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About 25.4 million people worldwide are living as refugees of whom 1.36 million are in Uganda. The refugees in this study were from South Sudan. The objective of this study was to determine the nutrition status of the refugee children and elucidate the factors that contribute to poor nutrition status among the host. The study used comparative analytical cross-sectional design on 340 children aged 6-59 months. The overall prevalence of global acute malnutrition was 3.9%, underweight 14.1%, and stunting 24.7%. Five factors contributed to poor nutrition status; household size (OR a 1.34, 1.92), illness in wasted, stunted and underweight (OR a 1.47, 1.49, 1.97) children, being a host in relation to wasting and stunting (OR a 1.81, 1.36) and deworming (OR a 3.2, 2.13). Although the host had good nutrient intake, the refugee children had better nutrition status. Therefore, the Uganda government should formulate a policy that allows the host to benefit equally from food relief during emergencies., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Nutritional deficiencies are common during pregnancy and a year after childbirth. At the same time, maternal depression affects many women during pregnancy up to 1 year after childbirth. The objectives of this study were to determine the associations between nutrition status, dietary intake, and maternal depression among pregnant women., Methods: This was a cross-sectional study that included 262 pregnant women aged 15 to 49 years attending the antenatal clinic in 2 public health facilities in urban low-income settlements in Nairobi, Kenya. Maternal depression was assessed using Edinburgh Postnatal Depression Scale (EPDS). Mid-upper arm circumference (MUAC) was used to determine nutritional status. Dietary intake was assessed using the 24-hour recall, and brain essential nutrients were assessed through a questionnaire. Odds ratio was used to test the associations. All maternal characteristics with P < .001 in the univariable analysis were considered in the multivariable logistic regression, variables with P < .05 were considered significant., Results: Of the 262 pregnant women, 33.6% (95% CI: 27.9-40.7) had depressive illness as indicated by EPDS >13. About 9.9% of pregnant women had MUAC < 23 cm. The study established statistically significant association between poor nutrition by MUAC and maternal depression ( P < .001). Maternal depression was statistically significantly associated with inadequate intake of brain food essential ( P = .002). Maternal depression was statistically significantly associated with lower income ( P < .001). In multivariable regression analysis, the main predictor of maternal depression was poor nutrition ( P < .004)., Conclusion: These findings reveal an association between poor nutrition and maternal depression. These results suggest that nutritional deficiencies could be a contributing factor for maternal depression. Study recommends dietary interventions as cost-effective way to reduce deficiencies and improve mental health problems for pregnant women. Assessment of maternal depression and dietary intake be integrated as fundamental components of antenatal care.

Background: Prepartum depression is common among pregnant women and has not been studied much in low and middle-income countries. Evidence shows that mental illnesses are more prevalent in urban than in rural areas. The study objective was to determine the magnitude of prepartum depression, risk factors, and real-life experiences of depression among pregnant women. Method: A mixed-method cross-sectional study was conducted. It included 262 pregnant women attending antenatal clinics in two public health facilities in the urban low-income settlement of Nairobi, Kenya. Edinburgh Postnatal Depression Scale (EPDS) with cut-off >13 was used to classify clinical depressive illness. Further, a focus group discussion was conducted with 20 women identified with the depression. Bivariate analysis with Odd's Ratio was used to test associations. Variables with a p<0.05 in multivariate were considered significant. Result: Out of the 262 women, 33.6% were found to have prepartum depression as indicated by an EPDS score of >13. Women's gestational age in the second trimester (87.5%) was statistically significantly associated with prepartum depression (p<0.001). Income levels <10,000 KES (58%) were statistically significantly associated with prepartum depression (p<0.001). Further, thematic analysis of qualitative data indicated that poverty, lack of social support, domestic violence, and unfriendly health care were major contributors to prepartum depression. Conclusion: Significant numbers of pregnant women were found to experience depression. This prevalence rate indicates a high disease burden of women who live with depression, which is not diagnosed because screening of depression is not done in primary health care centers. This study calls for a need and consideration for screening for perinatal depression in primary health care facilities, mainly in resource-poor areas. Interventions targeting means of resolving conflicts in families are highly needed. Such steps would help achieve key sustainable development goals where maternal and child health remains a key priority., Competing Interests: No competing interests were disclosed., (Copyright: © 2020 Madeghe BA et al.)

