Despite several efforts by the Kenyan Government to resolve household food insecurity, Seme Sub- County still has a higher number of households reporting a lack of food or money to purchase food, which is at 41.9 %. This rate is higher than the national proportion, which is at 36.2%. The region also has a higher under-five mortality rate at 72 deaths per 1000 live births compared to the national level of 52 deaths per 1000 live births. Despite the high death rate, Seme Sub-County mothers are still more than 50% likely to introduce complementary feeding early, which predisposes their children to a higherrisk of undernutrition, including stunting,wasting, and being underweight.The objective ofthisstudywasto assessthe demographic, socio-economic, dietary intake, and nutritional status of children aged 1-3 years in households in Seme SubCounty, Kenya. A total of 193 families with children aged 1-3 years were interviewed. A questionnaire was used to collect data on the socio- demographic and socio-economic characteristics of the households. The nutritional status of the child was assessed using anthropometric assessment. Multiple linear regression was used to determine the relationship between dietary intake and nutritional status of children aged 1-3 years. Most children, 38.9%, were stunted, denoting chronic malnutrition and long-term food deprivation in Seme; others were underweight at 16.1%, whereas a few were wasted at 8.8%. These rates are higher than the national rates, where stunting is at 26%, wasting at 4%, and underweight at 11%. The high rates might be attributed to most mothers in Seme Sub-County introducing complementary feeding early, hence predisposing their children to undernutrition (stunting, underweight, wasting). It might also be due to poor consumption of Vitamin A-rich vegetables and tubers by the children, which is 15.6% and most households reporting a lack of food or money to purchase food at 41.9%, which is still higher than the national rate of 36.2%. Further, there was a statistically significant relationship between stunting and low dietary diversity, p=0.02 in children aged 1-3 years, with chances of being stunted increasing by 12 in children aged 1-3 years consuming a lowly diversified diet, holding moderate diet diversity and high dietary diversity constant, β(95%CI) =12(11.92,12.08). This discovery denoted that a childwho ate a lowly diversified diet was most likely to be stunted. Keywords: Nutritional status, dietary diversity, stunting, underweight, wasting

Since the beginning of the COVID-19 pandemic, certain U.S. population groups have suffered higher rates of infection and mortality than whites, including Latinx. Public health officials blamed these outcomes on overcrowded housing and work in essential industries prior to the vaccine's availability. We sought to illuminate the lived experience of these factors through a qualitative study of undocumented Latinx immigrant workers in the secondary economy (n ​= ​34). This study focuses on the intersectionality of social locations for undocumented Latinx immigrants living in a relatively affluent suburb and working in the construction and service sectors prior to the pandemic. Their narratives revealed how the pandemic created financial precarity through prolonged periods of unemployment and food insecurity. Workers described worry over unpaid bills, and potentially catastrophic episodes in which they treated severe COVID-19 with home remedies. Long spells of unemployment, food insecurity, inability to pay bills and lack of access to healthcare emerged because of socio-political contexts including the nature of low-wage labor and lack of a safety net.

Although rural households in Kenya rely on agricultural production for their livelihood, attaining food security is challenging in areas experiencing harsh agro-ecological conditions. We utilized mixed methods research to examine the effect of agricultural production, including that of traditional foods, on household food insecurity in Seme sub-County of Kenya. Study participants believed that traditional foods protected against hunger. However, production of these foods, with the exception of traditional vegetables, was low. Poultry-keeping; cereal/grain, any vegetable and traditional vegetable production; and crop diversity were significantly associated with lower household food insecurity. Vegetable production maintained statistical significance after controlling for other variables.

