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Aims: Iodine plays a key role in thyroid hormone production and functioning. Inadequate iodine intake results in iodine deficiency (ID) which impairs the normal functioning of the thyroid. The deficiency is responsible for damage to brain development, growth retardation, cretinism, and thyroid dysfunction. Millions of people have been condemned to a life of few prospects and continued underdevelopment due to ID. The study was conducted to assess iodine status among primary school children in the Mt. Elgon region and the impact of salt iodization on this status. Study Design: A school-based cross-sectional descriptive study to assess iodine status among primary school children was employed in the study. Study Area and Duration: The study was carried out in Kenya, Bungoma County, Mount Elgon Sub-County. The study period was between 27th November 2018 and 26th November 2019. Methodology: Healthy primary school children aged 6 to 12 years who met the inclusion criteria were included in the study. Spot urine samples were collected in schools, while water samples were collected from different water sources. Salt was collected from households (HH) and at distribution outlets. The Sandell Kolthoff reaction was used to analyse urine and water samples while salt was analysed using iodometric titration. Results: The median urinary iodine concentration (UIC) was 200.7 µg/l. Out of which 0.55% were severely deficient, 5.25% moderately deficient, 18.23% with a mild deficiency, 25.69% had adequate iodine levels, 22.38% had more than adequate, and 27.90% had excess iodine levels. Household and salt samples from different distribution outlets that conformed to set standards of iodization were 49.4% and 63.64%, respectively. Iodine was not detected in all the water samples collected. Conclusion: The study population was found to have adequate iodine based on the median UIC of 200.7 µg/l. However, there was a coexistence of both deficiency and excessive UIC and salt iodization within the population. No iodine was detected in the water samples in the region.

This chapter provides an overview of two case studies that examine stakeholder reactions toward iodine biofortification in Uganda. The first case applies the protection motivation theory and evaluates the intention of school heads and parents of school‐aged children to include iodine‐biofortified legumes in school feeding programs. The second case study takes a broader scope of stakeholder groups and applies the analytical hierarchy process, a multicriteria decision‐making tool, to understand the stakeholders' evaluation of the relative importance of Strengths, Weaknesses, Opportunities, and Threats (SWOT) factors in implementing agronomic iodine biofortification in Uganda. Results from the two cases demonstrate that stakeholders are generally optimistic about the iodine biofortification strategy to improve iodine intake and address the prevalent iodine deficiency disorders. Both cases provide insights into key factors that need to be considered in implementing iodine biofortification technology in a developing country.

PurposeThis paper aims to describe food insecurity status, food consumption patterns of households and nutritional status of families residing along the baobab belt in Kitui and Kilifi counties of Kenya. It also explores associations between these and household socio-demographic characteristics.Design/methodology/approachA cross-sectional study design was performed with a sample of 216 caregiver/child pairs interviewed. Tablet-based semi-structured questions were used to obtain information on socio-demographic characteristics of children (6-13 years) and caregivers. Food insecurity status was assessed using the household food insecurity experience scale. Information on food consumption was obtained from qualitative 24-h recall as a basis for calculating a household dietary diversity score. Data were also obtained from a non-quantitative food frequency questionnaire. Anthropometric measurements of children and caregivers’ height and weight were taken to assess their nutritional status. Data were analyzed using Statistical Package for Social Science version 24 and WHO AnthroPlus 1.0.4.FindingsThe majority (98.2 per cent) of the households were food insecurity despite 81.5 and 57.4 per cent in Kitui and Kilifi counties, respectively, owning baobab trees. About 32.1 per cent of the households had poor dietary diversity scores (< 4). The prevalence of stunting (28.6 per cent), wasting (11.6 per cent) and underweight (25 per cent) rates among children were high. A significant association was observed between the children stunting rates with their age (p= 0.027), and also with household’s food security status (p< 0.001). Of the caregivers, 14.8 per cent were underweight, 18.1 per cent were overweight and 8.8 per cent were obese. There was significant association between the nutrition status of the caregivers and gender of the children (p< 0.001) and also with stunting rates of children (p= 0.047).Originality/valueThe study provides data on the current food security status and food consumption patterns of households and nutritional status of families residing along the baobab belt in Kenya which are mostly areas of marginal agricultural potential. The findings indicate a need for appropriate dietary improvements.