Background: Prepartum depression is common among pregnant women and has not been studied much in low and middle-income countries. Evidence shows that mental illnesses are prevalent in urban than in rural areas. The study objective was to determine the magnitude of prepartum depression, risk factors, and real-life experiences of depression among pregnant women. Method: A mixed-method cross-sectional study was conducted. It included 262 pregnant women attending antenatal clinics in two public health facilities in urban low-income settlement Nairobi, Kenya. Edinburgh Postnatal Depression Scale (EPDS) with cut-off >13 was used to classify clinical depressive illness. Further, a focus group discussion was conducted with 20 women identified with depression. Univariable analysis with Odd's Ratio was used to test associations. Variables with a p<0.05 in multivariable regression were considered significant. Result: Out of the 262 women, 33.6% were found to have clinical depression as indicated by EPDS score of >13. Women's gestational age was statistically significantly associated with prepartum depression [OR 4.27 (95% C.I. 2.08 - 8.79),  p < 0.001 ]. Income level ≤ 5000 KES was statistically significantly associated with prepartum depression [OR 3.64 (95% C.I.1.25 -10.60), p=0.018 ]. Further, thematic analysis of qualitative indicated that poverty, lack of social support, domestic violence, and unfriendly health care were major contributors to prepartum depression. Conclusion: Significant numbers of pregnant women were found to experience depression. This prevalence rate indicates a high disease burden of women who live with depression, which is not diagnosed because screening of depression is not done in primary health care centers. This study calls for a need and consideration for screening for perinatal depression in primary health care facilities, mainly in resource-poor areas. Interventions targeting means of resolving conflicts in families are highly needed. Such steps would help achieve key sustainable development goals where maternal and child health remains key priority., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Madeghe BA et al.)

Background: Prepartum depression is common among pregnant women and has not been studied much in low and middle-income countries. Evidence shows that mental illnesses are prevalent in urban than in rural areas. The study objective was to determine the magnitude of prepartum depression, risk factors, and real-life experiences of depression among pregnant women. Method: A mixed-method cross-sectional study was conducted. It included 262 pregnant women attending antenatal clinics in two public health facilities in urban low-income settlement Nairobi, Kenya. Edinburgh Postnatal Depression Scale (EPDS) with cut-off >13 was used to classify clinical depressive illness. Further, a focus group discussion was conducted with 20 women identified with depression. Univariable analysis with Odd's Ratio was used to test associations. Variables with a p<0.05 in multivariable regression were considered significant. Result: Out of the 262 women, 33.6% were found to have prepartum depression as indicated by EPDS score of >13. Women's gestational age was statistically significantly associated with depression [OR 3.37; (95% C.I 1.60 - 7.10); p < 0.001 ] Income levels <10,000 KES was statistically significantly associated with prepartum depression [OR 0.39; (95%; C.I 0.23 - 0.66); p < 0.001 ].  Further, thematic analysis of qualitative indicated that poverty, lack of social support, domestic violence, and unfriendly health care were major contributors to prepartum depression. Conclusion: Significant numbers of pregnant women were found to experience depression. This prevalence rate indicates a high disease burden of women who live with depression, which is not diagnosed because screening of depression is not done in primary health care centers. This study calls for a need and consideration for screening for perinatal depression in primary health care facilities, mainly in resource-poor areas. Interventions targeting means of resolving conflicts in families are highly needed. Such steps would help achieve key sustainable development goals where maternal and child health remains key priority., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Madeghe BA et al.)

