Mothers In Kenya Research Articles

Effect of Access to Workplace Supports for Breastfeeding Among Formally Employed Mothers in Kenya

ObjectivesWe evaluated the availability of workplace breastfeeding (BF) supports, and the associations between these supports and BF practices among formally employed mothers in Kenya – where many women work in horticulture farms and legislation requiring workplace BF supports is being implemented. We hypothesized that the availability of supports would be associated with a higher prevalence and greater odds of exclusive breastfeeding (EBF). MethodsWe conducted repeated cross-sectional surveys among formally employed mothers at 1–4 days, 6 weeks, 14 weeks, and 36 weeks (to estimate 24 weeks) postpartum at 3 health facilities in Naivasha from Sept. 2018 to Oct. 2019, 13 months after the 2017 Kenyan Health Act, which requires workplace BF support, was passed. We evaluated the associations of workplace BF supports with EBF practices using tests of proportions and adjusted logistic regression. ResultsAmong formally employed mothers (n = 564), reported workplace supports included on-site housing (16.8%), on-site daycare (9.4%), and private lactation spaces (2.8%). Mothers who used workplace on-site childcare were more likely to practice EBF than mothers who used community- or home-based childcare at both 6 weeks (95.7% versus 82.4%, p = 0.030) and 14 weeks (60.6% versus 22.2%, p < 0.001; [aOR (95% CI) = 5.11 (2.3, 11.7)]. Likewise, mothers who visited daycares at or near workplaces were more likely to practice EBF (70.0%) compared to those who did not visit a daycare (34.7%, p = 0.005) at 14-weeks. Among all mothers, 84.6% with access to workplace private lactation spaces practiced EBF, compared to 55.6% without such spaces, p = 0.037. Mothers who live in on-site housing were twice as likely [aOR (95% CI) = 2.06 (1.25, 3.41)] to practice EBF compared to those without access to on-site housing. ConclusionsFormally employed mothers in Kenya who used on-site childcare, lived in on-site housing, and had access to private workplace lactation rooms are more likely to practice EBF than mothers who lack these supports, while the use of community-based childcare in this context is associated with a lower prevalence of EBF. As the Kenya Health Act is implemented, provision of these supports and strategies to help women visit their children in daycare can enable EBF among employed mothers. Funding SourcesNIH Fogarty International Center.

Social Support, Maternal Agency, Postnatal Depression, and Domestic Violence Influence the Formal Employment-Exclusive Breastfeeding Relationship: Evidence From Kenya

ObjectivesWe previously demonstrated that formal employment among mothers in Kenya is associated with a lower prevalence and odds of exclusive breastfeeding (EBF). This study evaluated the influence of maternal social support, agency, postnatal depression, and domestic violence on the association between formal employment and EBF in Naivasha, Kenya, where many women work in agricultural labor. MethodsUsing cross-sectional data (n = 1,186), we examined validated scales of social support, agency, domestic violence, and postnatal depression as effect modifiers in adjusted, stratified models of the association between employment and EBF. We hypothesized that higher social support and agency would attenuate the odds ratios that evaluated employment and EBF, and domestic violence and depression would further decrease the odds of EBF based on employment. ResultsComparing formally employed to non-formally employed mothers, women with higher social support were more likely to practice EBF at 14 weeks: OR high (95%CI) = 0.22 (0.09, 0.51) and OR low = 0.12 (0.05, 0.29). The same trend was observed at 24 weeks. Among mothers with higher maternal agency compared to those with lower agency, the negative association between formal and EBF was decreased at both 14 weeks [OR high = 0.21 (0.09, 0.47) versus OR low = 0.16 (0.06, 0.44)] and 24 weeks. Comparing mothers who reported experiencing domestic violence to those who had not, the negative association between formal and EBF was increased at both 14 weeks [OR = 0.06 (0.01, 0.31) versus OR No violence = 0.18 (0.09, 0.36)] and 24 weeks. At 14 weeks, mothers with depression decreased the association between employment and EBF: [OR dep = 0.11 (0.03,0.45) versus OR no depression = 0.16 (0.08, 0.33). At 24 weeks, the employment-EBF relationship was non-significant among mothers with depression: [OR dep = 0.31 (0.08, 1.30) but remained significant among mothers without depression: OR no dep = 0.22 (0.12, 0.40). ConclusionsAmong formally employed mothers, maternal social support and agency improve the employment-breastfeeding relationship, while women exposed to domestic violence or postnatal depression experienced a further decrease in the likelihood of EBF. Supportive interventions to improve EBF and other maternal health factors are needed in the postpartum period for employed mothers. Funding SourcesNIH Fogarty International Center

