22 results on '"Wanjohi, Milka"'
Search Results
2. Balancing paid work and child care in a slum of Nairobi, Kenya: The case for centre-based child care
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Clark, Shelley, De Almada, Midanna, Kabiru, Caroline W, Muthuri, Stella, and Wanjohi, Milka
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- 2021
3. Realities and challenges of breastfeeding policy in the context of HIV: a qualitative study on community perspectives on facilitators and barriers related to breastfeeding among HIV positive mothers in Baringo County, Kenya
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Samburu, Betty Mogesi, Kimiywe, Judith, Young, Sera Lewise, Wekesah, Frederick Murunga, Wanjohi, Milka Njeri, Muriuki, Peter, Madise, Nyovani Janet, Griffiths, Paula L., and Kimani-Murage, Elizabeth W.
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- 2021
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4. Potential effectiveness of integrating human milk banking and lactation support on neonatal outcomes at Pumwani Maternity Hospital, Kenya.
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Wilunda, Calistus, Israel‐Ballard, Kiersten, Wanjohi, Milka, Lang'at, Nelson, Mansen, Kimberly, Waiyego, Mary, Kibore, Minnie, Kamande, Eva, Zerfu, Taddese, Kithua, Angela, Muganda, Rosemarie, Muiruri, Juliana, Maina, Beth, Njuguna, Emily, Njeru, Faith, Kiige, Laura W., Codjia, Patrick, Samburu, Betty, Mogusu, Esther, and Ngwiri, Thomas
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BREAST milk collection & preservation ,LACTATION ,MATERNAL health services ,MOTHERS ,LENGTH of stay in hospitals ,PILOT projects ,SOCIAL support ,CAREGIVERS ,CONFIDENCE intervals ,CLINICAL trials ,BREAST milk ,RESEARCH methodology ,HOSPITAL care of newborn infants ,REGRESSION analysis ,PREGNANCY outcomes ,PRE-tests & post-tests ,PUBLIC hospitals ,DESCRIPTIVE statistics ,RESEARCH funding ,ODDS ratio ,DATA analysis software ,CHILDREN - Abstract
We assessed the potential effectiveness of human milk banking and lactation support on provision of human milk to neonates admitted in the newborn unit (NBU) at Pumwani Maternity Hospital, Kenya. This pre–post intervention study collected data from mothers/caregivers and their vulnerable neonates or term babies who lacked sufficient mother's milk for several reasons admitted in the NBU. The intervention included establishing a human milk bank and strengthening lactation support. Preintervention data were collected between 5 October 2018 and 11 November 2018, whereas postintervention data were collected between 4 September 2019 and 6 October 2019. Propensity score‐matched analysis was performed to assess the effect of the intervention on exclusive use of human milk, use of human milk as the first feed, feeding intolerance and duration of NBU stay. The surveys included 123 and 116 newborns at preintervention and postintervention, respectively, with 160 newborns (80 in each group) being included in propensity score matched analysis. The proportion of neonates who exclusively used human milk during NBU stay increased from 41.3% preintervention to 63.8% postintervention (adjusted odds ratio [OR]: 2.68; 95% confidence interval [CI]: 1.31, 5.53) and those whose first feed was human milk increased from 55.0% preintervention to 83.3% postintervention (adjusted OR: 5.09; 95% CI: 2.18, 11.88). The mean duration of NBU stay was 27% (95% CI: 5.8%, 44.0%) lower in the postintervention group than in the preintervention group. The intervention did not affect feeding intolerance. Integrating human milk banking and lactation support may improve exclusive use of human milk among vulnerable neonates in a resource limited setting. Key messages: Mother's milk is recommended for feeding preterm and low birthweight neonates.However, when the provision of mother's milk is not feasible, the use of donor human milk—from a human milk bank—is recommended.In this quasi‐experimental study, human milk banking and lactation support intervention increased the exclusive use of human milk during hospital stay and the use of human milk as the first feed among neonates admitted in the newborn unit at Pumwani Maternity Hospital, Kenya.The intervention also reduced the duration of stay in the newborn unit and there was no impact on feeding intolerance.Human milk banking and lactation support may improve the exclusive use of human milk among vulnerable neonates in a resource‐limited setting. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Malnutrition, morbidity and infection in the informal settlements of Nairobi, Kenya: an epidemiological study
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De Vita, Maria Vittoria, Scolfaro, Carlo, Santini, Bruna, Lezo, Antonella, Gobbi, Federico, Buonfrate, Dora, Kimani-Murage, Elizabeth W., Macharia, Teresiah, Wanjohi, Milka, Rovarini, Jacopo Mattia, and Morino, Gianfranco
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- 2019
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6. Exploring the Experiences of Middle Income Mothers in Practicing Exclusive Breastfeeding in Nairobi, Kenya
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Wainaina, Caroline W., Wanjohi, Milka, Wekesah, Frederick, Woolhead, Gillian, and Kimani-Murage, Elizabeth
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Newborn infants -- Health aspects -- Analysis ,Women -- Health aspects -- Analysis ,Breast feeding -- Health aspects ,Health care industry - Abstract