Introduction : Although obesity prevalence is known to be rising in East Africa, research on childhood obesity is still minimal. We conducted a cross-sectional study to examine the prevalence of unhealthful dietary patterns, physical activity and sleep behaviors among primary school children in two urban settings in Kenya and explored the association between the behaviors and overweight/obesity among the children. Methods Six public schools, with children from low-, medium- and high-income households in Nairobi and Kisumu cities were purposively selected to participate in the study. Data was collected on randomly-selected students aged 10–12 years at each school. Students’ weights, heights, waist circumferences, and tricep, bicep, subscapular and suprailiac skinfolds were measured. Body-mass-index-for-age z-scores were used to classify students into underweight, healthy weight, overweight and obese categories. Waist-circumference-to-height ratio above 0.5 was used to define abdominal obesity and the total amount of body fat was estimated from the sum of skinfold measures. Parents, with the help of their children, completed questionnaires on student’s dietary, physical activity, and sleep behaviors. Anthropometric measurements and questionnaires were available for 390 students. We utilized prevalence ratio analysis to examine the association between socio-economic/demographic characteristics, unhealthful behaviors and overweight/obesity. Results Overall, 21% of the students were overweight or obese and 9% of them had abdominal obesity. Median total skinfold measurements was 32.5 mm. Prevalence of unhealthful behaviors varied significantly by student’s age, gender, school income levels, city, and frequency of consumption of restaurant foods. Students who consumed less than recommended amount of fruit servings had 1.68 times the risk of being overweight/obese, 2.49 times the risk of having abdominal obesity and 1.47 times the risk of having high total skinfold values compared to students with adequate fruit intake. Students with high frequency of consumption of red/processed meats had 1.50 times the risk of being overweight/obesity compared to students with less-frequent consumption. Conclusion We found a rather high prevalence of unhealthful dietary behaviors among primary school students in Kenya, identified their determinants, and the association between specific behaviors and overweight/obesity. These results can guide childhood obesity prevention measures in Kenya and other nations in East Africa.

Objective: We examined the prevalence of elevated blood pressure (BP) and hypertension among 390 primary school children of different socioeconomic status (SES) in two urban settings in Kenya and explored the association between children's BP status and their sociodemographic characteristics, dietary behaviours and overweight/obesity status. Methods: Children's BP and anthropometric measurements were taken and parents, with the help of their children, completed questionnaires on the children's dietary behaviours. An average of three BP readings was used to calculate BP percentiles by age, sex and height. BMI-for-age z-scores, waist-circumference-to-height ratio and the sum of skinfold measures were calculated. We utilized prevalence ratio analysis to examine the association between BP and sociodemographic characteristics, dietary behaviours and overweight/obesity. Results: About 9% of the school children had elevated BP and 33% had stage 1 hypertension. Among overweight children, the proportion of children with elevated BP was 1.85-fold greater and the proportion of children with hypertension was 1.83-fold greater compared with children with healthy body weight. Similar patterns of significant associations were seen among obese children, children with central obesity and children with high total skinfold values. The proportion of children with hypertension was 1.42-fold greater among children with high frequency of consumption of chips/crisps compared with children with lower frequency of consumption. Conclusion: These results increase our understanding BP patterns and determinants among school children in Kenya and can help inform noncommunicable disease prevention efforts.

We conducted a cross-sectional study to provide an overview primary school children food environment in two urban settings in Kenya. Six schools, catering to children from low-, medium- and high-income households in the cities of Nairobi and Kisumu in Kenya, participated in the study. Data on types of food places and foods offered were collected and healthy and unhealthy food availability scores calculated for each place. We utilized prevalence ratio analysis to examine associations between food availability, food place characteristics and neighborhood income levels. Altogether, 508 food places, located within 1 km of the schools and the school children's neighborhoods were observed. Open-air market sellers and kiosks were most common. The proportion of food places with high healthy food availability was 2.2 times greater among food places in Nairobi compared to Kisumu, 1.9 times greater in food places with multiple cashpoints, 1.7 times greater in medium/large sized food places and 1.4 times greater in food places located in high income neighborhoods. These findings highlight differences in availability of healthy foods and unhealthy foods across types of food places and neighborhood income levels and inform public health interventions aimed at promoting healthy food environments in Kenya.