Background: Globally, it is known that HIV-infected pregnant women are prone to depressive symptoms. Research evidences also suggest that nutrient deficiencies may enhance the depressive illness, and that fish oil omega-3 fatty acids may alleviate the depressive symptoms. The aim of this study was to assess the effect of fish oil omega-3 eicosapentaenoic acid-rich supplements on depressive symptoms among HIV-seropositive pregnant women., Trial Design: A randomized double-blinded controlled trial with two parallel groups was conducted. The intervention group received fish oil omega-3 of 3.17 g (eicosapentaenoic acid = 2.15 g; docosahexaenoic acid = 1.02 g) per day for 8 weeks, while the control group received soybean oil for a similar period., Method: Participants were HIV-seropositive pregnant women who were enrolled in prevention of mother-to-child transmission programs and attending antenatal clinics at selected Nairobi city county's health facilities. Recruitment was done from health records of HIV-infected pregnant women. Data analysis followed per-protocol analysis. Participants who completed the 8-week trial were included in the analysis of covariance statistical model with omega-3 as main effect. The covariates in the change in BDI-II depressive symptom score outcome were baseline characteristics and nutrient adequacy., Results: 282 participants were recruited 109 randomized to fish oil, and 107 to soybean oil. Completion rate was 86/109 (78.9%) and 96/107 (89.7%) respectively. At the end of week-8 of follow up most participants in both arms had mild depressive symptoms 82/86 (95.3%) in the Fish oil group and 94/96 (97.9%) in the Soybean oil group. The difference in effect between the intervention and control group was not statistically significant (1.01 (95% CI - 0.58 to 2.60), p  = 0.21)., Conclusion: Fish oil omega-3 with a daily dosage of 3.17 g (eicosapentaenoic acid = 2.15 g; docosahexaenoic acid = 1.02 g) appears to provide no added benefit in reduction of the symptoms of depression in HIV-infected pregnant women. Trial Registration Clinical Trial Registry: NCT01614249. Registered on June 5, 2012. https://clinicaltrials.gov/ct2/show/NCT01614249.

Streptococcus infantarius subsp. infantarius (Sii), a member of the Streptococcus bovis/Streptococcus equinus complex (SBSEC), predominates as dairy-adapted and non-adapted variants in fermented dairy products (FDP) in East and West Africa. Epidemiologic data suggest an association with colorectal cancer for most SBSEC members, including Sii from Kenyan patients. Phylogenetic relationships of East African human (EAH) isolates to those of dairy and pathogenic origin were analysed to better estimate potential health implications via FDP consumption. The MLST-derived population structure was also evaluated to provide host, disease, geography and dairy adaptation associations for 157 SBSEC isolates, including 83 novel Sii/SBSEC isolates of which 40 originated from Kenyan colonoscopy patients. Clonal complex (CC) 90 was delineated as potential pathogenic CC for Sii. Single EAH, West African dairy (WAD), food and animal Sii isolates clustered within CC-90, suggesting a potential link to pathogenic traits for CC-90. The majority of EAH and WAD Sii were clustered in a shared clade distinct from CC-90 and East African dairy (EAD) isolates. This indicates shared ancestry for the EAH and WAD clade and limitations to translate disease associations of EAH and CC-90 to EAD Sii, which could support the separation of pathogenic, pathobiont/commensal and food lineages.

Consumption of traditional fermented dairy products (tFDP) in Africa leads to the ingestion of up to 10 8 Streptococcus infantarius subspecies infantarius (Sii) per millilitre of spontaneously fermented milk. Sii is a member of the Streptococcus bovis/Streptococcus equinus complex (SBSEC) for which some members are associated particularly with colorectal cancer or endocarditis. The extent of health risks to tFDP consumers is largely unknown. A hospital-based unmatched case-control study was conducted at Kenyatta National Hospital, Nairobi (Kenya) on 80 cases and 193 controls that were selected exhaustively from patients attending colonoscopy at the hospital. Logistic regression models adjusted for age, sex and residency were used in the statistical analysis. Consumption of tFDP was not associated with CRC (odds ratio (OR) 1.4; 95% Confidence interval (CI) 0.7-2.7; p=0.34). Risk factors associated with CRC included age above 40 years, and consumption of processed meat and alcohol. Faecal carriage of Sii was significantly higher in persons with colon tumours and polyps compared to controls (8.4% vs 21.6%: OR: 4.6; CI 1.3-15.9). Patients with haemorrhoids represented an unexpected carrier group with significantly higher Sii faecal carriage (30.4%, CI: 17.7-45.8). Consumption of tFDP does not represent risk factors for CRC whereas Sii seems to be associated with CRC. However, there is urgent need to assess this finding also in the general population, investigate the causality of SBSEC, Sii and CRC as well as compare the phylogenetic, functional and genomic relationship between human and dairy Sii with regards to the ongoing application of Sii in FDP production., (Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.)