“From analog to digital”: The feasibility, acceptability, and preliminary outcomes of a positive parenting program for street-connected mothers in Kenya

Background: Children of street-connected women in Kenya are at risk of child maltreatment. There have been increasing calls for positive parenting programs for parents experiencing homelessness, however never has one been implemented with this population. We therefore adapted the evidence-based Parenting for Lifelong Health for Young Children program using participatory methods, and piloted the adapted program with street-connected mothers in Kenya. Objectives: To (a) determine if the adapted program was feasible and acceptable with street-connected mothers, and (b) assess indicative effects on child maltreatment, positive parenting, and parental stress. Participants and setting: Two groups of 15 mothers (ages 19+, and 20−) participated between June-July 2018 in Eldoret, Kenya. Participants were eligible if they (a) were the mother of at least one child and (b) self-identified as street-connected. Methods: Feasibility was measured via enrollment, attendance, drop-out rates, and engagement in take-away activities. Focus groups explored program acceptability and program outcomes. Self-report surveys assessed pre-post changes in child maltreatment, parental stress, parental sense of inefficacy, and positive parenting practices. Results: 70% of participants attended >3/4 of sessions, 10% dropped out, and >50% of take-away activities were completed. Participants reported high acceptability and requested its continuation for themselves and other parents. There was an increase in supporting good behaviour (t(21) = 8.15, p < .000) and setting limits (t(18) = 10.03, p < .000); a reduction in physical abuse (t(23) = −2.15, p = .042) and parental stress (t(22) = −7.08, p < .000); results for parental inefficacy were not statistically significant (t(22) = 0.15, p = .882). Conclusions: The adapted program is feasible and acceptable to street-connected mothers, and may reduce child maltreatment and parental stress, and increase positive parenting. Further research should test program effectiveness.

Exclusive breastfeeding among working mothers in Kenya: Perspectives from women, families and employers.

Exclusive breastfeeding (EBF) for the first 6 months of life improves survival, growth and development. In Kenya, recent legislation and policies advocate for maternity leave and workplace support for breastfeeding and breast milk expression. We conducted a qualitative study to describe factors influencing EBF for 6 months among mothers employed in commercial agriculture and tourism. We interviewed employed mothers (n = 42), alternate caregivers and employed mothers' husbands (n = 20), healthcare providers (n = 21), daycare directors (n = 22) and commercial flower farm and hotel managers (n = 16) in Naivasha, Kenya. Despite recognizing the recommended duration for EBF, employed mothers describe the early cessation of EBF in preparation for their return to work. Managers reported supporting mothers through flexible work hours and duties. Yet, few workplaces have lactation spaces, and most considered adjusting schedules more feasible than breastfeeding during work. Managers and healthcare providers believed milk expression could prolong EBF but thought mothers lack experience with pumping. The most frequently suggested interventions for improving EBF duration were to expand schedule flexibility (100% of groups), provide on‐site daycare (80% of groups) and workplace lactation rooms (60% of groups), improve milk expression education and increase maternity leave length (60% of groups). Returning to work corresponds with numerous challenges including lack of proximate or on‐site childcare and low support for and experience with milk expression. These factors currently make EBF for 6 months unattainable for most mothers in these industries. Interventions and supports to improve breastfeeding upon return to work are recommended to strengthen employed mothers' opportunity for EBF.