Maize is the most widely consumed staple food by the Kenyan population. Its wide consumption and centralized processing make it an appropriate fortification vehicle to supply essential micronutrients to the population. The legislation was enacted in 2012 that makes it mandatory for all commercial maize mills in Kenya to fortify the maize flour with specified micronutrients as a public health effort to reduce the prevalence of micronutrient deficiencies. However, there is limited information on the current status of maize milling and implementation of the flour fortification programme by these mills. A cross-sectional study was therefore carried out to characterize the commercial maize mills and determine the status of flour fortification in Kenya. Questionnaires were used to collect data. Information was obtained from 22 large-scale, 25 medium-scale and 31 small-scale mills. These mills had an installed capacity of 6084 metric tons/day of flour using roller and hammer mills. While all the large-scale mills implemented the recommended statutory flour fortification programs, only 45.8% of the medium and 24.1% of small-scale mills did so. There was evidence of weak quality management systems for fortified maize flour and most companies did not have trained mill operators. Regulatory monitoring was mainly done by the Kenya Bureau of Standards and the Ministry of Health. There is a need to enhance industry capacity in food fortification practices and fortification compliance. Key words: Fortification, maize flour, maize mills, mill characteristics.

Background: With enhanced rollout of anti-retroviral therapy (ART) following prevention of mother to child transmission (PMTCT) and the associated burden of opportunistic infections in developing countries, human immunodeficiency virus-immune reconstitution inflammatory syndrome (HIV-IRIS) may remain a public health area of major concern especially, in pregnancy. Ascertaining the association between maternal HIV infection and adverse maternal and birth related outcomes could be conflicted by the relationship between maternal-HIV- IRIS and the adverse pregnancy-fetal outcomes (APFOs) in HIV-infected mothers. We sought to estimate the incidence and determine possible predictors for adverse pregnancy-fetal outcomes with maternal-HIV-IRIS in ART naïve HIV infected pregnant women. Methodology: Subjects grouped in to IRIS exposed and non-IRIS exposed were followed from the end of first trimester for six and half months. Chi-square test was used to establish the association between the variables at p-value < 0.05. Regression analysis was performed to identify independent predictors of APFOs. Adjusted Relative Risk at 95% confidence interval was determined. Results: The IRIS exposed pregnant women, had a 26.47% adverse pregnancy-fetal outcomes cumulative incidence compared to 10.78% among IRIS non-exposed women. The APFO incidence rate estimate was 0.012 and 0.0045 per person’s week respectively. IRIS cases had 2.46 times the risk of experiencing an APFO compared to those who did not [OR=3; 95%CI: 1.4-6.4; P=.004], at bivariate analysis, not sustained at the multivariate analysis [AOR=1.6; 95%CI: 0.4-5.8; P = .508]. Multiple logistic regression dropped maternal HIV-IRIS and revealed; HIV-RNA viral load at baseline of above 50 copies/ml [AOR=2.7; 95%CI: 1.2-6.3; P=.017], Maternal placental syndrome(MPS) characterized by hypertensive event [AOR=0.1; 95%CI:0.0-1.0; P = .052] and mother’s general health during delivery [AOR= 4; 95%CI: 4.0:1.8-9.1;P=.001] as independent predictors of APFOs. Conclusion: There is a higher incidence of APFOs among maternal HIV-IRIS diagnosed pregnant women as compared to non-HIV maternal IRIS diagnosed pregnant women. In particular, MPS characterized by an hypertensive event, HIV-RNA viral load at baseline of above 50 copies/ml and mother’s general health during delivery are key predictors of an adverse pregnancy outcome. Interventions to reduce the associated risk predictors identified in this analysis should be studied for their effects on reducing APFOs.

Introduction:pregnant women need access to skilled attendance at birth and emergency obstetric care (EmOC) to avert maternal deaths. While poor EmOC services may explain the high maternal mortality, inadequate knowledge of providers is also part of the problem. This forms the basis of this paper, in a setting where 50.2% of women deliver in a health facility but maternal mortality remains high at 531/100,000 live births, compared to the national average of 362/100,000 in Kenya. Methods:a facility based cross-sectional survey was conducted in 2018 with a set of knowledge questions extracted from the averting maternal death and disability toolkit. Providers knowledge for maternal and newborn health (MNH) was assessed by interviewing nurses on duty in the maternity units. Data were entered in Ms Access and exported to R version 3.6.2 for descriptive and logistic regression analysis. Ethical clearance was obtained from Kenya Medical Research Unit. Results:a total of 55 nurses were interviewed. Majority (71%) of the respondents were diploma nurses. The overall knowledge score for MNH among the providers was adequate with a score of (64%). Generally, the midwives and higher diploma nurses consistently scored higher than diploma nurses in all the topic areas of MNH. In the mixed linear regression, determinants of knowledge score were seen in provider-level variables. Conclusion:overall, the providers scores were higher on intrapartum and newborn care compared to scores on care for complications. We conclude that in-service training on EmOC to providers is critical to reduction of maternal mortality.

