School age and adolescence is a dynamic period of growth and development forming a strong foundation for good health and productive adult life. Appropriate dietary intake is critical for forming good eating habits and provides the much needed nutrients for growth, long-term health, cognition and educational achievements. A large proportion of the population globally is in the school age or adolescence, with more than three quarters of these groups living in developing countries. An up-to-date review and discussion of the dietary intake of schoolchildren and adolescents in developing countries is suitable to provide recent data on patterns of dietary intake, adequacy of nutrient intake and their implications for public health and nutrition issues of concern. This review is based on literature published from 2000 to 2014 on dietary intake of schoolchildren and adolescents aged 6-19 years. A total of 50 studies from 42 countries reporting on dietary intake of schoolchildren and adolescents were included. The dietary intake of schoolchildren and adolescents in developing countries is limited in diversity, mainly comprising plant-based food sources, but with limited intake of fruits and vegetables. There is a low energy intake and insufficient micronutrient intake. At the same time, the available data indicate an emerging trend of consumption of high-energy snacks and beverages, particularly in urban areas. The existence of a negative and positive energy balance in the same population points to the dual burden of malnutrition and highlights the emerging nutrition transition in developing countries. This observation is important for planning public health nutrition approaches that address the concerns of the two ends of the nutrition divide.
BackgroundSince obesity in urban women is prevalent in Kenya the study aimed to determine predictors of overweight and obesity in urban Kenyan women.MethodsA cross-sectional study was undertaken in Nairobi Province. The province was purposively selected because it has the highest prevalence of overweight and obesity in Kenya.A total of 365 women aged 25–54 years old were randomly selected to participate in the study.ResultsHigher age, higher socio-economic (SE) group, increased parity, greater number of rooms in the house, and increased expenditure showed greater mean body mass index (BMI),% body fat and waist circumference (WC) at highly significant levels (p <0.001). Most of the variance in BMI was explained by age, total physical activity, percentage of fat consumed, parity and SE group in that order, together accounting for 18% of the variance in BMI. The results suggest that age was the most significant predictor of all the dependent variables appearing first in all the models, while parity was a significant predictor of BMI and WC. The upper two SE groups had significantly higher mean protein (p <0.05), cholesterol (p <0.05) and alcohol (p <0.001) intakes than the lower SE groups; while the lower SE groups had significantly higher mean fibre (p <0.001) and carbohydrate (p <0.05) intakes. A fat intake greater than 100% of the DRI dietary reference intake (DRI) had a significantly greater mean BMI (p <0.05) than a fat intake less than the DRI.ConclusionsThe predictors of overweight and obesity showed that urbanization and the nutrition transition were well established in the sample of women studied in the high SE groups. They exhibited a sedentary lifestyle and consumed a diet high in energy, protein, fat, cholesterol, and alcohol and lower in fibre and carbohydrate compared with those in the low SE groups.
Objective: To determine the impact of facility-based semi-intensive and home-based intensive counselling in improving exclusive breast-feeding (EBF) in a low-resource urban setting in Kenya. Design: A cluster randomized controlled trial in which nine villages were assigned on a 1:1:1 ratio, by computer, to two intervention groups and a control group. The home-based intensive counselling group (HBICG) received seven counselling sessions at home by trained peers, one prenatally and six postnatally. The facilitybased semi-intensive counselling group (FBSICG) received only one counselling session prenatally. The control group (CG) received no counselling from the research team. Information on infant feeding practices was collected monthly for 6 months after delivery. The data-gathering team was blinded to the intervention allocation. The outcome was EBF prevalence at 6 months. Setting: Kibera slum, Nairobi. Subjects: A total of 360 HIV-negative women, 34-36 weeks pregnant, were selected from an antenatal clinic in Kibera; 120 per study group. Results: Of the 360 women enrolled, 265 completed the study and were included in the analysis (CG n 89; FBSICG n 87; HBICG n 89). Analysis was by intention to treat. The prevalence of EBF at 6 months was 23?6 % in HBICG, 9?2 % in FBSICG and 5?6 % in CG. HBICG mothers had four times increased likelihood to practise EBF compared with those in the CG (adjusted relative risk 5 4?01; 95 % CI 2?30, 7?01; P 5 0?001). There was no significant difference between EBF rates in FBSICG and CG. Conclusions: EBF can be promoted in low socio-economic conditions using home-based intensive counselling. One session of facility-based counselling is not sufficient to sustain EBF. KeywordsExclusive breast-feeding Breast-feeding counselling Breast-feeding promotion Randomized controlled trial KenyaExclusive breast-feeding (EBF) promotion has been estimated to be the most effective intervention for saving the lives of young children, with the potential to prevent an estimated 13 % of deaths in low-resource settings (1) . WHO recommends EBF for 6 months (2) . In Africa only 32 % of infants less than 6 months of age are exclusively breast-fed. African countries making major strides in EBF for infants less than 6 months old include Rwanda (88 %), Ghana (63 %), Uganda (60 %) and Malawi (57 %) (3) . Despite an increase in EBF rate in Kenya from 13?2 % in 2003 (4) to 32?0 % in 2009 for infants less than 6 months of age, the number of children who exclusively breast-feed drops significantly with age to 13?2 % at 4-5 months (5)
Studies in urban informal settlements show widespread inappropriate infant and young child feeding (IYCF) practices and high rates of food insecurity. This study assessed the association between household food security and IYCF practices in two urban informal settlements in Nairobi, Kenya. The study adopted a longitudinal design that involved a census sample of 1110 children less than 12 months of age and their mothers aged between 12 and 49 years. A questionnaire was used to collect information on: IYCF practices and household food security. Logistic regression was used to determine the association between food insecurity and IYFC practices. The findings showed high household food insecurity; only 19.5% of the households were food secure based on Household Insecurity Access Score. Infant feeding practices were inappropriate: 76% attained minimum meal frequency; 41% of the children attained a minimum dietary diversity; and 27% attained minimum acceptable diet. With the exception of the minimum meal frequency, infants living in food secure households were significantly more likely to achieve appropriate infant feeding practices than those in food insecure households: minimum meal frequency (adjusted odds ratio (AOR)=1.26, P=0.530); minimum dietary diversity (AOR=1.84, P=0.046) and minimum acceptable diet (AOR=2.35, P=0.008). The study adds to the existing body of knowledge by demonstrating an association between household food security and infant feeding practices in low-income settings. The findings imply that interventions aimed at improving infant feeding practices and ultimately nutritional status need to also focus on improving household food security.
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