Food insecurity and malnutrition remain two major problems in Kenya that cause undernutrition (protein-energy malnutrition) and nutrient deficiencies. In a bid to combat the problem, the government has targeted increased production of the micronutrient (minerals, vitamins) fortified maize flour. This is mostly based on chemical fortificants, which is a short-term measure that targets reducing the level of malnutrition while creating better livelihoods. However, there is need to think about long-term and sustainable strategies. Among the causes that have led to food and nutrition insecurity in the country is the over reliance on maize as the staple food. Other staples in Kenya are sorghum, rice and millet. This study aimed at providing a better and more sustainable approach by fortifying maize based diets with grain amaranth. Maize was procured from National Cereals and Produce Board and processed to refined flour, while amaranth grain that had been toasted at 100ºC for 5 minutes and milled into flour was obtained from Annicos Limited Company, Nairobi. Complementary formulations were then prepared by blending the flours. The refined maize flour was mixed with varying ratios of 0, 20, 30 and 40% of the grain amaranth flour. The proximate composition, mineral content and microbiological analysis of the raw materials and the blends were determined using recognized standard methods, while protein digestibility was determined after enzyme digestion. Nutritional composition of grain amaranth flour differed significantly (p≤0.05) as compared to refined maize flour; amaranth flour was found to be superior in proteins (15.82%), lipids (7.61%), ash (2.54%) and fibre (4.39%), as compared to proteins (6.29%), lipids (1.92%), ash (0.55%) and fibre (0.76%) in refined maize flour. Adding grain amaranth flour to refined maize flour at the different ratios increased the nutrient density significantly (p≤0.05), particularly protein, iron, calcium and zinc. However, it decreased the digestibility of protein significantly (p≤0.05). The results indicate that although adding 40% grain amaranth gave the best results, the most acceptable blend was the 20% grain amaranth addition. They also indicate that "food to food" fortification can be an approach that can be adapted towards meeting the nutrition requirements of the society.
Improved health of infants is dependent on the supportive role of the fathers. There is limited research done in Kenya on father involvement and how it affects feeding practices of the infant. The objective of this study was to evaluate the impact on complementary feeding practice of nutrition education targeted to the father. A randomized control trial was conducted with 290 father-mother pairs recruited into the study. The mothers, who were six months pregnant and receiving antenatal services at Kisumu County Hospital, provided the contact point for recruitment of the fathers who were engaged in this study. The consenting mothers provided information of the 'expectant father' who were later contacted and invited to go to the hospital together with the mother. Consent was obtained from the study participants in a written form. Randomization was done to the father-mother pairs and eventually, each group had 145 pairs. The pairs in the intervention group were educated on complementary feeding while the other pairs in the control group did not get any intervention. Post-natal, feeding on solids and semi-solids of the infants were assessed at six months and at nine months of age. Qualitative assessment through focus group discussions were done to obtain information on fathers' support towards complementary feeding. Overall analysis was done on 278 pairs with 12 lost to follow up. Introduction to solids and semi-solids had been done by a majority (96.7%) by six months of the infant's age in both groups. Solid and semi-solid foods were introduced significantly earlier in the control group and compared to the intervention group (chi-square test; p<0.01). Minimum acceptable diet was significantly higher in the intervention group than the control group (chi-square test; p<0.01). In conclusion, giving fathers information on complementary feeding influences their support towards infant feeding, resulting in positive outcomes in complementary feeding practices.
Fathers' support is an essential component in ensuring success in improving infant feeding practices which have the overall impact of reducing infant mortality rates by 19%. Fathers are usually not targeted with information on infant feeding at the health facility or community level. Fathers have been identified as lacking knowledge, hence, not able to support the recommended infant feeding practices. The study was conducted in Kisumu East Sub County, Kisumu County, which was selected because of the high infant mortality rate in the region. A nutrition education intervention strategy was employed targeting the fathers with information on breastfeeding and complementary feeding through an experimental study in which 290 father-and-mother to be paired were recruited. There was randomization of study participants into either intervention group (145 pairs) where nutrition education was given, or control group (145 pairs) where nutrition education was not given. Recruitment was of all the women who were 6 months pregnant and attending antenatal clinic at Kisumu County Hospital between January-April 2016. The women gave the contacts of the father-to-be, which enabled follow-up to reach the fathers. Quantitative data were collected from the fathers through a pre-tested structured questionnaire that explored their knowledge of breastfeeding pre-intervention. Qualitative data were collected through focus group discussions to assess knowledge, beliefs, and practices on breastfeeding pre-intervention and post-intervention (9 months later).Results did not show any significant differences in the knowledge level on breastfeeding of fathers in the intervention and control group pre-intervention (p>0.05).Significant differences were observed post-intervention on knowledge levels on initiation of breastfeeding within an hour of birth (p =.01), continuation of breastfeeding for 2 years and beyond (p =.02) and exclusive breastfeeding (p =.02)and group affiliation. A Wilcoxon signed-rank test showed a statistically significant change in knowledge of the fathers in the intervention after receiving the nutrition education sessions (Z = -10.181, p = 0.000). The group discussions showed that fathers largely saw their role as the provision of food for maternal and infant feeding pre-intervention in both groups, while fathers reported additional roles postintervention in the intervention group including being a source of motivation and information to the mother. In conclusion, fathers have low knowledge levels on breastfeeding process which in turn affects their influence on breastfeeding practice. Nutrition education involving the fathers increases their knowledge on breastfeeding and influence to breastfeeding practice ultimately contributing to improved breastfeeding practices.
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