Background: In areas with incomplete salt iodization coverage, infants and children aged 6- 24 months weaning from breast milk and receiving complementary foods are at risk of iodine deficiency. However, few data exist on the risk of excessive iodine intake in this age group. Thyroglobulin (Tg) is a sensitive marker of iodine intake in school-age children and adults and may be used to estimate the optimal iodine intake range in infancy. The aim of this study was to assess the association of low and high iodine intakes with Tg and thyroid function in weaning infants. Methods: This multicenter cross-sectional study recruited infants aged 6-24 months (n = 1543 ; Mage = 12.2 ± 4.6 months) receiving breast milk with complementary foods, from seven countries in areas with previously documented deficient, sufficient, or excessive iodine intake in schoolchildren or pregnant women. Urinary iodine concentration (UIC) and Tg, total thyroxine, and thyrotropin were measured using dried blood spot testing. Results: Median UIC ranged from 48 μg/L (interquartile range 31-79 μg/L) to 552 μg/L (interquartile range 272-987 μg/L) across the study sites. Median Tg using dried blood spot testing was high (>50 μg/L) at estimated habitual iodine intakes 230 μg/day. Prevalence of overt thyroid disorders was low (

Acute excess iodine intake can damage the thyroid, but the effects of chronic excess iodine intake are uncertain. Few data exist for pregnant and lactating women and infants exposed to excessive iodine intake.This was a multicenter cross-sectional study. At study sites in rural Kenya and urban Tanzania previously reporting iodine excess in children, urinary iodine concentration (UIC), thyrotropin, total thyroxine, and thyroglobulin (Tg) were measured in school-age children (SAC), women of reproductive age, pregnant (PW) and lactating women, and breast-feeding and weaning infants. In a national study in Djibouti, UIC was measured in SAC and PW. At all sites, daily iodine intake was estimated based on UIC, and iodine concentration was measured in household salt and drinking water.The total sample size was 4636: 1390, 2048, and 1198 subjects from Kenya, Tanzania, and Djibouti, respectively. In Kenya and Tanzania: (i) median UIC was well above thresholds for adequate iodine nutrition in all groups and exceeded the threshold for excess iodine intake in SAC; (ii) iodine concentrations40 mg of iodine/kg were found in approximately 55% of household salt samples; (iii) iodine concentrations ≥10 μg/L were detected in 9% of drinking water samples; (iv) Tg was elevated in all population groups, but the prevalence of thyroid disorders was negligible, except that 5-12% of women of reproductive age had subclinical hyperthyroidism and 10-15% of PW were hypothyroxinemic. In Djibouti: (i) the median UIC was 335 μg/L (interquartile range [IQR] = 216-493 μg/L) in SAC and 265 μg/L (IQR = 168-449 μg/L) in PW; (ii) only 1.6% of Djibouti salt samples (n = 1200) were adequately iodized (15 mg/kg); (iii) the median iodine concentration in drinking water was 92 μg/L (IQR = 37-158 μg/L; n = 77). In all countries, UIC was not significantly correlated with salt or water iodine concentrations.Although iodine intake was excessive and Tg concentrations were elevated, there was little impact on thyroid function. Chronic excess iodine intake thus appears to be well tolerated by women, infants, and children. However, such high iodine intake is unnecessary and should be avoided. Careful evaluation of contributions from both iodized salt and groundwater iodine is recommended before any review of iodization policy is considered.

