Children In Rural Kenya Research Articles

Informal learning through Tippo games during the COVID-19 pandemic: the case of children in rural Kenya

ABSTRACT The COVID-19 pandemic had far-reaching effects on school-going children. With the indefinite closure of schools in many parts of the world, many children found themselves with limited avenues for play and interaction. The current qualitative study, anchored on social capital theory, aimed at investigating the informal learning that took place as children in one rural area in Kenya engaged in Tippo (Hide and Seek) game. Data was collected through naturalistic observation and analysed thematically. Findings revealed that the children gained social, cognitive and physical skills as they participated in the game. Theoretically, children gain when they play and interact with other children in line with social capital theory. A practical implication from this study, therefore, is for teachers and parents/guardians to encourage children (at all times, not just during pandemics) to engage in games such as Tippo, which can enhance the attainment of diverse social, cognitive and physical skills.

‘Counselling is not just providing information’: perceptions of caregivers and stakeholders on the design of nutrition and health counselling interventions for families with young children in rural Kenya

BackgroundGlobally, a fifth of the children continue to face chronic undernutrition with a majority of them situated in the Low- and Middle-Income Countries (LMIC). The rising numbers are attributed to aggravating factors like limited nutrition knowledge, poor feeding practices, seasonal food insecurity, and diseases. Interventions targeting behaviour change may reduce the devastating nutrition situation of children in the LMICs.ObjectiveFor the co-design of a Behaviour Change Communication (BCC) intervention for young children in rural Kenya, we aimed to identify the experiences, barriers, facilitators, and preferences of caregivers and stakeholders regarding nutrition and health counselling.DesignWe employed a qualitative study design and used a semi-structured interview guide. The in-depth interviews were recorded, transcribed, and analysed using content analysis, facilitated by the software NVivo.SettingHealth and Demographic Surveillance System (HDSS) area in Siaya County, rural Kenya.ParticipantsWe interviewed 30 caregivers of children between 6 and 23 months of age and 29 local stakeholders with experience in implementing nutrition projects in Kenya.ResultsNutrition and health counselling (NHC) was usually conducted in hospital settings with groups of mothers. Barriers to counselling were long queues and delays, long distances and high travel costs, the inapplicability of the counselling content, lack of spousal support, and a high domestic workload. Facilitators included the trust of caregivers in Community Health Volunteers (CHVs) and counselling services offered free of charge. Preferences comprised (1) delivering of counselling by CHVs, (2) offering individual and group counselling, (3) targeting male and female caregivers.ConclusionThere is a disconnect between the caregivers’ preferences and the services currently offered. Among these families, a successful BCC strategy that employs nutrition and health counselling should apply a community-based communication channel through trusted CHVs, addressing male and female caregivers, and comprising group and individual sessions.

Dietary Diversity and Dietary Patterns in School-Aged Children in Western Kenya: A Latent Class Analysis.

Inadequate diet among children has both immediate and long-term negative health impacts, but little is known about dietary diversity and dietary patterns of school-aged children in rural Kenya. We assessed dietary diversity and identified dietary patterns in school-aged children in Western Kenya using a latent class approach. We collected dietary intake using a 24 h dietary recall among students in elementary schools in two rural villages (hereafter village A and B) in Western Kenya in 2013. The mean (SD) age was 11.6 (2.2) years in village A (n = 759) and 12.6 (2.2) years in village B (n = 1143). We evaluated dietary diversity using the 10-food-group-based women’s dietary diversity score (WDDS) and found a mean (SD) WDDS of 4.1 (1.4) in village A and 2.6 (0.9) in village B. We identified three distinct dietary patterns in each village using latent class analysis. In both villages, the most diverse pattern (28.5% in A and 57.8% in B) had high consumption of grains, white roots and tubers, and plantains; dairy; meat, poultry, and fish; and other vegetables. Despite variation for some children, dietary diversity was relatively low for children overall, supporting the need for additional resources to improve the overall diet of children in western Kenya.

The Role of Mealtimes in Fostering Language Development and Aligning Home and School Learning: Protocol for a Multi-Method Study of Preschool Children in Rural Kenya and Zambia.

