ABSTRACT
Background: One in five young children globally suffer the consequences of stunted growth and development and millions experience deficiencies in zinc, iron, iodine, vitamins A and B12, nutrients found bioavailable in fish foods. Small-scale fisheries have the potential to generate income and augment fish consumption while being environmentally sustainable if appropriately managed. However, those engaged in small-scale fisheries are often marginalized, poor, and malnourished. The Samaki Salama project seeks to better understand and address these challenges through a three-arm, longitudinal matched cluster study which evaluates the impact of an integrated nutrition social marketing and modified fishing trap intervention. Methods: There will be 400 small-scale fisher households enrolled from Kilifi County, Kenya and residing in communities matched on location (rural), livelihoods, and child nutritional status. The sample will include mothers and other caregivers, children 6-60 months, and fishers in the family. Applying a cluster design, the matched communities will be divided into three groups: (1) control (n = 200); (2) multi-component nutrition social marketing intervention to fishers, mothers, and health workers (n = 100); and (3) multi-component nutrition social marketing intervention plus modified fishing traps and training (n = 100). Primary outcomes include child growth, fish food intakes, and fisheries yield of mature fish. Secondary outcomes are diet diversity, child diarrheal morbidity, and fisheries revenue. A process evaluation will be used to monitor and ensure fidelity of intervention delivery. Discussion: This study builds on a growing body of literature illustrating the effectiveness of nutrition focused social marketing campaigns to promote active engagement of participants, high compliance to the intervention, and sustained behavior change. The second intervention element of modified fishing traps that allow immature fish to escape enables participants to act on the messaging they receive and promotes sustainable fishing through increased harvest efficiency and reduced catch of immature fish. The integrated approach of the Samaki Salama intervention provides an example of how to leverage multiple disciplines to address key challenges to human and environmental health and illustrates a pathway for scaling study innovations to other small-scale fisheries systems. Trial registration: https://clinicaltrials.gov (NCT05254444).
Subject(s)
Fisheries , Nutritional Status , Animals , Child , Child, Preschool , Humans , Diet , Kenya , Rural Population , FishesABSTRACT
Dietary patterns spanning millennia could inform contemporary public health nutrition. Children are largely absent from evidence describing diets throughout human evolution, despite prevalent malnutrition today signaling a potential genome-environment divergence. This systematic review aimed to identify dietary patterns of children ages 6 months to 10 years consumed before the widespread adoption of agriculture. Metrics of mention frequency (counts of food types reported) and food groups (globally standardized categories) were applied to: compare diets across subsistence modes [gatherer-hunter-fisher (GHF), early agriculture (EA) groups]; examine diet quality and diversity; and characterize differences by life course phase and environmental context defined using Köppen-Geiger climate zones. The review yielded child diet information from 95 cultural groups (52 from GHF; 43 from EA/mixed subsistence groups). Animal foods (terrestrial and aquatic) were the most frequently mentioned food groups in dietary patterns across subsistence modes, though at higher frequencies in GHF than in EA. A broad range of fruits, vegetables, roots and tubers were more common in GHF, while children from EA groups consumed more cereals than GHF, associated with poor health consequences as reported in some studies. Forty-eight studies compared diets across life course phases: 28 showed differences and 20 demonstrated similarities in child versus adult diets. Climate zone was a driver of food patterns provisioned from local ecosystems. Evidence from Homo sapiens evolution points to the need for nutrient-dense foods with high quality proteins and greater variety within and across food groups. Public health solutions could integrate these findings into food-based dietary guidelines for children.
ABSTRACT
This study examines barriers to fish consumption during the complementary feeding period in two coastal counties of Kenya with high rates of child malnutrition. Study findings indicate that young child fish consumption is impacted by factors related to accessibility, food preferences, and caregiver's knowledge and beliefs about fish during the complementary feeding period. These factors are influenced by prominent community figures such as elder women and health workers, whose own beliefs and understandings are impacted by underlying cultural norms, potentially limiting fish consumption. To our knowledge, this is the first study conducted in the coastal region of Kenya to focus on understanding fish consumption attitudes and beliefs during the complementary feeding phase. Our findings represent a critical first step towards the creation of more effective policies and interventions to address the significant nutritional disparities that exist in the study population.