Malaria during pregnancy and transplacental transfer of Kaposi sarcoma-associated herpesvirus (KSHV) antibodies: a cohort study of Kenyan mother and child pairs

BackgroundKaposi sarcoma-associated herpesvirus (KSHV) seroprevalence in sub-Saharan African children can range up to 50% by age 2 years but factors affecting early age of KSHV infection are not well understood. Malaria during pregnancy has been associated with hindered transplacental transfer of antibodies to several pathogens but whether it affects transplacental transfer of KSHV antibodies is unknown. We aimed to determine if in utero malaria exposure reduced the transfer of KSHV antibodies across the placenta.MethodsA cohort study in Kisumu, Kenya enrolled pregnant women at their first antenatal clinic (ANC) visit and followed them through delivery. We included 70 KSHV-positive, HIV-negative mothers and their children. KSHV antibody levels were measured by ELISA (K8.1, ORF73) and multiplex assay (K8.1, ORF73, K10.5, ORF38, ORF50). Transplacental transfer of antibodies was measured by the cord to maternal blood ratio (CMR) of KSHV antibodies. Malaria during pregnancy was defined as detection of Plasmodium falciparum (Pf) DNA at any ANC visit or delivery. Among women with malaria during pregnancy, we examined time of last malaria infection prior to delivery (< 27 vs. 27+ weeks gestation) and malaria incidence rate (MIR) (episodes/100 person-weeks).ResultsKSHV seroprevalence (positive for K8.1 or ORF73 by ELISA) among pregnant women was 88%. Neither malaria during pregnancy, malaria infection timing, nor MIR were associated with maternal delivery KSHV antibody blood levels. Maternal delivery and cord blood KSHV antibody levels were highly correlated but these correlations did not differ by malaria during pregnancy. KSHV transplacental antibody transfer was not associated with malaria during pregnancy, malaria infection timing, nor MIR.ConclusionsMalaria during pregnancy does not appear to affect transfer of KSHV antibodies across the placenta.

Maternal Human Milk Oligosaccharide Profile Modulates the Impact of an Intervention with Iron and Galacto-Oligosaccharides in Kenyan Infants.

There is little data on human milk oligosaccharide (HMO) composition in Sub-Saharan Africa. Iron fortificants adversely affect the infant gut microbiota, while co-provision of prebiotic galacto-oligosaccharides (GOS) mitigates most of the adverse effects. Whether variations in maternal HMO profile can influence the infant response to iron and/or GOS fortificants is unknown. The aim of this study was to determine HMO profiles and the secretor/non-secretor phenotype of lactating Kenyan mothers and investigate their effects on the maternal and infant gut microbiota, and on the infant response to a fortification intervention with 5 mg iron (2.5 mg as sodium iron ethylenediaminetetraacetate and 2.5 mg as ferrous fumarate) and 7.5 g GOS. We studied mother–infant pairs (n = 80) participating in a 4-month intervention trial in which the infants (aged 6.5–9.5 months) received daily a micronutrient powder without iron, with iron or with iron and GOS. We assessed: (1) maternal secretor status and HMO composition; (2) effects of secretor status on the maternal and infant gut microbiota in a cross-sectional analysis at baseline of the intervention trial; and (3) interactions between secretor status and intervention groups during the intervention trial on the infant gut microbiota, gut inflammation, iron status, growth and infectious morbidity. Secretor prevalence was 72% and HMOs differed between secretors and non-secretors and over time of lactation. Secretor status did not predict the baseline composition of the maternal and infant gut microbiota. There was a secretor-status-by-intervention-group interaction on Bifidobacterium (p = 0.021), Z-scores for length-for-age (p = 0.022) and weight-for-age (p = 0.018), and soluble transferrin receptor (p = 0.041). In the no iron group, longitudinal prevalence of diarrhea was higher among infants of non-secretors (23.8%) than of secretors (10.4%) (p = 0.001). In conclusion, HMO profile may modulate the infant gut microbiota response to fortificant iron; compared to infants of secretor mothers, infants of non-secretor mothers may be more vulnerable to the adverse effect of iron but also benefit more from the co-provision of GOS.

