A systematic review was conducted to evaluate the status and intake of iron, vitamin A, iodine, folate and zinc in women of reproductive age (WRA) (≥15–49 years) and pregnant women (PW) in Ethiopia, Kenya, Nigeria and South Africa. National and subnational data published between 2005 and 2015 were searched via Medline, Scopus and national public health websites. Per micronutrient, relevant data were pooled into an average prevalence of deficiency, weighted by sample size (WAVG). Inadequate intakes were estimated from mean (SD) intakes. This review included 65 surveys and studies from Ethiopia (21), Kenya (11), Nigeria (21) and South Africa (12). In WRA, WAVG prevalence of anaemia ranged from 18–51%, iron deficiency 9–18%, and iron deficiency anaemia at 10%. In PW, the prevalence was higher, and ranged from 32–62%, 19–61%, and 9–47%, respectively. In WRA, prevalence of vitamin A, iodine, zinc and folate deficiencies ranged from 4–22%, 22–55%, 34% and 46%, while in PW these ranged from 21–48%, 87%, 46–76% and 3–12% respectively. Inadequate intakes of these micronutrients are high and corresponded with the prevalence figures. Our findings indicate that nationally representative data are needed to guide the development of nutrition interventions and public health programs, such as dietary diversification, micronutrient fortification and supplementation.

Globally, children aged under five years are prone to malnutrition. Maasai are a nomadic community in Kenya still upholding traditional and has a high rate of child undernutrition. Consideration of cultural practices is a pre-condition for ensuring appropriate dietary practices. However, information on the influence of culture on dietary practices among Maasai children is minimal. The possible influence of culture on dietary practices among these children was investigated. Six focus group discussions sessions each consisting of 10 mothers were conducted from two randomly selected villages in Sajiloni location, Kajiado County. Results from this study showed that children mainly consume cereals and legumes. Nomadism makes animal products inaccessible to most children. Livestock are considered a sign of wealth, thus mainly slaughtered on special occasions. Additionally, selling of animals or animal products is not encouraged limiting income that would improve the food basket. Some food taboos prohibit consumption of wild animals, chicken and fish limits the household food diversity. Consumption of vegetables is limited since they are perceived to be livestock feed. The belief that land is only for grazing contributes to low crop production and consumption thus the diets lack diversification. Maasai culture encourages introduction of blood, animal’s milk and bitter herbs to infants below six months, which affects exclusive breast feeding. The men are prioritized in food serving leading to less and poor quality food to children. The consumption of raw meat, milk and blood is likely to lead to infections. The practice of milk fermentation improves bioavailability of micronutrients and food safety. Socialism ensures sharing of available food while believe in traditional medicine hinder visit to health facilities thus no access to nutrition education. This study concludes that culture influence the dietary practices among children under five years. It recommended initiation of programs to create awareness on how the beliefs negatively affect dietary practices with a view for a change.

Appropriate infant and young child nutrition is critical for proper growth and development. In order to promote optimal nutrition at an early age, the World Health Organization (WHO) and UNICEF have developed the Baby Friendly Hospital Initiative (BFHI) to address poor breastfeeding practices in maternity wards. However, impact is limited in less developed countries like Kenya, where more than half of all births are home deliveries. Therefore, Kenya has explored the adoption of Baby Friendly Community Initiative (BFCI) in its rural settings. In contrast to the BFHI, the BFCI supports breastfeeding and optimal infant feeding in community. BFCI has been implemented in Koibatek, in rural Kenya. This study aimed at assessing the effectiveness of BFCI on complementary feeding practices of children aged 6–23 months, by comparing intervention and control groups. This was a randomized control study design that included 270 mother-infant pairs enrolled in the Baby Friendly Community Initiative (BFCI) project in Koibatek. Evaluation was carried out using structured questionnaires. A statistically significantly higher proportion of children in the intervention group compared to the control group attained minimum dietary diversity (77% vs. 58%; p = 0.001), minimum meal frequency (96% vs. 89%; p = 0.046) and minimum acceptable diet (77% vs. 61%; p = 0.005). The odds of attaining minimum dietary diversity, minimum meal frequency and minimum acceptable diet were statistically significantly higher for the intervention group compared to control group (OR: 4.95; 95%CI 2.44–10.03, p = < 0.001; OR: 14.84; 95%CI 2.75–79.9, p = 0.002; OR: 4.61; 95%CI 2.17–9.78, p = < 0.001 respectively). The BFCI intervention was successful in improving complementary feeding practices. Strengthening and prioritizing BFCI interventions could have a significant impact on child health outcomes in rural Kenya. ISRCTN03467700 . Registration 24 September 2014. Retrospectively registered.