Meat is a highly valued food among the Borana pastoralist community in Northern Kenya Borana produce a number of traditionally preserved beef and goat meat products Although these traditional products are widely appreciated there is concern about their nutritional quality especially because some of them are preserved with fats and other ingredients Thus the objectives of this study were to characterize the traditional meat product processes and to establish their nutrient profile and shelf life stability Samples were collected from study sites and analyzed in the laboratory Results showed that moisture contents ranged from to crude protein contents ranged from to while crude fat ranged from to Calcium magnesium iron potassium ranged from mg g mg g mg g and mg g respectively while riboflavin and niacin ranged from mg g and mg g respectively The fatty acid composition showed that beef and goat koche contained good amount of monounsaturated oleic acid at mean levels of and respectively The peroxide value acid value and thiobarbituric acid levels were below the value associated with meat spoilage during the expected shelf life Hence the traditional processed meat products could improve the food security of Borana communities due to its excellent nutrient source for a balanced meal

Despite the availability of novel strategies to prevent micronutrient malnutrition, such as biofortification, limited understanding of stakeholders often hampers their success. We build upon the existing literature on protection motivations (PMT) and technology acceptance (TAM) to develop an integrated PMTAM model for analyzing stakeholders' reactions, on both the supply and demand sides. Regarding the latter, the case of the iodine biofortified food chain is used to evaluate African households' interest. All model constructs, and threat appraisal in particular, are decisive in determining the uptake of biofortification, while also social demographics and own nutrition status play an important role.

Objective/Purpose: To use Protection Motivation Theory (PMT) to evaluate stakeholders' intention to adopt iodine biofortified foods as an alternative means to improve children's iodine status and overall school performance. Methods: A survey was administered with 360 parents of primary school children and 40 school heads. Protection motivation is measured through matching the cognitive processes they use to evaluate iodine deficiency (threat appraisal), as well as iodine biofortified foods to reduce the threat (coping appraisal). Data were analyzed through Robust (Cluster) regression analysis. Results: Gender had a significant effect on coping appraisal for school heads, while age, education, occupation, income, household size and knowledge were significant predictors of threat, coping appraisal and/or protection motivation intention among parents. Nevertheless, in the overall protection motivation model, only two coping factors, namely self-efficacy (parents) and response cost (school heads), influenced the intention to adopt iodine biofortified foods. Conclusion: School feeding programs incorporating iodine biofortification should strive to increase not only consumer knowledge about iodine but also its association to apparent deficiency disorders, boost self-efficacy and ensure that the costs incurred are not perceived as barriers of adoption. The insignificant threat appraisal effects lend support for targeting future communication on biofortification upon the strategies itself, rather than on the targeted micronutrient deficiency. PMT, and coping factors in particular, seem to be valuable in assessing intentions to adopt healthy foods. Nevertheless, research is needed to improve the impacts of threat appraisal factors.

Introduction in 2012, the Government of Kenya amended the Food, Drug and Chemical Substances Act to make the fortification of maize and wheat flour with folic acid mandatory. We assessed folate deficiency, awareness and use of folic acid fortified flour among pregnant women receiving antenatal care (ANC) at a clinic at Pumwani Maternity Hospital, Kenya, 2015. Methods we conducted a cross-sectional survey at Pumwani Maternity Hospital between October and November 2014. We enrolled pregnant women who received ANC and interviewed them using a semi-structured questionnaire after obtaining informed consent. Blood samples were collected from all study participants and serum folate level was analyzed by electrochemiluminescence immunoassay. Folate deficiency was defined as serum folate of < 10nmols/L and borderline folate deficiency was defined as serum folate of between 10nmols/L and 15nmols/L. Results among the 247 study participants, two (1%) had folate deficiency. One hundred and seventy-nine (73.4%) had heard about folic acid, but only 56 (23%) had heard about folic acid fortified flour. Overall, 198 (80%) study participants consumed fortified brands of maize flour and 205 (84%) consumed fortified brands of wheat flour; only four (2%) and two (1%) of study participants consumed specific brands of maize and wheat flour respectively because they were fortified. Conclusion the prevalence of folate deficiency was low and this may have been because of the availability of fortification programs. Although there was limited knowledge of fortified flour, utilization was high. The Kenyan Ministry of Health should enforce implementation of the legislation on maize flour and wheat flour fortification by all milling industries.