We conducted a cross-sectional study to examine the prevalence and determinants of overweight and obesity among schoolchildren at different levels of socio-economic status in Kenya. We explore children's weight status and dietary practices in the current analysis. The research study was conducted in Nairobi and Kisumu, the largest and the third-largest cities in Kenya. Three public schools, catering to children from households at low, medium and high socio-economic status were purposively selected to participate in the study in each city. Data was collected among children within the ages of 10–12 years enrolled in grades 4–6 at each school. Trained enumerators measured children's weights and heights. Parents, with the help of their respective schoolchildren, completed questionnaires on schoolchildren's dietary practices including consumption of fruits, vegetables, snacks foods, confectioneries, beverages and restaurant foods. Completed sets of body measurements and dietary practices data were available for 390 children. We used Wilcoxon-Mann Whitney, Kruskal Wallis and chi-square tests to compare schoolchildren's weight status and dietary practices across cities and school income status. Over 15% of the schoolchildren were overweight, 5.5% were obese and 3% were stunted. Schoolchildren's weight status did not significantly differ across cities. However, % of overweight or obese children were significantly higher among children attending high-income schools compared to those in middle- and low-income schools. Frequency of consumption of red meats, fries and take-away foods, and amount of fruit juice consumed per week were significantly higher among children enrolled in high-income schools. Frequency of consumption of breakfast, eating meals in front of a screen and amount of milk consumed per week were significantly lower among children enrolled in low-income schools. This study increases our understanding of dietary practices and overweight and obesity patterns among schoolchildren, and contributes to obesity prevention efforts in Kenya. Additional analysis will explore the relationship between dietary practices, and overweight and obesity. John Hopkins University.

The purpose of this study was to determine if nutritional knowledge is associated with recommended infant feeding practices among mothers in the Lubombo region of eSwatini. In April 2019, we conducted a cross-sectional survey to assess knowledge and practices among mothers (18–49 years) with at least one young child (0–24 months) in the Siphofaneni Tinkhundla (Administrative subdivision) of the Lubombo region of eSwatini. Community health workers invited mothers to a central meeting location were quantitative data was collected through one-on-one interviews. The questionnaire was broken up into four sections: 1) Sociodemographic, 2) Household Food Security Assessment, 3) Nutrition Practices, and 4) Nutrition Knowledge. Mothers were 18–48 years of age (mean: 26.95; SD: 6.5). We used logistic and multivariate regression to measure the association between breastfeeding practices and nutrition knowledge, and the association between diet diversity and nutrition knowledge. A total of 164 mothers completed the questionnaire. Participants were 18–48 years of age (mean: 26.95; SD: 6.5). Their children were 0–24 months of age (mean: 10.4; SD: 6.3). The total nutrition knowledge score ranged from 8 to 44 (mean: 21.8; SD: 6.14). Approximately 92% had heard of exclusive breastfeeding; of those mothers, 87% were able to properly explain the practice. Ninety three % of infants 0–5 months were breastfed, but less than half of those were exclusively breastfed. Exclusive breastfeeding practices were not significantly associated with nutrition knowledge. The mean for the Minimum Diet Diversity score was 3.7 (SD 1.38). Diet Diversity scores and nutrition knowledge were significantly associated (P = .011) after adjusting for infant sex, maternal education and household size. Education alone may not be sufficient for the adoption of recommended infant feeding practices among mothers. Future research should explore sociocultural and economic factors that may play a role in influencing recommended infant feeding practices. This study was funded by the Fulbright U.S. Student Program.

Objective: To examine mothers' and young children's consumption of indigenous and traditional foods (ITF), assess mothers' perception of factors that influence ITF consumption, and examine the relationship between perceived factors and ITF consumption. Design: Longitudinal study design across two agricultural seasons. Seven-day FFQ utilized to assess dietary intake. Mothers interviewed to assess their beliefs about amounts of ITF that they or their young children consumed and on factors that influence ITF consumption levels. Setting: Seme sub-County, Kenya. Participants: Mothers with young children. Results: Less than 60 % of mothers and children consumed ITF at time of assessment. Over 50 % of the mothers reported that their ITF consumption amounts and those of their children were below levels that mothers would have liked for themselves or for their young children. High cost, non-availability and poor taste were top three reasons for low ITF consumption levels. Mothers who identified high cost or non-availability as a reason for low levels of ITF consumption had significantly lower odds of consuming all ITF except amaranth leaves. Mothers who identified poor taste had significantly lower odds of consuming all ITF except green grams and groundnuts. Similar relationships were noted for young children's ITF consumption levels. Conclusions: A majority of the mothers reported that they and their children did not consume as much ITF as the mothers would have liked. Further studies should examine strategies to improve availability and affordability of ITF, as well as develop recipes that are acceptable to mothers and children.