Objectives To establish exclusive breastfeeding (EBF) practice, women are encouraged to initiate breastfeeding of their newborns within one hour of delivery and breastfeed exclusively for the first 6 months of the infant's life. Research in Kenya has shown evidence of a reduced rate of EBF with an increase in socio-economic class (SES). This study explores the experiences of middle-income women so as to understand their attitudes and practices of EBF and to contribute toward the Baby Friendly Hospital (BFHI) and Baby Friendly Community Initiatives (BFCI) programs in Kenya. Methods A qualitative study using nine in-depth interviews and two focus group discussions were conducted with middle-income women with a child < 2 years. Thematic content analysis was used to analyze the data. Results The majority of the women interviewed did not achieve EBF and this was attributed to many challenges that they encountered such as; inadequate workplace support including short maternity leave, lack of designated breast feeding facilities flexible hours and breastfeeding breaks. Support structures were highlighted as either inadequate or lacking while the internet was preferred by most of the women for breastfeeding information. Mass media was seen as more credible, though some women indicated that there was lack of depth in the information it provided. Conclusion The study showed that majority of women were unable to EBF for the first 6 months. Women experienced inadequate social, healthcare and workplace support and preferred online sites for information on breastfeeding than the healthcare professionals or mass media. Recommendation There is need to implement policies at the workplace that promote a breastfeeding friendly environment. There is also a need for more research on role of mass media in promotion of optimal breastfeeding practices, especially how to reach this population. There is a need for continued advocacy on social support including spousal, relatives, and other community members at the community level., Author(s): Caroline W. Wainaina [sup.1] [sup.2] , Milka Wanjohi [sup.2] , Frederick Wekesah [sup.2] , Gillian Woolhead [sup.1] , Elizabeth Kimani-Murage [sup.2] Author Affiliations: (Aff1) 0000 0004 1936 8470, grid.10025.36, [...]
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- 2018
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7. Integrated and simplified approaches to community management of acute malnutrition in rural Kenya: a cluster randomized trial protocol
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Kimani-Murage, Elizabeth Wambui, Pythagore, Hermann, Mwaniki, Elizabeth, Daniel, Tewoldeberha, Samburu, Betty, Cuellar, Pilar Charle, Mbochi, Regina, Njiru, James, Wangare, Lucy, Karimurio, Lydia, Agutu, Olivia, Maina, Lucy Gathigi, Okoth, Peter, Raburu, Judith, Wanjohi, Milka, Macharia, Triza, and Zerfu, Taddese Alemu
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- 2019
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8. Social value of a nutritional counselling and support program for breastfeeding in urban poor settings, Nairobi
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Goudet, Sophie, Griffiths, Paula L., Wainaina, Caroline W., Macharia, Teresia N., Wekesah, Frederick M., Wanjohi, Milka, Muriuki, Peter, and Kimani-Murage, Elizabeth
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- 2018
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9. Investigating foods and beverages sold and advertised in deprived urban neighbourhoods in Ghana and Kenya: a cross-sectional study
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Green, Mark Alan, Wanjohi, Milka Njeri, Aryeetey, Richmond Nii Okai, Green, Mark, Pradeilles, Rebecca, Laar, Amos, Osei-Kwasi, Hibbah, Bricas, Nicolas, Coleman, Nathaniel, Klomegah, Senam, Wanjohi, Milka, Tandoh, Akua, Akparibo, Robert, Aryeetey, Richmond, Griffiths, Paula, Kimani-Murage, Elizabeth, Mensah, Kobby, Muthuri, Stella, Zotor, Francis, Holdsworth, Michelle, University of Liverpool, African Population and Health Research Center, Inc (APHRC Campus), University of Ghana, Loughborough University, University of Sheffield [Sheffield], Marchés, Organisations, Institutions et Stratégies d'Acteurs (UMR MOISA), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad)-Centre International de Hautes Etudes Agronomiques Méditerranéennes - Institut Agronomique Méditerranéen de Montpellier (CIHEAM-IAMM), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Département Environnements et Sociétés (Cirad-ES), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad), University of Health and Allied Sciences [Ho] (UHAS), Department for International Development (DFID), DFID, Nutrition et Alimentation des Populations aux Suds (NutriPass), Institut de Recherche pour le Développement (IRD)-Université Montpellier 1 (UM1)-Université Montpellier 2 - Sciences et Techniques (UM2)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Université de Montpellier (UM), This work was supported by two funders. The ‘Dietary Transitions in Ghana’ project was funded by a grant from the Drivers of Food Choice (DFC) Competitive Grants Programme [grant number OPP1110043] which is funded by the Bill and Melinda Gates Foundation and the Department for International Development (DFID), and managed by the University of South Carolina Arnold School of Public Health, USA. DFC supports new research on understanding food choice among the poor in low/middle-income countries, strengthening country-level leadership in nutrition and fostering a global community of food-choice researchers. The TACLED project was funded by a Global Challenges Research Fund (GCRF) Foundation Award led by the MRC [grant number MR/P025153/1], and supported by AHRC, BBSRC, ESRC and NERC, with the aim of improving the health and prosperity of low/middle-income countries., Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), and Université Montpellier 1 (UM1)-Institut de Recherche pour le Développement (IRD)-Université Montpellier 2 - Sciences et Techniques (UM2)-Université de Montpellier (UM)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro)
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Urban Population ,030309 nutrition & dietetics ,Cross-sectional study ,statistics & research methods ,lcsh:Medicine ,Global Health ,Ghana ,Comportement alimentaire ,0302 clinical medicine ,Advertising ,Poverty Areas ,Medicine ,030212 general & internal medicine ,2. Zero hunger ,0303 health sciences ,Enquête auprès des consommateurs ,public health ,digestive, oral, and skin physiology ,Outcome measures ,General Medicine ,social phenomena [EN] ,Latent class model ,Latent Class Analysis ,accès à la nourriture ,Zone urbaine ,Beverages ,03 medical and health sciences ,Environmental health ,Humans ,E50 - Sociologie rurale ,nutrition & dietetics ,Food type ,Niveau de vie ,Descriptive statistics ,business.industry ,lcsh:R ,Food advertisements ,Kenya ,Cross-Sectional Studies ,Food ,business ,[SDV.AEN]Life Sciences [q-bio]/Food and Nutrition ,human activities ,E73 - Économie de la consommation ,Food environment - Abstract