Obesity is on the rise in developing countries, especially in urban areas. In this study, a cross-sectional study was conducted in two divisions in Nairobi province to determine the prevalence of and some risk factors associated with overweight and obesity among school children in Nairobi, Kenya. It involved 344 school children aged 9-14 years drawn from four randomly selected public and private primary schools. Weight and height were measured and body mass index was calculated. Nutrition status was determined using the World Health Organization age and gender specific BMI-for-age Z-scores (BAZ). The chi-square test was used to determine the relationship between overweight/obesity and selected socio-demographic characteristics. Complete anthropometric measurements were available for 321 children. Prevalence of combined overweight and obesity (BAZ > +1SD) was 19.0%, with prevalence being higher among girls (21.0%) than boys (16.9%) (p = 0.632). The prevalence among children in private schools was significantly higher (29.0%) than among those in public schools (11.5%) (p = 0.000). In addition, being a single child (p = 0.020), birth order (p = 0.017), mother’s occupation (p = 0.023) and type of residence (p = 0.028) were positively associated with overweight/obesity. The prevalence of overweight/obesity determined in this study is high and is a public health concern, with girls particularly at risk of becoming overweight.

Background Shigellosis is the major cause of bloody diarrhoea worldwide and is endemic in most developing countries. In Kenya, bloody diarrhoea is reported weekly as part of priority diseases under Integrated Disease Surveillance and Response System (IDSR) in the Ministry of Health. Methods We conducted a case control study with 805 participants (284 cases and 521 controls) between January and December 2012 in Kilifi and Nairobi Counties. Kilifi County is largely a rural population whereas Nairobi County is largely urban. A case was defined as a person of any age who presented to outpatient clinic with acute diarrhoea with visible blood in the stool in six selected health facilities in the two counties within the study period. A control was defined as a healthy person of similar age group and sex with the case and lived in the neighbourhood of the case. Results The main presenting clinical features for bloody diarrhoea cases were; abdominal pain (69 %), mucous in stool (61 %), abdominal discomfort (54 %) and anorexia (50 %). Pathogen isolation rate was 40.5 % with bacterial and protozoal pathogens accounting for 28.2 % and 12.3 % respectively. Shigella was the most prevalent bacterial pathogen isolated in 23.6 % of the cases while Entamoeba histolytica was the most prevalent protozoal pathogen isolated in 10.2 % of the cases. On binary logistic regression, three variables were found to be independently and significantly associated with acute bloody diarrhoea at 5 % significance level; storage of drinking water separate from water for other use (OR = 0.41, 95 % CI 0.20–0.87, p = 0.021), washing hands after last defecation (OR = 0.24, 95 % CI 0.08–.076, p = 0.015) and presence of coliforms in main source water (OR = 2.56, CI 1.21–5.4, p = 0.014). Rainfall and temperature had strong positive correlation with bloody diarrhoea. Conclusion The main etiologic agents for bloody diarrhoea were Shigella and E. histolytica. Good personal hygiene practices such as washing hands after defecation and storing drinking water separate from water for other use were found to be the key protective factors for the disease while presence of coliform in main water source was found to be a risk factor. Implementation of water, sanitation and hygiene (WASH) interventions is therefore key in prevention and control of bloody diarrhoea.

As a consequence of the growing interest in, and development of, various types of food with nutritional benefits, the modern consumer views their kitchen cabinet more and more as a medicine cabinet. Given that consumer evaluation of food is considered key to the successful production, marketing and finally consumption of food, a procedure commonly used in medical fields was employed to systematically review and summarize evidence of consumer evaluation studies on nutritious foods. The focus is primarily on consumer understanding of nutritious food and the underlying determinants of consumer evaluation. Our results highlight four groups of key determinants: (1) nutrition knowledge and information; (2) attitudes, beliefs, perceptions and behavioural determinants; (3) price, process and product characteristics; and (4) socio-demographics. The findings also point to the importance of understanding consumer acceptance as one many concepts in the consumer evaluation process, and provide support for developing appropriate strategies for improving health and well-being of consumers.

Indigenous knowledge on food preparation is an activity practised in almost all agricultural production system. Amongst the Borana pastoralist of Northern Kenya, milk and meat production are the cornerstone of livelihood, and more often abundance occurs without possibility of immediate consumption, triggering the need to preserve surplus for future consumption. The objective of this paper is to document and understand traditional meat preparation knowledge amongst Borana pastoralist’s women of Northern Kenya.The method of collecting information included in-depth interviews and participant observations to document meat preparation skills and knowledge of Borana people as appertains to traditional food ways. It was observed that methods of traditional meat processing and preparation included different forms of drying, use of heat and storage in fat. Fourteen traditional meat products and seven preservation techniques were documented. Drying and deep frying were the major form of meat preservation. Women skillfully put a lot of effort in all stages of meat preparation to produce an end product that is not only shelf stable but traditional products that are appreciated and nutritious. It was observed that only four of the products are currently in use, an indication of steady decline in meat handling knowledge and preparation.

