There is depressed prevalence of the optimum iron-folate supplementation in Kenya and in other subSaharan Africa countries. The study was motivated by the paucity of area-specific data on predictors of optimum iron-folate supplementation. The aim of the study was to assess the maternal, knowledge and institutional factors that predict 90+ days (optimum) iron-folate supplementation among pregnant women in a rural set-up in Eastern Kenya. A descriptive cross-sectional study to collect quantitative data from 352 mothers of under-five years old children attending 7 health facilities in Kalama Division of Machakos constituency within Machakos County in lower Eastern Kenya. Using a standard questionnaire, mothers recalled the number of days they had ingested iron-folate supplements in their latest pregnancies. The overall prevalence of optimum supplementation (90+ days) during latest pregnancies was 18.3% and on average the study mothers were supplemented for ~38 days during the antenatal period. Mothers who visited antenatal care (ANC) for ≥4days (odd ratio 004-1.116). Those who were supplemented with a combined form of supplement were more likely to have more days of supplementation (p=0.004), but not optimum (OR: 1.125, 95% CI: 0.419-3.021) compared to those who used single iron and folate supplement. To increase the proportion of pregnant mothers taking iron-folate supplements for 90+ days in low resource rural set-ups, there should be intensified counselling/education on ANC attendance ≥ 4 times and on minimum number of days for optimum iron-folate supplementation. Use of tablets as opposed to syrup increases the likelihood for antenatal ingestion of iron-folate supplements for 90+ days in rural low-resource set-up.[
HIV-infected mothers are more likely to exclusively breastfeed compared with HIV-uninfected mothers. In this resource-poor setting, maternal recall overestimates EBF rates as compared with the deuterium oxide dilution technique. Validating EBF recall data using the objective DO technique is highly recommended for accurate tracking toward global targets on breastfeeding practices.
Household food insecurity has been hypothesized to negatively impact breastfeeding practices and breast milk intake, but this relationship has not been rigorously assessed. To generate an evidence base for breastfeeding recommendations among food‐insecure mothers in settings where HIV is highly prevalent, we explored infant feeding practices among 119 mother–infant dyads in western Kenya at 6 and 24 weeks postpartum. We used the deuterium oxide dose‐to‐the‐mother technique to determine if breastfeeding was exclusive in the prior 2 weeks, and to quantify breast milk intake. Sociodemographic data were collected at baseline and household food insecurity was measured at each time point using the Household Food Insecurity Access Scale. Average breast milk intake significantly increased from 721.3 g/day at 6 weeks postpartum to 961.1 g/day at 24 weeks postpartum. Household food insecurity at 6 or 24 weeks postpartum was not associated with maternal recall of exclusive breastfeeding (EBF) in the prior 24 hr or deuterium oxide‐measured EBF in the prior 2 weeks at a significance level of 0.2 in bivariate models. In a fixed‐effects model of quantity of breast milk intake across time, deuterium oxide‐measured EBF in the prior 2 weeks was associated with greater breast milk intake (126.1 ± 40.5 g/day) and every one‐point increase in food insecurity score was associated with a 5.6 (±2.2)‐g/day decrease in breast milk intake. Given the nutritional and physical health risks of suboptimal feeding, public health practitioners should screen for and integrate programs that reduce food insecurity in order to increase breast milk intake.
Introduction cross-border mobility of persons with Tuberculosis (TB) is a global public health concern. We aimed at documenting health systems´ potential bottlenecks and opportunities in pulmonary TB continuum of care in cross-border expanses of East and Horn of Africa. Methods a cross-sectional program assessment with descriptive analysis of TB services, health staff capacities, diagnostic capacities, data management and reporting, and treatment outcomes. Data were extracted from health facility TB registers and semi-structured key informant interviews conducted in selected 26 cross-border sites within the 7 member states of the Intergovernmental Authority on Development (IGAD) region. Results the overall cross-border TB cure rate in the year preceding the study (37%) was way beneath the global target with considerable variations amongst the study countries. The restricted support to the cross-border health facilities was mediated and even exacerbated by expansive distances from the respective capital cities. Restricted geographical access to the facilities by cross-border populations was a longstanding challenge. Substantial staffing gaps, TB service delivery capacity needs and inadequate diagnostics were noticeable. The TB control guidelines were not harmonized between the countries and the inter-country referral systems were either absent or inappreciable, contributing to ineffective cross-border referrals and transfers. The frail linkages between stakeholders were contemptible, but increasing governments´ commitments in tackling infectious diseases were encouraging. Conclusion cross-border TB interventions should drive regional TB policies, strategies and programs that sustain countries´ coordination, harmonization of management guidelines, advocacy for increased human resources support, enhanced capacity building of cross-border TB staff, adequate diagnostics equipping of the cross-border health facilities and seamless transfer and referral of patients traversing boundaries.
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