ObjectivesThe aim of this study was to characterise the local foods and beverages sold and advertised in three deprived urban African neighbourhoods.DesignCross-sectional observational study. We undertook an audit of all food outlets (outlet type and food sold) and food advertisements. Descriptive statistics were used to summarise exposures. Latent class analysis was used to explore the interactions between food advertisements, food outlet types and food type availability.SettingThree deprived neighbourhoods in African cities: Jamestown in Accra, Ho Dome in Ho (both Ghana) and Makadara in Nairobi (Kenya).Main outcome measureTypes of foods and beverages sold and/or advertised.ResultsJamestown (80.5%) and Makadara (70.9%) were dominated by informal vendors. There was a wide diversity of foods, with high availability of healthy (eg, staples, vegetables) and unhealthy foods (eg, processed/fried foods, sugar-sweetened beverages). Almost half of all advertisements were for sugar-sweetened beverages (48.3%), with higher exposure to alcohol adverts compared with other items as well (28.5%). We identified five latent classes which demonstrated the clustering of healthier foods in informal outlets, and unhealthy foods in formal outlets.ConclusionOur study presents one of the most detailed geospatial exploration of the urban food environment in Africa. The high exposure of sugar-sweetened beverages and alcohol both available and advertised represent changing urban food environments. The concentration of unhealthy foods and beverages in formal outlets and advertisements of unhealthy products may offer important policy opportunities for regulation and action.
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- 2020
10. Factors affecting actualisation of the WHO breastfeeding recommendations in urban poor settings in Kenya
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Kimani-Murage, Elizabeth W., Wekesah, Frederick, Wanjohi, Milka, Kyobutungi, Catherine, Ezeh, Alex C., Musoke, Rachel N., Norris, Shane A., Madise, Nyovani J., and Griffiths, Paula
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- 2015
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11. Chapter 7 - Personalized Nutrition for Women, Infants, and Children
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Kimani-Murage, Elizabeth Wambui, Nyamasege, Carolyn K., Mutoni, Sandrine, Macharia, Teresia, Wanjohi, Milka, Kamande, Eva W., Mwaniki, Elizabeth, Muriuki, Peter G., Wekesah, Frederick Murunga, Wainaina, Caroline, Mutisya, Maurice, and Zerfu, Taddese Alemu
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- 2019
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12. The political economy of sugar-sweetened beverage taxation: an analysis from seven countries in sub-Saharan Africa.
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Thow, Anne Marie, Abdool Karim, Safura, Mukanu, Mulenga M., Ahaibwe, Gemma, Wanjohi, Milka, Gaogane, Lebogang, Justus Amukugo, Hans, Mulindabigwi Ruhara, Charles, Ngoma, Twalib, Asiki, Gershim, Erzse, Agnes, and Hofman, Karen
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TAXATION ,NON-communicable diseases ,BEVERAGES ,PRACTICAL politics ,LEADERSHIP ,STAKEHOLDER analysis ,INTERVIEWING ,PUBLIC health ,QUALITATIVE research ,CONCEPTUAL structures ,GOVERNMENT agencies ,PUBLIC opinion ,NUTRITION policy - Abstract
Background: Non-communicable diseases are on the rise across sub-Saharan Africa. The region has become a targeted growth market for sugar-sweetened beverages, which are associated with weight gain, cardiovascular diseases and diabetes. Objective: To identify politico-economic factors relevant to nutrition-related fiscal policies, and to draw lessons regarding strategies to strengthen sugar-sweetened beverages taxation in the region and globally. Methods: We collected documentary data on policy content, stakeholders and corporate political activity from seven countries in east and southern Africa augmented by qualitative interviews in Botswana, Namibia, Kenya and Zambia, and stakeholder consultations in Rwanda, Tanzania and Uganda. Data were analysed using a political economy framework, focusing on ideas, institutions, interests and power, and a 'bricolage' approach was employed to identify strategies for future action. Results: Non-communicable diseases were recognised as a priority in all countries. Kenya, Zambia, Rwanda, Tanzania and Uganda had taxes on non-alcoholic beverages, which varied in rate and tax base, but appeared to be motivated by revenue rather than health concerns. Botswana and Namibia indicated intention to adopt sugar-sweetened beverage taxes. Health-oriented sugar-sweetened beverage taxation faced challenges from entrenched economic policy paradigms for industry-led economic growth and was actively opposed by sugar-sweetened beverage-related industries. Strategies identified to support stronger sugar-sweetened beverage taxation included shifting the economic discourse to strengthen health considerations, developing positive public opinion, forging links with the agriculture sector for shared benefit, and leadership by a central government agency. Conclusions: There are opportunities for more strategic public health engagement with the economic sector to foster strong nutrition-related fiscal policy for non-communicable disease prevention in the region. [ABSTRACT FROM AUTHOR]
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- 2021
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13. The legal feasibility of adopting a sugar-sweetened beverage tax in seven sub-Saharan African countries.
