1
|
Ryckman T, Codjia P, Nordhagen S, Arimi C, Kirogo V, Kiige L, Kamudoni P, Beal T. A subnational affordability assessment of nutritious foods for complementary feeding in Kenya. Matern Child Nutr 2024; 20 Suppl 3:e13373. [PMID: 35666006 PMCID: PMC10782139 DOI: 10.1111/mcn.13373] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/17/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
Complementary feeding among children aged 6-23 months is a key determinant of micronutrient deficiencies and childhood stunting, the burdens of which remain high in Kenya. This study examines the affordability of complementary foods to increase young children's nutrient consumption across eight provinces in Kenya. We combined data from household surveys, food composition tables and published sources to estimate the cost of portion sizes that could meet half of the children's daily iron, vitamin A, calcium, zinc, folate, vitamin B12 and protein requirements from complementary feeding. These costs were compared to current household food expenditures. The selection of foods and price and expenditure data were stratified by province. Our analysis indicates that vitamin A, vitamin B12 and folate are affordable to most households in Kenya via liver, beans and in some provinces, orange-fleshed fruits and vegetables, avocado and small dried fish. Calcium, animal-source protein, zinc and iron were less affordable and there was more provincial variation. In some provinces, small dried fish were an affordable source of calcium, protein and zinc. In others (North Eastern, Central, Eastern, parts of Rift Valley and Coast), small dried fish were not commonly consumed and other foods were less affordable. Future research should consider interventions aimed at reducing prices, increasing availability and changing behaviours related to these foods. Solutions such as supplementation and fortification may be needed for iron and zinc in some locations. Food affordability presented the greatest barriers in North Eastern province, which had lower dietary diversity and may require additional targeted interventions.
Collapse
Affiliation(s)
- Theresa Ryckman
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | | | - Caroline Arimi
- Division of Nutrition and DieteticsMinistry of HealthNairobiKenya
| | - Veronica Kirogo
- Division of Nutrition and DieteticsMinistry of HealthNairobiKenya
| | | | | | - Ty Beal
- Global Alliance for Improved Nutrition (GAIN)WashingtonDCUSA
| |
Collapse
|
2
|
Kamudoni P, Kiige L, Ortenzi F, Beal T, Nordhagen S, Kirogo V, Arimi C, Zvandaziva C, Garg A, Codjia P, Rudert C. Identifying and understanding barriers to optimal complementary feeding in Kenya. Matern Child Nutr 2024; 20 Suppl 3:e13617. [PMID: 38180165 PMCID: PMC10782142 DOI: 10.1111/mcn.13617] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 01/06/2024]
Abstract
Optimal complementary feeding between the ages of 6 and 23 months provides children with the required range of nutritious and safe foods while continuing to be breastfed to meet their needs for essential nutrients and develop their full physical and cognitive potential. The rates of exclusive breastfeeding in the first 6 months of life have increased from 32% in 2008 to 60% in 2022 in Kenya. However, the proportion of children between 6 and 23 months receiving a minimum acceptable diet remains low and has declined from 39% in 2008 to 31% in 2023. The Kenyan Ministry of Health, GAIN and UNICEF collaborated to understand the drivers of complementary feeding practices, particularly proximal determinants, which can be directly addressed and acted upon. A secondary analysis of household surveys and food composition data was conducted to outline children's dietary patterns within the different regions of Kenya and the extent to which the affordability of animal-source foods could be improved. Ethnographic data were analyzed to identify socio-cultural barriers to optimal complementary feeding. Furthermore, we outlined the critical steps for developing user-friendly and low-cost complementary feeding recipes. The results of all the analyses are presented in five of the six papers of this Special Issue with this additional paper introducing the Kenyan context and some of the critical findings. The Special Issue has highlighted multidimensional barriers surrounding the use and availability of animal-source foods. Furthermore, it emphasizes the need for a multi-sectoral approach in enacting policies and programmes that address these barriers.
