street West, Montreal, QC H4B 1R6 Canada ,Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Canada
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8
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Pradeilles R, Irache A, Wanjohi MN, Holdsworth M, Laar A, Zotor F, Tandoh A, Klomegah S, Graham F, Muthuri SK, Kimani-Murage EW, Coleman N, Green MA, Osei-Kwasi HA, Bohr M, Rousham EK, Asiki G, Akparibo R, Mensah K, Aryeetey R, Bricas N, Griffiths P. Urban physical food environments drive dietary behaviours in Ghana and Kenya: A photovoice study. Health Place 2021; 71:102647. [PMID: 34375838 PMCID: PMC8520917 DOI: 10.1016/j.healthplace.2021.102647] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/20/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
We identified factors in the physical food environment that influence dietary behaviours among low-income dwellers in three African cities (Nairobi, Accra, Ho). We used Photovoice with 142 males/females (≥13 years). In the neighbourhood environment, poor hygiene, environmental sanitation, food contamination and adulteration were key concerns. Economic access was perceived as a major barrier to accessing nutritionally safe and healthy foods. Home gardening supplemented household nutritional needs, particularly in Nairobi. Policies to enhance food safety in neighbourhood environments are required. Home gardening, food pricing policies and social protection schemes could reduce financial barriers to safe and healthy diets.
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Affiliation(s)
- Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom.
| | - Ana Irache
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Michelle Holdsworth
- IRD (French National Research Institute for Sustainable Development), NUTRIPASS Unit, Université de Montpellier-IRD, Montpellier, France
| | - Amos Laar
- University of Ghana, Department of Population, Family & Reproductive Health, School of Public Health, Accra, Ghana
| | - Francis Zotor
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Akua Tandoh
- University of Ghana, Department of Population, Family & Reproductive Health, School of Public Health, Accra, Ghana
| | - Senam Klomegah
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Fiona Graham
- Population Health Sciences Institute, Newcastle University, United Kingdom
| | | | | | - Nathaniel Coleman
- University of Ghana, Department of Population, Family & Reproductive Health, School of Public Health, Accra, Ghana; Department of Obstetrics and Gynaecology, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Mark A Green
- Department of Geography and Planning, University of Liverpool, UK
| | | | - Marco Bohr
- School of Art & Design, Nottingham Trent University, UK
| | - Emily K Rousham
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Robert Akparibo
- Public Health Section, School of Health and Related Research, University of Sheffield, United Kingdom
| | - Kobby Mensah
- Department of Marketing and Entrepreneurship, University of Ghana Business School, Accra, Ghana
| | - Richmond Aryeetey
- University of Ghana, Department of Population, Family & Reproductive Health, School of Public Health, Accra, Ghana
| | - Nicolas Bricas
- UMR MOISA, CIRAD- Agricultural Research & International Cooperation Organization, Montpellier, France
| | - Paula Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom
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9
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Mutoro AN, Garcia AL, Kimani-Murage EW, Wright CM. Prevalence and overlap of known undernutrition risk factors in children in Nairobi Kenya. Matern Child Nutr 2021; 18:e13261. [PMID: 34355500 PMCID: PMC8710128 DOI: 10.1111/mcn.13261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/01/2022]
Abstract
We aimed to describe the co‐occurrence of known risk factors for undernutrition and the prevalence of modifiable risks in wasted, stunted and healthy children. Quota sampling was used to recruit healthy [weight for age Z scores (WAZ) > −2 SD] and undernourished [weight for length (WLZ) or WAZ scores ≤ −2 SD] children aged 6–24 months from seven clinics in low‐income areas of Nairobi. Structured interviews were used to identify exposure to socioeconomic, water and hygiene, infant feeding, dietary and behavioural risks (low interest in food, high food refusal and force feeding). We recruited 92 wasted WLZ ≤ −2 SD, 133 stunted (length for age Z scores LAZ ≤ −2 SD) and 172 healthy (LAZ and WLZ > 2SD) children. Nearly all children were exposed to hygiene risks (90%) and low dietary diversity (95%) regardless of nutritional status. Stunted children were more likely to be exposed to socio‐economic risks (54% healthy, 64% wasted and 72% stunted; P = 0.001). Compared with healthy children, wasted and stunted children were more likely to be exposed to infant feeding (25% healthy, 40% wasted and 41% stunted; P = 0.02) and behaviour risks (24% healthy, 49% wasted, and 44% stunted; P = 0.004). Overall, wasted and stunted children were twice as likely to be exposed to more than three risks (23% healthy, 48% wasted, and 50% stunted; P = <0.001). They were also more likely to be exposed to more than three modifiable risks (dietary, handwashing and behaviour risks). Wasting and stunting are associated with exposure to multiple risk factors, many of which are potentially modifiable using targeted advice.
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Affiliation(s)
- Antonina N Mutoro
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.,Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Ada L Garcia
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Elizabeth W Kimani-Murage
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.,Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
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10
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Samburu BM, Kimiywe J, Young SL, Wekesah FM, Wanjohi MN, Muriuki P, Madise NJ, Griffiths PL, Kimani-Murage EW. Realities and challenges of breastfeeding policy in the context of HIV: a qualitative study on community perspectives on facilitators and barriers related to breastfeeding among HIV positive mothers in Baringo County, Kenya. Int Breastfeed J 2021; 16:39. [PMID: 33964950 PMCID: PMC8106855 DOI: 10.1186/s13006-021-00385-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 04/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background Although recent policies have sought to increase the rates of exclusive breastfeeding (EBF) and continued breastfeeding for HIV exposed infants, few programs have considered the multiple social and cultural barriers to the practice. Therefore, to generate evidence for exclusive and continued breastfeeding policies in Kenya, we examined community perspectives on the facilitators and barriers in adherence to EBF for the HIV positive mothers. Methods Qualitative research was conducted in Koibatek, a sub-County in Baringo County Kenya, in August 2014 among 205 respondents. A total of 14 focus group discussions (n = 177), 14 In-depth Interviews and 16 key informant interviews were conducted. Transcribed data was analyzed thematically. NVivo version 10.0 computer qualitative software program was used to manage and facilitate the analysis. Results Facilitators to exclusive breastfeeding were perceived to include counselling at the health facility, desire to have a healthy baby, use of antiretroviral drugs and health benefits associated with breastmilk. Barriers to EBF included poor dissemination of policies, knowledge gap, misinterpretation of EBF, inadequate counselling, attitude of mother and health workers due to fear of vertical HIV transmission, stigma related to misconception and misinformation that EBF is only compulsory for HIV positive mothers, stigma related to HIV and disclosure, social pressure, lack of male involvement, cultural practices and traditions, employment, food insecurity. Conclusions There are multiple facilitators and barriers of optimal breastfeeding that needs a holistic approach to interventions aimed at achieving elimination of mother to child transmission. Extension of infant feeding support in the context of HIV to the community while building on existing interventions such as the Baby Friendly Community Initiative is key to providing confidential support services for the additional needs faced by HIV positive mothers.
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Affiliation(s)
| | - Judith Kimiywe
- Department of Foods, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Sera Lewise Young
- Institute of Policy Research, Northwestern University, Evanston, USA
| | - Frederick Murunga Wekesah
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya.,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Milka Njeri Wanjohi
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Peter Muriuki
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya.,Institute of Global Health Equity Education, University of Global Health Equity, Kigali, Rwanda
| | | | - Paula L Griffiths
- School of Sports, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,MRC/WITS Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elizabeth W Kimani-Murage
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya.,Wellcome Trust, London, UK.,Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G31 2ER, UK.,Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre, Stellenbosch University, Stellenbosch, South Africa.,International Health Institute, Brown University School of Public Health, Providence, USA
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11
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Nampijja M, Okelo K, Wekulo PK, Kimani-Murage EW, Elsey H. Improving the quality of child-care centres through supportive assessment and 'communities of practice' in informal settlements in Nairobi: protocol of a feasibility study. BMJ Open 2021; 11:e042544. [PMID: 33674370 PMCID: PMC7938982 DOI: 10.1136/bmjopen-2020-042544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Investing in children during the critical period between birth and age 5 years can have long-lasting benefits throughout their life. Children in Kenya's urban informal settlements, face significant challenges to healthy development, particularly when their families need to earn a daily wage and cannot care for them during the day. In response, informal and poor quality child-care centres with untrained caregivers have proliferated. We aim to co-design and test the feasibility of a supportive assessment and skills-building for child-care centre providers. METHODS AND ANALYSIS A sequential mixed-methods approach will be used. We will map and profile child-care centres in two informal settlements in Nairobi, and complete a brief quality assessment of 50 child-care centres. We will test the feasibility of a supportive assessment skills-building system on 40 child-care centres, beginning with assessing centre-caregivers' knowledge and skills in these centres. This will inform the subsequent co-design process and provide baseline data. Following a policy review, we will use experience-based co-design to develop the supportive assessment process. This will include qualitative interviews with policymakers (n=15), focus groups with parents (n=4 focus group discussions (FGDs)), child-care providers (n=4 FGDs) and joint workshops. To assess feasibility and acceptability, we will observe, record and cost implementation for 6 months. The knowledge/skills questionnaire will be repeated at the end of implementation and results will inform the purposive selection of 10 child-care providers and parents for qualitative interviews. Descriptive statistics and thematic framework approach will respectively be used to analyse quantitative and qualitative data and identify drivers of feasibility. ETHICS AND DISSEMINATION The study has been approved by Amref Health Africa's Ethics and Scientific Review Committee (Ref: P7802020 on 20th April 2020) and the University of York (Ref: HSRGC 20th March 2020). Findings will be published and continual engagement with decision-makers will embed findings into child-care policy and practice.
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Affiliation(s)
- Margaret Nampijja
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Kenneth Okelo
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Patricia Kitsao Wekulo
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | | | - Helen Elsey
- Department of Health Sciences, University of York, York, UK
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12
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Kimani-Murage EW, Kimiywe J, Mutoro AN, Wilunda C, Wekesah FM, Muriuki P, Mwangi BM, Samburu BM, Madise NJ, McGarvey ST, Griffiths PL. Effectiveness of the baby-friendly community initiative on exclusive breastfeeding in Kenya. Matern Child Nutr 2021; 17:e13142. [PMID: 33528102 PMCID: PMC8189218 DOI: 10.1111/mcn.13142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/17/2020] [Accepted: 01/05/2021] [Indexed: 12/01/2022]
Abstract
The baby-friendly hospital initiative (BFHI) promotes exclusive breastfeeding (EBF) in hospitals, but this is not accessible in rural settings where mothers give birth at home, hence the need for a community intervention. We tested the effectiveness of the baby-friendly community initiative (BFCI) on EBF in rural Kenya. This cluster randomized study was conducted in 13 community units in Koibatek sub-county. Pregnant women aged 15-49 years were recruited and followed up until their children were 6 months old. Mothers in the intervention group received standard maternal, infant and young child nutrition counselling, support from trained community health volunteers, health professionals and community and mother support groups, whereas those in the control group received standard counselling only. Data on breastfeeding practices were collected longitudinally. The probability of EBF up to 6 months of age and the restricted mean survival time difference were estimated. A total of 823 (intervention group n = 351) pregnant women were recruited. Compared with children in the control group, children in the intervention group were more likely to exclusively breastfeed for 6 months (79.2% vs. 54.5%; P < .05). Children in the intervention group were also exclusively breastfed for a longer time, mean difference (95% confidence interval [CI]) 0.62 months (0.38, 0.85; P < .001). The BFCI implemented within the existing health system and including community and mother support groups led to a significant increase in EBF in a rural Kenyan setting. This intervention has the potential to improve EBF rates in similar settings.