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Abdool Karim, Safura, Erzse, Agnes, Thow, Anne-Marie, Justus Amukugo, Hans, Ruhara, Charles, Ahaibwee, Gemma, Asiki, Gershim, Mukanu, Mulenga M., Ngoma, Twalib, Wanjohi, Milka, Karera, Abel, and Hofman, Karen
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TAX laws ,BEVERAGE laws ,NON-communicable diseases ,BEVERAGES ,PUBLIC health ,CONCEPTUAL structures ,GOVERNMENT policy - Abstract
Background: A number of countries have adopted sugar-sweetened beverage taxes to prevent non-communicable diseases but there is variance in the structures and rates of the taxes. As interventions, sugar-sweetened beverage taxes could be cost-effective but must be compliant with existing legal and taxation systems. Objectives: To assess the legal feasibility of introducing or strengthening taxation laws related to sugar-sweetened beverages, for prevention of non-communicable diseases in seven countries: Botswana, Kenya, Namibia, Rwanda, Tanzania, Uganda and Zambia. Methods: We assessed the legal feasibility of adopting four types of sugar-sweetened beverage tax formulations in each of the seven countries, using the novel FELIP framework. We conducted a desk-based review of the legal system related to sugar-sweetened beverage taxation and assessed the barriers to, and facilitators and legal feasibility of, introducing each of the selected formulations by considering the existing laws, laws related to impacted sectors, legal infrastructure, and processes involved in adopting laws. Results: Six countries had legal mandates to prevent non-communicable diseases and protect the health of citizens. As of 2019, all countries had excise tax legislation. Five countries levied excise taxes on all soft drinks, but most did not exclusively target sugar-sweetened beverages, and taxation rates were well below the World Health Organization's recommended 20%. In Uganda and Kenya, agricultural or HIV-related levies offered alternative mechanisms to disincentivise consumption of sugar-sweetened beverages without the introduction of new taxes. Nutrition-labelling laws in all countries made it feasible to adopt taxes linked to the sugar content of beverages, but there were lacunas in existing infrastructure for more sophisticated taxation structures. Conclusion: Sugar-sweetened beverage taxes are legally feasible in all seven countries Existing laws provide a means to implement taxes as a public health intervention. [ABSTRACT FROM AUTHOR]
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- 2021
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14. Study design: policy landscape analysis for sugar-sweetened beverage taxation in seven sub-Saharan African countries.
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Thow, Anne-Marie, Erzse, Agnes, Asiki, Gershim, Mulindabigwi Ruhara, Charles, Ahaibwe, Gemma, Ngoma, Twalib, Justus Amukugo, Hans, Wanjohi, Milka N., Mukanu, Mulenga M., Gaogane, Lebogang, Abdool Karim, Safura, and Hofman, Karen
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BEVERAGE laws ,HEALTH policy ,TAXATION ,NON-communicable diseases ,BEVERAGES ,RESEARCH methodology ,STAKEHOLDER analysis ,RETROSPECTIVE studies ,INTERVIEWING ,PUBLIC health ,CONCEPTUAL structures ,QUALITATIVE research ,GOVERNMENT policy ,POLICY sciences ,CONTENT analysis ,STATISTICAL sampling ,POLITICAL participation ,LONGITUDINAL method - Abstract
This paper reports on the design of a study to examine the policy landscape relevant to sugar-sweetened beverage taxation in seven sub-Saharan African countries. The study responds to the need for strong policy to address the rising burden of non-communicable diseases in the region. Sugar-sweetened beverage taxation has been widely recommended as a key component of a comprehensive policy approach to NCD prevention. However, it has proved a contentious policy intervention, with industry strongly opposing the introduction of such taxes. The aim was to identify opportunities to strengthen sugar-sweetened beverage taxation-related policy for the prevention of nutrition-related NCDs in a subset of Eastern and Southern African countries: Kenya, Tanzania, Botswana, Rwanda, Namibia, Zambia, Uganda. The study was conducted as a collaboration by researchers from nine institutions; including the seven study countries, South Africa, and Australia. The research protocol was collabora-tively developed, drawing on theories of the policy process to examine the existing availability of evidence, policy context, and stakeholder interests and influence. This paper describes the development of a method for a policy landscape analysis to strengthen policies relevant to NCD prevention, and specifically sugar-sweetened beverage taxation. This takes the form of a prospective policy analysis, based on systematic documentary analysis supplemented by consultations with policy actors, that is feasible in low-resource settings. Data were collected from policy documents, government and industry reports, survey documentation, webpages, and academic literature. Consultations were conducted to verify the completeness of the policy-relevant data collection. We analysed the frames and beliefs regarding the policy 'problems', the existing policy context and understandings of sugar-sweetened beverage taxation as a potential policy intervention, and the political context across relevant sectors, including industry interests and influence in the policy process. This study design will provide insights to inform public health action to support sugar-sweetened beverage taxation in the region. [ABSTRACT FROM AUTHOR]
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- 2021
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15. Factors influencing dietary behaviours in urban food environments in Africa: a systematic mapping review.
