Parental use of reward and punishment is a key to reinforcement or deterrence of food choices among children an aspect that affects nutritional status throughout an individual’s life span. Kenya has a population of 47,564,296 people according to demographic survey of Kenya 2019, of whom 1.4 % are school-going children aged 6-years in Juja Sub-County of Kiambu, (Kenya National Beural of Statistics,2019). Cross-sectional analytical research design was adopted on 384 parent-child pairs, who were disproportionately sampled. Researcher-administered questionnaires were used to collect data. SРSS software version 26.0 was used to analyse the data with significance p<.05. Anthropometry data was analysed using WHO Anthro-Plus Survey Analyzer and compared to BMI-for-age (BAZ), weight-for-age (WAZ) and height-for-age (HAZ) Scores for the target population. Pearson’s correlation (r) was used to establish association. Boys were 48.0% while girls were 52.0% with a mean age of 6.4± 0.1. Almost half the index children (45.1%) were born first. Mean household size was 5.0± 1.66 with maternal mean age at 34± 4.9 years and that of the fathers at 39± 4.8 years. The majority of mothers (73.0%) and fathers (76.1%) had tertiary level of education with more fathers than the mothers in the formal sector of employment, with a higher income. All (100%) children reported being rewarded by receiving incentives like praise words (60.1%), while majority of them (92.0%) reported being punished in multiple ways by the mothers when they refused to feed yet a third of fathers (61.0%) praised and gifted their children to feed. Prevalence of stunting (6.9%), underweight (7.1%), wasting (7.2%), overweight (16.4%) and obesity (11.7%) was observed in the study population. A positive strong significant relationship (p=0.05, x2=5.2) between age of the mothers and punishment was noted, also shouting threats, grounding, inflicting pain & withdrawal of privileges (p=0.05, x2=9.6) was common among the married mothers. More parents with tertiary education (74.6%) and higher incomes (40.5%) gifted and gave special permissions which had a stronger positive relationship to food choices (p=0.06, x2=4.33) and nutritional status (p=0.04, x2=5.9). Food choices had a strong positive relationship to nutritional status (p=0.05) and so did dietary diversity (p=0.6). Majority of the parents reported that the demographic characteristics (83.8%) and Socio-economic characteristics (90.7%) affected their food choices as a household. Almost all mothers (98.8%) and more than half of the fathers (55.4%) felt that rewarding and punishing the study children in relation to food had an effect on their food choices and approaches

Children with good nutrition status live beyond the age of five, their growth is less affected, and they gain in height and weight.The objective of the study was to determine demographic and socioeconomic determinants of nutritional status among children ages 6-59 months from female headed households (FHHs) in Luapula Valley.Cross-sectional analytical study design was used with sample size of 228 children ages 6-59 months.Questionnaires were used to collect data on demographic and socio-economic characteristics of the studied FHHs.Children's nutritional status was determined through measurements of weight, height/length and Mid Upper Arm Circumference, and also examination for the presence/absence of edema.Measurements were then used to compute nutritional status by use of ENA for SMART software, 2011.Results showed that 45.2% children were Stunted, 20.6% underweight, 6.6% wasted and 1.3% overweight.Wasting was 4.8% by MUAC and 5 children had oedema.Binary logistic regression analysis showed that the predictors of children's nutritional status were social cash transfer, Age of household head, size of the household and distance to the market.Therefore, it is recommended to foster programs that improve demographic and socio-economic status of female headed households and by implication children's nutritional status.

AbstractObjective:WHO BMI-for-agezscore (BAZ) is widely used in epidemiology, yet it does not distinguish body fat-free mass and fat mass which are better indicators of obesity and related risks. The stable isotope dilution techniques (SIDT) are gold standard methods of assessing body composition. Main objective was to assess significant differences in measurement and validity of WHO BMI-for-age classification for defining childhood obesity by comparing with body fatness using SIDT among schoolchildren.Design:A cross-sectional analytical study. A questionnaire, anthropometry and body composition data were used. SPSS was used to analyse data atP< 0·05 at 95 % CI.Setting:Primary schools in Nairobi City County, KenyaParticipants:One hundred seventy-nine schoolchildren aged 8–11 years were randomly sampled.Results:Prevalence of adiposity by reference SIDT (24·0 %) was significantly higher than that of obesity by BAZ > 2sd(2·8 %) (Wilcoxon test,P< 0·05). Concordance coefficient between SIDT and BAZ > 2sdin diagnosing obesity was poor (κ= 0·167). Only 11·6 % of children with excess body fat were correctly diagnosed as obese by BAZ > 2sd. The use of BAZ > 1sdfor overweight and obesity showed fair concordance coefficient (κ= 0·409,P< 0·001) with 32·5% of children with excess fat positively identified as overweight and obese.Conclusion:WHO BMI-for-age cut-off points severely underestimate the prevalence of overweight and obesity compared with body composition assessment by stable isotope dilution techniques. Evidence-informed interventions should be based on more accurate estimates of overweight and obesity than that can be provided by BAZ.