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Affiliation(s)
- Elizabeth W Kimani-Murage
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya.,International Health Institute, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life of Public Health, Brown University, Providence, RI, USA
| | - Judith Kimiywe
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Antonina N Mutoro
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya.,Human Nutrition, University of Glasgow, Glasgow, UK
| | - Calistus Wilunda
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | | | - Peter Muriuki
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Bonaventure M Mwangi
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Betty Mogesi Samburu
- Formerly Division of Nutrition and Dietetics, Ministry of Health in Kenya, Nairobi, Kenya.,Nutrition Section, United Nations Children's Fund (UNICEF) Kenya Country office, Nairobi, Kenya
| | - Nyovani Janet Madise
- Research and Development Policy, African Institute for Development Policy, Lilongwe, Malawi
| | - Stephen T McGarvey
- International Health Institute, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life of Public Health, Brown University, Providence, RI, USA
| | - Paula L Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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13
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Kimani-Murage EW, Macharia TN, Kamande EW, Gatheru PM, Donfouet HPP, Alemu T, Kiige L, Jobando S, Dinga LA, Samburu B, Atinda J, Watson S, Mitchell C, Griffiths P, Lilford R, Jackson D, Begin F, Moloney G. Assessment of the feasibility and potential effectiveness of a baby-friendly workplace support initiative in rural Kenya: a study protocol. ACTA ACUST UNITED AC 2021. [DOI: 10.18203/2349-3259.ijct20210142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<p class="abstract"><strong>Background:</strong> Employment poses a barrier in achieving the World Health Organization’s recommendation of exclusive breastfeeding for the first six months of life. Effective strategies and evidence to improve breastfeeding for women working in the agricultural sector – the main employer for women in Kenya – is lacking. This study aimed to inform (with evidence) the design and implementation of a scalable model of workplace support for breastfeeding in an agricultural setting in Kenya; as well as investigated the model’s potential operational feasibility and potential effectiveness, and its cost-effectiveness.</p><p class="abstract"><strong>Methods:</strong> The study employed a mixed methods approach and participatory methods at the pre-implementation, implementation and post-implementation phases. The pre-implementation phase generated evidence to inform the implementation. Mothers with children under 12 months were interviewed at the pre-implementation (2016) and post-implementation (2018) phase. Managers, supervisors, decision and policy makers, as well as other community members were also targeted. Statistical methods will include analysis of covariance and logistic regression. Additionally, cost-effectiveness and cost-benefit analyses will be done. Qualitative data will be analysed <em>in vivo</em>, using thematic analysis technique.</p><p class="abstract"><strong>Conclusions: </strong>Findings from this study aimed to inform the potential feasibility and potential effectiveness of a baby-friendly workplace support for breastfeeding initiative in an agricultural setting with a goal of improving child nutrition and health. The findings also contribute to policy and practice in Kenya by informing the development of workplace support guidelines.</p><p class="abstract"><strong>Trial Registration:</strong> ISRCTN registry, ISRCTN 64692465; date of registration: 21 December 2016 – retrospectively registered, http://www.isrctn.com/ISRCTN64692465.</p>
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14
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Hughes RC, Kitsao-Wekulo P, Bhopal S, Kimani-Murage EW, Hill Z, Kirkwood BR. Nairobi Early Childcare in Slums (NECS) Study Protocol: a mixed-methods exploration of paid early childcare in Mukuru slum, Nairobi. BMJ Paediatr Open 2020; 4:e000822. [PMID: 33344785 PMCID: PMC7716665 DOI: 10.1136/bmjpo-2020-000822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION The early years are critical. Early nurturing care can lay the foundation for human capital accumulation with lifelong benefits. Conversely, early adversity undermines brain development, learning and future earning.Slums are among the most challenging places to spend those early years and are difficult places to care for a child. Shifting family and work structures mean that paid, largely informal, childcare seems to be becoming the 'new normal' for many preschool children growing up in rapidly urbanising Africa. However, little is known about the quality of this childcare. AIMS To build a rigorous understanding what childcare strategies are used and why in a typical Nairobi slum, with a particular focus on provision and quality of paid childcare. Through this, to inform evaluation of quality and design and implementation of interventions with the potential to reach some of the most vulnerable children at the most critical time in the life course. METHODS AND ANALYSIS Mixed methods will be employed. Qualitative research (in-depth interviews and focus group discussions) with parents/carers will explore need for and decision-making about childcare. A household survey (of 480 households) will estimate the use of different childcare strategies by parents/carers and associated parent/carer characteristics. Subsequently, childcare providers will be mapped and surveyed to document and assess quality of current paid childcare. Semistructured observations will augment self-reported quality with observable characteristics/practices. Finally, in-depth interviews and focus group discussions with childcare providers will explore their behaviours and motivations. Qualitative data will be analysed through thematic analysis and triangulation across methods. Quantitative and spatial data will be analysed through epidemiological methods (random effects regression modelling and spatial statistics). ETHICS AND DISSEMINATION Ethical approval has been granted in the UK and Kenya. Findings will be disseminated through journal publications, community and government stakeholder workshops, policy briefs and social media content.
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Affiliation(s)
- Robert C Hughes
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Patricia Kitsao-Wekulo
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Sunil Bhopal
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | | | - Zelee Hill
- Epidemiology and Public Health, Institute of Global Health, University College London, London, UK
| | - Betty R Kirkwood
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
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15
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Mutisya M, Markey O, Rousham EK, Chintsanya JMN, Pradeilles R, Kimani-Murage EW, Madise NJ, Munthali AC, Kalimbira A, Holdsworth M, Griffiths PL, Haycraft E. Improving nutritional status among urban poor children in sub-Saharan Africa: An evidence-informed Delphi-based consultation. Matern Child Nutr 2020; 17:e13099. [PMID: 33145974 PMCID: PMC7988854 DOI: 10.1111/mcn.13099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 01/26/2023]
Abstract
In sub‐Saharan Africa (SSA), rapid urbanisation coupled with the high prevalence of infant and young child (IYC) undernutrition in low‐income settings means that interventions to support IYC nutrition are a priority. Little is known about how urbanisation influences IYC feeding (IYCF) practices, and evidence‐based interventions to improve IYC health/nutrition in the urban poor are lacking. Therefore, this research aimed to (a) systematically review evidence on interventions for improving the nutritional status of IYC aged 6–23 months living in urban poor areas (PROSPERO CRD42018091265) and (b) engage stakeholders to identify the highest ranking evidence gaps for improving IYCF programmes/policies. First, a rapid systematic review was conducted. This focused on the literature published regarding nutrition‐specific and nutrition‐sensitive complementary feeding interventions in urban poor areas, specifically low‐income informal settlements, in low‐ and middle‐income countries (LMICs). Six intervention studies met the review inclusion criteria. Intervention adherence was generally high, and indicators of maternal knowledge and IYC nutritional intake typically increased because of the interventions, but the impact on anthropometric status was small. Second, stakeholders working across SSA were engaged via a Delphi‐based approach to identify priority areas for future intervention. Stakeholders reported that a situational analysis was required to better understand IYCF in urban poor areas, particularly the causes of IYC undernutrition, and highlighted the need to involve local communities in defining how future work should proceed. Together, these findings indicate a need for more evidence regarding IYCF and the factors that drive it in urban poor areas across LMIC settings, but particularly in SSA.
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Affiliation(s)
- Maurice Mutisya
- African Population and Health Research Center, Nairobi, Kenya
| | - Oonagh Markey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emily K Rousham
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Jesman M N Chintsanya
- Department of Population Studies, Chancellor College, University of Malawi, Zomba, Malawi
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Alister C Munthali
- Centre for Social Research, Chancellor College, University of Malawi, Zomba, Malawi
| | | | - Michelle Holdsworth
- School of Health and Related Research, University of Sheffield, Sheffield, UK.,UMR NUTRIPASS, Research Institute for Development, Montpellier, France
| | - Paula L Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emma Haycraft
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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16
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Mutua MK, Mohamed SF, Kimani-Murage EW, Kiarie L, Janusz CB, Aaby P, Fisker AB, Echoka E, Ravn H. Complete and on-time routine childhood immunisation: determinants and association with severe morbidity in urban informal settlements, Nairobi, Kenya. Ann Hum Biol 2020; 47:132-141. [PMID: 32429760 DOI: 10.1080/03014460.2020.1725121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Completion of the full series of childhood vaccines on-time is crucial to ensuring greater protection against vaccine-preventable diseases.Aim: To examine determinants of complete and on-time vaccination and evaluate the relationship between vaccination patterns and severe morbidity outcomes.Subjects and methods: Vaccination information from infants in Nairobi Urban Health and Demographic Surveillance System was used to evaluate full and on-time vaccination coverage of routine immunisation. Logistic regression was used to identify determinants of full and on-time vaccination coverage. Cox regression model was used to evaluate the relationship between vaccination status and subsequent severe morbidity. A shared frailty cox model was fitted to account for the heterogeneity in hospitalisation episodes.Results: Maternal age, post-natal care, parity, ethnicity, and residence place were identified as determinants of vaccination completion. Institutional deliveries and residence place were identified as the determinants of on-time vaccination. A significant 58% (confidence interval [CI]: 15-79%) (p = .017) lower mortality was observed among fully immunised children compared with not fully immunised. Lower mortality was observed among on-time immunised children, 64% (CI: 20-84%) compared to those with delays.Conclusions: Improving vaccination timeliness and completion schedule is critical for protection against vaccine preventable diseases and may potentially provide protection beyond these targets.