Collapse
Affiliation(s)
| | | | | | - Ty Beal
- Global Alliance for Improved Nutrition (GAIN)WashingtonDCUSA
| | | | | | | | | | | | | | | |
Collapse
|
3
|
Codjia P, Kiige L, Rudert C, Nordhagen S, Beal T, Kirogo V, Ortenzi F, Gonzalez W, Kamudoni P, Garg A. Improving complementary feeding practices, programs and policies for optimal early childhood nutrition in Kenya: What would work? Matern Child Nutr 2024; 20 Suppl 3:e13616. [PMID: 38204287 PMCID: PMC10782134 DOI: 10.1111/mcn.13616] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 01/12/2024]
Abstract
Complementary feeding practices are greatly influenced by local contexts. Therefore, national home-grown evidence, policies and guidelines are critical to improving infant and young children's diets. This Special Issue has provided a comprehensive, evidence-based analysis of the situation, gaps and context-specific opportunities for improving young children's diets in Kenya. The primary research findings of the Special Issue supported the identification of a set of recommendations articulated across the four systems (food, health, water, sanitation and hygiene [WASH] and social protection) to improve food availability and accessibility in Kenya at the national and subnational levels. It is anticipated that the decentralised government functions seen in Kenya provide a strong opportunity to develop and mainstream context-specific recommendations into action. This Special Issue recommends adopting a multi-sectoral systems approach, including a shared vision, joint planning, implementation and monitoring, towards improving young children's diets with a focus on service delivery as well as scaled-up community social behaviour change interventions. In particular, the approach should entail advocacy for policy revisions for service delivery that support complementary feeding and development of costed implementation strategies in support of the same, across four critical systems-food, health, WASH and social protection, along with, the strengthening of national coordination, monitoring and accountability structures as per the Kenya Nutrition Action Plan. Finally, the development of a legal framework for enhanced accountability from all relevant sectors towards sustainable, nutritious, safe and affordable children's diets. These recommendations provide a clear direction in addressing the complementary feeding challenges, which the primary research of this Special Issue has presented.
Collapse
Affiliation(s)
| | | | | | | | - Ty Beal
- Global Alliance for Improved Nutrition (GAIN)WashingtonDistrict of ColumbiaUSA
| | | | | | - Wendy Gonzalez
- Global Alliance for Improved Nutrition (GAIN)GenevaSwitzerland
| | | | | |
Collapse
|
4
|
Kimiywe J, Craig H, Agyapong A, Thorne‐Lyman A, Matsisa P, Kiige L, Codjia P, Rudert C, Katua S, Wambu R, Samburu B, Kamudoni P, Chimanya K, Nordhagen S. Diets of infants and young children in two counties of Kenya: Key drivers and barriers to improvement. Matern Child Nutr 2024; 20 Suppl 3:e13334. [PMID: 36468358 PMCID: PMC10782136 DOI: 10.1111/mcn.13334] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 12/11/2022]
Abstract
Infant and young child feeding (IYCF) practices are influenced by many context-specific factors related to local food systems as well as social and cultural practices. Understanding these local contextual perspectives is essential for designing effective programs and policies. This paper uses focused ethnographic study methods to examine challenges experienced by mothers related to IYCF in two counties in Kenya, a country with considerable heterogeneity in agriculture, food systems, and cultures. A two-phase qualitative study was undertaken in each of Kilifi County and West Pokot County, entailing interviews and rating activities with mothers, health workers, and vendors. Interviews were audio-recorded, transcribed, translated into English, coded, and analysed by topic. Results show low levels of dietary diversity in both counties; in West Pokot, the level of adequate meal frequency is also low. Core foods in young child diets included maize porridge and family foods such as ugali (stiff maize porridge), vegetables, beans, fish, and plantains. Food safety, acceptability, and acquisition ease were the main drivers of food choice. Mothers generally felt that all core foods fed to young children are healthy and safe, but there was more variability regarding child acceptance, acquisition ease, cost, and convenience. Common barriers to feeding nutrient-dense foods to children included child illness, economic constraints, and limited knowledge of modification strategies, skills, or tools to make the foods suitable for young children. Potential actions to address these barriers include sharing information on child-appropriate recipes; raising awareness on local, affordable nutrient-dense foods; and improving WASH practices to reduce illness frequency.