Influences of Exclusive Breastfeeding Among Low-wage, Working Mothers in Kenya: Perspectives from Managers, Healthcare Providers, Daycare Directors, Mothers, and Fathers (OR30-02-19)

ObjectivesKenya has legislation and policies on maternity leave and workplace support for breastfeeding (BF), and breastmilk expression. The extent to which this framework influences the BF practices of low-wage mothers is unknown. The purpose of this study was to understand the influences of EBF for 6 mo among mothers employed in the commercial agriculture and tourism industries. MethodsWe conducted in-depth interviews with employed mothers (n = 25), husbands of employed mothers (n = 10), managers of commercial flower farms and hotels (n = 8), daycare directors (n = 22), and health care providers (n = 20) in Naivasha, Kenya. ResultsDespite a widespread recognition of the recommended 6 months duration for EBF, employed mothers describe early cessation of EBF in preparation for their return to work, following a mandated 3-mo maternity leave. Husbands of employed women support EBF and would like to see the duration of EBF extended, but note similar challenges. Managers support lactating mothers through flexible work schedules and duties, yet few farms or hotels have designated lactation areas, and most recognize that mothers prefer to arrive later or leave early rather than visit children to feed during the workday. Daycare directors describe lack of refrigeration for expressed milk, and low interest from mothers in leaving expressed milk to feed their children during the workday. Employers with on-site housing and/or daycare report a more favorable environment to support EBF. Health care providers perceive low-wage, maternal employment as a challenge to 6 months of EBF, yet see childcare and a strengthened continuum of education from antenatal care to immunization services and community outreach as opportunities to improve EBF promotion. ConclusionsBeliefs about optimal BF practices do not align with practice. Mothers employed in low-wage work receive some benefits from their employers to support child care responsibilities, but distance from daycare, a low efficacy for expressing and storing milk, and lack of support for milk expression currently make EBF unattainable for most mothers in these industries. Interventions to improve the desirability and feasibility of milk expression are needed to strengthen the opportunity for EBF for employed mothers. Funding SourcesFogarty International Center, National Institutes of Health.

Kenyan Curriculum Reforms and Mother Tongue Education: Issues, Challenges and Implementation Strategies

The implementation of mother tongue education (MTE) remains a challenge across Africa and Kenya in particular. This continues despite the fact that the maintenance and development of language and literacy skills in one’s mother tongue (MT) plays a critical role in facilitating second language (L2) learning, developing additive bilingualism and continuous cognitive development. Consequently, Kenya has had several education commissions in both colonial and post-colonial periods, which, together with the Constitution of Kenya have had a bearing on the language policy. However, the language policy has not been supported by a careful implementation strategy for MTE. Presently, Kenya is undergoing curriculum reforms from the ongoing 8-4-4 system, where learners study for eight years of basic (primary) education, four years of secondary education and four years of university education to a new system of 2-6-3-3-3. The 2-6-3-3-3 system comprises two years of pre-primary, six years of primary (three years lower and three years upper primary), six years of secondary (three years junior and three years senior) and three years of university education. While English has been given preponderant attention in the new curriculum, the role of MT has also been re-emphasised because it has not received as much attention as it deserves in the past. It is against this background and the ongoing debates on MTE that this paper attempts to examine the challenges that are likely to impede the implementation of MTE in the 2-6-3-3-3 curriculum reforms as outlined in the education policy. The paper further suggests some implementation strategies to avert the challenges. The study was conducted in Bungoma County in Kenya. Purposive sampling was used to identify key respondents from 10 schools which were used to pilot the new curriculum. The respondents included Grade 3 teachers, head teachers and quality assurance officers (QASOs). Focus group discussions (FGDs), unstructured interviews and document analysis were used to elicit data. The findings revealed that the implementation of MTE policy is likely to flop if it is not supported by careful implementation strategies that take care of teacher training, the production of teaching/learning materials and attempts to change the attitudes of parents towards indigenous languages. The paper advocates for implementation strategies such as greater resource allocation, teacher training on L1 methodologies, a change in attitude with regard to MTE, political will and clearer policy objectives to achieve the aims of an effective MTE system in Kenya.