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Affiliation(s)
- Martin K Mutua
- African Population and Health Research Center (APHRC), Nairobi, Kenya.,Jomo Kenyatta University of Agriculture and Technology (JKUAT), Nairobi, Kenya
| | - Shukri F Mohamed
- African Population and Health Research Center (APHRC), Nairobi, Kenya.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Lucy Kiarie
- African Population and Health Research Center (APHRC), Nairobi, Kenya.,International Youth Alliance for Family Planning (IYAFP), Washington, DC, USA
| | - Cara Bess Janusz
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Peter Aaby
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Faculty of Health Sciences, OPEN, University of Southern Denmark/Odense University Hospital, Odense, Denmark.,Bandim Health Project, Bissau, Guinea-Bissau
| | - Ane B Fisker
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Faculty of Health Sciences, OPEN, University of Southern Denmark/Odense University Hospital, Odense, Denmark.,Bandim Health Project, Bissau, Guinea-Bissau
| | - Elizabeth Echoka
- Center for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Henrik Ravn
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Faculty of Health Sciences, OPEN, University of Southern Denmark/Odense University Hospital, Odense, Denmark
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Wanjohi MN, Ogada I, Wekesah FM, Khayeka-Wandabwa C, Kimani-Murage EW. Relationship between maternal body composition during pregnancy and infant's birth weight in Nairobi informal settlements, Kenya. BMJ Nutr Prev Health 2020; 3:151-161. [PMID: 33521524 PMCID: PMC7841839 DOI: 10.1136/bmjnph-2019-000060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 11/04/2022] Open
Abstract
Background Maternal nutrition depletion during pregnancy compromises fetal programming, and is a cause of adverse birth outcomes. Maternal body composition measurement using direct body composition assessment methods such as the deuterium dilution technique provides better prediction of birth outcomes as compared with commonly used techniques like anthropometry. This study assessed body composition of pregnant mothers in urban informal settlements in Nairobi, Kenya, and established the relationship between maternal body composition and infant birth weight. Methods Deuterium dilution technique was used to determine body composition, including total body water (TBW), fat-free mass (FFM) and fat mass (FM), among 129 pregnant women who were enrolled into the study in their first or second trimester. Descriptive statistics and regression analysis were applied using Stata V.13. Results The mean TBW, FFM and FM were 33.3 L (±4.7), 45.7 kg (±6.5) and 17.01 kg (±7.4), respectively. Both TBW and FFM were significantly related to maternal age and gestation/pregnancy stage during body composition assessment while FM was significantly associated with gestation stage during body composition assessment. TBW and FFM were significantly lower in younger mothers (<20 years) compared with older mothers (≥20 years). The mean birth weight was 3.3 kg±0.42 kg. There was a positive association between infant birth weight and maternal TBW (p=0.031) and FFM (p=0.027), but not FM (p=0.88). Conclusion Non-fat components of the body (TBW and FFM) have a positive association with birth weight. Therefore, interventions to improve optimal maternal feeding practices, to enhance optimal gains in FFM and TBW during pregnancy are recommended, especially among young mothers.
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Affiliation(s)
- Milkah Njeri Wanjohi
- Maternal and Child Wellbeing, African Population and Health Research Center, Nairobi, Kenya
| | - Irene Ogada
- Department of Human Nutrition, St Francis Xavier University, Antigonish, Nova Scotia, Canada.,Department of Food Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Frederick Murunga Wekesah
- Health and Systems for Health Unit, African Population and Health Research Center, Nairobi, Kenya.,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Christopher Khayeka-Wandabwa
- School of Pharmaceutical Science and Technology (SPST), Health Science Platform, Tianjin University, Tianjin, China
| | - Elizabeth W Kimani-Murage
- Maternal and Child Wellbeing, African Population and Health Research Center, Nairobi, Kenya.,Wellcome Trust, London, UK
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18
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Samburu BM, Young SL, Wekesah FM, Wanjohi MN, Kimiywe J, Muriuki P, Griffiths PL, McGarvey ST, Madise NJ, Kimani-Murage EW. Effectiveness of the baby-friendly community initiative in promoting exclusive breastfeeding among HIV negative and positive mothers: a randomized controlled trial in Koibatek Sub-County, Baringo, Kenya. Int Breastfeed J 2020; 15:62. [PMID: 32664987 PMCID: PMC7362439 DOI: 10.1186/s13006-020-00299-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Although the baby-friendly community initiative (BFCI) has been proposed as a community-level approach to improve infant feeding practices, there is little data on its variation in effectiveness by HIV status. We conducted a study to determine the effectiveness of BFCI in changing knowledge and attitudes towards exclusive breastfeeding (EBF) and increasing the rates among HIV negative and HIV positive women in rural Kenya. Methods A community-based cluster-randomized controlled trial was implemented from April 2015 to December 2016 among 901 women enrolled across 13 clusters. The intervention groups received a minimum of 12 personalized home-based counselling sessions on infant feeding by trained community health volunteers from their first or second trimester of pregnancy until 6 months postpartum. Other interventions included education sessions at maternal child clinics, mother-to-mother support group meetings and bi-monthly baby-friendly gatherings targeting influencers. The control group received standard health education at the facility and during monthly routine home visits by community health volunteers not trained on BFCI. Primary outcome measures were the rates of EBF at week 1, months 2, 4 and 6 postpartum. Secondary outcomes included knowledge and attitudes regarding breastfeeding for HIV-exposed infants. Statistical methods included analysis of covariance and logistic regression. Results At 6 months, EBF rates among HIV negative mothers were significantly higher in the BFCI intervention arm compared to the control arm (81.7% versus 42.2% p = 0.001). HIV positive mothers in the intervention arm had higher EBF rates at 6 months than the control but the difference was not statistically significant (81.8% versus 58.4%; p = 0.504). In HIV negative group, there was greater knowledge regarding EBF for HIV-exposed infants in the intervention arm than in the control (92.1% versus 60.7% p = 0.001). Among HIV positive mothers, such knowledge was high among both the intervention and control groups (96% versus 100%, p > 0.1). HIV negative and positive mothers in the intervention arm had more favourable attitudes regarding EBF for HIV-exposed infants than the control (84.5% versus 62.1%, p = 0.001) and (94.6% versus 53.8% to p = 0.001) respectively. Conclusions BFCI interventions can complement facility-based interventions to improve exclusive and continued breastfeeding knowledge, attitudes, and behaviours among HIV negative and positive women.
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Affiliation(s)
- Betty Mogesi Samburu
- Formerly Division of Nutrition and Dietetics, Ministry of Health in Kenya, Nairobi, Kenya. .,United Nations Children's Fund (UNICEF) Kenya Country Office, Nairobi, Kenya.
| | - Sera Lewise Young
- Institute of Policy Research, Northwestern University, Evanston, USA
| | - Frederick Murunga Wekesah
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya.,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Milkah Njeri Wanjohi
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Judith Kimiywe
- Department of Foods, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Peter Muriuki
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya.,Institute of Global Health Equity Education, University of Global Health Equity, Kigali, Rwanda
| | - Paula L Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Stephen T McGarvey
- International Health Institute, Brown University School of Public Health, Providence, USA
| | | | - Elizabeth W Kimani-Murage
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya.,International Health Institute, Brown University School of Public Health, Providence, USA.,Wellcome Trust, London, UK.,Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G31 2ER, UK.,Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre, Stellenbosch University, Stellenbosch, South Africa
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19
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Green MA, Pradeilles R, Laar A, Osei-Kwasi H, Bricas N, Coleman N, Klomegah S, Wanjohi MN, Tandoh A, Akparibo R, Aryeetey RNO, Griffiths P, Kimani-Murage EW, Mensah K, Muthuri S, Zotor F, Holdsworth M. Investigating foods and beverages sold and advertised in deprived urban neighbourhoods in Ghana and Kenya: a cross-sectional study. BMJ Open 2020; 10:e035680. [PMID: 32595155 PMCID: PMC7322322 DOI: 10.1136/bmjopen-2019-035680] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to characterise the local foods and beverages sold and advertised in three deprived urban African neighbourhoods. DESIGN Cross-sectional observational study. We undertook an audit of all food outlets (outlet type and food sold) and food advertisements. Descriptive statistics were used to summarise exposures. Latent class analysis was used to explore the interactions between food advertisements, food outlet types and food type availability. SETTING Three deprived neighbourhoods in African cities: Jamestown in Accra, Ho Dome in Ho (both Ghana) and Makadara in Nairobi (Kenya). MAIN OUTCOME MEASURE Types of foods and beverages sold and/or advertised. RESULTS Jamestown (80.5%) and Makadara (70.9%) were dominated by informal vendors. There was a wide diversity of foods, with high availability of healthy (eg, staples, vegetables) and unhealthy foods (eg, processed/fried foods, sugar-sweetened beverages). Almost half of all advertisements were for sugar-sweetened beverages (48.3%), with higher exposure to alcohol adverts compared with other items as well (28.5%). We identified five latent classes which demonstrated the clustering of healthier foods in informal outlets, and unhealthy foods in formal outlets. CONCLUSION Our study presents one of the most detailed geospatial exploration of the urban food environment in Africa. The high exposure of sugar-sweetened beverages and alcohol both available and advertised represent changing urban food environments. The concentration of unhealthy foods and beverages in formal outlets and advertisements of unhealthy products may offer important policy opportunities for regulation and action.
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Affiliation(s)
- Mark Alan Green
- Department of Geography & Planning, University of Liverpool, Liverpool, UK
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Amos Laar
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | | | | | - Nathaniel Coleman
- Department of Population, Family and Reproductive Health, University of Ghana, Legon, Ghana
| | - Senam Klomegah
- Department of Family and Community Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Milka Njeri Wanjohi
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Akua Tandoh
- Department of Population, Family and Reproductive Health, University of Ghana, Legon, Ghana
| | - Robert Akparibo
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | | | - Paula Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Kobby Mensah
- Business School, University of Ghana, Legon, Ghana
| | | | - Francis Zotor
- Department of Family and Community Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Michelle Holdsworth
- NUTRIPASS Unit, French Research Institute for Sustainable Development (IRD), Montpellier, France
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20
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Mutoro AN, Garcia AL, Kimani-Murage EW, Wright CM. Eating and feeding behaviours in children in low-income areas in Nairobi, Kenya. Matern Child Nutr 2020; 16:e13023. [PMID: 32476265 PMCID: PMC7506998 DOI: 10.1111/mcn.13023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/25/2020] [Accepted: 04/23/2020] [Indexed: 11/27/2022]
Abstract
Child eating and caregiver feeding behaviours are critical determinants of food intake, but they are poorly characterized in undernourished children. We aimed to describe how appetite, food refusal and force‐feeding vary between undernourished and healthy children aged 6–24 months in Nairobi and identify potential variables for use in a child eating behaviour scale for international use. This cross‐sectional study was conducted in seven clinics in low‐income areas of Nairobi. Healthy and undernourished children were quota sampled to recruit equal numbers of undernourished children (weight for age [WAZ] or weight for length [WLZ] Z scores ≤2SD) and healthy children (WAZ > 2SD). Using a structured interview schedule, questions reflecting child appetite, food refusal and caregiver feeding behaviours were rated using a 5‐point scale. Food refusal and force‐feeding variables were then combined to form scores and categorized into low, medium and high. In total, 407 child–caregiver pairs, aged median [interquartile range] 9.98 months [8.7 to 14.1], were recruited of whom 55% were undernourished. Undernourished children were less likely to ‘love food’ (undernourished 78%; healthy 90% p = < 0.001) and more likely to have high food refusal (18% vs. 3.3% p = <0.001), while their caregivers were more likely to use high force‐feeding (28% vs. 16% p = 0.03). Undernourished children in low‐income areas in Nairobi are harder to feed than healthy children, and force‐feeding is used widely. A range of discriminating variables could be used to measure child eating behaviour and assess the impact of interventions.