A combination of malnutrition, Human immune deficiency virus (HIV) and Acquired immune Deficiency Syndrome (AIDS) leads to a vicious cycle of immune malfunction, malnutrition and infectious diseases. Despite more funds being accessible for PLHIV treatment, and many of such programs having positive outcomes, HIV remains a greater basis of morbidity and mortality. The aim of this study was to determine the effect of dietary intake and demographic and social economic status among adult patients living with HIV and AIDS attending Narok County Referral Hospital. The study adopted cross-sectional analytical design. Purposive sampling was used to select Narok county referral hospital, the PLHIV attending the comprehensive care clinic at the hospital and key informants. Simple random sampling was applied to select the 121 respondents from the PLHIV visiting the clinic. A structured questionnaire and anthropometric form were used to collect the data. Besides, 24-hour dietary recalls and a 7-day food frequency questionnaire were used to collect dietary data and were analyzed both descriptively and inferentially; the test of significance was done at a significant level of 0.05. The results were used to establish the nutritional status of PLHIV clients. Secondary data of the patients was collected from their files. The study established that most of the respondents were not consuming the required level of nutrients such as fiber, fat, cholesterol, vitamins E, B1 and 2, Folic Acid, zinc and iron. This was reflected in the 7-day food frequency questionnaire which showed that most patients were not getting the required foods from all the categories considered. It was also noted that most patients had financial challenges and this influenced their dietary intake and hence nutritional status was not statistically significant among PLHIV attending Narok County referral hospital. The study concluded that the three measures of nutritional status used in this study (BMI, MUAC and WHIR) may not be adequate predictors among adult PLHIV. The results are expected to be beneficial to health facilities at the County and National levels, health partners, beneficiaries, health care workers and researchers.

Objective To compare the World Health Organization (WHO) body mass index (BMI)-for-age definition of obesity against measured body fatness in African children. Methods In a prospective multicentre study over 2013 to 2017, we recruited 1516 participants aged 8 to 11 years old from urban areas of eight countries (Ghana, Kenya, Mauritius, Morocco, Namibia, Senegal, Tunisia and United Republic of Tanzania). We measured height and weight and calculated BMI-for-age using WHO standards. We measured body fatness using the deuterium dilution method and defined excessive body fat percentage as >25% in boys and >30% in girls. We calculated the sensitivity and specificity of BMI z-score > + 2.00 standard deviations (SD) and used receiver operating characteristic analysis and the Youden index to determine the optimal BMI z-score cut-off for classifying excessive fatness. Findings The prevalence of excessive fatness was over three times higher than BMI-for-age-defined obesity: 29.1% (95% CI: 26.8 to 31.4; 441 children) versus 8.8% (95% CI: 7.5 to 10.4; 134 children). The sensitivity of BMI z-score > + 2.00 SD was low (29.7%, 95% CI: 25.5 to 34.2) and specificity was high (99.7%, 95% CI: 99.2 to 99.9). The receiver operating characteristic analysis found that a BMI z-score + 0.58 SD would optimize sensitivity, and at this cut-off the area under the curve was 0.86, sensitivity 71.9% (95% CI: 67.4 to 76.0) and specificity 91.1% (95% CI: 89.2 to 92.7). Conclusion While BMI remains a practical tool for obesity surveillance, it underestimates excessive fatness and this should be considered when planning future African responses to the childhood obesity pandemic.

