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Mokaya M, Kyallo F, Yiga P, Koole JL, Boedt T, Vangoitsenhoven R, Matthys C. Designing Mobile Phone Text Messages Using the Behavior Change Wheel Framework to Influence Food Literacy in Adults With Type 2 Diabetes in Kenya: Protocol for a Systematic Development Study. JMIR Res Protoc 2023; 12:e48271. [PMID: 38048150 PMCID: PMC10728794 DOI: 10.2196/48271] [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] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The worldwide prevalence of type 2 diabetes (T2D) has increased in the past decade, and it is projected to increase by 126% by 2045 in Africa. At the same time, mobile phone use has increased in Africa, providing a potential for innovative mobile health interventions to support diabetes care. OBJECTIVE This study aimed to apply the Behavior Change Wheel (BCW) framework to develop text messages to influence food literacy in adults with T2D in urban Kenya. METHODS The 8 steps of the BCW framework guided the development of text messages: (1) Define the problem in behavioral terms; (2) select target behaviors; (3) specify the target behaviors based on who needs to perform the behaviors, what needs to change, and when, where, how often, and with whom; (4) identify what needs to change; (5) identify intervention functions; (6) select policy categories; (7) select behavior change techniques (BCTs); and (8) select the mode of delivery. Recent exploratory studies in Kenya and other low- and middle-income countries provided information that was used to contextualize the intervention. RESULTS In step 1, the behavioral problem was defined as unhealthy dietary patterns among adults with T2D. In step 2, based on a qualitative study in the target population, the target behavior was selected to be evaluation of reliable sources of information, and selection and preparation of healthy food. In step 3, unhealthy dietary patterns were selected. In step 4, 10 domains of the Theoretical Domains Framework were identified, and in step 5, 5 intervention functions were linked to the domains and unhealthy dietary patterns were specified. In step 6, communication and regulations were identified as policy categories, while in step 7, 9 BCTs were selected from the Behavior Change Technique Taxonomy version 1. In step 8, the most suitable mode of delivery was determined to be mobile text messages. A total of 36 mobile text messages were developed based on the 9 BCTs. CONCLUSIONS This study shows the step-by-step application of the BCW framework to develop mobile text messages to influence food literacy in adults with T2D. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/48271.
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Affiliation(s)
- Moses Mokaya
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Experimental and Clinical Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Florence Kyallo
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Peter Yiga
- Mildmay Research Centre, Kampala, Uganda
| | - Janna Lena Koole
- Experimental and Clinical Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Tessy Boedt
- Experimental and Clinical Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Roman Vangoitsenhoven
- Experimental and Clinical Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals, Leuven, Belgium
| | - Christophe Matthys
- Experimental and Clinical Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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Theuri AW, Makokha A, Kyallo F, Gichure JN. Effect of using mobile phone communication on dietary management of Type 2 Diabetes Mellitus patients in Kenya. J Diabetes Metab Disord 2023; 22:367-374. [PMID: 37255807 PMCID: PMC10225419 DOI: 10.1007/s40200-022-01153-6] [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] [Received: 06/01/2022] [Accepted: 10/22/2022] [Indexed: 06/01/2023]
Abstract
Purpose Advancements in management of non-communicable diseases using regular reminders on lifestyle and dietary behaviors have been effectively achieved using mobile phones. This study evaluates the effects of regular communication using a mobile phone on dietary management of Type 2 Diabetes Mellitus (T2DM) among patients attending Kitui County Referral Hospital (KCRH) in Kenya. Methods Pre/post-study design among eligible and consenting T2DM patients visiting KCRH was used for this study. One hundred and thirty-eight T2DM patients were enrolled; 67 in the intervention group (IG) and 71 in the control group (CG). The IG received regular reminders on key dietary practices through their mobile phones for six months while the CG did not. The Net Effect of Intervention (NEI) and bivariate logistic regression were used to determine the impact of mobile phone communication intervention at p < 0.05. SPSS version 24 was used to analyze the data. Results The results revealed an increase of respondents who adhered to the meal plan in the IG from 47.8% to 59.7% compared to a decrease from 49.3% to 45.1% in CG with corresponding NEI increasing (16.1%) significantly (p < 0.05). The proportion of respondents with an increased frequency of meals increased from 41.8 to 47.8% in the IG compared to a reduction from 52.1% to 45.1% in the CG with corresponding NEI increasing (13.0%) significantly (p < 0.05). Conclusion Regular reminders on lifestyle and dietary behaviors using mobile phone communication improved adherence to dietary practices such as meal planning and frequency of meals in the management of T2DM.