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Affiliation(s)
- Antonina N Mutoro
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Ada L Garcia
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Elizabeth W Kimani-Murage
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.,Maternal and Child Well-being Unit, African Population and Health Research Center, Nairobi, Kenya
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21
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Amugsi DA, Dimbuene ZT, Kimani-Murage EW. Socio-demographic factors associated with normal linear growth among pre-school children living in better-off households: A multi-country analysis of nationally representative data. PLoS One 2020; 15:e0224118. [PMID: 32160190 PMCID: PMC7065827 DOI: 10.1371/journal.pone.0224118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/25/2020] [Indexed: 11/18/2022] Open
Abstract
This study examined the socio-demographic factors associated with normal linear growth among pre-school children living in better-off households, using survey data from Ghana, Kenya, Nigeria, Mozambique and Democratic Republic of Congo (DRC). The primary outcome variable was child height-for-age z-scores (HAZ), categorised into HAZ≥-2SD (normal growth/not stunted) and HAZ<-2 (stunted). Using logistic regression, we estimated adjusted odds ratios (aORs) of the factors associated with normal growth. Higher maternal weight (measured by body mass index) was associated with increased odds of normal growth in Mozambique, DRC, Kenya and Nigeria. A unit increase in maternal years of education was associated with increased odds in normal growth in DRC (aOR = 1.06, 95% CI = 1.03, 1.09), Ghana (aOR = 1.08, 95% CI = 1.04, 1.12), Mozambique (aOR = 1.08, 95% CI = 1.05, 1.11) and Nigeria (aOR = 1.07, 95% CI = 1.06, 1.08). A year increase in maternal age was positively associated with normal growth in all the five countries. Breastfeeding was associated with increased odds of normal growth in Nigeria (aOR = 1.30, 95% CI = 1.16, 1.46) and Kenya (aOR = 1.37, 95% CI = 1.05, 1.79). Children of working mothers had 25% (aOR = 0.75, 95% CI = 0.60, 0.93) reduced odds of normal growth in DRC. A unit change in maternal parity was associated with 10% (aOR = 0.90, 95% CI = 0.84, 0.97), 23% (aOR = 0.77, 95% CI = 0.63, 0.93), 25% (aOR = 0.75, 95% CI = 0.69, 0.82), 6% (aOR = 0.94, 95% CI = 0.89, 0.99) and 5% (aOR = 0.95, 95% CI = 0.92, 0.99) reduced odds of normal growth in DRC, Ghana, Kenya, Mozambique and Nigeria, respectively. A child being a male was associated with 18% (aOR = 0.82, 95% CI = 0.68, 0.98), 40% (aOR = 0.60, 95% CI = 0.40, 0.89), 37% (aOR = 0.63, 95% CI = 0.51, 0.77) and 21% (aOR = 0.79, 95% CI = 0.71, 0.87) reduced odds of normal child growth in DRC, Ghana, Kenya and Nigeria, respectively. In conclusion, maternal education, weight, age, breastfeeding and antenatal care are positively associated with normal child growth. In contrast, maternal parity, employment, and child sex and age are associated negatively with normal growth. Interventions to improve child growth should take into account these differential effects.
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Affiliation(s)
- Dickson Abanimi Amugsi
- Maternal and Child Wellbeing Unit, Research Division, African Population and Health Research Center, Nairobi, Kenya
- * E-mail: ,
| | - Zacharie T. Dimbuene
- Department of Population Sciences and Development, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Microdata Access Division, Statistics Canada, Ottawa, Canada
| | - Elizabeth W. Kimani-Murage
- Maternal and Child Wellbeing Unit, Research Division, African Population and Health Research Center, Nairobi, Kenya
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22
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De Vita MV, Scolfaro C, Santini B, Lezo A, Gobbi F, Buonfrate D, Kimani-Murage EW, Macharia T, Wanjohi M, Rovarini JM, Morino G. Malnutrition, morbidity and infection in the informal settlements of Nairobi, Kenya: an epidemiological study. Ital J Pediatr 2019; 45:12. [PMID: 30642368 PMCID: PMC6332593 DOI: 10.1186/s13052-019-0607-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 01/03/2019] [Indexed: 11/23/2022] Open
Abstract
Background Malnutrition constitutes one of the major public health challenges throughout the developing world. Urban poverty and malnutrition have been on the rise, with an increased rate of morbidity. We herein explore the relationship between infections and nutritional status and the related association with hygienic conditions as risk of infection in children residing in the slums of Nairobi. Methods Case-control study based on a secondary analysis of quantitative data collected from a cluster randomized trial carried out in two slums of Nairobi. The following information about resident children were selected: babies’ anthropometric measurements, related life conditions, data on infant-feeding practices, food security, hygiene, immunization coverage and morbidity were collected and updated with structured questionnaires until 12 months of life. Prevalence of malnutrition was calculated, then both bivariate and multivariate analysis were used to explore the relationship between malnutrition and its determinants. Results The study involved a total of 1119 babies registered at birth (51.28% male and 48.03% female infants). Overall the prevalence of malnutrition was high, with 26.3% of the children being stunted, 6.3% wasted and 13.16% underweight. Prevalence of wasting was higher in the first months of life, while in older children more case of stunting and underweight were captured. Wasted infants were significantly associated with common childhood illnesses: with cough and rapid breathing as well as with diarrhea (p-value< 0.05). Stunting was associated with hygienic conditions (p-value< 0.05 in households that did not perform any water treatment and for children that had a toilet within the house compound), immunization program and low-birth-weight. Moreover, regression analysis showed that significant determinants of stunting were sex and feeding practices. Underweight was significantly associated with socio-demographic factors. Conclusions In the specific environment where the study was conducted acute malnutrition is correlated with acute infections, while chronic malnutrition is more influenced by WASH conditions. Therefore, our findings suggest that one cannot separate infection and its risk factors as determinants of the whole malnutrition burden.
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Affiliation(s)
- Maria Vittoria De Vita
- Amici del Mondo - World Friends Onlus / Ruaraka Uhai Neema Hospital, P.O. Box 39433-00623, Nairobi, Kenya. .,Department of Pediatrics - Infectious Diseases Unit - Regina Margherita Children's Hospital, University of Turin, Turin, Italy. .,World Friends (Kenya) @ Ruaraka Uhai Neema Hospital, Off Thika Rd, opp. Safari Park Hotel, P.O. Box 29433-00623, Nairobi, Kenya.
| | - Carlo Scolfaro
- Department of Pediatrics - Infectious Diseases Unit - Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Bruna Santini
- Division of Nutrition, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Antonella Lezo
- Division of Nutrition, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Federico Gobbi
- Centre for Tropical Diseases, IRCCS-Ospedale Sacro Cuore don Calabria, Negrar, 37024, Verona, Italy
| | - Dora Buonfrate
- Centre for Tropical Diseases, IRCCS-Ospedale Sacro Cuore don Calabria, Negrar, 37024, Verona, Italy
| | | | - Teresiah Macharia
- African Population and Health Research Centre, APHRC Campus, P.O. Box 10787-00100, Nairobi, Kenya
| | - Milka Wanjohi
- African Population and Health Research Centre, APHRC Campus, P.O. Box 10787-00100, Nairobi, Kenya
| | - Jacopo Mattia Rovarini
- Amici del Mondo - World Friends Onlus / Ruaraka Uhai Neema Hospital, P.O. Box 39433-00623, Nairobi, Kenya
| | - Gianfranco Morino
- Amici del Mondo - World Friends Onlus / Ruaraka Uhai Neema Hospital, P.O. Box 39433-00623, Nairobi, Kenya
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23
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Kimani-Murage EW, Griffiths PL, Wekesah FM, Wanjohi M, Muhia N, Muriuki P, Egondi T, Kyobutungi C, Ezeh AC, McGarvey ST, Musoke RN, Norris SA, Madise NJ. Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi: a cluster randomized controlled trial. Global Health 2017; 13:90. [PMID: 29258549 PMCID: PMC5735795 DOI: 10.1186/s12992-017-0314-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 11/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exclusive breastfeeding (EBF) improves infant health and survival. We tested the effectiveness of a home-based intervention using Community Health Workers (CHWs) on EBF for six months in urban poor settings in Kenya. METHODS We conducted a cluster-randomized controlled trial in Korogocho and Viwandani slums in Nairobi. We recruited pregnant women and followed them until the infant's first birthday. Fourteen community clusters were randomized to intervention or control arm. The intervention arm received home-based nutritional counselling during scheduled visits by CHWs trained to provide specific maternal infant and young child nutrition (MIYCN) messages and standard care. The control arm was visited by CHWs who were not trained in MIYCN and they provided standard care (which included aspects of ante-natal and post-natal care, family planning, water, sanitation and hygiene, delivery with skilled attendance, immunization and community nutrition). CHWs in both groups distributed similar information materials on MIYCN. Differences in EBF by intervention status were tested using chi square and logistic regression, employing intention-to-treat analysis. RESULTS A total of 1110 mother-child pairs were involved, about half in each arm. At baseline, demographic and socioeconomic factors were similar between the two arms. The rates of EBF for 6 months increased from 2% pre-intervention to 55.2% (95% CI 50.4-59.9) in the intervention group and 54.6% (95% CI 50.0-59.1) in the control group. The adjusted odds of EBF (after adjusting for baseline characteristics) were slightly higher in the intervention arm compared to the control arm but not significantly different: for 0-2 months (OR 1.27, 95% CI 0.55 to 2.96; p = 0.550); 0-4 months (OR 1.15; 95% CI 0.54 to 2.42; p = 0.696), and 0-6 months (OR 1.11, 95% CI 0.61 to 2.02; p = 0.718). CONCLUSIONS EBF for six months significantly increased in both arms indicating potential effectiveness of using CHWs to provide home-based counselling to mothers. The lack of any difference in EBF rates in the two groups suggests potential contamination of the control arm by information reserved for the intervention arm. Nevertheless, this study indicates a great potential for use of CHWs when they are incentivized and monitored as an effective model of promotion of EBF, particularly in urban poor settings. Given the equivalence of the results in both arms, the study suggests that the basic nutritional training given to CHWs in the basic primary health care training, and/or provision of information materials may be adequate in improving EBF rates in communities. However, further investigations on this may be needed. One contribution of these findings to implementation science is the difficulty in finding an appropriate counterfactual for community-based educational interventions. TRIAL REGISTRATION ISRCTN ISRCTN83692672 . Registered 11 November 2012. Retrospectively registered.