Implementation of the ‘Return to School’ Policy for Teenage Mothers in Kenya: A Rights-Based Perspective

Implementation of the ‘Return to School’ Policy for Teenage Mothers in Kenya: A Rights-Based Perspective

Ecological immunity of human milk: Life history perspectives from the United States and Kenya.

Previous research has established population variation in anti-inflammatory immunological biomarkers in human milk. This immunity is potentially ecology-dependent and may alter the life history trade-off between growth and maintenance in infants. The current study has two aims: (1) to assess the ecological differences in milk immunity in two populations, one from the urban U.S. and one from rural Kenya; and (2) to test the hypothesis that milk immunity can affect infant growth indicators. Kenyan Ariaal (n = 233) and U.S. (n = 75) breastfeeding mother-infant pairs participated in a cross-sectional study at two separate field sites. Laboratory analysis was performed on milk for the anti-inflammatory biomarkers TGF-β2, sTNF-αRI, sTNF-αRII, and IL-1ra using ELISA. Multiple imputation was used to extrapolate data below the limit of detection before multivariate analysis. There were significant differences between U.S. and Kenyan mothers on all four milk biomarkers, with Kenyan mothers having significantly higher sTNF-αRI and sTNF-αRII and lower TGF-β2 and IL-1ra than U.S. mothers. U.S. mothers with higher milk TGF-β2 and IL-1ra have infants that are significantly longer and heavier for their age, while Kenyan mothers with higher sTNF-αRI have significantly longer and heavier infants for their age, and those with higher TGF-β2 have marginally significantly longer infants. There were significant differences in ecological milk immunity between U.S. and Kenyan mothers. These differences potentially play a role in the growth of their infants. Further research in milk immunity should consider the possibility of shared maternal-infant life histories.

A cancer-associated Epstein-Barr virus BZLF1 promoter variant enhances lytic infection.

Latent Epstein-Barr virus (EBV) infection contributes to both B-cell and epithelial-cell malignancies. However, whether lytic EBV infection also contributes to tumors is unclear, although the association between malaria infection and Burkitt lymphomas (BLs) may involve excessive lytic EBV replication. A particular variant of the viral promoter (Zp) that controls lytic EBV reactivation is over-represented, relative to its frequency in non-malignant tissue, in EBV-positive nasopharyngeal carcinomas and AIDS-related lymphomas. To date, no functional differences between the prototype Zp (Zp-P) and the cancer-associated variant (Zp-V3) have been identified. Here we show that a single nucleotide difference between the Zp-V3 and Zp-P promoters creates a binding site for the cellular transcription factor, NFATc1, in the Zp-V3 (but not Zp-P) variant, and greatly enhances Zp activity and lytic viral reactivation in response to NFATc1-inducing stimuli such as B-cell receptor activation and ionomycin. Furthermore, we demonstrate that restoring this NFATc1-motif to the Zp-P variant in the context of the intact EBV B95.8 strain genome greatly enhances lytic viral reactivation in response to the NFATc1-activating agent, ionomycin, and this effect is blocked by the NFAT inhibitory agent, cyclosporine, as well as NFATc1 siRNA. We also show that the Zp-V3 variant is over-represented in EBV-positive BLs and gastric cancers, and in EBV-transformed B-cell lines derived from EBV-infected breast milk of Kenyan mothers that had malaria during pregnancy. These results demonstrate that the Zp-V3 enhances EBV lytic reactivation to physiologically-relevant stimuli, and suggest that increased lytic infection may contribute to the increased prevalence of this variant in EBV-associated malignancies.

Knowledge of, and attitudes to giving expressed breastmilk to infants in rural coastal Kenya; focus group discussions of first time mothers and their advisers