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Osei-Kwasi, Hibbah, Mohindra, Aarti, Booth, Andrew, Laar, Amos, Wanjohi, Milka, Graham, Fiona, Pradeilles, Rebecca, Cohen, Emmanuel, and Holdsworth, Michelle
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FOOD habits ,URBAN ecology (Sociology) ,URBAN agriculture ,META-analysis ,FOOD prices ,BODY composition ,SCHOOL attendance ,STREET food - Abstract
Objective: To identify factors influencing dietary behaviours in urban food environments in Africa and identify areas for future research.Design: We systematically reviewed published/grey literature (protocol CRD4201706893). Findings were compiled into a map using a socio-ecological model on four environmental levels: individual, social, physical and macro.Setting: Urban food environments in Africa.Participants: Studies involving adolescents and adults (11-70 years, male/female).Results: Thirty-nine studies were included (six adolescent, fifteen adolescent/adult combined and eighteen adult). Quantitative methods were most common (twenty-eight quantitative, nine qualitative and two mixed methods). Studies were from fifteen African countries. Seventy-seven factors influencing dietary behaviours were identified, with two-thirds at the individual level (45/77). Factors in the social (11/77), physical (12/77) and macro (9/77) environments were investigated less. Individual-level factors that specifically emerged for adolescents included self-esteem, body satisfaction, dieting, spoken language, school attendance, gender, body composition, pubertal development, BMI and fat mass. Studies involving adolescents investigated social environment-level factors more, for example, sharing food with friends. The physical food environment was more commonly explored in adults, for example, convenience/availability of food. Macro-level factors associated with dietary behaviours were food/drink advertising, religion and food prices. Factors associated with dietary behaviour were broadly similar for men and women.Conclusions: The dominance of studies exploring individual-level factors suggests a need for research to explore how social, physical and macro-level environments drive dietary behaviours of adolescents and adults in urban Africa. More studies are needed for adolescents and men, and studies widening the geographical scope to encompass all African countries. [ABSTRACT FROM AUTHOR]- Published
- 2020
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16. List of Contributors
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Abrahams, Mariette, Alam, Fakhrul, Battelino, T., Boland, Mike, Braconi, Daniela, Bronlund, John, Bryant, Eleanor, Chen, Chih-Han, Cicaloni, Vittoria, De Miguel-Etayo, P., Fehér, András, Gibney, Eileen R., González-Rodríguez, Liliana Guadalupe, Grimaldi, Keith Anthony, Harding, Alice, Iglesia, I., Kamande, Eva W., Katsarou, Vaia, Kimani-Murage, Elizabeth Wambui, Kiss, Marietta, Macharia, Teresia, Moreno, L.A., Muriuki, Peter G., Mutisya, Maurice, Mutoni, Sandrine, Mwaniki, Elizabeth, Nyamasege, Carolyn K., Oliveira, Bruno M.P.M., Ong, Andy S.J., Peral Suárez, África, Perea-Sánchez, José Miguel, Poínhos, Rui, Rankin, Audrey, Robinson, Sarita, Santucci, Annalisa, Singhrao, Sim K., Spiga, Ottavia, Stewart-Knox, Barbara, Szakály, Zoltán, Toumazou, Christofer, Tsolaki, Magdalini, Veiga-Herreros, Pablo, Wainaina, Caroline, Wanjohi, Milka, Wekesah, Frederick Murunga, and Zerfu, Taddese Alemu
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- 2019
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17. Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi: a cluster randomized controlled trial.
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Kimani-Murage, Elizabeth W., Griffiths, Paula L., Wekesah, Frederick Murunga, Wanjohi, Milka, Muhia, Nelson, Muriuki, Peter, Egondi, Thaddaeus, Kyobutungi, Catherine, Ezeh, Alex C., McGarvey, Stephen T., Musoke, Rachel N., Norris, Shane A., and Madise, Nyovani J.