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Affiliation(s)
- Elizabeth W. Kimani-Murage
- African Population and Health Research Center (APHRC), P.O. 10787, Nairobi, 00100 Kenya
- International Health Institute, Brown University, Providence, RI USA
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
| | - Paula L. Griffiths
- Centre for Global Health and Human Development, Loughborough University, Loughborough, UK
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frederick Murunga Wekesah
- African Population and Health Research Center (APHRC), P.O. 10787, Nairobi, 00100 Kenya
- Julius Center of Health Sciences and Primary Care, Utrecht Medical Center, Utrecht, The Netherlands
| | - Milka Wanjohi
- African Population and Health Research Center (APHRC), P.O. 10787, Nairobi, 00100 Kenya
| | - Nelson Muhia
- African Population and Health Research Center (APHRC), P.O. 10787, Nairobi, 00100 Kenya
| | - Peter Muriuki
- African Population and Health Research Center (APHRC), P.O. 10787, Nairobi, 00100 Kenya
| | - Thaddaeus Egondi
- African Population and Health Research Center (APHRC), P.O. 10787, Nairobi, 00100 Kenya
| | - Catherine Kyobutungi
- African Population and Health Research Center (APHRC), P.O. 10787, Nairobi, 00100 Kenya
| | - Alex C. Ezeh
- African Population and Health Research Center (APHRC), P.O. 10787, Nairobi, 00100 Kenya
| | | | - Rachel N. Musoke
- Department of Paediatrics, University of Nairobi, Nairobi, Kenya
| | - Shane A. Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
| | - Nyovani J. Madise
- Centre for Global Health, Population, Poverty, and Policy University of Southampton, Southampton, UK
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Wanjohi M, Griffiths P, Wekesah F, Muriuki P, Muhia N, Musoke RN, Fouts HN, Madise NJ, Kimani-Murage EW. Sociocultural factors influencing breastfeeding practices in two slums in Nairobi, Kenya. Int Breastfeed J 2017; 12:5. [PMID: 28096888 PMCID: PMC5225512 DOI: 10.1186/s13006-016-0092-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 12/12/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite numerous interventions promoting optimal breastfeeding practices in Kenya, pockets of suboptimal breastfeeding practices are documented in Kenya's urban slums. This paper describes cultural and social beliefs and practices that influence breastfeeding in two urban slums in Nairobi, Kenya. METHODS Qualitative data were collected in Korogocho and Viwandani slums through 10 focus group discussions and 19 in-depth interviews with pregnant, breastfeeding women and community health volunteers and 11 key-informant interviews with community leaders. Interviews were audiotaped, transcribed verbatim, coded in NVIVO and analyzed thematically. RESULTS Social and cultural beliefs and practices that result to suboptimal breastfeeding practices were highlighted including; considering colostrum as 'dirty' or 'curdled milk', a curse 'bad omen' associated with breastfeeding while engaging in extra marital affairs, a fear of the 'evil eye' (malevolent glare which is believed to be a curse associated with witchcraft) when breastfeeding in public and breastfeeding being associated with sagging breasts. Positive social and cultural beliefs were also identified including the association of breast milk with intellectual development and good child health. The beliefs and practices were learnt mainly from spouses, close relatives and peers. CONCLUSION Interventions promoting behavior change with regards to breastfeeding should focus on dispelling the beliefs and practices that result to suboptimal breastfeeding practices and to build on the positive ones, while involving spouses and other family members as they are important sources of information on breastfeeding. TRIAL REGISTRATION ISRCTN83692672: December 2013 (retrospectively registered).
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Affiliation(s)
- Milka Wanjohi
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Paula Griffiths
- Centers for Global Health and Human Development; Loughborough University, Loughborough, UK
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frederick Wekesah
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Peter Muriuki
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Nelson Muhia
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Rachel N. Musoke
- Departments of Pediatrics, University of Nairobi, Nairobi, Kenya
| | - Hillary N. Fouts
- Department of Child and Family Studies, University of Tennessee, Knoxville, USA
| | - Nyovani J. Madise
- Center for Global Health, Population, Poverty, and Policy University of Southampton, Southampton, UK
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Amugsi DA, Dimbuene ZT, Bakibinga P, Kimani-Murage EW, Haregu TN, Mberu B. Dietary diversity, socioeconomic status and maternal body mass index (BMI): quantile regression analysis of nationally representative data from Ghana, Namibia and Sao Tome and Principe. BMJ Open 2016; 6:e012615. [PMID: 27678544 PMCID: PMC5051549 DOI: 10.1136/bmjopen-2016-012615] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To (a) assess the association between dietary diversity (DD) score, socioeconomic status (SES) and maternal body mass index (BMI), and (b) the variation of the effects of DD and SES at different points of the conditional distribution of the BMI. METHODS The study used Demographic and Health Surveys round 5 data sets from Ghana, Namibia and Sao Tome and Principe. The outcome variable for the analysis was maternal BMI. The DD score was computed using 24-hour dietary recall data. Quantile regression (QR) was used to examine the relationship between DD and SES, and maternal BMI, adjusting for other covariates. The QR allows the covariate effects to vary across the entire distribution of maternal BMI. RESULTS Women who consumed an additional unit of DD achieved an increase of 0.245 in BMI for those in the 90th quantile in Ghana. The effect of household wealth increases for individuals across all quantiles of the BMI distribution and in all the 3 countries. A unit change in the household wealth score was associated with an increase of 0.038, 0.052 and 0.065 units increase in BMI for individuals in the 5th quantile in Ghana, Namibia and Sao Tome and Principe, respectively. Also, 0.237, 0.301 and 0.174 units increased for those in the 90th quantile in Ghana, Namibia and Sao Tome and Principe, respectively. Education had a significant positive effect on maternal BMI across all quantiles in Namibia and negative effect at the 5th, 10th and 90th quantiles in Sao Tome and Principe. CONCLUSIONS There is heterogeneity in the effects of DD and SES on maternal BMI. Studies focusing on the effects of diet and socioeconomic determinants on maternal BMI should examine patterns of effects at different points of the conditional distribution of the BMI and not just the average effect.
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Affiliation(s)
| | | | | | | | | | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
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Kimani-Murage EW, Kimiywe J, Kabue M, Wekesah F, Matiri E, Muhia N, Wanjohi M, Muriuki P, Samburu B, Kanyuira JN, Young SL, Griffiths PL, Madise NJ, McGarvey ST. Feasibility and effectiveness of the baby friendly community initiative in rural Kenya: study protocol for a randomized controlled trial. Trials 2015; 16:431. [PMID: 26416177 PMCID: PMC4587817 DOI: 10.1186/s13063-015-0935-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 08/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions promoting optimal infant and young child nutrition could prevent a fifth of under-5 deaths in countries with high mortality. Poor infant and young child feeding practices are widely documented in Kenya, with potential detrimental effects on child growth, health and survival. Effective strategies to improve these practices are needed. This study aims to pilot implementation of the Baby Friendly Community Initiative (BFCI), a global initiative aimed at promoting optimal infant and young child feeding practices, to determine its feasibility and effectiveness with regards to infant feeding practices, nutrition and health outcomes in a rural setting in Kenya. METHODS The study, employing a cluster-randomized trial design, will be conducted in rural Kenya. A total of 12 clusters, constituting community units within the government's Community Health Strategy, will be randomized, with half allocated to the intervention and the other half to the control arm. A total of 812 pregnant women and their respective children will be recruited into the study. The mother-child pairs will be followed up until the child is 6 months old. Recruitment will last approximately 1 year from January 2015, and the study will run for 3 years, from 2014 to 2016. The intervention will involve regular counseling and support of mothers by trained community health workers and health professionals on maternal, infant and young child nutrition. Regular assessment of knowledge, attitudes and practices on maternal, infant and young child nutrition will be done, coupled with assessment of nutritional status of the mother-child pairs and morbidity for the children. Statistical methods will include analysis of covariance, multinomial logistic regression and multilevel modeling. The study is funded by the NIH and USAID through the Program for Enhanced Research (PEER) Health. DISCUSSION Findings from the study outlined in this protocol will inform potential feasibility and effectiveness of a community-based intervention aimed at promoting optimal breastfeeding and other infant feeding practices. The intervention, if proved feasible and effective, will inform policy and practice in Kenya and similar settings, particularly regarding implementation of the baby friendly community initiative. TRIAL REGISTRATION ISRCTN03467700 ; Date of Registration: 24 September 2014.
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Affiliation(s)
- Elizabeth W Kimani-Murage
- African Population and Health Research Centre (APHRC), APHRC Campus, Kirawa Road, Off PeponiRoad, P.O. Box 10787, 00100, Nairobi, Kenya.
| | - Judith Kimiywe
- Department of Food, Nutrition and Dietetics, Kenyatta University, School of Applied Human Sciences Complex, Conference Road, Room HE7, P.O. Box 43844, 00100, Nairobi, Kenya.
| | - Mark Kabue
- Jhpiego, Off Riverside Drive, 14 Riverside, Arlington Block-2nd Floor, Nairobi, Kenya.
| | - Frederick Wekesah
- African Population and Health Research Centre (APHRC), APHRC Campus, Kirawa Road, Off PeponiRoad, P.O. Box 10787, 00100, Nairobi, Kenya.
| | - Evelyn Matiri
- PATH, ACS Plaza, 4th floor, Lenana Road, P.O. Box 76634-00508, Nairobi, Kenya.
| | - Nelson Muhia
- African Population and Health Research Centre (APHRC), APHRC Campus, Kirawa Road, Off PeponiRoad, P.O. Box 10787, 00100, Nairobi, Kenya.
| | - Milka Wanjohi
- African Population and Health Research Centre (APHRC), APHRC Campus, Kirawa Road, Off PeponiRoad, P.O. Box 10787, 00100, Nairobi, Kenya.
| | - Peterrock Muriuki
- African Population and Health Research Centre (APHRC), APHRC Campus, Kirawa Road, Off PeponiRoad, P.O. Box 10787, 00100, Nairobi, Kenya.
| | - Betty Samburu
- Human Nutrition and Dietetics Unit, Ministry of Health, P.O. Box 43319-00100, Nairobi, Kenya.
| | - James N Kanyuira
- Action Against Hunger (ACF), 4th Floor, Suite 17, Green House, Ngong Road, P.O. Box 39900-00623, Nairobi, Kenya.
| | - Sera L Young
- Department of Population Medicine and Diagnostics, Program in International Nutrition, Cornell University, Ithaca, NY, USA.
| | - Paula L Griffiths
- Centre for Global Health and Human Development, Loughborough University, Loughborough, UK.
| | - Nyovani J Madise
- Centre for Global Health, Population, Poverty and Policy, ESRC Centre for Population Change, Faculty of Social and Human Science, University of Southampton, Building 58, Room 2001, Southampton, SO17 1BJ, UK.
| | - Stephen T McGarvey
- International Health Institute, Brown University, Providence, RI 02903, USA.