BackgroundThe association between school and home is fundamental to sustainable education: parents’ understanding of the school’s priorities and teachers’ understanding of their pupils’ home environment are both vital for children to remain in school and succeed academically. The relationship between parents and teachers is closest in preschool settings, providing a valuable opportunity to build bridges between home and school. In this protocol paper, we outline our planned methods for identifying beneficial home and school behaviors.ObjectiveOur project aims to identify culture-specific structures and behaviors in home and school settings, which influence the quantity and quality of child-directed speech and identify positive experiences that can help improve children’s linguistic development and nutrition.MethodsUsing a mixed methods approach and focusing on early language learning, nutrition, and responsive caregiving, we will video-record and analyze mealtime language and eating behaviors at home and in school, targeting 80 preschool children and their families in rural Kenya and Zambia. In addition, we will assess children’s language skills through audio recordings and use questionnaire-based interviews to collect extensive sociodemographic and dietary data.ResultsBetween the start of our project in January 2020 and the end of December 2021, we had collected complete sets of sociodemographic, observational, and food recall data for 40 children in Kenya and 16 children in Zambia. By the end of May 2022, we had started data collection for an additional 24 children in Zambia and transcribed and coded approximately 85% of the data. By the end of September, 2022, we plan to complete data collection, transcription, and coding for the entire sample of 80 children across both countries. From September 2022 onwards, we will focus on analyzing our language data, and we hope to have results ready for publication in early 2023. By relating children’s language outcomes and nutritional intake to the observed mealtime behaviors, we hope to identify practices that increase the quantity and quality of child-directed speech and improve children’s nutritional intake.ConclusionsGood nutrition and the promotion of language learning are key issues in early childhood development. By using a cross-cultural approach, combining a variety of methods, and working closely with stakeholders and policy makers throughout the project, we hope to find and share best practices for improving children’s linguistic outcomes and nutrition and lay the foundation for the development of practitioner networks and parent outreach programs.International Registered Report Identifier (IRRID)DERR1-10.2196/36925

Household-level consumption data can be redistributed for individual-level Optifood diet modeling: analysis from four countries.

A barrier to using Optifood linear programming (LP), which identifies nutrient gaps and supports population‐specific food‐based recommendation (FBR) development, is the requirement for dietary intake data. We investigated whether Household Consumption and Expenditure Surveys (HCESs) could be used instead of individual‐level 24‐h recalls (24HRs). The 24HR data from 12‐ to 23‐month‐old breastfeeding children in rural Kenya, Uganda, Guatemala, and Bangladesh were paired with HCES food consumption data from similar areas (n = 8) and time periods. HCES food intakes (g/week) were estimated using adult male equivalents, adjusted for breastfeeding. Paired HCES‐ and 24HR‐defined LP inputs and outputs were compared using percentage agreement. Mean overall percentage agreements were 42%, 63%, and 80%, for food, food subgroup, and food‐group model parameters, respectively. HCES food lists were on average 1.3 times longer than 24HR. Similar nutrient gaps (77–100% agreement), food sources of nutrients (71–100% agreement), and FBRs (80–100% agreement) were identified. The results suggest that HCES data can be used in Optifood analyses for 12‐ to 23‐month‐old children, despite recognized challenges of using it to estimate dietary intakes of young children compared with older age groups. Further analyses, however, are required for different age groups and locations to confirm expectations that it would perform equally well.

Neurological impairment and disability in children in rural Kenya.

AimTo investigate geographical change over time in the burden of neurological impairments in school‐aged children in a demographic surveillance area.MethodWe investigated changes in neurological impairment prevalence in five domains (epilepsy and cognitive, hearing, vision, and motor impairments) using similar two‐phase surveys conducted in 2001 (n=10 218) and 2015 (n=11 223) and determined changes in location‐level prevalence, geographical clustering, and significant risk factors for children aged 6 to 9 years (mean 7y 6mo, SD 1y) of whom 50.4% were males. Admission trends for preterm birth, low birthweight (LBW), and encephalopathy were determined using admission data to a local hospital.ResultsOverall prevalence for any neurological impairment decreased from 61 per 1000 (95% confidence interval [CI] 48.0–74.0) in 2001 to 44.7 per 1000 (95% CI 40.9–48.6) in 2015 (p<0.001). There was little evidence of geographical variation in the prevalence of neurological impairments in either survey. The association between neurological impairments and some risk factors changed significantly with year of survey; for example, the increased association of adverse perinatal events with hearing impairments (exponentiated coefficient for the interaction=5.94, p=0.03). Annual admission rates with preterm birth (rate ratio 1.08, range 1.07–1.09), LBW (rate ratio 1.08, range 1.06–1.10), and encephalopathy (rate ratio 1.08, range 1.06–1.09) significantly increased between 2005 and 2016 (p<0.001).InterpretationThere was a significant decline in the prevalence of neurological impairments and differential changes in the associations of some risk factors with neurological impairments over the study period. Limited geographical variation suggests that similar interventions are appropriate across the defined area.