Collapse
Affiliation(s)
- Judith Kimiywe
- Department of Food, Nutrition and DieteticsKenyatta University School of Public Health and Applied Human SciencesNairobiKenya
| | - Hope Craig
- Department of International HealthCenter for Human Nutrition, Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Abigail Agyapong
- College of Agriculture and Life SciencesCornell UniversityIthacaNew YorkUSA
| | - Andrew Thorne‐Lyman
- Department of International HealthCenter for Human Nutrition, Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of International HealthCenter for a Livable Future, Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Patrick Matsisa
- Department of Mathematics and StatisticsJomo Kenyatta University of Agriculture and TechnologyNairobiKenya
| | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Lowe A, Callis A, DiGirolamo A, Girard AW, Boakye A, Ogutu E, Omosa E, Okeyo F, Odollo L, Samburu B, Arimi C, Kamudoni P, Gonzalez W, Codjia P, Kiige L. Evidence-based complementary feeding recipe book for Kenyan caregivers: A novel approach. Matern Child Nutr 2024; 20 Suppl 3:e13475. [PMID: 37789710 PMCID: PMC10782138 DOI: 10.1111/mcn.13475] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/28/2022] [Accepted: 01/05/2023] [Indexed: 10/05/2023]
Abstract
The Kenyan Ministry of Health (MOH) and a consortium of nutritionists, researchers and communication, and design specialists developed a novel approach to create an evidence-based recipe book promoting complementary feeding (CF) in Kenya. The ADAPT approach includes five steps: applied research (A), dialogue with stakeholders (D), adapted behaviour change communication (BCC) theories (A), purpose-driven visual communication (P), and tailoring to priority audiences (T). Through this approach, the recipe book addresses key knowledge gaps using behaviour change theories and visual communication best practice to increase accessibility, acceptability, retention and motivation for behaviour change. The book addresses barriers to CF identified through formative applied research. Dialogue with stakeholders helped ensure cultural appropriateness and the book's alignment with MOH recommendations and key messages. The book uses behaviour change theories to approach the reader in a respectful way that motivates behaviour change. The use of consistent, purpose-driven visuals helps ensure key messages are easily understood and accessible to all caregivers regardless of literacy level. The book's tone and content are tailored to its audiences' attributes, needs and preferences. This five-step process inspired the development of ADAPT, a novel approach that integrates behaviour change and visual communication for greater impact. This paper outlines how the consortium used the ADAPT approach to develop an evidence-based book that thoughtfully and holistically addresses a wide range of barriers, provides practical solutions and increases self-efficacy around CF. It offers a blueprint for public health practitioners from any field who are interested in using visual behaviour change communication to promote healthy behaviour.
Collapse
Affiliation(s)
- Alyssa Lowe
- Georgia Health Policy CenterGeorgia State UniversityAtlantaGeorgiaUSA
| | | | - Ann DiGirolamo
- Georgia Health Policy CenterGeorgia State UniversityAtlantaGeorgiaUSA
| | - Amy W. Girard
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - Amma Boakye
- Georgia Health Policy CenterGeorgia State UniversityAtlantaGeorgiaUSA
| | - Emily Ogutu
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - Esther Omosa
- International Livestock Research InstituteNairobiKenya
| | - Frida Okeyo
- Department of Community Health and Development, School of Public HealthGreat Lakes University of KisumuNairobiKenya
| | - Lawrence Odollo
- Department of Community Health and Development, School of Public HealthGreat Lakes University of KisumuNairobiKenya
| | - Betty Samburu
- United Nations Children's Fund Kenya Country OfficeNairobiKenya
| | | | | | | | - Patrick Codjia
- United Nations Children's Fund Kenya Country OfficeNairobiKenya
| | - Laura Kiige
- United Nations Children's Fund Kenya Country OfficeNairobiKenya
| |
Collapse
|
6
|
Traoré F, Omolo M, Beal T, Nordhagen S, Codjia P, Kiige L, Kamudoni P, Arimi C, Kirogo V, Ortenzi F, Wouabe ED. Modelling policies to improve affordability and consumption of nutritious foods for complementary feeding in Kenya. Matern Child Nutr 2024; 20 Suppl 3:e13519. [PMID: 38204288 PMCID: PMC10782137 DOI: 10.1111/mcn.13519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/09/2023] [Accepted: 03/23/2023] [Indexed: 01/12/2024]
Abstract
In Kenya 26% of children under age 5 experience stunted growth, 4% are wasted and 11% are underweight. In pregnant women, the prevalence of iron deficiency is 36% and iron-deficiency anaemia prevalence is 26%. Previous studies have identified affordability as a key barrier to the intake of nutrients, particularly from animal-source foods (ASFs). Thus, this study analyzes to what extent the affordability of ASF in Kenya can be improved. It focuses on four ASFs: eggs, milk, chicken and beef. Using a computable general equilibrium model, three policy simulations were undertaken to establish the impact of potential changes on nutritious ASF availability and affordability: a 20% increase in total factor productivity (TFP) for the four products; a 20% TFP increase plus a 25% reduction in trade and transportation margins; and a 20% TFP increase for ASF and maize (a key input in animal feed). Simulations suggest increasing the productivity of the four ASF products would increase their availability and lower consumer prices (up to 17% lower). Household consumption of the four commodities would increase, resulting in improved household dietary diversity. Rural households would gain more compared with urban households. Poor households (the lowest 40%) would register larger welfare (Equivalent Variation) gains than other households in both urban and rural areas. The richest 20% of the population would neither lose nor gain following the policy changes. Reducing transportation costs and trade margins and increasing maize productivity could further reduce the price of ASFs through lower production costs and increased consumption.
