Undernutrition of orphans and vulnerable children: a comparison of cash transfer beneficiaries and non beneficiaries in Korogocho slums, Nairobi.

OBJECTIVE: To assess the prevalence and associated factors for undernutrition among the beneficiaries of Kenya Cash Transfer Program compared to non-beneficiaries in Korogocho, Nairobi. Optimal nutrition reduces the prevalence of undernutrition and contributes to improved child survival and development. METHODS: A comparative descriptive cross-sectional study design in which a total of 336 children were sampled from the two groups each consisting 168 children. A questionnaire was administered to caregivers. A Food Frequency Questionnaire and a 24 Hour Recall sought information on foods consumed. Anthropometric measurements were taken based on standard procedures. Wasting, underweight and stunting were determined based on a z-score of > or = -2 or < -2 SD. A chi-square test was used to test significance associations of wasting, underweight and stunting with other variables. RESULTS: A majority (89.3%) and (73.8%) of the principal caregivers were females among the beneficiaries and non-beneficiaries respectively. Among the beneficiaries, prevalence of wasting was 6%, underweight 6% and stunting 32.7%. Among non-beneficiaries, undernutrition was higher with wasting 9.5%, underweight 17.9% and stunting 37.5%. There was a significant difference (chi2 = 11.351, df = 1, p = 0.001) for underweight among the beneficiaries and non-beneficiaries. Nutrient inadequacies were high in vitamin A, folate and zinc in both beneficiaries and non-beneficiaries. In beneficiaries, undernutrition was significantly (p < 0.05) associated with number of children aged 6-59 months in the household, cash transfer used on food, carbohydrate intake, protein intake and frequency of breastfeeding. Among non-beneficiaries, undernutrition was significantly (p < 0.05) associated with number of household members, number of children 6-59 months in the household and income spent on food. CONCLUSIONS: There was improved nutritional status among the beneficiaries compared to non-beneficiaries. However, there is need of training beneficiaries on the best use of the cash transfers and educating them on consumption of adequate food to improve nutrient intake and eventually their nutritional status.

NUTRIENT INTAKE AMONG PREGNANT TEENAGE GIRLS ATTENDING ANTE-NATAL CLINICS IN TWO HEALTH FACILITIES IN BUNGOMA SOUTH DISTRICT, WESTERN KENYA.

OBJECTIVE: To assess the adequacy of nutrientintake including proteins, energy, calcium, iron, folate and vitamin C and identify the factors associated with nutrient intake. DESIGN: Cross sectional study. SETTING: Healthy facility based. Bungoma District Hospital and Bumula Health centre. SUBJECTS: Teenage pregnant girls attending Antenatal Clinic participated after providing written consent, with girls under 18 years being considered as emancipated minors. A standardised interviewer administered Food Frequency Questionnaire was used to asses the dietary intake. Nutrient calculator was used to determine the nutrient intake of the study participant. RESULTS: The intakes of all selected nutrients were significantly lower than the RDA. Protein intake was significantly associated with Education (OR: 0.537; 95% CI: 0.318-0.907), income (OR: 0.049; 95% CI: 0.919-0.128) and perceived food shortage (OR: 0.617; 95% CI: 0.389-0.890). Energy intake was significantly associated with income (p = 0.007, OR: 2.103; 95%CI: 1.225-3.608). Iron intake was significantly associated with perceived food shortage (OR: 2.548; 95% CI: 1.632-3.980). Hookworm affected calcium intake (OR: 3.074; 95% CI: 1.089-8.698) and malaria parasites affected folate intake (OR: 0.355; 95% CI: 0.226-0.557). Those with hookworm were 3 times more likely to have inadequate calcium intake as compared to those without. CONCLUSION: All the nutrients selected were lower than the Required Dietary Allowance. Level of education, income, Hookworm and malaria affected intake of various nutrients.

Assessment of body composition and breast milk volume in lactating mothers in pastoral communities in Pokot, Kenya, using deuterium oxide.