Milk is a major source of nutrients, but can also be a vehicle for zoonotic foodborne diseases, especially when raw milk is consumed. In Africa, poor processing and storage conditions contribute to contamination, outgrowth and transmission of pathogens, which lead to spoilage, reduced food safety and security. Fermentation helps mitigate the impact of poor handling and storage conditions by enhancing shelf life and food safety. Traditionally-fermented sour milk products are culturally accepted and widely distributed in Africa, and rely on product-specific microbiota responsible for aroma, flavor and texture. Knowledge of microbiota and predominant, technologically important microorganisms is critical in developing products with enhanced quality and safety, as well as sustainable interventions for these products, including Africa-specific starter culture development. This narrative review summarizes current knowledge of technologically-important microorganisms of African fermented dairy products (FDP) and raw milk, taking into consideration novel findings and taxonomy when re-analyzing data of 29 publications covering 25 products from 17 African countries. Technologically-important lactic acid bacteria such as Lactococcus lactis and Streptococcus infantarius subsp. infantarius (Sii), Lactobacillus spp. and yeasts predominated in raw milk and FDP across Africa. Re-analysis of data also suggests a much wider distribution of Sii and thus a potentially longer history of use than previously expected. Therefore, evaluating the role and safety of African Sii lineages is important when developing interventions and starter cultures for FDP in Africa to enhance food safety and food security. In-depth functional genomics, epidemiologic investigations and latest identification approaches coupled with stakeholder involvement will be required to evaluate the possibility of African Sii lineages as novel food-grade Streptococcus lineage., (Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The Streptococcus bovis/Streptococcus equinus complex (SBSEC) comprises seven (sub)species classified as human and animal commensals, emerging opportunistic pathogens and food fermentative organisms. Changing taxonomy, shared habitats, natural competence and evidence for horizontal gene transfer pose difficulties for determining their phylogeny, epidemiology and virulence mechanisms. Thus, novel phylogenetic and functional classifications are required. An SBSEC overarching multi locus sequence type (MLST) scheme targeting 10 housekeeping genes was developed, validated and combined with host-related properties of adhesion to extracellular matrix proteins (ECM), activation of the immune responses via NF-KB and survival in simulated gastric juice (SGJ)., Results: Commensal and pathogenic SBSEC strains (n = 74) of human, animal and food origin from Europe, Asia, America and Africa were used in the MLST scheme yielding 66 sequence types and 10 clonal complexes differentiated into distinct habitat-associated and mixed lineages. Adhesion to ECMs collagen I and mucin type II was a common characteristic (23 % of strains) followed by adhesion to fibronectin and fibrinogen (19.7 %). High adhesion abilities were found for East African dairy and human blood isolate branches whereas commensal fecal SBSEC displayed low adhesion. NF-KB activation was observed for a limited number of dairy and blood isolates suggesting the potential of some pathogenic strains for reduced immune activation. Strains from dairy MLST clades displayed the highest relative survival to SGJ independently of dairy adaptation markers lacS/lacZ., Conclusion: Combining phylogenetic and functional analyses via SBSEC MLST enabled the clear delineation of strain clades to unravel the complexity of this bacterial group. High adhesion values shared between certain dairy and blood strains as well as the behavior of NF-KB activation are concerning for specific lineages. They highlighted the health risk among shared lineages and establish the basis to elucidate (zoonotic-) transmission, host specificity, virulence mechanisms and enhanced risk assessment as pathobionts in an overarching One Health approach.