Religiosity and parental educational aspirations for children in Kenya

Poor households make little investments in human capital, despite the potential benefits and are hence trapped in poverty. To overcome this poverty trap, households can invest more in children’s education as such investments reflect hopes and aspirations to break the intergenerational poverty chain. In this study, we examine the relationship between religiosity and parental educational aspirations for their children in rural Kenya. We study religiosity from both an extensive (membership in a religious institution) and an intensive perspective (extent of personal spiritual practice such as engaging in worship, meditating and praying) and elicit parental aspirations for children using vignettes. By employing inverse probability weighting with regression adjustment and multivalued treatment effects estimators on cross-sectional data, we show that membership in a religious institution and high levels of religiosity increases the educational aspirations of parents for their children and girls in particular. Overall, we provide empirical correlational evidence that religion can be a transformative pathway to socio-economic development through nudging aspirations and loosening internal constraints and activating progressive beliefs about development in many rural African settings.

The Impact of Local Agrobiodiversity and Food Interventions on Cost, Nutritional Adequacy, and Affordability of Women and Children's Diet in Northern Kenya: A Modeling Exercise.

Wild plant species are often excellent sources of micronutrients and have the potential to promote healthy living, yet they are under-exploited. Distribution of micronutrient powders as diet supplements can play an effective role in reducing micronutrient deficiencies among infants and young children. However, assessing their effects in ensuring a nutritious diet at low cost have been limited. This study assessed the impact of including wild plant species and micronutrient powders in modeled optimized lowest-cost diets for women and children in rural Kenya. Market surveys, focus group discussions in six villages and a 24-h dietary intake recall were used to collect data that were subsequently entered in the cost of diet linear programming tool to model lowest-cost nutritious diets for women and children in Turkana County, Kenya. Three wild vegetables, three wild fruits, and micronutrient powder were added to the models to assess their impact on the cost and the nutrient adequacy of the diets. A locally adapted cost optimized nutritious diet without any intervention costs between 50 and 119 Kenyan shillings (KES) daily ($0.5 to $1.2) for children between 6 and 23 months and 173 to 305 KES ($1.8 to $2.9) for women. Addition of the three wild vegetables resulted in cost reductions between 30 and 71% as well as making up for iron and zinc gaps. The micronutrient powder had an insignificant effect on diet cost and filling nutrient gaps. Edible wild plant species, specifically wild vegetables, can reduce diet costs in considerable proportions while filling nutrient gaps year-round. However, affordability of a nutritious diet remains a major challenge in Turkana County, irrespective of the wealth group.

Mothers' beliefs about indigenous and traditional food affordability, availability and taste are significant predictors of indigenous and traditional food consumption among mothers and young children in rural Kenya.

To examine mothers' and young children's consumption of indigenous and traditional foods (ITF), assess mothers' perception of factors that influence ITF consumption, and examine the relationship between perceived factors and ITF consumption. Longitudinal study design across two agricultural seasons. Seven-day FFQ utilized to assess dietary intake. Mothers interviewed to assess their beliefs about amounts of ITF that they or their young children consumed and on factors that influence ITF consumption levels. Seme sub-County, Kenya. Mothers with young children. Less than 60 % of mothers and children consumed ITF at time of assessment. Over 50 % of the mothers reported that their ITF consumption amounts and those of their children were below levels that mothers would have liked for themselves or for their young children. High cost, non-availability and poor taste were top three reasons for low ITF consumption levels. Mothers who identified high cost or non-availability as a reason for low levels of ITF consumption had significantly lower odds of consuming all ITF except amaranth leaves. Mothers who identified poor taste had significantly lower odds of consuming all ITF except green grams and groundnuts. Similar relationships were noted for young children's ITF consumption levels. A majority of the mothers reported that they and their children did not consume as much ITF as the mothers would have liked. Further studies should examine strategies to improve availability and affordability of ITF, as well as develop recipes that are acceptable to mothers and children.