BackgroundThe World Health Organization (WHO)/UNICEF Baby-Friendly Hospital Initiative step number five of the “Ten steps to successful breastfeeding” states “Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants.” Urban mothers in Nairobi have low rates of exclusive breastfeeding after returning to work but there are no published data on rural Kenya mothers’ infant feeding practices when working or schooling away from home.MethodsWe explored knowledge of, and attitudes to, the practice of giving expressed breastmilk in a mixed methods observational study of breastfeeding in rural Kenyan mothers. Fifty mothers with newborns, identified by nurses and community health workers, were asked questions about their experiences of breastfeeding and who they had sought or received advice from on breastfeeding. Focus group discussions, one with community health workers, and four each with mothers and their named advisers were held. Recordings were analyzed using a thematic framework approach.ResultsThe main themes were: the baby’s right to feed from the breast, lack of knowledge about expressing and giving breastmilk, negative attitudes towards expressed breastmilk, and traditional customs for disposing of expressed breast milk. Most participants did not have any experience of giving expressed breastmilk to infants. They described practices of expressing and discarding milk when the mother or baby was ill, to relieve discomfort from engorgement or after the baby had died.ConclusionsFeeding expressed breastmilk to infants is a new concept in this context. Promotion of, and training in this practice would help mothers to maintain their milk supply when away from their babies and benefit the infants of working and schoolgirl mothers.

Association of maternal KIR gene content polymorphisms with reduction in perinatal transmission of HIV-1.

The role of killer cell immunoglobulin-like receptors (KIRs) in the transmission of HIV-1 has not been extensively studied. Here, we investigated the association of KIR gene content polymorphisms with perinatal HIV-1 transmission. The KIR gene family comprising 16 genes was genotyped in 313 HIV-1 positive Kenyan mothers paired with their infants. Gene content polymorphisms were presented as presence of individual KIR genes, haplotypes, genotypes and KIR gene concordance. The genetic data were analyzed for associations with perinatal transmission of HIV. There was no association of infant KIR genes with perinatal HIV-1 transmission. After adjustment for gravidity, viral load, and CD4 cell count, there was evidence of an association between reduction in perinatal HIV-1 transmission and the maternal individual KIR genes KIR2DL2 (adjusted OR = 0.50; 95% CI: 0.24–1.02, P = 0.06), KIR2DL5 (adjusted OR = 0.47; 95% CI: 0.23–0.95, P = 0.04) and KIR2DS5 (adjusted OR = 0.39; 95% CI: 0.18–0.80, P = 0.01). Furthermore, these maternal KIR genes were only significantly associated with reduction in perinatal HIV transmission in women with CD4 cell count ≥ 350 cells/ μl and viral load <10000 copies/ml. Concordance analysis showed that when both mother and child had KIR2DS2, there was less likelihood of perinatal HIV-1 transmission (adjusted OR = 0.44; 95% CI: 0.20–0.96, P = 0.039). In conclusion, the maternal KIR genes KIR2DL2, KIR2DL5, KIR2DS5, and KIR2DS2 were associated with reduction of HIV-1 transmission from mother to child. Furthermore, maternal immune status is an important factor in the association of KIR with perinatal HIV transmission.

Early Childhood Development in Children Born to HIV-Infected Mothers: Perspectives From Kenyan Clinical Providers and Caregivers.

Objective. To understand the perspectives of clinical providers and caregivers regarding early childhood development (ECD) in children born to HIV-infected mothers in Kenya. Methods. This was a qualitative study of provider and caregiver perspectives on ECD at 5 Kenyan HIV clinics, using semistructured interviews and focus group discussions. Constant comparison and triangulation methods were employed to elucidate the concepts of ECD. Results. Twenty-five providers and 67 caregivers participated. While providers understood ECD in terms of milestones, caregivers strongly equated ECD with physical growth. Factors affecting ECD, such as nutrition, perinatal effects, and illness, were perceived differently by providers and caregivers. Both groups generally believed that HIV-infected children would have typical ECD if adherent to their HIV treatment. Conclusions. Important considerations regarding ECD in this population were uncovered. Understanding provider and caregiver perspectives’ on ECD in HIV-exposed children is critical for promoting ECD in this community.

Examining High Rates of Preventable Maternal Mortality in Kenya: Could Provisional Measures be an Effective Tool to Guarantee Safe Pregnancy?