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NUTRITION counseling ,BREASTFEEDING ,URBAN poor ,PUBLIC health ,CHILD nutrition ,POVERTY areas ,CLUSTER analysis (Statistics) ,COMPARATIVE studies ,COUNSELING ,HOME care services ,RESEARCH methodology ,MEDICAL care research ,MEDICAL cooperation ,NUTRITION ,RESEARCH ,RESEARCH funding ,STATISTICAL sampling ,CITY dwellers ,SOCIAL support ,EVALUATION research ,RANDOMIZED controlled trials - Abstract
Background: Exclusive breastfeeding (EBF) improves infant health and survival. We tested the effectiveness of a home-based intervention using Community Health Workers (CHWs) on EBF for six months in urban poor settings in Kenya.Methods: We conducted a cluster-randomized controlled trial in Korogocho and Viwandani slums in Nairobi. We recruited pregnant women and followed them until the infant's first birthday. Fourteen community clusters were randomized to intervention or control arm. The intervention arm received home-based nutritional counselling during scheduled visits by CHWs trained to provide specific maternal infant and young child nutrition (MIYCN) messages and standard care. The control arm was visited by CHWs who were not trained in MIYCN and they provided standard care (which included aspects of ante-natal and post-natal care, family planning, water, sanitation and hygiene, delivery with skilled attendance, immunization and community nutrition). CHWs in both groups distributed similar information materials on MIYCN. Differences in EBF by intervention status were tested using chi square and logistic regression, employing intention-to-treat analysis.Results: A total of 1110 mother-child pairs were involved, about half in each arm. At baseline, demographic and socioeconomic factors were similar between the two arms. The rates of EBF for 6 months increased from 2% pre-intervention to 55.2% (95% CI 50.4-59.9) in the intervention group and 54.6% (95% CI 50.0-59.1) in the control group. The adjusted odds of EBF (after adjusting for baseline characteristics) were slightly higher in the intervention arm compared to the control arm but not significantly different: for 0-2 months (OR 1.27, 95% CI 0.55 to 2.96; p = 0.550); 0-4 months (OR 1.15; 95% CI 0.54 to 2.42; p = 0.696), and 0-6 months (OR 1.11, 95% CI 0.61 to 2.02; p = 0.718).Conclusions: EBF for six months significantly increased in both arms indicating potential effectiveness of using CHWs to provide home-based counselling to mothers. The lack of any difference in EBF rates in the two groups suggests potential contamination of the control arm by information reserved for the intervention arm. Nevertheless, this study indicates a great potential for use of CHWs when they are incentivized and monitored as an effective model of promotion of EBF, particularly in urban poor settings. Given the equivalence of the results in both arms, the study suggests that the basic nutritional training given to CHWs in the basic primary health care training, and/or provision of information materials may be adequate in improving EBF rates in communities. However, further investigations on this may be needed. One contribution of these findings to implementation science is the difficulty in finding an appropriate counterfactual for community-based educational interventions.Trial Registration: ISRCTN ISRCTN83692672 . Registered 11 November 2012. Retrospectively registered. [ABSTRACT FROM AUTHOR]- Published
- 2017
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18. How does poverty affect children's nutritional status in Nairobi slums? A qualitative study of the root causes of undernutrition.
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Goudet, Sophie M, Kimani-Murage, Elizabeth W, Wekesah, Frederick, Wanjohi, Milka, Griffiths, Paula L, Bogin, Barry, and Madise, Nyovani J
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NUTRITIONAL status ,MALNUTRITION risk factors ,MATERNAL age ,SANITATION ,STREET food ,MALNUTRITION ,POVERTY areas ,COMPARATIVE studies ,FOCUS groups ,RESEARCH methodology ,MEDICAL cooperation ,POVERTY ,RESEARCH ,RESEARCH funding ,CITY dwellers ,QUALITATIVE research ,EVALUATION research - Abstract
Objective: Children in slums are at high risk of undernutrition, which has long-term negative consequences on their physical growth and cognitive development. Severe undernutrition can lead to the child's death. The present paper aimed to understand the causes of undernutrition in children as perceived by various groups of community members in Nairobi slums, Kenya.Design: Analysis of ten focus group discussions and ten individual interviews with key informants. The main topic discussed was the root causes of child undernutrition in the slums. The focus group discussions and key informant interviews were recorded and transcribed verbatim. The transcripts were coded in NVivo by extracting concepts and using a constant comparison of data across the different categories of respondents to draw out themes to enable a thematic analysis.Setting: Two slum communities in Nairobi, Kenya.Subjects: Women of childbearing age, community health workers, elders, leaders and other knowledgeable people in the two slum communities (n 90).Results: Participants demonstrated an understanding of undernutrition in children.Conclusions: Findings inform target criteria at community and household level that can be used to identify children at risk of undernutrition. To tackle the immediate and underlying causes of undernutrition, interventions recommended should aim to: (i) improve maternal health and nutrition; (ii) promote optimal infant and young children feeding practices; (iii) support mothers in their working role; (iv) increase access to family planning; (v) improve water, sanitation and hygiene (WASH); (vi) address alcohol problems at all levels; and (vii) address street food issues with infant feeding counselling. [ABSTRACT FROM AUTHOR]- Published
- 2017
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19. Sociocultural factors influencing breastfeeding practices in two slums in Nairobi, Kenya.