An Agricultural and Finance Intervention Improved Dietary Intake and Nutritional Status of Children Living in HIV-affected Households in Western Kenya (P10-129-19)

ObjectivesTo test whether an intervention that was shown previously to have improved food security, dietary intake of adults, and HIV health outcomes also improved dietary intake and nutritional status of children living in HIV-affected households. MethodsThe study was conducted in the Nyanza Region, Kenya where two health facilities were randomly assigned as intervention or control arms. The intervention included a human-powered water pump, a microfinance loan to purchase farm commodities, and training in sustainable farming practices and financial management. One hundred children (6 to 60 months of age) were enrolled in each arm from households with HIV-infected adults 18 to 49 years old on antiretroviral therapy and with access to surface water and land. Children were assessed beginning in April 2012 and every three months for one year. Data were collected on dietary intake, height, weight, and mid-upper arm circumference (MUAC). The difference in differences from first visit and in linear trends over visits were tested using fixed-effects regression models. ResultsCompared to the control arm, children in the intervention arm had a larger increase in weight at the 12-month visit (β: 0.42, 95% CI: 0.08, 0.76) and increase in MUAC at the 6-month visit (β: 0.28, 95% CI: 0.08, 0.49), with no difference in changes in height over time. Compared to the control arm, the intervention arm had a larger increasing linear trend over time in intake of staples (β: 0.22, 95% CI: 0.02, 0.44), fruits and vegetables (β: 0.42, 95% CI: 0.10, 0.75), and meat (β: 0.07, 95% CI: 0.03, 0.12), and a larger decreasing linear trend in intake of condiments (β: -0.16, 95% CI: -0.23, -0.09) and tea (β: -0.12, 95% CI: -0.19, -0.05), with no differences in intake of eggs, dairy and fat over time. ConclusionsThis intervention that improved food security, dietary intake, and HIV health outcomes of HIV-infected adults also improved dietary intake and nutritional status of children living in those households. Multisectoral agricultural and financial interventions have the potential to improve the nutritional status of HIV-affected children in rural Kenya and should be further explored. Funding SourcesNational Institute of Mental Health.

Effects of lipid-based nutrient supplements and infant and young child feeding counseling with or without improved water, sanitation, and hygiene (WASH) on anemia and micronutrient status: results from 2 cluster-randomized trials in Kenya and Bangladesh

ABSTRACTBackgroundAnemia in young children is a global health problem. Risk factors include poor nutrient intake and poor water quality, sanitation, or hygiene.ObjectiveWe evaluated the effects of water quality, sanitation, handwashing, and nutrition interventions on micronutrient status and anemia among children in rural Kenya and Bangladesh.DesignWe nested substudies within 2 cluster-randomized controlled trials enrolling pregnant women and following their children for 2 y. These substudies included 4 groups: water, sanitation, and handwashing (WSH); nutrition (N), including lipid-based nutrient supplements (LNSs; ages 6–24 mo) and infant and young child feeding (IYCF) counseling; WSH+N; and control. Hemoglobin and micronutrient biomarkers were measured after 2 y of intervention and compared between groups using generalized linear models with robust SEs.ResultsIn Kenya, 699 children were assessed at a mean ± SD age of 22.1 ± 1.8 mo, and in Bangladesh 1470 participants were measured at a mean ± SD age of 28.0 ± 1.9 mo. The control group anemia prevalences were 48.8% in Kenya and 17.4% in Bangladesh. There was a lower prevalence of anemia in the 2 N intervention groups in both Kenya [N: 36.2%; prevalence ratio (PR): 0.74; 95% CI: 0.58, 0.94; WSH+N: 27.3%; PR: 0.56; 95% CI: 0.42, 0.75] and Bangladesh (N: 8.7%; PR: 0.50; 95% CI: 0.32, 0.78; WSH+N: 7.9%, PR: 0.46; 95% CI: 0.29, 0.73). In both trials, the 2 N groups also had significantly lower prevalences of iron deficiency, iron deficiency anemia, and low vitamin B-12 and, in Kenya, a lower prevalence of folate and vitamin A deficiencies. In Bangladesh, the WSH group had a lower prevalence of anemia (12.8%; PR: 0.74; 95% CI: 0.54, 1.00) than the control group, whereas in Kenya, the WSH+N group had a lower prevalence of anemia than did the N group (PR: 0.75; 95% CI: 0.53, 1.07), but this was not significant (P = 0.102).ConclusionsIYCF counseling with LNSs reduced the risks of anemia, iron deficiency, and low vitamin B-12. Effects on folate and vitamin A varied between studies. Improvements in WSH also reduced the risk of anemia in Bangladesh but did not provide added benefit over the nutrition-specific intervention.These trials were registered at clinicaltrials.gov as NCT01590095 (Bangladesh) and NCT01704105 (Kenya).