AbstractThis article analyses the barriers that expectant mothers face in accessing appropriate, quality medical services in Kenya, and investigates the potential for the regional African human rights adjudicator to use provisional measures (PMs) to protect expectant mothers. The article aims to explore whether PMs adopted by the African Commission on Human and Peoples’ Rights could be an appropriate legal tool to secure protection for expectant mothers who are dealing with obstacles in obtaining the medical services that they need. In that regard, this contribution suggests that the situation of certain expectant mothers in Kenya meets the two necessary conditions to grant PMs under the African Human Rights system: that the situation is urgent and the measures are necessary to prevent irreparable damage. It suggests that, following the tendency of other international human rights bodies, the Commission has the potential to play a relevant role in the context of maternal mortality.

Exclusive Breastfeeding Is More Common Among HIV-Infected Than HIV-Uninfected Kenyan Mothers at 6 Weeks and 6 Months Postpartum.

To compare breastfeeding practices determined by mothers' own recall versus a stable isotope technique (deuterium oxide dilution) among human immunodeficiency virus (HIV)-infected and HIV-uninfected mothers at 6 weeks and 6 months postpartum. Exclusive breastfeeding (EBF) rates were assessed cross-sectionally at 6 weeks and 6 months postpartum among 75 HIV-positive and 68 HIV-negative women attending postnatal care. EBF was derived from maternal 24-hour recall of foods that were fed to the infant and by objective measurement of nonhuman milk-water intake using deuterium oxide (DO) dilution technique. Multivariable logistic analyses were adjusted for infant sex, gravidity, maternal age, marital status, and maternal education. Using recall method, a greater proportion of HIV-infected mothers exclusively breastfed than HIV-uninfected mothers both at 6 weeks postpartum [94.1% versus 76.9%, respectively (adjusted odds ratio [aOR] 7.81; 95% confidence interval [CI] 1.9-31.6, p = 0.004)] and at 6 months postpartum [75% versus 59.7%, respectively (aOR 2.27; 95% CI 1.0-5.3, p = 0.058)]. At 6 weeks postpartum EBF rates from the DO technique were 23.5% and 13.8% for HIV-positive and HIV-negative mothers, respectively (aOR 0.35; 95% CI 0.11-1.04, p = 0.059). At 6 months postpartum, the DO technique determined EBF rates were 43.3% among HIV-positive and 24.2% among HIV-negative mothers, respectively (aOR 2.4; 95% CI 1.0-5.7, p = 0.048). 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.

Maternal health services utilisation by Kenyan adolescent mothers: Analysis of the Demographic Health Survey 2014

BackgroundKenya has one of the highest adolescent fertility rates in East-Africa, estimated at 106 births per 1000 females aged 15–19years. In addition to promoting safe sexual behaviour, utilisation of maternal health services (MHS) is essential to prevent poor outcomes of pregnancy and childbirth. To ensure optimum planning, particularly in the context of the Sustainable Development Goals, this study assesses the current service utilisation patterns of Kenyan adolescent mothers and the factors that affect this utilisation. MethodsUsing data from the recently published 2014 Kenya Demographic Health Survey, we collected demographic and utilisation data of all three MHSs (antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC)) of adolescent mothers aged 15–19years. We then conducted bivariate and multivariate analyses to test associations between selected demographic and service utilisation variables. ResultsOur findings showed that half of Kenyan adolescent mothers have had their first birth by the age of 16. MHS utilisation rates amongst Kenyan adolescent mothers were 93%, 65%, 92% for ANC, SBA and PNC respectively. Mother’s education, religion, ethnicity, place of residence, wealth quintile, mass media exposure, and geographical region were significant predictors for both ANC and SBA utilisation. Education level of partner was significant for ANC utilisation while parity was significant for both SBA and PNC. ConclusionsAdolescent MHS utilisation is not optimum in Kenya. More work that includes affordable care provision, cultural re-orientation, targeted mass-media campaigns and male involvement in care need to be done with emphasis on the most disadvantaged areas.

Is competence enough to enable Kenyan mothers to make good infant and young child feeding decisions?