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Wanjohi, Milka, Griffiths, Paula, Wekesah, Frederick, Muriuki, Peter, Muhia, Nelson, Musoke, Rachel N., Fouts, Hillary N., Madise, Nyovani J., and Kimani-Murage, Elizabeth W.
- Abstract
Background: Despite numerous interventions promoting optimal breastfeeding practices in Kenya, pockets of suboptimal breastfeeding practices are documented in Kenya's urban slums. This paper describes cultural and social beliefs and practices that influence breastfeeding in two urban slums in Nairobi, Kenya. Methods: Qualitative data were collected in Korogocho and Viwandani slums through 10 focus group discussions and 19 in-depth interviews with pregnant, breastfeeding women and community health volunteers and 11 key-informant interviews with community leaders. Interviews were audiotaped, transcribed verbatim, coded in NVIVO and analyzed thematically. Results: Social and cultural beliefs and practices that result to suboptimal breastfeeding practices were highlighted including; considering colostrum as 'dirty' or 'curdled milk', a curse 'bad omen' associated with breastfeeding while engaging in extra marital affairs, a fear of the 'evil eye' (malevolent glare which is believed to be a curse associated with witchcraft) when breastfeeding in public and breastfeeding being associated with sagging breasts. Positive social and cultural beliefs were also identified including the association of breast milk with intellectual development and good child health. The beliefs and practices were learnt mainly from spouses, close relatives and peers. Conclusion: Interventions promoting behavior change with regards to breastfeeding should focus on dispelling the beliefs and practices that result to suboptimal breastfeeding practices and to build on the positive ones, while involving spouses and other family members as they are important sources of information on breastfeeding. Trial registration: ISRCTN83692672: December 2013 (retrospectively registered) [ABSTRACT FROM AUTHOR]
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- 2017
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20. Feasibility and effectiveness of the baby friendly community initiative in rural Kenya: study protocol for a randomized controlled trial.
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Kimani-Murage, Elizabeth W., Kimiywe, Judith, Kabue, Mark, Wekesah, Frederick, Matiri, Evelyn, Muhia, Nelson, Wanjohi, Milka, Muriuki, Peterrock, Samburu, Betty, Kanyuira, James N., Young, Sera L., Griffiths, Paula L., Madise, Nyovani J., and McGarvey, Stephen T.
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EDUCATION of mothers ,BREASTFEEDING ,CHILD health services ,COMMUNITY health services ,COMPARATIVE studies ,COUNSELING ,EXPERIMENTAL design ,HEALTH attitudes ,HEALTH care teams ,HEALTH education ,INFANTS ,INFANT mortality ,MOTHERS ,MULTIVARIATE analysis ,NUTRITIONAL assessment ,NUTRITIONAL requirements ,RESEARCH funding ,NUTRITION disorders in infants ,RURAL health services ,STATISTICAL sampling ,TIME ,LOGISTIC regression analysis ,PILOT projects ,EVALUATION research ,RANDOMIZED controlled trials ,EVALUATION of human services programs ,NUTRITIONAL status ,PREVENTION ,DIAGNOSIS - Abstract
Background: Interventions promoting optimal infant and young child nutrition could prevent a fifth of under-5 deaths in countries with high mortality. Poor infant and young child feeding practices are widely documented in Kenya, with potential detrimental effects on child growth, health and survival. Effective strategies to improve these practices are needed. This study aims to pilot implementation of the Baby Friendly Community Initiative (BFCI), a global initiative aimed at promoting optimal infant and young child feeding practices, to determine its feasibility and effectiveness with regards to infant feeding practices, nutrition and health outcomes in a rural setting in Kenya.Methods: The study, employing a cluster-randomized trial design, will be conducted in rural Kenya. A total of 12 clusters, constituting community units within the government's Community Health Strategy, will be randomized, with half allocated to the intervention and the other half to the control arm. A total of 812 pregnant women and their respective children will be recruited into the study. The mother-child pairs will be followed up until the child is 6 months old. Recruitment will last approximately 1 year from January 2015, and the study will run for 3 years, from 2014 to 2016. The intervention will involve regular counseling and support of mothers by trained community health workers and health professionals on maternal, infant and young child nutrition. Regular assessment of knowledge, attitudes and practices on maternal, infant and young child nutrition will be done, coupled with assessment of nutritional status of the mother-child pairs and morbidity for the children. Statistical methods will include analysis of covariance, multinomial logistic regression and multilevel modeling. The study is funded by the NIH and USAID through the Program for Enhanced Research (PEER) Health.Discussion: Findings from the study outlined in this protocol will inform potential feasibility and effectiveness of a community-based intervention aimed at promoting optimal breastfeeding and other infant feeding practices. The intervention, if proved feasible and effective, will inform policy and practice in Kenya and similar settings, particularly regarding implementation of the baby friendly community initiative.Trial Registration: ISRCTN03467700 ; Date of Registration: 24 September 2014. [ABSTRACT FROM AUTHOR]- Published
- 2015
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21. Effectiveness of personalised, home-based nutritional counselling on infant feeding practices, morbidity and nutritional outcomes among infants in Nairobi slums: study protocol for a cluster randomised controlled trial.