Evidence suggests that household inequalities contribute to food insecurity and nutrient deficiencies in rural Ugandan women. In this mixed-methods study, 64 participants from two villages in the Wakiso District were interviewed and asked questions from FANTA's Household Food Insecurity Access Scales (HFIAS) tool. Participants detailed foods consumed within the last 24hr; these data were used to create Household Dietary Diversity (HDDS) scores. Discussion group qualitative data were evaluated through thematic analysis. There was no statistically significant evidence to suggest that the gender of the head of the household influenced these scores. The mean HFIAS score was 9.3 out of 27 and the mean HDDS was 6.4 out of 14. The qualitative data paints a picture of economically independent women who are overburdened by household responsibilities. Additionally, participants reported limited access to marketplaces to sell crops directly and therefore sold to agricultural middlemen. Technical investments in low-cost storage technologies are recommended to ensure more negotiation power with middlemen while also improving household food security.

The purpose of this presentation is to demonstrate how a term paper peer review activity enhanced students’ collaboration and promoted their critical thinking skills. This study was conducted in a fully online graduate course, which was first offered in the Summer 2014 semester. Students were required to take the course as part of the Masters of Science in Global Health and Masters of Public Health programs. The course was offered via the Blackboard platform and utilized multiple strategies to enhance student participation. The course was designed in a modular format with course activities including individual watching streaming lecture videos, discussion blogs, journal article reviews and presentations in video delivery, synchronous case study in Blackboard Collaborate sessions, and term paper writing. The term paper peer review activity was added in the Summer 2015 semester. The p urpose of the peer review activity was for students to learn from your peers' feedback as they work towards completing their term paper. Expected learning outcomes for the peer review were that students would become competent in scientific writing. Students’ feedback indicated their appreciation of the support from team members. Preliminary analysis indicated that students became more reflective during the writing process and a better quality of term paper was shown in their final grades. Faculty in either undergraduate or graduate program will learn the design of peer review and how it promotes students’ interaction and support in a group setting in online environments.

Summary Sun‐drying is a low‐cost, low‐technology fish preservation method frequently employed in developing areas. However, the process promotes lipid oxidation and its associated undesired flavours and odours. This study investigated low‐technology solutions for impact on lipid oxidation and sensory attributes of oven‐dried omena fish ( Rastrineobola argentea ). Two oven‐drying conditions and four doses of clove water extract ‘dip’ pretreatments were studied in a complete factorial design. Lipid oxidation in dried fish was assessed by TBARS , peroxide value and fatty acid analysis by GC ‐ FID . Results showed that soaking in 10 g L −1 clove water extract for 1 h and oven‐drying at 150 °C × 30 min significantly reduced TBARS and peroxide values in omena fish by 77% and 79%, respectively, and polyene index showed improved retention of long‐chain polyunsaturated fats, compared to original drying condition. Lastly, panellists of a triangle test were able to discriminate between biscuits made with the modified and original dried fish.