Adequate dietary intake is important in achieving optimal nutrition and health for people before and during treatment of HIV. Inadequate nutrition causes health issues and fatalities among prisoners. Thus, this study assesses dietary intake and factors affecting food service among male prisoners living with HIV at selected prisons in Kenya. A cross sectional analytical study design was adopted on a sample of 113 male prisoners living with HIV, randomly sampled from 4 prisons. Data collection tools included a structured questionnaire used to collect demographic, 24 h recall and food frequency data. During data analysis, 24 h recall data was analyzed using Nutri-survey software, and further analysis via SPSS software. Results revealed that slightly more than half the prisoners (50.4%) were aged 36-53 years. Primary education was attained by 60.2% and secondary education by 21.2%. Mean dietary intake for macronutrients was: Energy (1815±218 Kcal), Protein (56±12 g), fat (32±6 g), Carbohydrates (322±45 g), Fiber (41±23 g) and PUFA (8±1 g). None attained Recommended Daily Allowances (RDA) for energy, fat and PUFAs. Mean key micronutrients were: Vitamin A (1195.1±812.7), Vitamin B6 (1.9±0.9), Vitamin C (55.7±18.4), Iron (10.2±2.7), Magnesium (488.1±152.3) and Zinc (13.9±6.7). None met RDA for Iron. Therefore, provision of a nutritionally balanced diet in prisons can ensure nutrients adequacy. Key words: Dietary intake, food service, prisoners living with HIV.

BACKGROUND:Intake of micronutrient-rich foods among children aged 6 to 23 months in Nairobi is low.OBJECTIVE:This study aimed to assess existing coverage and utilization of micronutrient powders (MNPs), fortified staples, and iodized salt among children aged 6 to 23 months prior to implementation of an MNP program.METHODS:A cross-sectional survey among caregivers of children aged 6 to 23 months (n = 618) was implemented in 7 neighborhoods within Nairobi County, representing the implementation area of the new MNP program.RESULTS:Results for MNP coverage and utilization showed 28.5% of all caregivers were aware of MNP, 18.5% had ever received MNP for their child, and 10.8% had fed MNP to their child in the previous 7 days. Effective coverage (ie, the child had been given the MNP at least 3 times in the previous 7 days) was 5.8%. Effective coverage of infants and young children with poor feeding practices was significantly lower as compared to those with non-poor feeding practices (coverage ratio, 0.34; confidence interval, 0.12-0.70). Most households purchased iodized salt (96.9%), fortified oil (61.0%), and fortified maize flour (93.9%). An estimated 23.9% of vitamin A requirements of children (6-23 months) were provided from fortified oil and 50.7% of iron from fortified maize flour. Most households consumed processed milk (81%).CONCLUSION:Coverage of MNPs in the surveyed neighborhoods was low. Coverage of fortified salt, oil, and maize flour was high and provided significant amount of micronutrients to children. Processed milk has potential as a vehicle for food fortification.

Infant and young child feeding practices have substantial consequences for the growth, development, and survival of children. Children should be exclusively breastfed for the first 6 months of life and thereafter continue to breastfeed for 2 years or longer. Children are vulnerable to malnutrition thus nutrition and health status of the confined children is of interest. The purpose of this study was to establish feeding practices of children 0-59 months incarcerated with their mothers in selected women’s prisons in Kenya. A cross-sectional analytical study was conducted on an exhaustive sample of 202 children and 193 mothers, drawn from a sample of eight out of the 35 women prisons in Kenya. Data collection tools included: a structured researcher-administered questionnaire for mothers and children. Exclusive breastfeeding rate was 69.4%; continued breastfeeding at 1 and 2 years year (88.5%; 52.2%). The mean Dietary Diversity Score (DDS) was 3.52 ± 1.04 foods groups out of 7 groups with 53.3% having attained the minimum DDS and 86.5% of breastfed children having attained the minimum frequency meal consumption. About half of the children (48.6%) attained the minimum acceptable diet. In terms of nutritional status, 21.4% of the children were stunted, 3.8% wasted and 7.5% were underweight. Dietary practices were associated with underweight; not attaining the minimum dietary diversity and minimum acceptable diet was associated with underweight (p = 0.012; p = 0.014); Illness 2 weeks prior to the study was correlated with underweight (p=0.012). Feeding practices significantly influenced nutritional status among children accompanying incarcerated mothers in prisons in Kenya.

Human immunodeficiency virus (HIV) is associated with increased nutrient needs and compromised body immunity. Minimal information exists on effect of food-based interventions on health status of people living with HIV (PLHIV) and not on antiretroviral therapy (ART). This study investigated the efficacy of amaranth grain (Amaranthus cruentus) consumption on CD4 count and morbidity patterns among PLHIV. A one group pre-test-post-test study design was used on a sample of 66 pre-ART adults living with HIV. The study involved collection of baseline characteristics of the respondents; this was followed by consumption of amaranth grain porridge (100 g) for six months. Post-test data was collected and paired t- test was used to compare pre-test and post-test data. Daily consumption of 100 g of amaranth grain porridge increased nutrient intake. A significant increase (P=0.004) in CD4 count from 498.2±163 SD at baseline to 608 ± 157 SD post-test was observed. There was a significant decline in the number of respondents with any form of illnesses from a total of 52 (78.8%) at baseline to 21 (31.8%) respondents at month six (P=0.031). Amaranth grain increased nutrient intake, CD4 count and consequently reduced the prevalence of illness. The study recommends that nutrition and health practitioners should educate PLHIV on importance of use of amaranth grain to complement usual dietary intake. Key words: Amaranth grain, CD4 count, morbidity pattern, people living with human immunodeficiency virus (PLHIV).

