Constance Awuor Gewa

Objective: We examined the prevalence of elevated blood pressure (BP) and hypertension among 390 primary school children of different socioeconomic status (SES) in two urban settings in Kenya and explored the association between children's BP status and their sociodemographic characteristics, dietary behaviours and overweight/obesity status. Methods: Children's BP and anthropometric measurements were taken and parents, with the help of their children, completed questionnaires on the children's dietary behaviours. An average of three BP readings was used to calculate BP percentiles by age, sex and height. BMI-for-age z-scores, waist-circumference-to-height ratio and the sum of skinfold measures were calculated. We utilized prevalence ratio analysis to examine the association between BP and sociodemographic characteristics, dietary behaviours and overweight/obesity. Results: About 9% of the school children had elevated BP and 33% had stage 1 hypertension. Among overweight children, the proportion of children with elevated BP was 1.85-fold greater and the proportion of children with hypertension was 1.83-fold greater compared with children with healthy body weight. Similar patterns of significant associations were seen among obese children, children with central obesity and children with high total skinfold values. The proportion of children with hypertension was 1.42-fold greater among children with high frequency of consumption of chips/crisps compared with children with lower frequency of consumption. Conclusion: These results increase our understanding BP patterns and determinants among school children in Kenya and can help inform noncommunicable disease prevention efforts.

We examined patterns of unhealthful dietary, PA and sleep behaviors among primary school children of different socio-economic status (SES) in two urban settings in Kenya and explored the association between these behaviors and overweight/obesity among the children. Data was collected on 390 children, aged 10-12 years, who attended public primary schools in two cities. Children’s anthropometric measurements were taken and parents, with the help of their children, completed questionnaires on children’s dietary, physical activity, and sleep behaviors. Body-mass-index-for-age z-scores, waist-circumference-to-height ratio, and the sum of skinfold measures were calculated. We utilized prevalence ratio analysis to examine the association between socio-economic/demographic characteristics, unhealthful behaviors and overweight/obesity. Overall, 21% of the children were overweight or obese and 9% had abdominal obesity. Prevalence of unhealthful behaviors varied significantly by child’s age, gender, school income levels, city, and frequency of consumption of restaurant foods. Children who consumed less than recommended amount of fruit servings had 1.68 times the risk of being overweight/obese, 2.49 times the risk of having abdominal obesity and 1.47 times the risk of having high total skinfold values compared to children with adequate fruit intake. Children with high frequency of consumption of red/processed meats had 1.50 times the risk of being overweight/obesity compared to children with less-frequent consumption. We found rather high prevalence of unhealthful behaviors among primary school children in Kenya, identified their determinants, and the association between specific behaviors and overweight/obesity. These results can guide childhood obesity prevention measures in Kenya and neighboring countries.

Although rural households in Kenya rely on agricultural production for their livelihood, attaining food security is challenging in areas experiencing harsh agro-ecological conditions. We utilized mixed methods research to examine the effect of agricultural production, including that of traditional foods, on household food insecurity in Seme sub-County of Kenya. Study participants believed that traditional foods protected against hunger. However, production of these foods, with the exception of traditional vegetables, was low. Poultry-keeping; cereal/grain, any vegetable and traditional vegetable production; and crop diversity were significantly associated with lower household food insecurity. Vegetable production maintained statistical significance after controlling for other variables.