Adherence to home fortification with micronutrient powders in Kenyan pre-school children: self-reporting and sachet counts compared to an electronic monitoring device

BackgroundThe efficacy of home fortification with iron-containing micronutrient powders varies between trials, perhaps in part due to population differences in adherence. We aimed to assess to what extent adherence measured by sachet count or self-reporting forms is in agreement with adherence measured by electronic device. In addition, we explored how each method of adherence assessment (electronic device, sachet count, self-reporting forms) is associated with haemoglobin concentration measured at the end of intervention; and to what extent baseline factors were associated with adherence as measured by electronic device.MethodsThree hundred thirty-eight rural Kenyan children aged 12-36 months were randomly allocated to three treatment arms (home fortification with two different iron formulations or placebo). Home fortificants were administered daily by parents or guardians over a 30 day-intervention period. We assessed adherence using an electronic device that stores and provides information of the time and day of opening of the container that was used to store the fortificants sachets in each child’s residence. In addition, we assessed adherence by self-reporting and sachet counts. We also measured haemoglobin concentration at the end of intervention.ResultsAdherence, defined as having received at least 24 sachets (≥ 80%), during the 30-day intervention period was attained by only 60.6% of children as assessed by the electronic device. The corresponding values were higher when adherence was assessed by self-report (83.9%; difference: 23.3%, 95% CI: 18.8% to 27.8%) or sachet count (86.3%; difference: 25.7%, 95% CI: 21.0% to 30.4%). Among children who received iron, each 10 openings of the electronic cap of the sachet storage container were associated with an increase in haemoglobin concentration at the end of intervention by 1.2 g/L (95% CI: 0.0 to 1.9 g/L). Adherence was associated with the age of the parent but not with intervention group; with age, sex or anthropometric indices of the child; or with age or sex of the parent or guardian.ConclusionsThe use of self -reporting and sachet count may lead to overestimates of adherence to home fortification.Trial registrationThe trial was registered with ClinicalTrials.gov (NCT02073149) on 25 February 2014.

Tungiasis-related life quality impairment in children living in rural Kenya.

BackgroundTungiasis (sand flea disease) is a neglected tropical skin disease caused by female sand fleas (Tunga spp.) embedded in the skin of the host. The disease is common in sub-Saharan Africa and predominantly affects children living in impoverished rural communities. In these settings tungiasis is associated with important morbidity. Whether tungiasis impairs life quality has never been studied.MethodsThe study was performed in 50 children with tungiasis, living in resource-poor communities in coastal Kenya. Based on the Dermatology Life Quality Index (DLQI) a tool was developed to determine life quality impairment associated with tungiasis in children, the tungiasis-related Dermatology of Life Quality Index (tungiasis-related-DLQI). Pain and itching were assessed using visual scales ranging from 0–3 points. The intensity of infection and the acute and chronic severity of tungiasis were determined using standard methods.ResultsSeventy eight percent of the patients reported a moderate to very large effect of tungiasis on life quality at the time of the diagnosis. The degree of impairment correlated with the number of viable sand fleas present in the skin (rho = 0.64, p < 0.001), the severity score of acute clinical pathology (rho = 0.74, p < 0.001), and the intensity of pain (rho = 0.82, p < 0.001). Disturbance of sleep and concentration difficulties were the most frequent restriction categories (86% and 84%, respectively). Four weeks after curative treatment, life quality had improved significantly. On the individual level the amelioration of life quality correlated closely with the regression of clinical pathology (rho = 0.61, p < 0.001).ConclusionThe parasitic skin disease tungiasis considerably impairs life quality in children in rural Kenya. After effective treatment, life quality improves rapidly.