The prevalence of HIV/AIDS among men who have sex with men (MSM) in Nairobi has been reported to be 16.4% which is a public health concern. The aim of this study was to determine factors that affected accessibility to, acceptability of, and adherence to HIV/AIDS prevention services by men who have sex with men in Nairobi County, Kenya.Methods. The study used a mixed methods design, applying both quantitative and qualitative methods.Results. Over 70% of MSM reported that TB drugs, antiretroviral drugs, lubricants, condoms, and other STI treatment services were accessible. However, 31.6% of MSM reported that discrimination at the health facility level was a hindrance to accessing HIV/AIDS prevention services while 26.3% reported encountering stigma. 48.4% of MSM consumed alcohol while taking of drugs was reported, at 36.1%.Conclusion. Discrimination and stigma adversely affected MSM seeking HIV/AIDS prevention services in health facilities. MSM engaged in alcohol and substance abuse that likely affected their health seeking behavior. Although most prevention services are reported as accessible, uptake of the same needs to be considered.

Pica is an indicator of low micronutrients in a pregnant woman’s health. Low micronutrients pose a great risk to an otherwise healthy pregnancy. A healthy pregnancy, results in a healthy mother and baby; the critical probability in every pregnancy. The aim of the study was to introduce multiple micronutrients to promote maternal nutrition and influence development in pregnancy health outcomes. Sub-populations at risk of nutritional deficiencies and provided opportunities for early intervention to support the known benefit of multiple micronutrients on pregnancy outcomes i.e. up to six weeks (42 days) post delivery. The variations on pregnancy health, pica and hemoglobin levels among the Multiple Micronutrients (MMs) and Iron Folic Acid (IFA) groups. This was a block randomized controlled study. The intervention arm received MMs while the control received the usual care of IFA. A structured questionnaire with open and closed ended questions was used. Focus group discussions were conducted using a semi-structured guide to collect the qualitative data on the effects of prenatal multiple micronutrients among the pregnant women. The study assumed equal variances based on the Levene’s test of >0.10 (f, 0.196, p=0.661). The difference in inter trimester weight gain means was 5.85 kgs for MMs and 5.52 kgs for IFA (t, 0.109, p=0.914), duration to resumption of household work was 7 days for MMs and 14 days for the IFA groups. The hemoglobin level increased by; 1.25 g/dl for MMs, and 0.45 g/dl for the IFA (t, 0.897, p= 0.376). Pica for stones was experienced among 55.6% of pregnant women; however there was no pica within 14 days among MMs enrollment, but persisted in the IFA group. The study demonstrated no significance in the importance of multiple micronutrients in increasing hemoglobin level (P,0.376), reduction of pica craving during pregnancy (P,0.176) and resumption of household duties (P,0.067) post delivery compared to those on Iron Folic Acid.

Background: Developing countries with high maternal mortality need to invest in indicators that not only provide information about how many women are dying, but also where, and what can be done to prevent these deaths. The unmet Obstetric Needs (UONs) concept provides this information. This concept was applied at district level in Kenya to assess how many women had UONs and where the women with unmet needs were located. Methods: A facility based retrospective study was conducted in 2010 in Malindi District, Kenya. Data on pregnant women who underwent a major obstetric intervention (MOI) or died in facilities that provide comprehensive Emergency Obstetric Care (EmOC) services in 2008 and 2009 were collected. The difference between the number of women who experienced life threatening obstetric complications and those who received care was quantified. The main outcome measures in the study were the magnitude of UONs and their geographical distribution. Results: 566 women in 2008 and 724 in 2009 underwent MOI. Of these, 185 (32.7%) in 2008 and 204 (28.1%) in 2009 were for Absolute Maternal Indications (AMI). The most common MOI was caesarean section (90%), commonly indicated by Cephalopelvic Disproportion (CPD)–narrow pelvis (27.6% in 2008; 26.1% in 2009). Based on a reference rate of 1.4%, the overall MOI for AMI rate was 1.25% in 2008 and 1.3% in 2009. In absolute terms, 22 (11%) women in 2008 and 12 (6%) in 2009, who required a life saving intervention failed to get it. Deficits in terms of unmet needs were identified in rural areas only while urban areas had rates higher than the reference rate (0.8% vs. 2.2% in 2008; 0.8% vs. 2.1% in 2009). Conclusions: The findings, if used as a proxy to maternal mortality, suggest that rural women face higher risks of dying during pregnancy and childbirth. This indicates the need to improve priority setting towards ensuring equity in access to life saving interventions for pregnant women in underserved areas. publishedVersion