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Affiliation(s)
- Alice Wairimu Theuri
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, P.O Box 62000-00200, Nairobi, Kenya
- Department of Food Science, Nutrition and Technology, South Eastern Kenya University, P.O Box 170-90200, Kitui, Kenya
| | - Anselimo Makokha
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, P.O Box 62000-00200, Nairobi, Kenya
| | - Florence Kyallo
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, P.O Box 62000-00200, Nairobi, Kenya
| | - Josphat Njenga Gichure
- Department of Food Science, Nutrition and Technology, South Eastern Kenya University, P.O Box 170-90200, Kitui, Kenya
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Mokaya M, Saruni E, Kyallo F, Vangoitsenhoven R, Matthys C. Perceived facilitators and barriers to healthy dietary behaviour in adults with type 2 diabetes mellitus in Kenya: A qualitative study. Public Health Nutr 2022; 25:1-24. [PMID: 36214084 PMCID: PMC9991632 DOI: 10.1017/s136898002200221x] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/23/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to explore the facilitators and barriers to healthy dietary behaviour in adults with type 2 diabetes mellitus (T2DM) in Kenya. DESIGN A qualitative descriptive design using telephone interviews was applied. An interview guide was developed through a modified theoretical framework. SETTING This study was conducted in selected hospitals in Nakuru County, located in west-central Kenya. PARTICIPANTS A two-step sampling strategy was used to select hospitals and study participants. Adult participants aged 30 to 85 years old, with T2DM from six hospitals were selected based on their ability to openly elaborate on the theme of dietary behaviour. RESULTS Thirty respondents were interviewed (mean age 62 years; 43.3% females). The average duration of the interviews was 32:02 minutes (SD 17.07). The highest-ranking internal facilitators of healthy dietary behaviour were knowledge of healthy food choices, gardening, self-efficacy, food preparation skills and eating at home. External facilitators included inaccurate beliefs and information on food and diet, education by healthcare workers, food availability, proximity to food selling points and family support. Internal barriers included tastes and preferences, health conditions barring intake of certain foods, and random eating of unhealthy foods. External barriers included socioeconomic factors, seasonal unavailability of fruits and food safety concerns. CONCLUSIONS Facilitators and barriers to healthy dietary behaviour among Kenyan adults with T2DM are related to food literacy and include selection, preparation and eating. Interventions to enhance healthy dietary behaviour should target context-specific knowledge, skills and self-efficacy.
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Affiliation(s)
- Moses Mokaya
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Experimental and Clinical Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, 3000Leuven, Belgium
| | - Eddah Saruni
- Department of Community Health Nursing, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Florence Kyallo
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | - Christophe Matthys
- Experimental and Clinical Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, 3000Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
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Mokaya M, Kyallo F, Vangoitsenhoven R, Matthys C. Clinical and patient-centered implementation outcomes of mHealth interventions for type 2 diabetes in low-and-middle income countries: a systematic review. Int J Behav Nutr Phys Act 2022; 19:1. [PMID: 34991593 PMCID: PMC8734304 DOI: 10.1186/s12966-021-01238-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 01/03/2021] [Accepted: 12/06/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The prevalence of Type 2 Diabetes is rising in Low- and Middle-Income Countries (LMICs), affecting all age categories and resulting in huge socioeconomic implications. Mobile health (mHealth) is a potential high-impact approach to improve clinical and patient-centered outcomes despite the barriers of cost, language, literacy, and internet connectivity. Therefore, it is valuable to examine the clinical and implementation outcomes of mHealth interventions for Type 2 Diabetes in LMICs. METHODS The Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines were applied in framing and reporting the review criteria. A systematic search of Cochrane Library, Web of Science, PubMed, Scopus, and Ovid databases was performed through a combination of search terms. Randomized Controlled Trials (RCTs) and cohort studies published in English between January 2010 and August 2021 were included. Risk of bias for missing results in the included studies was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2). Quantitative and qualitative methods were used to synthesize the results. RESULTS The search identified a total of 1161 articles. Thirty studies from 14 LMICs met the eligibility criteria. On clinical outcomes, 12 and 9 studies reported on glycated hemoglobin (HbA1c )and fasting blood glucose (FBG) respectively. Text messages was the most commonly applied mHealth approach, used in 19 out of the 30 studies. Ten out of the 12 studies (83.3%) that reported on HbA1c had a percentage difference of <0.3% between the mHealth intervention and the comparison group. Additionally, studies with longer intervention periods had higher effect size and percentage difference on HbA1c (1.52 to 2.92%). Patient-centred implementation outcomes were reported variedly, where feasibility was reported in all studies. Acceptability was reported in nine studies, appropriateness in six studies and cost in four studies. mHealth evidence reporting and assessment (mERA) guidelines were not applied in all the studies in this review. CONCLUSION: mHealth interventions in LMICs are associated with clinically significant effectiveness on HbA1 but have low effectiveness on FBG. The application of mERA guidelines may standardize reporting of patient-centered implementation outcomes in LMICs. TRIAL REGISTRATION PROSPERO: Registration ID 154209.