Background: In genera self declared female headed-households in most developing countries tend to be poorer, own less and have less access to job opportunities., Objective: To assess the nutritional status of pre-schoolers by gender differentiation of heads of households., Design: A cross-sectional descriptive study carried out in February 2003., Setting: Four beneficiary villages registered under the Ethio-Danish joint community development programme in North Ethiopia., Subjects: A total of 144 heads of random systematically selected households regrouped as male-headed (n = 96) and female-headed households (n = 48) with their respective preschoolers., Main Outcome Measures: Nutritional status of two groups of children categorised by gender of the head of household., Results: The number of pre-schoolers from male-headed households was 1.54 as opposed to the female-headed households (1.08). The proportion of stunted and underweight pre-schoolers was significantly higher in female headed-households than in the male-headed households while the prevalence of wasting was practically similar. The proportion of vaccinated and breastfed children, although not statistically significant, was higher in male headed households while the practice of colostrums feeding, giving water and butter, vitamin A and appropriate weaning was better in female headed households. The difference noted in prevalence of feeding colostrums was significant. The energy, protein and vitamin A intake in almost all of the households was below the recommended daily allowances; showing a nutrient adequacy ratio of 50.2%, 48.8% and 17.9% respectively whereas iron intake exceeded 100%. The energy, protein, vitamin A and iron intake was better in the male-headed households than in female-headed households. The difference, however, was statistically significant for energy only., Conclusion: This study delineated that chronic child under-nutrition is not only higher among female children but also in female headed households and hence the implication of gender biased violation of the right to nutrition security. Other important implication of this study is that apart from gender issues alternative livelihood options that promote healthy behaviours, such as, improving the provision of health services and curbing the harmful traditional practices that may have a dual impact on the well being of mothers and children is recommended.

Objective: To identify the factors associated with childhood under-nutrition in North Wollo, Ethiopia., Design: A cross-sectional study., Setting: Four purposefully selected rural villages (kebeles) in North Wollo zone of the Amhara Region, Ethiopia., Subjects: One hundred-forty four sampled households with under five year old children (n=200) comprising of 96 male-headed, 24 female-headed and 24 landless with children aged between six and 59 months., Main Outcome Measures: Determinations of anthropometric measurements and various socio-economic factors., Results: The overall prevalence rate of under nutrition as determined by stunting, underweight and wasting was 44.5%, 25.0% and 9.0% respectively with more preponderance among the toddlers. The proportion of under nutrition was higher in female-headed households. Shortage of farmland, lack of irrigation, dispossession of livestock, shortage of non-farm employment options, parental illiteracy, high number of children, water inadequacy, food taboos and wrong eating habits of families, poor child feeding practices, deprivation of health nutrition education as well as maternal attributes such as young motherhood, low body mass index and short stature of mothers influenced the nutritional status of the children. The prominent risk factors for undernutrition among children were dispossession of livestock, child food taboos and wrong eating habits of families, deprivation of health/nutrition education, short stature and early marriage of mothers., Conclusion: This study led to the conclusion that improvement of household resources through promotion of irrigation and initiation of income generating livelihood options can reverse the nutrition situation for better. Health and nutrition education focusing on appropriate child feeding, eradication of harmful traditional practices such as early marriage and inequitable intra-household food distribution, encouragement of family planning and nutrition interventions including food diversification is recommended.

Objective: To evaluate the impact of daily and weekly iron supplementation on serum zinc status among anaemic lactating mothers., Design: A randomised iron intervention controlled trial., Setting: Seven urban slum communities of Addis Ababa., Subjects: Phase one of the study involved 207 anaemic lactating women assigned into two intervention groups; the daily (N=71) and weekly (N=71) Iron supplemented and the control group (N=68). Supplementation with 60 mg tablet containing 300 microg ferrous sulphate and 400 microg folic acid was done for three months while the control group was n otsupplemented. Phase two involved 53 participants systematically drawn from phase one., Main Outcome Measures: Haemoglobin from all subjects and serum zinc and ferittin levels following three months supplementation. Zinc status based on serum zinc value of less than 10.7% micromole/L., Results: The mean baseline characteristics and serum zinc of the women at baseline were similar, overall marginal zinc deficiency prevalence was 11.3% and no zinc deficiency was detected. Following supplementation, zinc deficiency was detected in the supplemented groups but not in the control group. The mean serum zinc significantly changed in both supplemented groups while no change was observed in the control group. The reduction in the mean serum zinc was significantly higher in the daily than in the weekly supplemented group., Conclusion: Iron supplementation impacts negatively on serum zinc status (exacerbates zinc deficiency) and hence, its contribution to zinc deficiency deserves further investigation especially in the context of the on-going promotion of double fortification strategies that involve iron.