Collapse
Affiliation(s)
| | - Miriam Omolo
- The African Policy Research InstituteNairobiKenya
| | - Ty Beal
- Global Alliance for Improved NutritionWashingtonDistrict of ColumbiaUSA
| | | | | | | | | | | | | | | | - Eric Djimeu Wouabe
- Global Alliance for Improved NutritionWashingtonDistrict of ColumbiaUSA
- Present address:
Results for DevelopmentWashingtonDistrict of ColumbiaUSA
| |
Collapse
|
7
|
Codjia P, Kutondo E, Kamudoni P, Munga J, Ahluwalia A, Sharma I, de Jong Y, Amolo T, Maina-Gathigi L, Mwenda V, Chaudhry H, Bukania Z. Mid-term evaluation of Maternal and Child Nutrition Programme (MCNP II) in Kenya. BMC Public Health 2022; 22:2191. [PMID: 36443721 PMCID: PMC9702643 DOI: 10.1186/s12889-022-14627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Kenya is faced with a triple burden of malnutrition which is multi-faceted with health and socio-economic implications. Huge geographical disparities exist, especially, in the arid and semi-arid lands exacerbated by inadequate resource allocation to the nutrition sector and challenges in multi-sectoral coordination and nutrition governance. UNICEF’s Maternal and Child Nutrition Programme is a four-year (2018–2022) resilience-building, multi-sectoral program focused on pregnant and lactating women, mothers of children under five years and children under five years. The objective of the mid-term evaluation was to establish the relevance, effectiveness, efficiency, and sustainability of the programme. Methods The field evaluation conducted between June and July 2021, adopted a concurrent mixed-methods approach, where qualitative information was gathered through 29 key informant interviews and 18 focus group discussions (6 FGDs per population group; women of reproductive age, adolescent girls and men). Quantitatively, data were obtained through desk review of secondary data from programme reports, budgets, and project outputs where descriptive analysis was undertaken using Excel software. Qualitative information was organized using Nvivo software and analyzed thematically. Results The findings provide evidence of the relevance of the Maternal and Child Nutrition Programme II to the nutrition situation in Kenya and its alignment with the Government of Kenya and donor priorities. Most planned programme targets were achieved despite operating in a COVID-19 pandemic environment. The use of innovative approaches such as family mid-upper arm circumference, integrated management of acute malnutrition surge model, Malezi bora and Logistic Management Information Management System contributed to the realization of effective outputs and outcomes. Stringent financial management strategies contributed toward programme efficiencies; however, optimal utilization of the resources needs further strengthening. The programme adopted strategies for strengthening local capacity and promoting ownership and long-term sustainability. Conclusion The programme is on track across the four evaluation criteria. However, a few suggestions are recommended to improve relevance, effectiveness, efficiency, and sustainability. A formal transition strategy needs to be developed in consultation with multi-stakeholder groups and implemented in phases. UNICEF Nutrition section should explore a more integrated programming mode of delivery through joint initiatives with other agencies under the Delivery as One UN agenda, along the more gender transformative approaches with more systematic involvement of males and females in gender-based discussions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14627-2.