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Mohamed SF, Izugbara C, Moore AM, Mutua M, Kimani-Murage EW, Ziraba AK, Bankole A, Singh SD, Egesa C. The estimated incidence of induced abortion in Kenya: a cross-sectional study. BMC Pregnancy Childbirth 2015; 15:185. [PMID: 26294220 PMCID: PMC4546129 DOI: 10.1186/s12884-015-0621-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 08/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The recently promulgated 2010 constitution of Kenya permits abortion when the life or health of the woman is in danger. Yet broad uncertainty remains about the interpretation of the law. Unsafe abortion remains a leading cause of maternal morbidity and mortality in Kenya. The current study aimed to determine the incidence of induced abortion in Kenya in 2012. METHODS The incidence of induced abortion in Kenya in 2012 was estimated using the Abortion Incidence Complications Methodology (AICM) along with the Prospective Morbidity Survey (PMS). Data were collected through three surveys, (i) Health Facilities Survey (HFS), (ii) Prospective Morbidity Survey (PMS), and (iii) Health Professionals Survey (HPS). A total of 328 facilities participated in the HFS, 326 participated in the PMS, and 124 key informants participated in the HPS. Abortion numbers, rates, ratios and unintended pregnancy rates were calculated for Kenya as a whole and for five geographical regions. RESULTS In 2012, an estimated 464,000 induced abortions occurred in Kenya. This translates into an abortion rate of 48 per 1,000 women aged 15-49, and an abortion ratio of 30 per 100 live births. About 120,000 women received care for complications of induced abortion in health facilities. About half (49%) of all pregnancies in Kenya were unintended and 41% of unintended pregnancies ended in an abortion. CONCLUSION This study provides the first nationally-representative estimates of the incidence of induced abortion in Kenya. An urgent need exists for improving facilities' capacity to provide safe abortion care to the fullest extent of the law. All efforts should be made to address underlying factors to reduce risk of unsafe abortion.
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Affiliation(s)
- Shukri F Mohamed
- Research Division African Population and Health Research Center (APHRC), APHRC Campus, Manga close off Kirawa road, Kitisuru, P.O. Box, 10787-00100, Nairobi, Kenya.
| | - Chimaraoke Izugbara
- Research Division African Population and Health Research Center (APHRC), APHRC Campus, Manga close off Kirawa road, Kitisuru, P.O. Box, 10787-00100, Nairobi, Kenya.
| | - Ann M Moore
- Research Division, Guttmacher Institute, 125 Maiden Lane, 7th floor, New York, NY, 10038, USA.
| | - Michael Mutua
- Research Division African Population and Health Research Center (APHRC), APHRC Campus, Manga close off Kirawa road, Kitisuru, P.O. Box, 10787-00100, Nairobi, Kenya.
| | - Elizabeth W Kimani-Murage
- Research Division African Population and Health Research Center (APHRC), APHRC Campus, Manga close off Kirawa road, Kitisuru, P.O. Box, 10787-00100, Nairobi, Kenya.
| | - Abdhalah K Ziraba
- Research Division African Population and Health Research Center (APHRC), APHRC Campus, Manga close off Kirawa road, Kitisuru, P.O. Box, 10787-00100, Nairobi, Kenya.
| | - Akinrinola Bankole
- Research Division, Guttmacher Institute, 125 Maiden Lane, 7th floor, New York, NY, 10038, USA.
| | - Susheela D Singh
- Research Division, Guttmacher Institute, 125 Maiden Lane, 7th floor, New York, NY, 10038, USA.
| | - Caroline Egesa
- Research Division African Population and Health Research Center (APHRC), APHRC Campus, Manga close off Kirawa road, Kitisuru, P.O. Box, 10787-00100, Nairobi, Kenya.
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Kimani-Murage EW, Muthuri SK, Oti SO, Mutua MK, van de Vijver S, Kyobutungi C. Evidence of a Double Burden of Malnutrition in Urban Poor Settings in Nairobi, Kenya. PLoS One 2015; 10:e0129943. [PMID: 26098561 PMCID: PMC4476587 DOI: 10.1371/journal.pone.0129943] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 05/14/2015] [Indexed: 01/09/2023] Open
Abstract
Background Many low- and middle-income countries are undergoing a nutrition transition associated with rapid social and economic transitions. We explore the coexistence of over and under- nutrition at the neighborhood and household level, in an urban poor setting in Nairobi, Kenya. Methods Data were collected in 2010 on a cohort of children aged under five years born between 2006 and 2010. Anthropometric measurements of the children and their mothers were taken. Additionally, dietary intake, physical activity, and anthropometric measurements were collected from a stratified random sample of adults aged 18 years and older through a separate cross-sectional study conducted between 2008 and 2009 in the same setting. Proportions of stunting, underweight, wasting and overweight/obesity were dettermined in children, while proportions of underweight and overweight/obesity were determined in adults. Results Of the 3335 children included in the analyses with a total of 6750 visits, 46% (51% boys, 40% girls) were stunted, 11% (13% boys, 9% girls) were underweight, 2.5% (3% boys, 2% girls) were wasted, while 9% of boys and girls were overweight/obese respectively. Among their mothers, 7.5% were underweight while 32% were overweight/obese. A large proportion (43% and 37%%) of overweight and obese mothers respectively had stunted children. Among the 5190 adults included in the analyses, 9% (6% female, 11% male) were underweight, and 22% (35% female, 13% male) were overweight/obese. Conclusion The findings confirm an existing double burden of malnutrition in this setting, characterized by a high prevalence of undernutrition particularly stunting early in life, with high levels of overweight/obesity in adulthood, particularly among women. In the context of a rapid increase in urban population, particularly in urban poor settings, this calls for urgent action. Multisectoral action may work best given the complex nature of prevailing circumstances in urban poor settings. Further research is needed to understand the pathways to this coexistence, and to test feasibility and effectiveness of context-specific interventions to curb associated health risks.
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Affiliation(s)
| | | | - Samuel O. Oti
- African Population and Health Research Center, Nairobi, Kenya
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Martin K. Mutua
- African Population and Health Research Center, Nairobi, Kenya
| | - Steven van de Vijver
- African Population and Health Research Center, Nairobi, Kenya
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
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Ziraba AK, Izugbara C, Levandowski BA, Gebreselassie H, Mutua M, Mohamed SF, Egesa C, Kimani-Murage EW. Unsafe abortion in Kenya: a cross-sectional study of abortion complication severity and associated factors. BMC Pregnancy Childbirth 2015; 15:34. [PMID: 25884662 PMCID: PMC4338617 DOI: 10.1186/s12884-015-0459-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 01/29/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Complications due to unsafe abortion cause high maternal morbidity and mortality, especially in developing countries. This study describes post-abortion complication severity and associated factors in Kenya. METHODS A nationally representative sample of 326 health facilities was included in the survey. All regional and national referral hospitals and a random sample of lower level facilities were selected. Data were collected from 2,625 women presenting with abortion complications. A complication severity indicator was developed as the main outcome variable for this paper and described by women's socio-demographic characteristics and other variables. Ordered logistic regression models were used for multivariable analyses. RESULTS Over three quarters of abortions clients presented with moderate or severe complications. About 65% of abortion complications were managed by manual or electronic vacuum aspiration, 8% by dilation and curettage, 8% misoprostol and 19% by forceps and fingers. The odds of having moderate or severe complications for mistimed pregnancies were 43% higher than for wanted pregnancies (OR, 1.43; CI 1.01-2.03). For those who never wanted any more children the odds for having a severe complication was 2 times (CI 1.36-3.01) higher compared to those who wanted the pregnancy then. Women who reported inducing the abortion had 2.4 times higher odds of having a severe complication compared to those who reported that it was spontaneous (OR, 2.39; CI 1.72-3.34). Women who had a delay of more than 6 hours to get to a health facility had at least 2 times higher odds of having a moderate/severe complication compared to those who sought care within 6 hours from onset of complications. A delay of 7-48 hours was associated with OR, 2.12 (CI 1.42-3.17); a delay of 3-7 days OR, 2.01 (CI 1.34-2.99) and a delay of more than 7 days, OR 2.35 (CI 1.45-3.79). CONCLUSIONS Moderate and severe post-abortion complications are common in Kenya and a sizeable proportion of these are not properly managed. Factors such as delay in seeking care, interference with pregnancy, and unwanted pregnancies are important determinants of complication severity and fortunately these are amenable to targeted interventions.
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Affiliation(s)
- Abdhalah Kasiira Ziraba
- African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, off Kirawa road, Kitisuru, P.O. Box 10787-00100, Nairobi, Kenya.
| | - Chimaraoke Izugbara
- African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, off Kirawa road, Kitisuru, P.O. Box 10787-00100, Nairobi, Kenya.
| | | | | | - Michael Mutua
- African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, off Kirawa road, Kitisuru, P.O. Box 10787-00100, Nairobi, Kenya.
| | - Shukri F Mohamed
- African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, off Kirawa road, Kitisuru, P.O. Box 10787-00100, Nairobi, Kenya.
| | - Caroline Egesa
- African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, off Kirawa road, Kitisuru, P.O. Box 10787-00100, Nairobi, Kenya.
| | - Elizabeth W Kimani-Murage
- African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, off Kirawa road, Kitisuru, P.O. Box 10787-00100, Nairobi, Kenya.