Psychometric properties of the Ndetei–Othieno–Kathuku (NOK) Scale: A mental health assessment tool for an African setting

Background: Research suggests that psychiatric conditions in children and adolescents are highly debilitating, with sparse resources for assessment and treatment in low- and middle-income countries (LMICs).Objectives: The primary aim of this study was to evaluate the reliability, validity, and latent factor structure of an ethnographically-grounded assessment instrument for detecting common mental health complaints among rural Kenyan children and adolescents.Methods: The Ndetei–Othieno–Kathuku Scale (NOK) was delivered to 2 282 children aged 10 to 18 years old. Exploratory factor analysis identified four latent factors. This structure was confirmed in subsequent confirmatory factor analyses. External validity was explored by investigating associations among NOK factors and Youth Self-Report DSM-oriented scales.Results: Findings suggest the NOK possesses good internal reliability and a four-factor latent structure corresponding to depression, anxiety, somatic complaints, and a mixed factor. Significant associations ranging from small to medium effect sizes were noted between NOK factors and YSR DSM-oriented scales.Conclusions: Exploratory findings suggest that the NOK possesses adequate psychometric properties among this population. This ethnographically-grounded instrument may be uniquely suited to screening for mental health complaints among Kenyan children and adolescents.

Contribution of urinary tract infection to the burden of febrile illnesses in young children in rural Kenya.

IntroductionThe clinical features of UTI in young children may not localize to the urinary tract and closely resemble other febrile illnesses. In malaria endemic areas, a child presenting with fever is often treated presumptively for malaria without investigation for UTI. Delayed or inadequate treatment of UTI increases the risk of bacteremia and renal scarring in young children and subsequently complications as hypertension and end stage renal disease in adulthood.MethodsA cross-sectional study was carried out in a hospital in western Kenya. Inpatients and outpatients 2 months to five years with axillary temperature ≥37.5°C and no antibiotic use in the previous week were enrolled between September 2012 and April 2013. Urine dipstick tests, microscopy, and cultures were done and susceptibility patterns to commonly prescribed antibiotics established. UTI was defined as presence of pyuria (a positive urine dipstick or microscopy test) plus a positive urine culture.ResultsA total of 260 subjects were recruited; 45.8% were female and the median age was 25months (IQR: 13, 43.5). The overall prevalence of UTI was 11.9%. Inpatients had a higher prevalence compared to outpatients (17.9% v 7.8%, p = 0.027). UTI co-existed with malaria but the association was not significant (OR 0.80, p = 0.570). The most common organisms isolated were Escherichia coli (64.5%) and Staphylococcus aureus (12.9%) and were sensitive to ciproflaxin, cefuroxime, ceftriaxone, gentamycin and nitrofurantoin but largely resistant to more commonly used antibiotics such as ampicillin (0%), amoxicillin (16.7%), cotrimoxazole (16.7%) and amoxicillin-clavulinate (25%).ConclusionOur study demonstrates UTI contributes significantly to the burden of febrile illness in young children and often co-exists with other infections. Multi-drug resistant organisms are common therefore choice of antimicrobial therapy should be based on local sensitivity pattern.

The relationship between agricultural biodiversity, dietary diversity, household food security, and stunting of children in rural Kenya.