Objective: Most of the peanut butter marketed in Nairobi is processed in cottage industry and its aflatoxin contamination status has not been documented. This study was therefore conducted to determine the status of aflatoxin contamination in groundnuts and peanut butter in Nairobi and Nyanza. Methodology and results: Eighty two fresh samples comprising raw and roasted groundnuts and peanut butter were obtained from market outlets and cottage processors in Nairobi and Nyanza regions. The marketers and processors were asked for information on the source of groundnuts. The incidence of Aspergillus section Flavi was determined using standard laboratory methods. Defective nuts in raw groundnuts were determined by manual sorting. Aflatoxin analysis was done using competitive ELISA technique. Groundnuts in Nairobi were imported from Malawi while those Nyanza were grown in the region. The fungal species isolated from the samples were: Aspergillus flavus (L and S strains), A. parasiticus, A. niger, A. tamari, A. alliaceus, A. caeletus and Penicillium spp. The percentage of defective nuts among all unsorted groundnuts ranged from 0.0% to 26.3%. The mean percent defective nuts was higher for Nairobi samples than Nyanza. Aflatoxin levels in all samples ranged from 0 to 2377.1 μg/kg. The mean aflatoxin level was higher for raw samples from Nairobi than Nyanza. The source of groundnuts and defective nuts were positively associated with aflatoxin levels. Conclusions and application of findings: The source of groundnuts and presence of defective nuts were identified as the main factors influencing increased aflatoxin contamination in the cottage industry. Mechanisms for inspection and certification of imported groundnuts should be put in place accompanied by effective monitoring for compliance to set aflatoxins standards. All the market players should sort their groundnuts before selling or processing in order to reduce aflatoxin contamination of peanut butter. Key words: Aflatoxin, cottage industry, groundnut, peanut butter. J. Appl. Biosci. 2013

To determine utilization of iron and folic acid supplementation services among pregnant women in Kenya. A cross sectional study was conducted at Nyeri Hospital, a regional referral hospital in central Kenya. Women attending the antenatal clinic were selected through systematic sampling. A semi-structured questionnaire was administered to collect information on utilization of folic acid and iron supplementation services. Women who ingested folic acid or iron supplements for >4 days in a week were considered “highly compliant”. The health worker in-charge of the antenatal clinic was interviewed about the frequency of supplement stock-outs during the past year. Haemoglobin concentration was measured directly from one drop of capillary blood and measured using portable HEMOCUE B-Hb photometer. Of the 381 women interviewed, only 23.6 % obtained antenatal care in the first trimester; 69.3 and 51.2 % received folic acid and iron supplements, respectively. However, only half (45–58 %) received any information about supplementation. Most women were initiated on folic acid (80.7 %) or iron (67.7 %) after 12 and 16 weeks of gestation, respectively, well after the recommended time period. However, more than 80 % of those who received folic acid and iron were highly compliant. Stock-outs were common at the facility. Of 361 women tested for Hb level, the prevalence of anaemia (Hb levels < 11 g/dl) was 7.8 %. Health workers need to better explain the importance of supplements to pregnant women. Women who come late to antenatal clinic miss opportunities to start supplementation early in pregnancy. Problems with supply chain management exacerbate the problem.