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Kimani-Murage EW, Wekesah F, Wanjohi M, Kyobutungi C, Ezeh AC, Musoke RN, Norris SA, Madise NJ, Griffiths P. Factors affecting actualisation of the WHO breastfeeding recommendations in urban poor settings in Kenya. Matern Child Nutr 2014; 11:314-32. [PMID: 25521041 PMCID: PMC6860346 DOI: 10.1111/mcn.12161] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Poor breastfeeding practices are widely documented in Kenya, where only a third of children are exclusively breastfed for 6 months and only 2% in urban poor settings. This study aimed to better understand the factors that contribute to poor breastfeeding practices in two urban slums in Nairobi, Kenya. In‐depth interviews (IDIs), focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with women of childbearing age, community health workers, village elders and community leaders and other knowledgeable people in the community. A total of 19 IDIs, 10 FGDs and 11 KIIs were conducted, and were recorded and transcribed verbatim. Data were coded in NVIVO and analysed thematically. We found that there was general awareness regarding optimal breastfeeding practices, but the knowledge was not translated into practice, leading to suboptimal breastfeeding practices. A number of social and structural barriers to optimal breastfeeding were identified: (1) poverty, livelihood and living arrangements; (2) early and single motherhood; (3) poor social and professional support; (4) poor knowledge, myths and misconceptions; (5) HIV; and (6) unintended pregnancies. The most salient of the factors emerged as livelihoods, whereby women have to resume work shortly after delivery and work for long hours, leaving them unable to breastfeed optimally. Women in urban poor settings face an extremely complex situation with regard to breastfeeding due to multiple challenges and risk behaviours often dictated to them by their circumstances. Macro‐level policies and interventions that consider the ecological setting are needed.
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Affiliation(s)
| | - Frederick Wekesah
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Milka Wanjohi
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | | | - Alex C Ezeh
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Rachel N Musoke
- Department of Paediatrics, University of Nairobi, Nairobi, Kenya
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nyovani J Madise
- Centre for Global Health, Population, Poverty, and Policy, University of Southampton, Southampton, UK
| | - Paula Griffiths
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Centre for Global Health and Human Development, Loughborough University, Loughborough, UK
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Kimani-Murage EW, Schofield L, Wekesah F, Mohamed S, Mberu B, Ettarh R, Egondi T, Kyobutungi C, Ezeh A. Vulnerability to food insecurity in urban slums: experiences from Nairobi, Kenya. J Urban Health 2014; 91:1098-113. [PMID: 25172616 PMCID: PMC4242851 DOI: 10.1007/s11524-014-9894-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Food and nutrition security is critical for economic development due to the role of nutrition in healthy growth and human capital development. Slum residents, already grossly affected by chronic poverty, are highly vulnerable to different forms of shocks, including those arising from political instability. This study describes the food security situation among slum residents in Nairobi, with specific focus on vulnerability associated with the 2007/2008 postelection crisis in Kenya. The study from which the data is drawn was nested within the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), which follows about 70,000 individuals from close to 30,000 households in two slums in Nairobi, Kenya. The study triangulates data from qualitative and quantitative sources. It uses qualitative data from 10 focus group discussions with community members and 12 key-informant interviews with community opinion leaders conducted in November 2010, and quantitative data involving about 3,000 households randomly sampled from the NUHDSS database in three rounds of data collection between March 2011 and January 2012. Food security was defined using the Household Food Insecurity Access Scale (HFIAS) criteria. The study found high prevalence of food insecurity; 85% of the households were food insecure, with 50% being severely food insecure. Factors associated with food security include level of income, source of livelihood, household size, dependence ratio; illness, perceived insecurity and slum of residence. The qualitative narratives highlighted household vulnerability to food insecurity as commonplace but critical during times of crisis. Respondents indicated that residents in the slums generally eat for bare survival, with little concern for quality. The narratives described heightened vulnerability during the 2007/2008 postelection violence in Kenya in the perception of slum residents. Prices of staple foods like maize flour doubled and simultaneously household purchasing power was eroded due to worsened unemployment situation. The use of negative coping strategies to address food insecurity such as reducing the number of meals, reducing food variety and quality, scavenging, and eating street foods was prevalent. In conclusion, this study describes the deeply intertwined nature of chronic poverty and acute crisis, and the subsequent high levels of food insecurity in urban slum settings. Households are extremely vulnerable to food insecurity; the situation worsening during periods of crisis in the perception of slum residents, engendering frequent use of negative coping strategies. Effective response to addressing vulnerability to household food insecurity among the urban poor should focus on both the underlying vulnerabilities of households due to chronic poverty and added impacts of acute crises.
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Affiliation(s)
- E W Kimani-Murage
- African Population and Health Research Centre, Nairobi, Kenya, P.O. Box 10787, 00100, Nairobi, Kenya,
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Kimani-Murage EW, Fotso JC, Egondi T, Abuya B, Elungata P, Ziraba AK, Kabiru CW, Madise N. Trends in childhood mortality in Kenya: the urban advantage has seemingly been wiped out. Health Place 2014; 29:95-103. [PMID: 25024120 PMCID: PMC4158907 DOI: 10.1016/j.healthplace.2014.06.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 06/12/2014] [Accepted: 06/13/2014] [Indexed: 12/05/2022]
Abstract
Background We describe trends in childhood mortality in Kenya, paying attention to the urban–rural and intra-urban differentials. Methods We use data from the Kenya Demographic and Health Surveys (KDHS) collected between 1993 and 2008 and the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected in two Nairobi slums between 2003 and 2010, to estimate infant mortality rate (IMR), child mortality rate (CMR) and under-five mortality rate (U5MR). Results Between 1993 and 2008, there was a downward trend in IMR, CMR and U5MR in both rural and urban areas. The decline was more rapid and statistically significant in rural areas but not in urban areas, hence the gap in urban–rural differentials narrowed over time. There was also a downward trend in childhood mortality in the slums between 2003 and 2010 from 83 to 57 for IMR, 33 to 24 for CMR, and 113 to 79 for U5MR, although the rates remained higher compared to those for rural and non-slum urban areas in Kenya. Conclusions The narrowing gap between urban and rural areas may be attributed to the deplorable living conditions in urban slums. To reduce childhood mortality, extra emphasis is needed on the urban slums.
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Affiliation(s)
- E W Kimani-Murage
- African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya.
| | | | - T Egondi
- African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya
| | - B Abuya
- African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya
| | - P Elungata
- African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya
| | - A K Ziraba
- African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya
| | - C W Kabiru
- African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya
| | - N Madise
- Centre for Global Health, Population, Poverty, Policy University of Southampton, Southampton, UK
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Kimani-Murage EW, Kyobutungi C, Ezeh AC, Wekesah F, Wanjohi M, Muriuki P, Musoke RN, Norris SA, Griffiths P, Madise NJ. Effectiveness of personalised, home-based nutritional counselling on infant feeding practices, morbidity and nutritional outcomes among infants in Nairobi slums: study protocol for a cluster randomised controlled trial. Trials 2013; 14:445. [PMID: 24370263 PMCID: PMC3879433 DOI: 10.1186/1745-6215-14-445] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 12/09/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Nutrition in the first 1,000 days of life (during pregnancy and the first two years) is critical for child growth and survival. Poor maternal, infant and young child nutrition (MIYCN) practices are widely documented in Kenya, with potential detrimental effects on child growth and survival. This is particularly a problem in slums, where most urban residents live. For example, exclusive breastfeeding for the first six months is only about two per cent. Innovative strategies to reach slum residents are therefore needed. Strategies like the Baby Friendly Hospital Initiative have proven effective in some settings but their effectiveness in resource-limited settings, including slums where many women do not deliver in hospital, is questionable. We propose to test the effectiveness of a home-based intervention on infant feeding practices, nutrition and health outcomes of infants born in two slums in Nairobi, Kenya. METHODS/DESIGN The study, employing a cluster-randomised study design, will be conducted in two slums in Nairobi: Korogocho and Viwandani where 14 community units (defined by the Government's health care system) will form the unit of randomization. A total of 780 pregnant women and their respective child will be recruited into the study. The mother-child pair will be followed up until the child is one year old. Recruitment will last approximately one year and three months from September 2012 to December 2013. The mothers will receive regular, personalised, home-based counselling by trained Community Health Workers on MIYCN. Regular assessment of knowledge, attitudes and practices on MIYCN will be done, coupled with assessments of nutritional status of the mother-child pairs and diarrhea morbidity for the children. Statistical methods will include analysis of covariance and multinomial logistic regression. Additionally, cost-effectiveness analysis will be done. The study is funded by the Wellcome Trust and will run from March 2012 to February 2015. DISCUSSION Interventions aimed at promoting optimal breastfeeding and complementary feeding practices are considered to have high impact and could prevent a fifth of the under-five deaths in countries with high mortality rates. This study will inform policy and practice in Kenya and similar settings regarding delivery mechanisms for such high-impact interventions, particularly among urban poor populations. TRIAL REGISTRATION ISRCTN83692672.
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Affiliation(s)
| | - Catherine Kyobutungi
- African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya
| | - Alex C Ezeh
- African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya
| | - Frederick Wekesah
- African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya
| | - Milka Wanjohi
- African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya
| | - Peterrock Muriuki
- African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya
| | - Rachel N Musoke
- Department of Paediatrics, University of Nairobi, Nairobi, Kenya
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paula Griffiths
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Global Health and Human Development, Loughborough University, Loughborough, UK
| | - Nyovani J Madise
- Centre for Global Health, Population, Poverty, and Policy University of Southampton, Southampton, UK
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Kimani-Murage EW. Exploring the paradox: double burden of malnutrition in rural South Africa. Glob Health Action 2013; 6:19249. [PMID: 23364082 PMCID: PMC3556706 DOI: 10.3402/gha.v6i0.19249] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 10/25/2012] [Accepted: 10/25/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This article is a review of the PhD thesis by Elizabeth Kimani-Murage that explores the double burden of malnutrition in rural South Africa. This is in the context of a worryingly rapid increase in obesity and obesity-related diseases in low- and middle-income countries (LMICs) including South Africa, and in the wake of on-going nutrition transition and lifestyle changes in these countries. OBJECTIVE To understand the profiles of malnutrition among children and adolescents in a poor, high HIV prevalent, transitional society in a middle-income country. METHODS A cross-sectional growth survey was conducted in 2007 targeting 4,000 children and adolescents aged 1-20 years. In addition, HIV testing was carried out on children aged 1-5 years and Tanner pubertal assessment among adolescents aged 9-20 years. RESULTS The study shows stunting at an early age and adolescent obesity, particularly among girls, that co-exists in the same socio-geographic population. The study also shows that HIV is an independent modifiable risk factor for poor nutritional outcomes in children and makes a significant contribution to nutritional outcomes at the individual level. Significant predictors of undernutrition at an early age, documented at individual, household, and community levels, include child's HIV status, age and birth weight, maternal age, age of household head, and area of residence. Significant predictors of overweight/obesity and risk for metabolic disease during adolescence, documented at individual and household levels include child's age, sex, and pubertal development, household-level food security, socio-economic status, and household head's highest education level. CONCLUSIONS The combination of early stunting and adolescent obesity raises critical concerns in the wake of the rising public health importance of metabolic diseases in LMICs. This is because, both paediatric obesity and adult short stature are risk factors for metabolic syndrome and metabolic diseases in adulthood. Clearly, policies and interventions to address malnutrition in this and other transitional societies need to be double-pronged and gender-sensitive.