BACKGROUND: In sub-Saharan Africa, the practice of breast-feeding infants is common. Records documenting the intake of breast milk amongst infants are limited. This study evaluated the association between maternal body composition and the intake of breast milk in infants from the pastoral communities within Pokot, Kenya. METHODS: The study was conducted in 10 lactating mothers who were participating in a longitudinal study aimed at determining maternal body composition, iron stores and vitamin A status during the third trimester pregnancy and four months after they had given birth. Maternal and infant anthropometric measurements were made, and maternal blood samples were taken to determine serum retinol and ferritin levels. Infant milk intake and maternal fat-free mass (FFM) and percent body fat (% BF) were measured using 'the dose to the mother method'. A measured deuterium oxide ((2)H(2)O) dose was given to the mother. Urine and breast milk from the mother, and saliva samples from the infant, were collected on days 1, 8 and 14 after dosing. RESULTS: The mean (+/- SD) maternal mid upper arm circumference (MUAC) and body mass index (BMI) were 21.8 (0.9) cm and 18.6 (1.0) kg/height (m(2)), respectively. Infant weight and weight/age Z score were 4.956 (0.874) kg and -1.750 (0.77), respectively. Throughout the study, the infants gained 20 (4) g/day in body weight and had a milk intake of 555 (22) ml/day. The energy intake of the infant was 1,602 (148) kJ/day and was lower (p < 0.05) than the 2,404 (423) kJ/day estimated requirement by the FAO/WHO/UNU. The maternal FFM, %BF, Hb, Hct, ferritin and retinol were 32.8 (3.1) kg, 17.24 (7.0), 11.5 (1.3) g/dl, 33.9 (4.9), 16.2 (0.1) microg/l and 0.894 (0.16) micromol/l, respectively. Infant milk intake was significantly and positively correlated to maternal pregnancy triceps (r = 0.679) p < 0.05) and pregnancy MUAC (r = 0.725) p < 0.05). Maternal pregnancy MUAC was an important predictor of infant breast milk intake. CONCLUSION: Data on volume of breast milk consumed by the infants suggests, at least for this group of infants, that adequate growth may not be achieved. There is a possibility that lactating mothers practicing exclusive breast-feeding and living under harsh conditions may experience periods of low breast milk volume. Body composition and biochemical findings among this group of Pokot mothers indicate dietary inadequacies that require nutritional intervention.

Serum retinol, iron status and body composition of lactating women in Nandi, Kenya.

BACKGROUND: Maternal vitamin A and iron status was investigated among lactating mothers in a rural community in Kenya. The aim of the study was to establish the prevalence and the relationship of these key nutrients to maternal body composition. METHODS: Eighty-eight mothers provided samples of breast milk and blood for determination of breast milk vitamin A, serum retinol and ferritin. Estimators of body composition were based on the mother's weight, height and skinfold measurements. RESULTS: A total of 78.1% women had breast milk retinol <1.05 micromol/l with 38 and 62% having lactated for a period of <4 and >4 months, respectively. Prevalence of severely deficient serum retinol <0.35 micromol/l and ferritin <12 microg/l was 10 and 37%, respectively. Women with serum ferritin <12 microg/l had significantly lower average hemoglobin (p < 0.01), hematocrit (p < 0.01) and serum retinol (p < 0.05). Serum retinol of mothers who had lactated for <4 months was significantly but negatively correlated with total body fat (r = -0.40; p < 0.05). With a lactation period of >4 months a close relationship was found between serum retinol and hemoglobin (r = 0.26; p <0.01), serum retinol and serum ferritin (r = 0.20; p < 0.05), and fat free mass significantly but negatively correlated with breast milk fat (r = -0.27; p < 0.05). Serum retinol in combination with hematocrit significantly affected both maternal hemoglobin (p < 0.01) and serum ferritin (p < 0.01). CONCLUSION: A high prevalence of vitamin A and iron deficiency was observed in this group of lactating women. Low levels of fat mass were directly related to these indicators of malnutrition.

Glycaemic responses after ingestion of some local foods by non-insulin dependent diabetic subjects.

Fifteen non-insulin dependent diabetic volunteers, aged 51 +/- 3.9 years, were studied over a two month period to determine their glycaemic responses to various local foods. They were all on chlorpropamide and one subject was removed from analysis due to concurrent use of insulin. They received on separate occasions two servings of white bread, one serving of: brown bread, white lice, English potatoes, maize meal, millet and cassava each. Each meal contained 50 g of carbohydrate. A total of 107 glucose tolerance tests (GTTs) were performed and the glycaemic index (GI) for each food calculated. The mean blood sugars at 0,60 and 120 minutes were comparable for each food, and the peak rise occurred at 60 minutes. The highest rise (4.0 mmol/I) was seen with millet porridge. The highest GI was seen with white rice and the lowest with English potatoes (159.9 and 34.3 respectively). Overall, the cereals conferred higher GIs than the root vegetables. The GIs of English potatoes, maize meal, millet and cassava significantly differed from that of white bread. It is concluded that, using GIs, dietary guidelines comprising locally available and affordable foods can be made.