Introduction : Although obesity prevalence is known to be rising in East Africa, research on childhood obesity is still minimal. We conducted a cross-sectional study to examine the prevalence of unhealthful dietary patterns, physical activity and sleep behaviors among primary school children in two urban settings in Kenya and explored the association between the behaviors and overweight/obesity among the children. Methods Six public schools, with children from low-, medium- and high-income households in Nairobi and Kisumu cities were purposively selected to participate in the study. Data was collected on randomly-selected students aged 10–12 years at each school. Students’ weights, heights, waist circumferences, and tricep, bicep, subscapular and suprailiac skinfolds were measured. Body-mass-index-for-age z-scores were used to classify students into underweight, healthy weight, overweight and obese categories. Waist-circumference-to-height ratio above 0.5 was used to define abdominal obesity and the total amount of body fat was estimated from the sum of skinfold measures. Parents, with the help of their children, completed questionnaires on student’s dietary, physical activity, and sleep behaviors. Anthropometric measurements and questionnaires were available for 390 students. We utilized prevalence ratio analysis to examine the association between socio-economic/demographic characteristics, unhealthful behaviors and overweight/obesity. Results Overall, 21% of the students were overweight or obese and 9% of them had abdominal obesity. Median total skinfold measurements was 32.5 mm. Prevalence of unhealthful behaviors varied significantly by student’s age, gender, school income levels, city, and frequency of consumption of restaurant foods. Students who consumed less than recommended amount of fruit servings had 1.68 times the risk of being overweight/obese, 2.49 times the risk of having abdominal obesity and 1.47 times the risk of having high total skinfold values compared to students with adequate fruit intake. Students with high frequency of consumption of red/processed meats had 1.50 times the risk of being overweight/obesity compared to students with less-frequent consumption. Conclusion We found a rather high prevalence of unhealthful dietary behaviors among primary school students in Kenya, identified their determinants, and the association between specific behaviors and overweight/obesity. These results can guide childhood obesity prevention measures in Kenya and other nations in East Africa.

We conducted a cross-sectional study to provide an overview primary school children food environment in two urban settings in Kenya. Six schools, catering to children from low-, medium- and high-income households in the cities of Nairobi and Kisumu in Kenya, participated in the study. Data on types of food places and foods offered were collected and healthy and unhealthy food availability scores calculated for each place. We utilized prevalence ratio analysis to examine associations between food availability, food place characteristics and neighborhood income levels. Altogether, 508 food places, located within 1 km of the schools and the school children’s neighborhoods were observed. Open-air market sellers and kiosks were most common. The proportion of food places with high healthy food availability was 2.2 times greater among food places in Nairobi compared to Kisumu, 1.9 times greater in food places with multiple cashpoints, 1.7 times greater in medium/large sized food places and 1.4 times greater in food places located in high income neighborhoods. These findings highlight differences in availability of healthy foods and unhealthy foods across types of food places and neighborhood income levels and inform public health interventions aimed at promoting healthy food environments in Kenya.

Objective: To examine mothers’ and young children’s consumption of indigenous and traditional foods (ITF), assess mothers’ perception of factors that influence ITF consumption, and examine the relationship between perceived factors and ITF consumption.Design: Longitudinal study design across two agricultural seasons. Seven-day FFQ utilized to assess dietary intake. Mothers interviewed to assess their beliefs about amounts of ITF that they or their young children consumed and on factors that influence ITF consumption levels.Setting: Seme sub-County, Kenya.Participants: Mothers with young children.Results: Less than 60 % of mothers and children consumed ITF at time of assessment. Over 50 % of the mothers reported that their ITF consumption amounts and those of their children were below levels that mothers would have liked for themselves or for their young children. High cost, non-availability and poor taste were top three reasons for low ITF consumption levels. Mothers who identified high cost or non-availability as a reason for low levels of ITF consumption had significantly lower odds of consuming all ITF except amaranth leaves. Mothers who identified poor taste had significantly lower odds of consuming all ITF except green grams and groundnuts. Similar relationships were noted for young children’s ITF consumption levels.Conclusions: A majority of the mothers reported that they and their children did not consume as much ITF as the mothers would have liked. Further studies should examine strategies to improve availability and affordability of ITF, as well as develop recipes that are acceptable to mothers and children.