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Kimani-Murage EW, Manderson L, Norris SA, Kahn K. "It's my secret": barriers to paediatric HIV treatment in a poor rural South African setting. AIDS Care 2012; 25:744-7. [PMID: 23244783 PMCID: PMC3756619 DOI: 10.1080/09540121.2012.748865] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 10/22/2012] [Indexed: 12/05/2022]
Abstract
In South Africa, a third of children born are exposed to HIV, while fewer undergo an HIV confirmatory test. Anti-retroviral therapy (ART) coverage among children remains low-despite roll-out of the national ART programme in South Africa in 2004. This study sought to understand critical barriers to seeking HIV-related care for children in rural South Africa. Data presented in this article derive from community-based qualitative research in poor rural villages in north-east South Africa; this includes 21 in-depth interviews in 2008 among caregivers of children identified as HIV-positive in 2007 from a randomly selected community-based sample. Using NVIVO 8, data were coded and analysed, using a constant comparative method to identify themes and their repetitions and variations. Structural barriers leading to poor access to health care, and social and systems barriers, all influenced paediatric HIV treatment seeking. Of concern was the expressed need to maintain secrecy regarding a child's HIV status to avoid stigma and discrimination, and misconceptions regarding the course of HIV disease in children; this led to a delay in seeking appropriate care. These barriers need to be addressed, including through focused awareness campaigns, improved access to health care and interventions to address rural poverty and development at both household and community levels. In addition, training of health care professionals to improve their attitudes and practice may be necessary. However, this study only provides the perspective of the caregivers; further studies with health care providers are needed to gain a fuller picture for appropriate policy and practice guidance.
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Kimani-Murage EW, Kahn K, Pettifor JM, Tollman SM, Klipstein-Grobusch K, Norris SA. Predictors of adolescent weight status and central obesity in rural South Africa. Public Health Nutr 2011; 14:1114-22. [PMID: 21356151 PMCID: PMC3370923 DOI: 10.1017/s1368980011000139] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate predictors of adolescent obesity in rural South Africa. DESIGN Cross-sectional study. Height, weight and waist circumference were measured using standard procedures. Overweight and obesity in adolescents aged 10-17 years were assessed using the International Obesity Taskforce cut-offs, while the WHO adult cut-offs were used for participants aged 18-20 years. Waist-to-height ratio of >0.5 defined central obesity in those at Tanner stages 3-5. Linear and logistic regression analysis was used to evaluate risk factors. SETTING Agincourt sub-district, rural South Africa. SUBJECTS Participants (n 1848) were aged 10-20 years. RESULTS Combined overweight and obesity was higher in girls (15 %) than boys (4 %), as was central obesity (15 % and 2 %, respectively). With regard to overweight/obesity, fourfold higher odds were observed for girls and twofold higher odds were observed for participants from households with the highest socio-economic status (SES). The odds for overweight/obesity were 40 % lower if the household head had not completed secondary level education. For central obesity, the odds increased 10 % for each unit increase in age; girls had sevenfold higher odds v. boys; post-pubertal participants had threefold higher odds v. pubertal participants; those with older mothers aged 50+ years had twofold higher odds v. those whose mothers were aged 35-49 years; those in highest SES households had twofold higher odds v. those in lowest SES households. CONCLUSIONS In rural South Africa, adolescent females are most at risk of obesity which increases with age and appears to be associated with higher SES. To intervene effectively, it is essential to understand how household factors influence food choice, diet and exercise.
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Affiliation(s)
- Elizabeth W Kimani-Murage
- MRC/Wits Rural Public Health and Health Transitions Research Unit Agincourt, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Kimani-Murage EW, Madise NJ, Fotso JC, Kyobutungi C, Mutua MK, Gitau TM, Yatich N. Patterns and determinants of breastfeeding and complementary feeding practices in urban informal settlements, Nairobi Kenya. BMC Public Health 2011; 11:396. [PMID: 21615957 PMCID: PMC3118248 DOI: 10.1186/1471-2458-11-396] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 05/26/2011] [Indexed: 01/15/2023] Open
Abstract
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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Affiliation(s)
| | - Nyovani J Madise
- University of Southampton, Centre for Global Health, Population, Poverty, and Policy, Faculty of Social and Human Science, Southampton, UK
| | | | | | - Martin K Mutua
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Tabither M Gitau
- University of the Witwatersrand, MRC Mineral Metabolism Research Unit, Department of Paediatrics, Faculty of Health Sciences, Johannesburg, South Africa
| | - Nelly Yatich
- African Population and Health Research Center (APHRC), Nairobi, Kenya
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Kimani-Murage EW, Norris SA, Pettifor JM, Tollman SM, Klipstein-Grobusch K, Gómez-Olivé XF, Dunger DB, Kahn K. Nutritional status and HIV in rural South African children. BMC Pediatr 2011; 11:23. [PMID: 21439041 PMCID: PMC3076265 DOI: 10.1186/1471-2431-11-23] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 03/25/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achieving the Millennium Development Goals that aim to reduce malnutrition and child mortality depends in part on the ability of governments/policymakers to address nutritional status of children in general and those infected or affected by HIV/AIDS in particular. This study describes HIV prevalence in children, patterns of malnutrition by HIV status and determinants of nutritional status. METHODS The study involved 671 children aged 12-59 months living in the Agincourt sub-district, rural South Africa in 2007. Anthropometric measurements were taken and HIV testing with disclosure was done using two rapid tests. Z-scores were generated using WHO 2006 standards as indicators of nutritional status. Linear and logistic regression analyses were conducted to establish the determinants of child nutritional status. RESULTS Prevalence of malnutrition, particularly stunting (18%), was high in the overall sample of children. HIV prevalence in this age group was 4.4% (95% CI: 2.79 to 5.97). HIV positive children had significantly poorer nutritional outcomes than their HIV negative counterparts. Besides HIV status, other significant determinants of nutritional outcomes included age of the child, birth weight, maternal age, age of household head, and area of residence. CONCLUSIONS This study documents poor nutritional status among children aged 12-59 months in rural South Africa. HIV is an independent modifiable risk factor for poor nutritional outcomes and makes a significant contribution to nutritional outcomes at the individual level. Early paediatric HIV testing of exposed or at risk children, followed by appropriate health care for infected children, may improve their nutritional status and survival.
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Affiliation(s)
- Elizabeth W Kimani-Murage
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, South Africa.
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Kimani-Murage EW, Manderson L, Norris SA, Kahn K. 'You opened our eyes': care-giving after learning a child's positive HIV status in rural South Africa. Health Soc Care Community 2010; 18:264-271. [PMID: 20039969 DOI: 10.1111/j.1365-2524.2009.00891.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Caregivers of young children identified as HIV positive, residing in Agincourt, rural South Africa were advised of their child's status. How was this knowledge received, and how did it influence care-giving and support? Interviews were conducted in May to June 2008 with caregivers of HIV positive children aged 1-5 years, 1 year following the child's HIV test and disclosure of status. Drawing on data from 31 semi-structured questionnaires and 21 in-depth interviews, we describe caregivers' attitudes, reactions, fears and aspirations after learning a child's HIV status, the perceived usefulness of the knowledge, barriers to care-giving and support received. Sociodemographic data collected through the questionnaire were analysed using Stata. Qualitative data were coded in NVIVO 8 and analysed inductively to identify themes and their repetitions and variations. Although almost half of the caregivers responded negatively initially, 1 year later, almost all had accepted and valued knowing their child's HIV status as this had enhanced their competency in care-giving. Counselling from health providers and personal spirituality helped caregivers to accept the child's status and cope with its implications. Most caregivers had high aspirations for the child's future, despite some expressed difficulties associated with care-giving, including financial constraints, information gaps and barriers to healthcare. The results indicate an opportunity for paediatric HIV screening in communities with high HIV prevalence. This would facilitate early uptake of available interventions, so enhancing the survival of HIV positive children.
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Affiliation(s)
- Elizabeth W Kimani-Murage
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa.
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Kimani-Murage EW, Kahn K, Pettifor JM, Tollman SM, Dunger DB, Gómez-Olivé XF, Norris SA. The prevalence of stunting, overweight and obesity, and metabolic disease risk in rural South African children. BMC Public Health 2010; 10:158. [PMID: 20338024 PMCID: PMC2853509 DOI: 10.1186/1471-2458-10-158] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 03/25/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low- to middle-income countries are undergoing a health transition with non-communicable diseases contributing substantially to disease burden, despite persistence of undernutrition and infectious diseases. This study aimed to investigate the prevalence and patterns of stunting and overweight/obesity, and hence risk for metabolic disease, in a group of children and adolescents in rural South Africa. METHODS A cross-sectional growth survey was conducted involving 3511 children and adolescents 1-20 years, selected through stratified random sampling from a previously enumerated population living in Agincourt sub-district, Mpumalanga Province, South Africa. Anthropometric measurements including height, weight and waist circumference were taken using standard procedures. Tanner pubertal assessment was conducted among adolescents 9-20 years. Growth z-scores were generated using 2006 WHO standards for children up to five years and 1977 NCHS/WHO reference for older children. Overweight and obesity for those <18 years were determined using International Obesity Task Force BMI cut-offs, while adult cut-offs of BMI > or = 25 and > or = 30 kg/m2 for overweight and obesity respectively were used for those > or = 18 years. Waist circumference cut-offs of > or = 94 cm for males and > or = 80 cm for females and waist-to-height ratio of 0.5 for both sexes were used to determine metabolic disease risk in adolescents. RESULTS About one in five children aged 1-4 years was stunted; one in three of those aged one year. Concurrently, the prevalence of combined overweight and obesity, almost non-existent in boys, was substantial among adolescent girls, increasing with age and reaching approximately 20-25% in late adolescence. Central obesity was prevalent among adolescent girls, increasing with sexual maturation and reaching a peak of 35% at Tanner Stage 5, indicating increased risk for metabolic disease. CONCLUSIONS The study highlights that in transitional societies, early stunting and adolescent obesity may co-exist in the same socio-geographic population. It is likely that this profile relates to changes in nutrition and diet, but variation in factors such as infectious disease burden and physical activity patterns, as well as social influences, need to be investigated. As obesity and adult short stature are risk factors for metabolic syndrome and Type 2 diabetes, this combination of early stunting and adolescent obesity may be an explosive combination.
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Affiliation(s)
- Elizabeth W Kimani-Murage
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - John M Pettifor
- MRC Mineral Metabolism Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen M Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Xavier F Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- MRC Mineral Metabolism Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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