Knowledge, Attitude and Practices (KAP) that Contribute to Low Vitamin A Coverage among Caregivers of Children 6-59 Months: Results from the KAP Survey done in Kenya.

Objectives: The uptake of VAS for children 6-59 months in Kenya is low with only 30% receiving the recommended two doses of VAS yearly. The KAP survey was done to determine socio-cultural enablers and barriers of coverage and uptake of two dose VAS and thus inform the design of responsive behavior change and communication (BCC) strategies. Methods: KAP involved 3842 caregiver interviews,48 In-depth Interviews (IDIs),69 key informant interviews (KIIs) and 48 focus group discussions (FGDs) in 12 counties. Results: The KAP identified facility health workers (FHWs), community health workers (CHWs), and Early childhood and development centers (ECD) teachers as the key influencers to VAS uptake and coverage. Barriers to uptake and coverage include: 1) Restrictive policy that only allows trained health workers to deliver VAS 2) Low knowledge on correct and benefits of VAS 3) Inadequate reporting tools and poor recording and reporting 4) Low demand/uptake of VAS by caregivers post immunization 5) Frequent stock-outs especially for 100,000 IUs capsules. Enablers to uptake and coverage include: 1) Integration of VAS into other child survival services2)Delivery of VAS through ECD centers3) Consistent stocks availability. Conclusions: The KAP results will be used to identify key barriers for the target population and their potential for influencing VAS uptake and coverage. The KAP results will be used to inform the VAS strategy and also the development of a BCC strategy that responds to the socio-cultural beliefs and roles of the targeted population thereby creating an enabling environment for VAS uptake and coverage among children 6-59 months.

Adequacy of Diets for Kenyan Women and Children under Five Years Using 24 hr Recall Data.

Objectives: The Ministry of Health in conjunction with several stakeholders conducted a nationally representative 24-hour dietary recall component of the Kenya National Micronutrient Survey (KNMS) to characterize the average intake and dietary pattern of women of reproductive age and children 7-59 months. Methods: 296 clusters were randomly selected for the KNMS survey. Within each cluster, we randomly selected 2 households that met the inclusion criteria of having either a women of reproductive age, a child under five years of age or both, who are usual residents of the household. An interactive 24-hr recall multiple pass approach was used to collect one day dietary intake data on all households and repeated on a sub-set of 20% households on non-consecutive days. Using PC-SIDE software (version 1.0, June 2013) for data analysis, we determined the usual intake of each nutrient. We report here the dietary data of 399 women (15-49 years) 55 children (7-12 months) and 214 children (13-59 months). Results: Average energy, iron, vitamin A and zinc intakes in women were 1944 kcal, 12.6 mg, 778 μg and 8.1 mg respectively while these nutrient intakes in children 7-12 months and 13-59 months were 473 Kcal, 2.5 mg, 126 μg, 2.1mg and 1036 kcal, 6.3 mg, 366 μg, 4.3 mg respectively. Prevalence of inadequacy among women, children 7-12 months and children 13-59 months using EAR cutoffs and adjusting for intra individual variability was 17%, 94% and 9% for iron; 43%, 99% and 41% for vitamin A; 49%, 62% and 23% for zinc respectively. Conclusions: These data point towards a number of programmatic interventions to improve the adequacy of diets for Kenyan women and children.

Validation of a Photo Atlas for Food Portion Estimation for a National 24-hr Recall Dietary Survey in Kenya.

Objectives: Reliance on respondents’ individual recall ability for accurate dietary data collection is always a challenge. We developed a photo atlas to aid respondents in recall of foods eaten during the interactive 24 hr recall multiple pass approach for data collection during the Kenya National Micronutrient Survey 2011. Photographs of foods are preferred for estimating portion sizes because the amount eaten is easier for the respondent to visualize. However, it was necessary to validate the photo atlas before using it. Methods: Seven common Kenyan food items were chosen for validation of the atlas: cassava root, tomatoes, eggplant, raw chicken wings and legs, watermelon and fried dough. Each color photo displayed three differently sizes of each food item to capture “large,” “medium,” and “small”. Actual food portions were used for comparison with the photos. Volunteers were asked to rate the level of similarity between the actual-life food item and the item in the photograph on a scale of 1 to 5. Five indicated “Perfect Match” and one indicated “Not a Match.” 84 volunteers from KEMRI and Kibera were conveniently selected for the validation exercise. Results: Exact matches were highly observed in all sizes of whole foods (onions (52.4; 61.9%; 59%), tomatoes (59.5%; 58.3%; 63.1%) and eggplants 35.7%; 27.4% and 63.1%) compared to sliced food items. No significant differences observed between female and male matches of food items. Conclusions: Identification of difficult to recall foods can be presented as food albums and used as dietary data collection tools.