The study was to determine the role of Dietary diversity (DD), household food security (HFS), and agricultural biodiversity (AB) on stunted growth in children. Two cross‐sectional studies were undertaken 6 months apart. Interviews were done with mothers/caregivers and anthropometric measurements of children 24–59 months old. HFS was assessed by household food insecurity access scale (HFIAS). A repeated 24‐h recall was used to calculate a dietary diversity score (DDS). Agricultural biodiversity (AB) was calculated by counting the number of edible plants and animals. The study was undertaken in resource‐poor households in two rural areas in Kenya. Mothers/Care givers and household with children of 24–59 months of age were the main subjects. The prevalence of underweight [WAZ <−2SD] ranged between 16.7% and 21.6% and stunting [HAZ <−2SD] from 26.3% to 34.7%. Mean DDS ranged from 2.9 to 3.7 and HFIAS ranged from 9.3 to 16.2. AB was between 6.6 and 7.2 items. Households with and without children with stunted growth were significantly different in DDS (P = 0.047) after the rainy season and HFIAS (P = 0.009) in the dry season, but not with AB score (P = 0.486). The mean AB for households with children with stunted growth were lower at 6.8, compared to 7.0 for those with normal growth, however, the difference was insignificant. Data indicate that households with children with stunted growth and those without are significantly different in DDS and HFIAS but not with AB. This suggests some potential in using DDS and HFIAS as proxy measures for stunting.

Anemia and Iron Status are Predictors of Gut Microbiome Composition and Metabolites in Infants and Children in Rural Kenya

BackgroundThe gut microbiome in childhood has been linked to inflammation and immune function, but very little is known about the differences in the gut microbiome comparing anemic and nonanemic infants and children in Sub‐Saharan Africa.DesignIn a cross sectional study in infants (4–6 month‐olds) and preschool children (2–5 yr‐olds) (n=134) in rural Kenya, we measured haemoglobin (Hb) and iron status, analyzed gut microbiota composition by 16S pyrosequencing and targeted real‐time PCR (qPCR), and measured fecal calprotectin (a marker of intestinal inflammation) and fecal short chain fatty acids.ResultsAnemia rates were 67% and 46% among the infants and children, respectively. The infant gut microbiome consisted of the phyla Actinobacteria (64.3% of reads), Firmicutes (22.4%; including 4.7% Lactobacillus), Bacteroidetes (8.9%; including 3.6% Bacteroides and 4.3% Prevotella), and Proteobacteria (4.1%; including 3.3% Escherichia/Shigella); and was highly dominated by the family of Bifidobacteriaceae, contributing 63.0% of the total 16S rRNA. In contrast, the 2–5 y‐olds had an adult‐like gut microbiota profile with low abundances of Proteobacteria and aerobic gram negative bacteria but high abundances of Firmicutes and Bacteroides. There was no significant effect of baseline anemia status on phylogenetic diversity among the infants, but there were significant differences in taxa between anemic and nonanemic infants: nonanemic infants harbored lower abundances of Prevotella (2.0% vs 4.5%, p=0.014), whereas, they showed higher abundances of Actinomycetales (0.14% vs 0.09%, p=0.004) and Streptococcus (6.3% vs 3.9%, p=0.023). Among the infants, there was a positive correlation between Hb and Roseburia (r2= 0.146; p=0.03), a positive correlation between Hb and sum of pathogenic E.coli (r2=0.139; p=0.047; n=101), a negative correlation between serum transferrin receptor and the sum of pathogenic E.coli (r2=−0.158, p=0.024) and greater numbers of Clostridium difficile in anemic than in nonanemic infants (p=0.022). Among the older children, there was a positive correlation between Hb and Clostridia cluster XIV (r2=0.469, p=0.001) and Clostridia cluster IV (r2=0.381, p=0.01), a negative correlation between Hb and the sum of pathogenic E.coli (r2=0.402; p=0.008), a negative correlation between serum ferritin and the sum of pathogenic E.coli (r2=0.390; p=0.042) and lower abundance of Clostridia cluster XIV and IV in anemic vs. nonanemic children (p= 0.002 and 0.006, respectively). There were no significant differences in fecal calprotectin in anemic vs. nonanemic infants or children. In anemic infants and children, acetate and propionate concentrations were higher and butyrate was lower than in nonanemic infants and children.ConclusionsIn infancy, higher Hb and better iron status predict higher amounts of pathogenic E.coli. In contrast, among older children, higher Hb and better iron status predict lower amounts of pathogenic E.coli. Anemic infants and children do not have greater gut inflammation, but have lower fecal butyrate concentrations, compared to nonanemic children. Thus, relationships between anemia, iron status and pathogenic gut microbiota differ by age in rural Kenya.Support or Funding InformationThis project was supported by the Eunice Kennedy Shriver National Institute Of Child Health &amp; Human Development under grant number U01HD064921, the European Union's Seventh Framework Programme (Fp7/2007‐2013) under grant agreement number 211484 and the ETH Zurich, Switzerland.

