Background: 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. Methods: A cross-sectional study was conducted among 202 school-children aged 8-11 years, systematically sampled from four randomly selected schools. Structured questionnaire, key informant interviews and focus group discussions were used to collect data. A nutrition knowledge score was determined (correct response: 1, incorrect: 0). Overall knowledge level was the total of correct responses in percentages. Scores of ≤40 %, 41-69 % and ≥70 % were categorized as low, moderate and high knowledge respectively. Dietary practices were determined from frequency of food consumption, habitual patterns and attitude on what they ate. Data were analyzed using SPSS. P-value of p < 0.05 was considered significant. Results: Pupils had moderate nutrition knowledge (mean score 5.16 ± 1.6, 51.6 %). 65 % did not care what they ate. About 82 % ate food in front of TV unsupervised. Over 70 % had consumed sweetened beverages and 73 % junk foods in previous 7 days. Only 9 % consumed fruits 4-7 times a week. Almost all study children carried money to school and made decision on foods to buy. Chips, candies, sausages and smokies, doughnuts and chocolate were preferred snacks. Nutrition knowledge had no significant relationship with dietary practices, but attitude had. Conclusion: Children had moderate nutrition knowledge and poor dietary practices, associated with negative dietary attitude. This study recommends activities to raise awareness on the effect of poor dietary practices on obesity and related health risks.

Few studies have evaluated the impact of fortification with iron-rich foods such as amaranth grain and multi-micronutrient powder (MNP) containing low doses of highly bioavailable iron to control iron deficiency anemia (IDA) in children. We assessed the efficacy of maize porridge enriched with amaranth grain or MNP to reduce IDA in Kenyan preschool children. In a 16-wk intervention trial, children (n = 279; 12-59 mo) were randomly assigned to: unrefined maize porridge (control; 4.1 mg of iron/meal; phytate:iron molar ratio 5:1); unrefined maize (30%) and amaranth grain (70%) porridge (amaranth group; 23 mg of iron/meal; phytate:iron molar ratio 3:1); or unrefined maize porridge with MNP (MNP group; 6.6 mg iron/meal; phytate:iron molar ratio 2.6:1; 2.5 mg iron as NaFeEDTA). Primary outcomes were anemia and iron status with treatment effects estimated relative to control. At baseline, 38% were anemic and 30% iron deficient. Consumption of MNP reduced the prevalence of anemia [-46% (95% CI: -67, -12)], iron deficiency [-70% (95% CI: -89, -16)], and IDA [-75% (95% CI: -92, -20)]. The soluble transferrin receptor [-10% (95% CI: -16, -4)] concentration was lower, whereas the hemoglobin (Hb) [2.7 g/L (95% CI: 0.4, 5.1)] and plasma ferritin [40% (95% CI: 10, 95)] concentrations increased in the MNP group. There was no significant change in Hb or iron status in the amaranth group. Consumption of maize porridge fortified with low-dose, highly bioavailable iron MNP can reduce the prevalence of IDA in preschool children. In contrast, fortification with amaranth grain did not improve iron status despite a large increase in iron intake, likely due to high ratio of phytic acid:iron in the meal.

This study investigated the effect of adding grain amaranth flour on sensory acceptability of maize porridge in Kenya. Factors influencing the intention of mothers to feed their children on grain amaranth were identified. A significant difference between the various porridge ratios (50:50, 70:30, and 100:0 amaranth:maize) either in unfermented or fermented form could be detected. Preference for the unfermented amaranth enriched maize porridge was observed. Intention significantly correlated and predicted grain amaranth consumption (p < .001). Knowledge and health value significantly predicted health behavior identity. Interaction between barriers and intention negatively influenced behavior. Findings suggest that unfermented amaranth enriched maize porridge is acceptable. Unfermented porridge with 70% amaranth can be considered for use in a program aimed at increasing dietary iron intake among children. Increasing awareness about micronutrient deficiencies and nutritional benefits of grain amaranth could enhance its consumption.