Background Despite the importance of multiple psychosocial factors on nutrition-related behavior, very few studies have explored beyond the role of mothers’ knowledge and perception of child-focused outcomes on the duration of exclusive breastfeeding in Africa. Our objective was to determine the relationships among mothers’ knowledge, outcome expectancies, normative beliefs, and cessation of exclusive breastfeeding in rural Kenya. Methods A cross-sectional survey was conducted among 400 mothers of children, 0-24 months old, in rural Kenya. Early child-feeding practices, knowledge of breastfeeding recommendations, beliefs associated with impact of exclusive breastfeeding on child- and mother-focused outcomes and perception of acceptability of exclusive breastfeeding by important others were examined. Cox regression analysis was used to assess the relationship between independent variables of interest and cessation of exclusive breastfeeding. Results Being knowledgeable of breastfeeding-related recommendations, positive beliefs on the impact of exclusive breastfeeding on child- focused outcomes, having a more positive perception of the impact of exclusive breastfeeding on mother-focused outcomes and a more positive perception of acceptability of exclusive breastfeeding by important others were associated with significantly lower risks of premature cessation of exclusive breastfeeding. Conclusion In addition to knowledge levels, mothers’ beliefs play an important role in mothers’ decisions to practice exclusive breastfeeding. Mother’s beliefs on the impact of exclusive breastfeeding on the mother’s health, physical appearance and ability to engage in other activities were shown to have the strongest relationship with premature cessation of exclusive breastfeeding. Addressing these beliefs has the potential to contribute to more effective exclusive breastfeeding promotion efforts in rural Kenya.

While the potential of agricultural production to improve women's and children's nutrition has been recognized, there is still limited understanding of the specific pathways through which USAID‐funded Feed the Future value chains can positively impact nutritional status in vulnerable households. The current study was conducted to document the process and progress made by two Rwanda‐based Feed the Future activities, the Integrated Improved Livelihoods Program (IILP) and the Rwanda Dairy Competitiveness Program II (RDCP II), in working along agriculture‐to nutrition pathways. Specifically, we explored how increases in income, as a result of participating in Feed the Future activities, changed purchasing and consumption patterns and how engagement in the activities affected care‐seeking and care‐giving practices and women's empowerment. Interviews and discussions were conducted with activity staff and beneficiaries and, community leaders in three districts of Rwanda. Quantitative data were summarized into means and percentages. Qualitative data were coded into specific themes. Study results indicate a general improvement in program beneficiaries' income, crop production, and women's empowerment. Despite the positive trend, IILP and RDCP II face challenges that may hinder further movement along the agriculture‐to‐nutrition pathways, including demands on women's time and energy use, low consumption of animal‐sourced foods, targeting children's nutrition within the first 1,000 days, and monitoring nutrition indicators. The research highlights gaps that need to be addressed to further improve women and children's nutrition in Rwanda.

We utilized the most recent Demographic Health Survey data to explore the distribution of feeding practices and examine relationships between complementary feeding and socio-demographic and health behaviour indicators in Kenya, Uganda and Tanzania. We based our analysis on complementary dietary diversity scores calculated for children 6-23 months old. Geographically, Kenya displayed clear division of children's diet diversity scores across its regions, unlike Uganda and Tanzania. Less than 40% of the children's meal frequencies in Uganda and Tanzania had met the minimum daily recommended levels. Only 30-40% of children in Kenya, Tanzania and Uganda had consumed diets with adequate diversity. Children's age, breastfeeding status, mother's education level and working status, household wealth index, prenatal care visits, receiving vitamin A supplements, using modern contraceptives and meal frequencies were significantly associated with adequate complementary food diversity in at least one of the three countries included in the current analyses. These analyses contribute to a better understanding and targeting of infant and young child feeding within the East African region.

We conducted a cross‐sectional survey to assess the association between breastfeeding‐related knowledge, perception and social norms and premature cessation of exclusive breastfeeding (EBF) in rural Kenya. Four‐hundred mothers with children, 0 ‐24 months participated in the survey. Mothers were asked to recall breastfeeding practices since birth. A battery of close and open‐ended questions were used to assess EBF‐related knowledge and social norms, and mothers' perception on the impact of EBF on children's health and growth, impact of EBF on mother's health and physical appearance and impact of EBF on family dynamics. Participants' knowledge and perception scores were calculated as a percentage of correctly‐answered questions. Mean knowledge and perception scores were above 75%. Over 14% and 23% of mothers indicated that EBF was not acceptable to their male partners and in‐laws, respectively. Higher knowledge levels and more positive perception on the impact of EBF on children's health, family dynamics and mother's health were each significantly associated with lower risks of premature cessation of EBF. Mothers who reported that EBF was not acceptable to either their male partners or in‐laws were significantly associated with higher risks of premature cessation of EBF. This study identifies specific determinants that need to be addressed in breast‐feeding promotion activities in rural Kenya. Psychosocial factors play an important role in determining individuals' decisions to engage in particular health‐related behaviors.