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Affiliation(s)
- Moses Mokaya
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Florence Kyallo
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Roman Vangoitsenhoven
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Matthys
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
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Abdullahi LH, Rithaa GK, Muthomi B, Kyallo F, Ngina C, Hassan MA, Farah MA. Best practices and opportunities for integrating nutrition specific into nutrition sensitive interventions in fragile contexts: a systematic review. BMC Nutr 2021; 7:46. [PMID: 34321101 PMCID: PMC8320180 DOI: 10.1186/s40795-021-00443-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background Annually, undernutrition contributes globally to 45% (3.1 million) of preventable deaths in children under 5. Effect following undernutrition i.e. physical growth & cognitive development etc. can be prevented during the first 1000 days also called window of opportunity. There is substantial evidence of positive nutrition outcomes resulting from integrating nutrition-specific interventions into nutrition specific program. However, there is paucity of knowledge on establishing and sustaining effective integration of nutrition intervention in fragile context. The objective of this review is to map and review the integration of nutrition-specific intervention to nutrition sensitive program and its impacts on nutrition outcomes. Methods In the study, we systematically searched the literature on integrated nutrition intervention into multi-sectoral programme in PUBMED, Google’s Scholar, the Cochrane Library, World Health Organisation (WHO), United Nations Children’s Fund (UNICEF), World Bank and trial registers from their inception until Oct 30, 2020 for up-to-date published and grey resources. We screened records, extracted data, and assessed risk of bias in duplicates. This study is registered with PROSPERO (CRD42020209730). Result Forty-four studies were included in this review, outlining the integration of nutrition-specific interventions among children 0–59 months with various existing programme. Most common integration platform in the study included integrated community case management and Integrated Management of Childhood Illness, Child Health Days, immunization, early child development, and cash transfers. Limited quantitative data were suggestive of some positive impact on nutrition and non-nutrition outcomes with a number of model of integration which varies according to the context and demands of the particular setting in which integration occurs. Conclusion Overall, existing evidence for nutrition sensitive and specific interventions is not robust and remains limited. It’s worthwhile to note, for future studies/interventions should be based on the context key criteria like relevance, political support, effectiveness, feasibility, expected contribution to health system strengthening, local capacities, ease of integration and targeting for sustainability, cost effectiveness and financial availability. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-021-00443-1.