Objective: To determine and compare the socio-economic characteristics, childcare and feeding practices among children aged 6-59 months of households participating in a World Vision Kenya programme with non-participants., Design: A comparative cross-sectional survey., Setting: A World Vision Kenya project area (Kimundi and Yinthungu sub-locations) and a non-project area (Thavu and Yeekanga sub-locations) both in Kathonzweni division, Makueni district., Study Population: A random sample of 320 children aged 6-59 months and their respective households. A sub-sample (n=60) was assessed for dietary intake., Results: A significantly higher proportion of children in the non-project area (63.8%) than in the project area (37.5 %)(p=0.00) were introduced to complementary foods within the first three months. The first main food given to children in both areas was unenriched cereal porridge. In both areas, grandmothers were reported to be the main alternative caregivers though most of the mothers prepared food for the children while other caretakers did the actual feeding., Conclusion: No significant difference was noted in the childcare practices in the two areas contrary to what may have been expected since the programme aimed at promoting appropriate childcare and feeding practices hence the expected difference.

A cross-sectional study was done from March to May 1997 in four selected slum kebeles (villages) of Addis Ababa in which nutritional status of 758 children aged 6 to 36 months was examined and stratified into malnourished and well nourished groups. Analysis of hygiene and health seeking practices of randomly selected households of the two sets of children determined practices that significantly exacerbate childhood malnutrition. The rates of immunization for the malnourished (80.2%) and well nourished households (77.6%) were practically the same. No significant difference was found in the prevalence of home treatment or food withholding habits at times of diarrhoea episodes between the two groups. The study established six variables to predict childhood malnutrition in the slum section of Addis Ababa: 1) presence of child waste inside house (Odds Ratio = 7.44; p < 0.0001), 2) diarrhoea treatment at the hospital (OR = 0.47;p < 0.05), 3) prolonged storage of cooked foods (OR = 2.86;p < 0.05), 4) feeding with washed hands (OR = 0.44; p < 0.01), and 5) poor handling of drinking water (OR = 3.18; p < 0.01) and 6) foods (OR = 3.52; p < 0.01). Hence strong and sustainable advice with a view of changing the behaviours of households towards good personal and household hygiene practices, and increased utilization of health settings is recommended as these may limit the overall success of public health programmes.

Most nutrition education programmes in Kenya operate on the premise that nutritional knowledge can have an impact on children's nutritional status. It has, however, been argued that nutritional knowledge among low income groups is unlikely to have an impact, hence, the need to establish whether there is a relationship between nutritional status and maternal nutritional knowledge. In a cross-sectional survey carried out in a Nairobi slum (Kibera), nutritional status of 363 children aged six to 24 months was measured and nutritional knowledge of their mothers assessed. Makina village was randomly selected as the study site and all consenting households were involved in the study. The study established that most mothers (97.5%) have access to nutrition education. Prevalence of stunting (86.2%) and underweight (58.4%) was high but that of wasting (1.9%) was low. There was no significant relationship between the nutritional status of children and overall nutritional knowledge. Unexpectedly, a negative relationship was found between nutritional status and mothers' ability to recognise clinical signs of malnutrition, knowledge in the weaning process and dietary management during sickness. Knowledge on frequency of feeding was, however, positively related to nutritional states. In conclusion, nutritional knowledge alone is inadequate in ensuring young children's nutrition security and, hence, for nutrition education programmes to have a positive impact, facilitational strategies must be incorporated.

Assessments of nutritional status of semi-arid population in Kiambu District comprising 1042 persons from 260 households showed that 64.2% of the households had at least one malnourished person. The main aim of the study was to establish whether patterns of households malnutrition were distinguishable by specific risk indicators. Fourteen patterns of household malnutrition were established by classifying malnourished people according to age vis-a-vis nutritional status of other members of that household and six risk indicators were found to be related to malnutrition at the household level. Although partial relation was found between patterns and some indicators, no risk was found to be exclusively related to a specific pattern but failure to establish such a relationship was attributed to sample size.