Background: Nutrition and HIV are strongly related and any immune impairment as a result of HIV leads to malnutrition while malnutrition leads to immune impairment and thus worsens the effect of HIV. Individuals living with HIV have special nutritional needs irrespective of whether they are on anti-retroviral treatment or receiving care services. Objective: To establish nutritional status of adult male on ART at Kericho District Hospital, Kenya. Design: Cross sectional analytical study. Setting: HIV clinic at Kericho District Hospital, Kenya. Subjects: HIV positive adult male patients Results: Body Mass Index ≥18.5 and ≤ 24.5 (70.92), >16 & 25.5 and < 30 (11.94), ≤ 16 (2.58) and ≥30. Conclusion: There is a high burden of malnutrition among PLHIV on ART (29.1%). Nutritional assessment, Counseling and support (NACS) should be the key intervention during the course of chronic HIV care and follow up.

Background: It is unfortunate that while Highly Active Anti-retroviral Therapy (HAART) has become the standard of care among HIV positive patients, the medications have been associated with metabolic abnormalities recognised to cause lipidemia. Objective: To establish lipidemia status among HIV positive adult male patients attending HIV clinic at Kericho District Hospital. Design: A cross sectional analytical study. Setting: HIV clinic at Kericho District Hospital, Kenya. Subjects: HIV positive adult male patients Results: The results indicated that the mean age was 43.52 ± 9.17 years and out of which 82.27% were married. Primary Education level attained 40.97% .The mean lipid profile level was LDL 2.5 ± 1.05mmol/l, cholesterol 4.49 mmol/L ± 1.28 mmol/l, HDL 1.47 ± 0.58 mmol/l and triglycerides 1.96 ± 1.32 mmol/l, against the expected level of LDL (1.1. - 2.4 mmol/L), HDL (0.9 - 1.68 mmol/L) triglyceride (0.41 - 2.61 mmol/L) and total cholesterol (2.55 - 5.7 mmol/L).The prevalence lipidemia was 48.17%. Conclusion: The findings showed that the mean LDL was elevated with proportion of lipidemia at a significant higher level among HIV positive adult patients on HAART with considerable improvement in the nutritional status. Future work should investigate the biological mechanisms and pathways through which micronutrients affects high density lipoprotein (HDL) and low density lipoproteins (LDL).

Kenya is undergoing rapid urbanization resulting in changing lifestyles. Childhood dietary habits are changing and might result in childhood obesity and related health risks. Dietary habits learnt in early life are likely to be carried to adulthood. Nutrition knowledge and positive attitude are known to influence dietary practices. There is paucity of information on nutrition knowledge, attitude and practices of school-children in cities. This study established nutrition knowledge, attitude and practices among urban school children in Nairobi.

The pattern of infant and young child feeding that provides the most benefit includes being put to the breast within an hour of birth, exclusive breastfeeding for 6 months, continued breastfeeding along with complementary foods up to 2 years of age or beyond, and avoidance of any bottle-feeding. However, since there are no published data from Kenya regarding trends in these feeding practices, this research undertook time trend estimation of these feeding practices using the 1998, 2003, and 2008-2009 Kenya Demographic and Health Survey and also examined the multivariate relationships between sociodemographic factors and feeding practices with data from 2008 to 2009. Logistic regression was used to test the significance of trends and to analyze sociodemographic characteristics associated with feeding practices. There was a significant decline in early initiation of breastfeeding among children in Central and Western provinces and those residing in urban areas. Trends in exclusive breastfeeding showed significant improvement in most sociodemographic segments, whereas trends in complementary feeding and breastfeeding remained stable. Bottle-feeding significantly decreased among children aged 12 to 23 months, as well as those living in Coast, Eastern, and Rift Valley provinces. In the multivariate analysis, the province was significantly associated with feeding practices, after controlling for child's size, birth order, and parity. The stagnant (and in some cases worsening) trends in early initiation of breastfeeding and complementary feeding with breastfeeding paint a worrisome picture of breastfeeding practices in Kenya; therefore, efforts to promote the most beneficial feeding practices should be intensified.