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Affiliation(s)
| | - Gilbert K Rithaa
- Horn Population Research & Development (HPRD), Mogadishu, Somalia
| | - Bonface Muthomi
- Horn Population Research & Development (HPRD), Mogadishu, Somalia
| | - Florence Kyallo
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Clementina Ngina
- Independent nutrition consultant, Nairobi, Kenya.,Independent nutrition consultant, Mogadishu, Somalia
| | - Mohamed A Hassan
- Scaling Up Nutrition (SUN), Office of Prime Minister, Mogadishu, Somalia
| | - Mohamed A Farah
- Scaling Up Nutrition (SUN), Office of Prime Minister, Mogadishu, Somalia
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Anyango G, Kagera I, Mutua F, Kahenya P, Kyallo F, Andang’o P, Grace D, Lindahl JF. Effectiveness of Training and Use of Novasil Binder in Mitigating Aflatoxins in Cow Milk Produced in Smallholder Farms in Urban and Periurban Areas of Kenya. Toxins (Basel) 2021; 13:281. [PMID: 33920858 PMCID: PMC8071220 DOI: 10.3390/toxins13040281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/15/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022] Open
Abstract
Aflatoxins, which commonly contaminate animal feeds and human food, present a major public health challenge in sub-Saharan Africa. After ingestion by cows, aflatoxin B1 is metabolized to aflatoxin M1 (AFM1), some of which is excreted in milk. This study involved smallholder dairy farms in urban and periurban areas of Nairobi and Kisumu, Kenya. The objective was to determine the effectiveness of training and providing farmers with aflatoxin binder (NovaSil®) on AFM1 contamination in raw milk. A baseline survey was undertaken and 30 farmers whose milk had AFM1 levels above 20 ppt were randomly selected for inclusion in the study. Of these, 20 farmers were part of the intervention, and were given training on the usage of the NovaSil® binder, while 10 served as a control group. All farmers were visited biweekly for three months for interviews and milk samples were collected to measure the AFM1 levels. The AFM1 levels were quantified by enzyme linked immunosorbent assay. The NovaSil® binder significantly reduced AFM1 concentrations in the raw milk produced by the farmers in the intervention group over the duration of the study (p < 0.01). The control farms were more likely to have milk with AFM1 levels exceeding the regulatory limit of 50 ppt compared to the intervention farms (p < 0.001) (odds ratio = 6.5). The farmers in the intervention group perceived that there was an improvement in milk yield, and in cow health and appetite. These farmers also felt that the milk they sold, as well as the one they used at home, was safer. In conclusion, the use of binders by dairy farmers can be effective in reducing AFM1 in milk. Further research is needed to understand their effectiveness, especially when used in smallholder settings.
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Affiliation(s)
- Gladys Anyango
- Department of Animal and Human Health, International Livestock Research Institute, Nairobi 00100, Kenya; (G.A.); (I.K.); (F.M.); (D.G.)
- Department of Public Health, Maseno University, Kisumu 40100, Kenya;
| | - Irene Kagera
- Department of Animal and Human Health, International Livestock Research Institute, Nairobi 00100, Kenya; (G.A.); (I.K.); (F.M.); (D.G.)
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi 00200, Kenya;
| | - Florence Mutua
- Department of Animal and Human Health, International Livestock Research Institute, Nairobi 00100, Kenya; (G.A.); (I.K.); (F.M.); (D.G.)
| | - Peter Kahenya
- Department of Food Science and Technology, Jomo Kenyatta University of Agriculture and Technology, Nairobi 00200, Kenya;
| | - Florence Kyallo
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi 00200, Kenya;
| | - Pauline Andang’o
- Department of Public Health, Maseno University, Kisumu 40100, Kenya;
| | - Delia Grace
- Department of Animal and Human Health, International Livestock Research Institute, Nairobi 00100, Kenya; (G.A.); (I.K.); (F.M.); (D.G.)
- Natural Resources Institute, University of Greenwich, Central Avenue, Chatham Maritime ME4 4TB, UK
| | - Johanna F. Lindahl
- Department of Animal and Human Health, International Livestock Research Institute, Nairobi 00100, Kenya; (G.A.); (I.K.); (F.M.); (D.G.)