Background: Although the baby-friendly community initiative (BFCI) has been proposed as a community-level approach to improve infant feeding practices, there is little data on its variation in effectiveness by HIV status. We conducted a study to determine the effectiveness of BFCI in changing knowledge and attitudes towards exclusive breastfeeding (EBF) and increasing the rates among HIV negative and HIV positive women in rural Kenya.Methods: A community-based cluster-randomized controlled trial was implemented from April 2015 to December 2016 among 901 women enrolled across 13 clusters. The intervention groups received a minimum of 12 personalized home-based counselling sessions on infant feeding by trained community health volunteers from their first or second trimester of pregnancy until 6 months postpartum. Other interventions included education sessions at maternal child clinics, mother-to-mother support group meetings and bi-monthly baby-friendly gatherings targeting influencers. The control group received standard health education at the facility and during monthly routine home visits by community health volunteers not trained on BFCI. Primary outcome measures were the rates of EBF at week 1, months 2, 4 and 6 postpartum. Secondary outcomes included knowledge and attitudes regarding breastfeeding for HIV-exposed infants. Statistical methods included analysis of covariance and logistic regression.Results: At 6 months, EBF rates among HIV negative mothers were significantly higher in the BFCI intervention arm compared to the control arm (81.7% versus 42.2%p = 0.001). HIV positive mothers in the intervention arm had higher EBF rates at 6 months than the control but the difference was not statistically significant (81.8% versus 58.4%;p = 0.504). In HIV negative group, there was greater knowledge regarding EBF for HIV-exposed infants in the intervention arm than in the control (92.1% versus 60.7%p = 0.001). Among HIV positive mothers, such knowledge was high among both the intervention and control groups (96% versus 100%,p > 0.1). HIV negative and positive mothers in the intervention arm had more favourable attitudes regarding EBF for HIV-exposed infants than the control (84.5% versus 62.1%,p = 0.001) and (94.6% versus 53.8% top = 0.001) respectively.Conclusions: BFCI interventions can complement facility-based interventions to improve exclusive and continued breastfeeding knowledge, attitudes, and behaviours among HIV negative and positive women.

Presently, close to 1 billion people suffer from hunger and food insecurity. Statistics in Kenya indicates that over 10 million people suffer from chronic food insecurity and poor nutrition, 2–4 million people require emergency food assistance at any given time with nearly 30 % of Kenya's children being undernourished, 35 % stunted while micro-nutrient deficiency is wide spread. Key among the challenges contributing to inadequate foods include lack of certified seeds, seasonal production (rain-fed), high post-harvest losses and wastages, poor transportation, low value additions which reduce their market competitiveness. The present paper examines some of the underlying causes for high food wastage experience in Kenya and the associated challenges in addressing these problems. The paper also provides an overview of some of the basic solutions that have been recommended by various stakeholders. However, in spite of the recent efforts made to mitigate food wastage, there is still an urgent need to address these gaps through participatory, innovative community based interventions that will create resilience to climate change and enhance livelihoods of smallholder farmers in diverse ecosystems.

Interventions promoting optimal infant and young child nutrition could prevent a fifth of under-5 deaths in countries with high mortality. Poor infant and young child feeding practices are widely documented in Kenya, with potential detrimental effects on child growth, health and survival. Effective strategies to improve these practices are needed. This study aims to pilot implementation of the Baby Friendly Community Initiative (BFCI), a global initiative aimed at promoting optimal infant and young child feeding practices, to determine its feasibility and effectiveness with regards to infant feeding practices, nutrition and health outcomes in a rural setting in Kenya. The study, employing a cluster-randomized trial design, will be conducted in rural Kenya. A total of 12 clusters, constituting community units within the government’s Community Health Strategy, will be randomized, with half allocated to the intervention and the other half to the control arm. A total of 812 pregnant women and their respective children will be recruited into the study. The mother-child pairs will be followed up until the child is 6 months old. Recruitment will last approximately 1 year from January 2015, and the study will run for 3 years, from 2014 to 2016. The intervention will involve regular counseling and support of mothers by trained community health workers and health professionals on maternal, infant and young child nutrition. Regular assessment of knowledge, attitudes and practices on maternal, infant and young child nutrition will be done, coupled with assessment of nutritional status of the mother-child pairs and morbidity for the children. Statistical methods will include analysis of covariance, multinomial logistic regression and multilevel modeling. The study is funded by the NIH and USAID through the Program for Enhanced Research (PEER) Health. Findings from the study outlined in this protocol will inform potential feasibility and effectiveness of a community-based intervention aimed at promoting optimal breastfeeding and other infant feeding practices. The intervention, if proved feasible and effective, will inform policy and practice in Kenya and similar settings, particularly regarding implementation of the baby friendly community initiative. ISRCTN03467700 ; Date of Registration: 24 September 2014