BACKGROUND/OBJECTIVES: Despite successes recorded in combating iodine deficiency, more than 2 billion people are still at risk of iodine deficiency disorders. Rural landlocked and mountainous areas of developing countries are the hardest hit, hence the need to explore and advance novel strategies such as biofortification. SUBJECTS/METHODS: We evaluated adoption, purchase, and consumption of iodine biofortified vegetable legumes (IBVL) using the theory of protection motivations (PMT) integrated with an economic valuation technique. A total of 1,200 participants from three land-locked locations in East Africa were recruited via multi-stage cluster sampling, and data were collected using two, slightly distinct, questionnaires incorporating PMT constructs. The survey also elicited preferences for iodine biofortified foods when offered at a premium or discount. Determinants of protection motivations and preferences for iodine biofortified foods were assessed using path analysis modelling and two-limit Tobit regression, respectively. RESULTS: Knowledge of iodine, iodine-health link, salt iodization, and biofortification was very low, albeit lower at the household level. Iodine and biofortification were not recognized as nutrient and novel approaches, respectively. On the other hand, severity, fear, occupation, knowledge, iodine status, household composition, and self-efficacy predicted the intention to consume biofortified foods at the household level; only vulnerability, self-efficacy, and location were the most crucial elements at the school level. In addition, results demonstrated a positive willingness-to-pay a premium or acceptance of a lesser discount for biofortification. Furthermore, preference towards iodine biofortified foods was a function of protection motivations, severity, vulnerability, fear, response efficacy, response cost, knowledge, iodine status, gender, age. and household head. CONCLUSIONS: Results lend support for prevention of iodine deficiency in unprotected populations through biofortification; however ‘threat’ appraisal and socio-economic predictors are decisive in designing nutrition interventions and stimulating uptake of biofortification. In principle, the contribution is threefold: 1) Successful application of the integrated model to guide policy formulation; 2) Offer guidance to stakeholders to identify and tap niche markets; 3) stimulation of rural economic growth around school feeding programmes.

BACKGROUND/OBJECTIVES: Although it is crucial to identify those children likely to be treated in an appropriate nutrition rehabilitation programme and discharge them at the appropriate time, there is no golden standard for such identification. The current study examined the appropriateness of using Mid-Upper Arm Circumference for the identification, follow-up and discharge of malnourished children. We also assessed its discrepancy with the Weight-for-Height based diagnosis, the rate of recovery, and the discharge criteria of the children during nutrition rehabilitation. SUBJECTS/METHODS: The study present findings from 156 children (aged 6-59 months) attending a supplementary feeding programme at Makadara and Jericho Health Centres, Eastern District of Nairobi, Kenya. Records of age, weight, height and mid-upper arm circumference were selected at three stages of nutrition rehabilitation: admission, follow-up and discharge. The values obtained were then used to calculate z-scores as defined by WHO Anthro while estimating different diagnostic indices. RESULTS: Mid-upper arm circumference single cut-off (

Background: The knowledge on emergency obstetric care (EmOC) is limited in Kenya, where only partial data from sub-national studies exist. The EmOC process indicators have also not been integrated into routine health management information system to monitor progress in safe motherhood interventions both at national and lower levels of the health system. In a country with a high maternal mortality burden, the implication is that decision makers are unaware of the extent of need for life-saving care and, therefore, where to intervene. The objective of the study was to assess the actual existence and functionality of EmOC services at district level. Methods: This was a facility-based cross-sectional study. Data were collected from 40 health facilities offering delivery services in Malindi District, Kenya. Data presented are part of the “Response to accountable priority setting for trust in health systems” (REACT) study, in which EmOC was one of the service areas selected to assess fairness and legitimacy of priority setting in health care. The main outcome measures in this study were the number of facilities providing EmOC, their geographical distribution, and caesarean section rates in relation to World Health Organization (WHO) recommendations. Results: Among the 40 facilities assessed, 29 were government owned, seven were private and four were voluntary organisations. The ratio of EmOC facilities to population size was met (6.2/500,000), compared to the recommended 5/500,000. However, using the strict WHO definition, none of the facilities met the EmOC requirements, since assisted delivery, by vacuum or forceps was not provided in any facility. Rural–urban inequities in geographical distribution of facilities were observed. The facilities were not providing sufficient life-saving care as measured by caesarean section rates, which were below recommended levels (3.7% in 2008 and 4.5% in 2009). The rates were lower in the rural than in urban areas (2.1% vs. 6.8%; p < 0.001 ) in 2008 and (2.7% vs. 7.7%; p < 0.001) in 2009. Conclusions: The gaps in existence and functionality of EmOC services revealed in this study may point to the health system conditions contributing to lack of improvements in maternal survival in Kenya. As such, the findings bear considerable implications for policy and local priority setting. publishedVersion