Collapse
|
8
|
Gabes M, Jourdan C, Schramm K, Masur C, Abels C, Kamudoni P, Salek S, Apfelbacher C. Hyperhidrosis Quality of Life Index (HidroQoL©): further validation and clinical application in patients with axillary hyperhidrosis using data from a phase III randomized controlled trial. Br J Dermatol 2020; 184:473-481. [PMID: 32510573 DOI: 10.1111/bjd.19300] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The Hyperhidrosis Quality of Life Index (HidroQoL©) is a validated patient-reported outcome measure capturing the quality of life of people affected by hyperhidrosis. OBJECTIVES We aimed to extend the validity evidence to physician-confirmed diagnosis of primary axillary hyperhidrosis. METHODS Data from a phase III randomized placebo-controlled clinical trial were used (n = 171). Confirmatory factor analysis was carried out to confirm the a priori two-factor structure of the HidroQoL. Internal consistency was assessed using Cronbach's α. Intraclass correlation coefficients (ICCs) were calculated to evaluate test-retest reliability after days -7 to -4. Convergent validity was assessed using correlations with the Dermatology Life Quality Index (DLQI), the Hyperhidrosis Disease Severity Scale (HDSS) and gravimetric sweat production. Known groups were analysed to evaluate discriminative validity. Responsiveness after 29 days was assessed and minimal important difference (MID) values were calculated using both anchor- and distribution-based approaches. All analyses were carried out for total HidroQoL and its two domains. RESULTS The two-factor structure of the HidroQoL was confirmed. Internal consistency and test-retest reliability were strong (Cronbach's α 0·81-0·90; ICCs 0·89-0·93). Correlations with other outcome measures were in line with a priori hypotheses. The HidroQoL discriminated between different severity groups (P ≤ 0·001) and showed sensitivity to change towards improvement (P < 0·001). An MID value of 4 is proposed for the total scale. CONCLUSIONS This study supports excellent measurement properties including clinical applicability of the HidroQoL in primary axillary hyperhidrosis and suggests a MID of 4 be applied to clinical trial data.
Collapse
Affiliation(s)
- M Gabes
- Institute of Social Medicine and Health Economics, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.,Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - C Jourdan
- FGK Clinical Research GmbH, Munich, Germany
| | - K Schramm
- FGK Clinical Research GmbH, Munich, Germany
| | - C Masur
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | - C Abels
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | | | - S Salek
- School of Life and Medical Sciences, University of Hertfordshire, UK.,Institute of Medicines Development, Cardiff, UK
| | - C Apfelbacher
- Institute of Social Medicine and Health Economics, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| |
Collapse
|
9
|
Hjertholm KG, Holmboe-Ottesen G, Iversen PO, Mdala I, Munthali A, Maleta K, Shi Z, Ferguson E, Kamudoni P. Seasonality in associations between dietary diversity scores and nutrient adequacy ratios among pregnant women in rural Malawi - a cross-sectional study. Food Nutr Res 2019; 63:2712. [PMID: 30837821 PMCID: PMC6397333 DOI: 10.29219/fnr.v63.2712] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 11/20/2022] Open
Abstract
Background Dietary diversity scores (DDS) are simple indicators often used as proxies for nutrient adequacy. A 10-food group indicator is proposed by the Food and Agriculture Organization of the United Nations as a global standard for measuring dietary diversity among women in low-resource settings. However, its validity as a proxy for nutrient adequacy across different agricultural seasons for pregnant women has not been determined. Objective We studied associations between DDS and nutrient adequacy ratios (NAR) across two different agricultural seasons (pre- and post-harvest seasons) for pregnant women in rural Malawi and assessed whether a 1-day DDS or a 3-day DDS would be the best indicator of nutrient adequacy. Design Dietary intakes of 330 pregnant women were assessed between gestational weeks 28 and 35. Intakes of energy, macronutrients, and 11 micronutrients were estimated using three repeated interactive 24-h diet recalls, and DDS were also calculated from these days. Correlation coefficients (r) between DDS, NAR, and mean adequacy ratio (MAR) of the 11 micronutrients were determined. Results After energy adjustments, we found significant correlations between DDS and MAR with both DDS indicators in the preharvest season (r = 0.22–0.23; p < 0.001) but not in the post-harvest season (p > 0.05). For individual energy-adjusted NARs, correlations were not consistently significant across the two seasons and the two DDS indicators. Conclusions Our results suggest that DDS could be used to predict overall nutrient adequacy during the preharvest season. As similar correlations were found using both the 1- and 3-day indicators, we recommend using a 1-day DDS, for simplicity. However, as the indicators are sensitive to seasonality they should be used with care in this study setting.