The aim of this study was to explore factors associated with maternal infant and young child feeding motivation in urban and rural Kenya. We conducted 18 focus group discussions with mothers of children 0 to 23months of age and healthcare workers. The data were transcribed, translated, and explored following the principles of content analysis. We first explored and coded the data inductively and categorized it according to emerging themes representing the most relevant topics for young child feeding. After this, these themes were theorized into an explanatory framework. Finally, the results yielded seven themes integrated into self-determination theory's three basic motivation-building pillars: autonomy, competence, and relatedness. We found that maternal intrahousehold autonomy on child feeding was substantial. However, this autonomy was lost for a period of time while in close contact with the healthcare staff. The authority of the healthcare workers was at its peak when the child was born and faded gradually as the child grew. Building maternal competence is important for child-feeding outcomes, but our data showed that the health education methods used by the healthcare workers were inadequate to improve maternal to improve the motivation. The competence of Kenyan healthcare workers should be improved in the area of complementary feeding counseling, and they should be trained to provide practical and emotional support as a way of increasing maternal motivation on infant and child feeding.

Male partner involvement in efforts to eliminate mother-to-child transmission of HIV in Kisumu County, Western Kenya, 2015.

Introductionrates of caesarean sections (CS) have been rising globally over time. Our study sought to identify factors associated with CS among mothers delivering at Mama Lucy Kibaki Hospital in Nairobi city county, Kenya.Methodswe conducted an unmatched case-control study using a 1:2 case-to-control ratio. Cases were defined as mothers who delivered through CS at the hospital while controls were defined as mothers who delivered through vaginal birth. Semi-structured questionnaires were used to interview study participants. We calculated means and proportions of demographic and obstetric characteristics of the mothers and crude odds ratios (cOR) and 95% confidence intervals (CI) to identify factors associated with CS. We performed multivariable logistic regression to identify independent factors associated with CS.Resultswe enrolled 396 participants consisting of 132 cases and 264 controls. We identified 148 (56.1%) spontaneous vaginal births. There were 89 (67.4%) primary CS. Among the 67 (50.7%) cases that had intrapartum complications, 28 (41.8%) had arrest of labor while among the 52 (19.7%) controls that had intrapartum complications 21 (40.4%) had abnormal intra-partum bleeding. There were 85 (65.4%) emergency caesarean sections, out of which 33 (25%) were due to failure of labor to progress. Of the elective caesarean sections, 26 (19.7%) were repeat caesarean. Delivering a baby with a normal birth weight (cOR = 0.39,95% CI 0.18, 0.94) and being formally employed (cOR = 1.90 (95% CI 1.4, 3.1)) were associated with CS. Being formally employed (AOR = 1.78, p = 0.030) was independently associated with a mother undergoing CS compared to mothers who were not formally employed, while mothers whose babies had a normal birth weight, ≥ 2.5kg (AOR = 0.40, p = 0.040) were less likely to undergo CS as compared to mothers whose babies had a low birth weight.Conclusionemployment status and birth weight were associated with CS in urban Kenyan mothers.

Childhood exposure to emotional abuse and later life stress among Kenyan women: a mediation analysis of cross-sectional data

ABSTRACTBackground and objective: We explore whether perceived stress among Kenyan mothers is predicted by childhood exposure to emotional abuse – both witnessed among parents and experienced directly. Further, we explore whether this association is mediated by social support, family functioning and polygynous marriage.Design: We used cross-sectional data from a systematic random sample (n = 1974) of mothers in semi-rural Kenya.Methods: Data were collected using validated scales and trained interviewers. Analyses were conducted using bootstrapped structural equation models and fixed-effects linear regression models, controlling for age and household wealth.Results: Reported experience of emotional abuse – both directly experienced and observed among household adults – was high in the present population (72.5% and 69%, respectively). Perceived stress among women was significantly higher if they were exposed to more emotional abuse during childhood (p < .001). Lower social support, worse family functioning and higher rates of polygynous marriage mediated pathways between emotional abuse exposure during childhood and adult perceived stress.Conclusion: Future research should investigate whether social integration, identity formation and self-esteem underlie observed dynamics in sub-Saharan Africa. Efforts to promote social integration and support should target children currently experiencing emotional abuse, and may include child-targeted high quality television programing and adult-targeted media and celebrity campaigns.