Evidence suggests that household inequalities contribute to food insecurity and nutrient deficiencies in rural Ugandan women. In this mixed-methods study, 64 participants from two villages in the Wakiso District were interviewed and asked questions from FANTA’s Household Food Insecurity Access Scales (HFIAS) tool. Participants detailed foods consumed within the last 24 hr; these data were used to create Household Dietary Diversity (HDDS) scores. Discussion group qualitative data were evaluated through thematic analysis. There was no statistically significant evidence to suggest that the gender of the head of the household influenced these scores. The mean HFIAS score was 9.3 out of 27 and the mean HDDS was 6.4 out of 14. The qualitative data paints a picture of economically independent women who are overburdened by household responsibilities. Additionally, participants reported limited access to marketplaces to sell crops directly and therefore sold to agricultural middlemen. Technical investments in low-cost storage technologies are recommended to ensure more negotiation power with middlemen while also improving household food security.

Summary: Sun‐drying is a low‐cost, low‐technology fish preservation method frequently employed in developing areas. However, the process promotes lipid oxidation and its associated undesired flavours and odours. This study investigated low‐technology solutions for impact on lipid oxidation and sensory attributes of oven‐dried omena fish (Rastrineobola argentea). Two oven‐drying conditions and four doses of clove water extract ‘dip’ pretreatments were studied in a complete factorial design. Lipid oxidation in dried fish was assessed by TBARS, peroxide value and fatty acid analysis by GC‐FID. Results showed that soaking in 10 g L⁻¹ clove water extract for 1 h and oven‐drying at 150 °C × 30 min significantly reduced TBARS and peroxide values in omena fish by 77% and 79%, respectively, and polyene index showed improved retention of long‐chain polyunsaturated fats, compared to original drying condition. Lastly, panellists of a triangle test were able to discriminate between biscuits made with the modified and original dried fish.

The purpose of this presentation is to demonstrate how a term paper peer review activity enhanced students’ collaboration and promoted their critical thinking skills. This study was conducted in a fully online graduate course, which was first offered in the Summer 2014 semester. Students were required to take the course as part of the Masters of Science in Global Health and Masters of Public Health programs. The course was offered via the Blackboard platform and utilized multiple strategies to enhance student participation. The course was designed in a modular format with course activities including individual watching streaming lecture videos, discussion blogs, journal article reviews and presentations in video delivery, synchronous case study in Blackboard Collaborate sessions, and term paper writing. The term paper peer review activity was added in the Summer 2015 semester. The purpose of the peer review activity was for students to learn from your peers' feedback as they work towards completing their term paper. Expected learning outcomes for the peer review were that students would become competent in scientific writing. Students’ feedback indicated their appreciation of the support from team members. Preliminary analysis indicated that students became more reflective during the writing process and a better quality of term paper was shown in their final grades. Faculty in either undergraduate or graduate program will learn the design of peer review and how it promotes students’ interaction and support in a group setting in online environments.

Despite the importance of multiple psychosocial factors on nutrition-related behavior, very few studies have explored beyond the role of mothers’ knowledge and perception of child-focused outcomes on the duration of exclusive breastfeeding in Africa. Our objective was to determine the relationships among mothers’ knowledge, outcome expectancies, normative beliefs, and cessation of exclusive breastfeeding in rural Kenya. A cross-sectional survey was conducted among 400 mothers of children, 0-24 months old, in rural Kenya. Early child-feeding practices, knowledge of breastfeeding recommendations, beliefs associated with impact of exclusive breastfeeding on child- and mother-focused outcomes and perception of acceptability of exclusive breastfeeding by important others were examined. Cox regression analysis was used to assess the relationship between independent variables of interest and cessation of exclusive breastfeeding. Being knowledgeable of breastfeeding-related recommendations, positive beliefs on the impact of exclusive breastfeeding on child- focused outcomes, having a more positive perception of the impact of exclusive breastfeeding on mother-focused outcomes and a more positive perception of acceptability of exclusive breastfeeding by important others were associated with significantly lower risks of premature cessation of exclusive breastfeeding. In addition to knowledge levels, mothers’ beliefs play an important role in mothers’ decisions to practice exclusive breastfeeding. Mother’s beliefs on the impact of exclusive breastfeeding on the mother’s health, physical appearance and ability to engage in other activities were shown to have the strongest relationship with premature cessation of exclusive breastfeeding. Addressing these beliefs has the potential to contribute to more effective exclusive breastfeeding promotion efforts in rural Kenya.