Improved food quality, quantity and security among Kenyan orphans and vulnerable children: associations with participation in a multisectoral community-based program, age, gender, and sexual risk

The present study evaluates factors associated with improved food quantity, quality and diversity among participants in a 3-year multisectoral program targeting sibling families of orphans and vulnerable children in rural Kenya. This cross-sectional study evaluates food adequacy and diversity using the World Food Programme’s Food Consumption Score, food access over the previous year, and food dependence on outside-household resources among 1060 families of orphan or vulnerable siblings. The primary comparison group was program-enrolled households who had not yet received any program inputs. Mixed effects logistic models were used to assess the association of food quantity, quality and security with program participation, program inputs and respondent characteristics. Increased time in the program was significantly associated with improved food quantity, quality and security. Other covariates significantly predicting improved food quantity, quality and security included using program-funds to cultivate small-holder farms, increased monthly income, self-efficacy and the number of partners in previous year. After adjusting for monthly income and other covariates, duration of program participation remained a significant predictor of improved food consumption, quality and security. The study presents a unique community-based intervention, hybridizing insights from multiple disciplines that warrants further study to improve the food quantity, quality and security of orphans and vulnerable children across sub-Saharan Africa.

Invasive Group A Streptococcus Infection among Children, Rural Kenya.

To determine the extent of group A Streptococcus (GAS) infections in sub-Saharan Africa and the serotypes that cause disease, we analyzed surveillance data for 64,741 hospital admissions in Kilifi, Kenya, during 1998-2011. We evaluated incidence, clinical presentations, and emm types that cause invasive GAS infection. We detected 370 cases; of the 369 for which we had data, most were skin and soft tissue infections (70%), severe pneumonia (23%), and primary bacteremia (14%). Overall case-fatality risk was 12%. Incidence of invasive GAS infection was 0.6 cases/1,000 live births among neonates, 101/100,000 person-years among children <1 year of age, and 35/100,000 among children <5 years of age. Genome sequencing identified 88 emm types. GAS causes serious disease in children in rural Kenya, especially neonates, and the causative organisms have considerable genotypic diversity. Benefit from the most advanced GAS type-specific vaccines may be limited, and efforts must be directed to protect against disease in regions of high incidence.

Zinc, iron and calcium are major limiting nutrients in the complementary diets of rural Kenyan children.

Poor quality infant and young child (IYC) diets contribute to chronic under‐nutrition. To design effective IYC nutrition interventions, an understanding of the extent to which realistic food‐based strategies can improve dietary adequacy is required. We collected 24‐h dietary recalls from children 6–23 months of age (n = 401) in two rural agro‐ecological zones of Kenya to assess the nutrient adequacy of their diets. Linear programming analysis (LPA) was used to identify realistic food‐based recommendations (FBRs) and to determine the extent to which they could ensure intake adequacy for 12 nutrients. Mean nutrient densities of the IYC diets were below the desired level for four to nine of the 10 nutrients analysed, depending on the age group. Mean dietary diversity scores ranged from 2.1 ± 1.0 among children 6–8 months old in Kitui County to 3.7 ± 1.1 food groups among children 12–23 months old in Vihiga County. LPA confirmed that dietary adequacy for iron, zinc and calcium will be difficult to ensure using only local foods as consumed. FBRs for breastfed children that promote the daily consumption of cows'/goats' milk (added to porridges), fortified cereals, green leafy vegetables, legumes, and meat, fish or eggs, 3–5 times per week can ensure dietary adequacy for nine and seven of 12 nutrients for children 6–11 and 12–23 months old, respectively. For these rural Kenyan children, even though dietary adequacy could be improved via realistic changes in habitual food consumption practices, alternative interventions are needed to ensure dietary adequacy at the population level.