Collapse
Affiliation(s)
- Katrine G Hjertholm
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Gerd Holmboe-Ottesen
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Per O Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Division of Human Nutrition, Stellenbosch University, Tygerberg, South Africa
| | - Ibrahimu Mdala
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Alister Munthali
- School of Public Health and Medicine, University of Malawi, Zomba, Malawi
| | - Kenneth Maleta
- School of Public Health and Medicine, University of Malawi, Zomba, Malawi
| | - Zumin Shi
- Discipline of Medicine, School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Penjani Kamudoni
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
10
|
Kamudoni P, Mueller B, Halford J, Schouveller A, Stacey B, Salek MS. The impact of hyperhidrosis on patients' daily life and quality of life: a qualitative investigation. Health Qual Life Outcomes 2017; 15:121. [PMID: 28595584 PMCID: PMC5465471 DOI: 10.1186/s12955-017-0693-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An understanding of the daily life impacts of hyperhidrosis and how patients deal with them, based on qualitative research, is lacking. This study investigated the impact of hyperhidrosis on the daily life of patients using a mix of qualitative research methods. METHODS Participants were recruited through hyperhidrosis patient support groups such as the Hyperhidrosis Support Group UK. Data were collected using focus groups, interviews and online surveys. A grounded theory approach was used in the analysis of data transcripts. Data were collected from 71 participants, out of an initial 100 individuals recruited. RESULTS Seventeen major themes capturing the impacts of hyperhidrosis were identified; these covered all areas of life including daily life, psychological well-being, social life, professional /school life, dealing with hyperhidrosis, unmet health care needs and physical impact. CONCLUSIONS Psychosocial impacts are central to the overall impacts of hyperhidrosis, cutting across and underlying the limitations experienced in other areas of life.
Collapse
Affiliation(s)
- P Kamudoni
- Institute of Medicines Development, Duffryn House, Cardiff, CF, 23 6NP, UK.
| | - B Mueller
- Medical Science and Operations Department, Riemser Pharma GmbH, Greifswald, Germany
| | | | | | | | - M S Salek
- Institute of Medicines Development, Duffryn House, Cardiff, CF, 23 6NP, UK.,Department of pharmacy, School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, Herts, UK
| |
Collapse
|
11
|
Hjertholm KG, Iversen PO, Holmboe-Ottesen G, Mdala I, Munthali A, Maleta K, Shi Z, Ferguson E, Kamudoni P. Maternal dietary intake during pregnancy and its association to birth size in rural Malawi: A cross-sectional study. Matern Child Nutr 2017; 14. [PMID: 28217860 DOI: 10.1111/mcn.12433] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 12/20/2016] [Accepted: 01/10/2017] [Indexed: 11/28/2022]
Abstract
In low-resource settings, such as rural Malawi, pregnant women are prone to energy and micronutrient deficiencies with the consequence of delivering low-birth weight infants with higher risks of morbidity and mortality. This study aimed to examine the association between maternal dietary intakes during pregnancy and infant birth size. Dietary intakes of 203 pregnant women were assessed between 28 and 35 weeks of gestation and their infants' (n = 132) birth size measured. Intakes of energy, macronutrients, and 11 micronutrients were estimated using a 3-day interactive 24-hr diet recall. Semiquantitative data on food intakes for four additional days were also collected to assess food patterns. Using multilevel linear regression modeling, maternal intakes of carbohydrate were negatively associated with neonate length (β: -0.1; 95% CI: -0.2, 0.0 cm/E%) and abdominal circumference (β: -0.1, 95% CI: -0.2, 0.0 cm/E%), whereas intakes of fat were positively associated with neonate length (β: 0.1; 95% CI: 0.0, 0.2 cm/E%) and abdominal circumference (β: 0.1; 95% CI: 0.0, 0.2 cm/E%). Vitamin C intakes were positively associated with birth weight (β: 1.4; 95% CI: 0.5, 2.3 g/mg). The frequency of milk intake was positively associated with birth weight (β: 75.3; 95% CI: 13.6, 137.0 g/day). These findings offer practical suggestions for food-based interventions in the study area to promote inclusion of fat, vitamin C-rich foods, and milk in pregnancy.