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, 75007 Uppsala, Sweden
- Zoonosis Science Centre, Department of Medical Biochemistry and Microbiology, Uppsala University, 75123 Uppsala, Sweden
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Mutwiri LN, Kyallo F, Kiage B, Van der Schueren B, Matthys C. Can Improved Legume Varieties Optimize Iron Status in Low- and Middle-Income Countries? A Systematic Review. Adv Nutr 2020; 11:1315-1324. [PMID: 32330226 PMCID: PMC7490168 DOI: 10.1093/advances/nmaa038] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/03/2020] [Accepted: 03/11/2020] [Indexed: 01/08/2023] Open
Abstract
Iron and zinc deficiencies are some of the most widespread micronutrient deficiencies in low- and middle-income countries (LMIC). Dietary diversification, food fortification, nutrition education, and supplementation can be used to control micronutrient deficiencies. Legumes are important staple foods in most households in LMIC. Legumes are highly nutritious (good sources of essential minerals, fiber, and low glycemic index) and offer potential benefits in addressing nutrition insecurity in LMIC. Several efforts have been made to increase micronutrient intake by use of improved legumes. Improved legumes have a higher nutrient bioavailability, lower phytate, or reduced hard-to-cook (HTC) defect. We hypothesize that consumption of improved legumes leads to optimization of zinc and iron status and associated health outcomes. Therefore, the objective of this review is to examine the evidence on the efficacy of interventions using improved legumes. Nine relevant studies are included in the review. Consumption of improved legumes resulted in a ≥1.5-fold increase in iron intake. Several studies noted modest improvements in biomarkers of iron status [hemoglobin (Hb), serum ferritin (SF), and transferrin receptor] associated with consumption of improved legumes. Currently, no efficacy studies assessing the relation between consumption of improved legumes and zinc status are available in the literature. Evidence shows that, in addition to repletion of biomarkers of iron status, consumption of improved legumes is associated with both clinical and functional outcomes. The prevalence of iron deficiency (ID) decreases with consumption of improved legumes, with increases of ≤3.0 g/L in Hb concentrations. Improvement in cognition and brain function in women has been reported as well. However, further research is necessary in more at-risk groups and also to show if the reported improvements in status markers translate to improved health outcomes. Evidence from the included studies shows potential from consumption of improved legumes suggesting them to be a sustainable solution to improve iron status.
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Affiliation(s)
- Linet N Mutwiri
- School of Food and Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya,Nutrition & Obesity Unit, Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | - Florence Kyallo
- School of Food and Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Beatrice Kiage
- School of Food and Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Bart Van der Schueren
- Nutrition & Obesity Unit, Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium,Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Matthys
- Nutrition & Obesity Unit, Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium,Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium,Address correspondence to CM (e-mail: )
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Kagera I, Kahenya P, Mutua F, Anyango G, Kyallo F, Grace D, Lindahl J. Status of aflatoxin contamination in cow milk produced in smallholder dairy farms in urban and peri-urban areas of Nairobi County: a case study of Kasarani sub county, Kenya. Infect Ecol Epidemiol 2018; 9:1547095. [PMID: 30598736 PMCID: PMC6263096 DOI: 10.1080/20008686.2018.1547095] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction: Milk consumption in Kenya supersedes other countries in East Africa. However, milk contamination with aflatoxin M1 (AFM1) is common, but the magnitude of this exposure and the health risks are poorly understood and need to be monitored routinely. This study aimed at assessing the awareness, knowledge and practices of urban and peri-urban farmers about aflatoxins and determining the levels of aflatoxin contamination in on-farm milk in a selected area within Nairobi County. Materials and methods: A cross-sectional study was undertaken to assess aflatoxin contamination levels of milk in Kasarani sub-county. A total of 84 milk samples were collected from small-holder dairy farms and analyzed for AFM1 using Enzyme-Linked Immunosorbent Assay (ELISA). Results and Discussion: Ninety nine percent of the samples (83/84) analysed were contaminated with AFM1. The mean aflatoxin level was 84 ng/kg with 64% of the samples exceeding the EU legal limit of 50 ng/kg. Whereas 80% of the farmers were aware of aflatoxin, there was no correlation between farmers' knowledge and gender with AFM1 prevalence. Conclusion: This study concludes that AFM1 is a frequent contaminant in milk and there is need to enhance farmers awareness on mitigation.
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Affiliation(s)
- Irene Kagera
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.,Department of Animal and Human Health, International Livestock Research Institute, Nairobi, Kenya
| | - Peter Kahenya
- Department of Food Science and Technology, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Florence Mutua
- Department of Animal and Human Health, International Livestock Research Institute, Nairobi, Kenya.,Department of Public Health, Pharmacology & Toxicology, University of Nairobi, Nairobi, Kenya
| | - Gladys Anyango
- Department of Public Health, Maseno University, Kisumu, Kenya
| | - Florence Kyallo
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Delia Grace
- Department of Animal and Human Health, International Livestock Research Institute, Nairobi, Kenya
| | - Johanna Lindahl
- Department of Animal and Human Health, International Livestock Research Institute, Nairobi, Kenya.,Zoonosis Science Centre, Uppsala University, Uppsala, Sweden.,Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
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