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Kimani-Murage, Elizabeth W., Kyobutungi, Catherine, Ezeh, Alex C., Wekesah, Frederick, Wanjohi, Milka, Muriuki, Peterrock, Musoke, Rachel N., Norris, Shane A., Griffiths, Paula, and Madise, Nyovani J.
- Subjects
ANIMAL nutrition ,DISEASES ,CLINICAL trials ,PREGNANCY - Abstract
Background Nutrition in the first 1,000 days of life (during pregnancy and the first two years) is critical for child growth and survival. Poor maternal, infant and young child nutrition (MIYCN) practices are widely documented in Kenya, with potential detrimental effects on child growth and survival. This is particularly a problem in slums, where most urban residents live. For example, exclusive breastfeeding for the first six months is only about two per cent. Innovative strategies to reach slum residents are therefore needed. Strategies like the Baby Friendly Hospital Initiative have proven effective in some settings but their effectiveness in resource-limited settings, including slums where many women do not deliver in hospital, is questionable. We propose to test the effectiveness of a home-based intervention on infant feeding practices, nutrition and health outcomes of infants born in two slums in Nairobi, Kenya. Methods/Design The study, employing a cluster-randomised study design, will be conducted in two slums in Nairobi: Korogocho and Viwandani where 14 community units (defined by the Government's health care system) will form the unit of randomization. A total of 780 pregnant women and their respective child will be recruited into the study. The mother-child pair will be followed up until the child is one year old. Recruitment will last approximately one year and three months from September 2012 to December 2013. The mothers will receive regular, personalised, home-based counselling by trained Community Health Workers on MIYCN. Regular assessment of knowledge, attitudes and practices on MIYCN will be done, coupled with assessments of nutritional status of the mother-child pairs and diarrhea morbidity for the children. Statistical methods will include analysis of covariance and multinomial logistic regression. Additionally, cost-effectiveness analysis will be done. The study is funded by the Wellcome Trust and will run from March 2012 to February 2015. Discussion Interventions aimed at promoting optimal breastfeeding and complementary feeding practices are considered to have high impact and could prevent a fifth of the under-five deaths in countries with high mortality rates. This study will inform policy and practice in Kenya and similar settings regarding delivery mechanisms for such high-impact interventions, particularly among urban poor populations. Trial registration ISRCTN83692672 [ABSTRACT FROM AUTHOR]
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- 2013
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22. Perceptions on donated human milk and human milk banking in Nairobi, Kenya.
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Kimani‐Murage, Elizabeth Wambui, Wanjohi, Milka Njeri, Kamande, Eva Watiri, Macharia, Teresia Njoki, Mwaniki, Elizabeth, Zerfu, Taddese, Ziraba, Abdhalah, Muiruri, Juliana Waithera, Samburu, Betty, Govoga, Allan, Kiige, Laura Wangui, Ngwiri, Thomas, Mirie, Waithira, Musoke, Rachel, Amundson‐Mansen, Kimberly, and Israel‐Ballard, Kiersten
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BREASTFEEDING , *BREAST milk , *CONSUMER attitudes , *ORGAN donation , *FOCUS groups , *INTERVIEWING , *RESEARCH methodology , *STATISTICAL sampling , *QUALITATIVE research , *BREAST milk collection & preservation , *JUDGMENT sampling , *QUANTITATIVE research , *THEMATIC analysis , *ATTITUDES of mothers , *CROSS-sectional method , *DATA analysis software , *DESCRIPTIVE statistics - Abstract
Donor human milk (DHM) is recomended as the best alternative when use of mothers' own milk is not a feasible option. Kenya has not yet established human milk banks (HMBs) for provision of safe DHM, which is free from any physical, chemical, microbiological contaminants or pathogens. This study aimed to establish the perceptions on donating and using DHM, and establishing HMBs in Kenya. Qualitative data were collected through 17 focus group discussions, 29 key informant interviews, and 25 in‐depth interviews, with women of childbearing age, community members, health workers, and policy makers. Quantitative interviews were conducted with 868 mothers of children younger than 3 years. Descriptive analysis of quantitative data was performed in STATA software, whereas qualitative interviews were coded using NVIVO and analysed thematically. Majority of them had a positive attitude towards donating breast milk to a HMB (80%) and feeding children on DHM (87%). At a personal level, participants were more willing to donate their milk to HMBs (78%) than using DHM for their own children (59%). The main concerns on donation and use of DHM were personal dislikes, fear of transmission of diseases including HIV, and hygiene concerns. Ensuring safety of DHM was considered important in enhancing acceptability of DHM and successful establishment of the HMBs. When establishing HMBs, Kenya must take into consideration communication strategies to address the main concerns raised regarding the quality and safety of the DHM. The findings will contribute to the development of HMB guidelines in Kenya and other African contexts. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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