Collapse
Affiliation(s)
- Katrine G Hjertholm
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Gerd Holmboe-Ottesen
- Department of Community Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ibrahimu Mdala
- Department of Community Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Alister Munthali
- School of Public Health and Family Medicine, University of Malawi, Zomba, Malawi
| | - Kenneth Maleta
- School of Public Health and Family Medicine, University of Malawi, Zomba, Malawi
| | - Zumin Shi
- Discipline of Medicine, School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Penjani Kamudoni
- Department of Community Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
12
|
Kamudoni P, Salek MS, Mueller B. The Burden Of Primary Hyperhidrosis On The Patient: Eq-5d-5l Utilities, Willingness To Pay And Daily Time Spent In Managing The Condition. Value Health 2014; 17:A611. [PMID: 27202131 DOI: 10.1016/j.jval.2014.08.2141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - B Mueller
- Riemser Pharma GmbH, Greifswald - Insel Riems, Germany
| |
Collapse
|
13
|
Kamudoni P, Gründer G, Sychla H, Juha B. An Evaluation of the Comparative Effectiveness of Clomethiazole Against Diazepam in the Treatment of Alcohol Withdrawal Syndrome in Routine Clinical Practice. Value Health 2014; 17:A454. [PMID: 27201257 DOI: 10.1016/j.jval.2014.08.1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - G Gründer
- RWTH Aachen University, Aachen, Germany
| | - H Sychla
- RWTH Aachen University, Aachen, Germany
| | - B Juha
- Cheplapharm Arzneimittel GmbH, Greifswald - Insel Riems, Germany
| |
Collapse
|
14
|
Salek MS, Kamudoni P. Quality of life measurement in dermatology consultation: impact on patient reported outcomes. GIORN ITAL DERMAT V 2013; 148:263-275. [PMID: 23670063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
It is now recognized that therapy should not only seek to cure disease, but also to affect outcomes that matter to the patients the most; those related to their functioning in their everyday life and their overall quality of life. In those situations where elimination of disease/complete cure is not possible for example in chronic conditions, limiting the complications from the illness, so that patients can still maintain a comfortable and satisfying life, becomes the goal of treatment. This coupled with the growing patient rights movement and the need for patients to be a part of treatment decision-making process means that patient's health-related quality of life is no longer just an important consequence of health-care, but it is increasingly regarded as an explicit ultimate goal.
Collapse
Affiliation(s)
- M S Salek
- Centre for Socioeconomic Research, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK.
| | | |
Collapse
|
15
|
Kamudoni P, Maleta K, Shi Z, Holmboe-Ottesen G. Infant feeding practices in the first 6 months and associated factors in a rural and semiurban community in Mangochi District, Malawi. J Hum Lact 2007; 23:325-32. [PMID: 17991797 DOI: 10.1177/0890334407307567] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This cross-sectional study aimed at investigating infant feeding practices and their sociodemographic correlates in Mangochi District, Malawi. Questionnaire data from 157 rural and 192 semiurban mother-infant pairs were obtained. Early breastfeeding (< 1 hour after delivery) was practiced among 68.2% of the rural and 63% of the semiurban mothers. Colostrum was given by 96% of the sampled mothers. Exclusive breastfeeding rates in the sample at 2, 4, and 6 months were 39.1%, 27.5%, and 7.5%, respectively. At 4 months, exclusive breastfeeding was significantly higher in the semiurban (46.8%) than in the rural (4.7%) group. Living in the rural area (OR = 1.87; 95% CI 1.26-2.76) and giving birth outside a health facility (OR = 1.36; 95% CI 1.00-1.85) were risk factors for stopping exclusive breastfeeding before 6 months. The results suggest that semiurban mothers are more likely to practice optimum breastfeeding and that health facilities have an important role in its promotion.
Collapse
Affiliation(s)
- Penjani Kamudoni
- Institute of General Practice and Community Medicine, University of Oslo, Blindern, Oslo, Norway.
| | | | | | | |
Collapse
|