Background. Although animal-source foods provide a rich source of complete protein and a variety of micro-nutrients, a majority of these foods are not accessible to a large proportion of populations in low-income nations. Locally available and affordable nutrient-dense dietary solutions that are accessible all year round can provide the most viable solution to improving food and nutrition security for these vulnerable populations. However, their potential to improve nutritional status among pregnant women has not been documented.Objective. The study was conducted to help guide the development of fish-enhanced and soybean-enhanced supplemental snacks and evaluate their acceptability among pregnant women in rural Kenya.Methods. We developed fish-enhanced and soybean-enhanced snacks using the small local lake fish omena (Rastrineobola argentea) and soybean flour. A cross-sectional study design was used to assess snack acceptance levels among HIV-infected and -noninfected pregnant women, two high-risk groups for nutrient deficiencies.Results. Overall, 96%, 80%, and 81% of participants, indicated that they liked the taste, odor, texture, and color of wheat, fish-enhanced, or soybean-enhanced snacks, respectively. No significant differences were noted across participants' HIV status. Focus group discussions with the women further supported results from the quantitative ratings.Conclusions. Our analysis demonstrates the feasibility of developing acceptable, nutrient-dense food supplements using locally available foods in rural Kenya and contributes culturally acceptable, affordable, and sustainable solutions to the problem of undernutrition among pregnant women in low-income countries in sub-Saharan Africa.

Animal source foods (ASFs), particularly meat of a wide variety, fish, fowl meat, milk, eggs, snails, worms and other small animals supply not only high-quality and readily digested protein and energy, but also readily absorbable and bioavailable micronutrients. The inclusion of ASFs in the diet promotes growth, cognitive function, physical activity and health, and is particularly important for children and pregnant women. The importance of ASF consumption for health and nutritional outcomes has been documented in observational settings and, more recently, in intervention studies. A recent Kenyan study provides causal evidence that adding even a modest amount of meat to the diet of schoolchildren improves cognitive function and school performance, physical activity, growth (increased lean body mass), micronutrient status and morbidity. Outcomes from several nutrition interventions promoting ASF production and consumption have also demonstrated improvements in nutritional outcomes. Non-governmental organizations (NGOs) have played a key role in promoting ASFs in the diets of populations in low-income countries and in addressing issues that constrain household production and utilization of ASFs, and the chapter provides examples of the activities of several NGOs operating in Africa. In addition to current strategies, small freshwater fish and rabbits are two ASF sources with great potential for addressing nutritional deficiencies that have not received sufficient attention. Even modest amounts of meat and other ASFs in the diet from a variety of sources can greatly improve the overall nutrition and micronutrient status, health and function of rural populations.

Objective: To examine the impact of a family‐based nutrition education program on nutrition knowledge, diet, physical activity, and food purchasing behaviors of Latina mothers and children participating in Northern Virginia Women, Infant, Children (WIC) programs.Methods: Surveys were administered to mothers (n=15) using a pre‐test/post‐test design. The family‐based nutrition intervention included 1) Discussion and lecture on food labels, food purchasing, portion sizes, and healthy meals, 2) Experiential learning focused on preparation and storage of low‐cost, healthy meals incorporating WIC foods, and 3) A Zumba class and discussion on physical activity.Results: The data revealed improved diet such that mothers reported increased fruit and vegetable consumption, decreased juice consumption among their children. Mothers reported their children were more physically active. Further, mothers prepared more meals at home using raw ingredients.Conclusions: The findings are significant in that they support growing literature of the success of family based interventions. Further, these data show the importance of integrating experiential learning activities such as cooking and physical activity with the more traditional didactic methods.This research was supported the Virginia Department of Health and the HRSA funded Virginia Commonwealth Public Health Training Center.Grant Funding Source: Supported by the Virginia Department of Health and HRSA funded Virginia PHTC