Master of Science in Human Nutrition

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Assessing Factors Hindering the Effectiveness of The Family Muac Program in Detecting Malnutrition Among Under-Five Years Children in Banisa Sub-County, Mandera County
(KeMU, 2024-09) SAIDA, ROBLE HASSAN
The Family MUAC Program, which involves training mothers and caregivers to use a Mid-Upper Arm Circumference (MUAC) tape to detect signs of malnutrition in children, has shown positive outcomes in terms of improving nutrition surveillance and early detection of malnourished children. In its implementation, there have been challenges which have made the program not successful as it was intended. The study general objective focused on the barriers to effectiveness of family MUAC programs in Banisa sub-county in Mandera County. In this case, the study focused on four objectives which included; assessing mothers’ sociodemographic characteristics, socioeconomic factors, health facility services, and training factors’ influence on nutrition surveillance and early detection of malnutrition among children aged 6-59 months in Banisa sub-county in Mandera County. The early detection and nutritional surveillance amounted to effectiveness of the family MUAC programs. The study was guided by Cognitive Behavioral Theory (CBT) which informed the study variables. The study adopted correlation research design, where the study sought to establish any statistically significant correlations between the independent and the dependent variable, effectiveness of family MUAC program. Target population was 293 mothers from Banisa Sub-County, from where a sample size was established at 236 mothers, but managed to get 209 fully filled questionnaires. This corresponded to 89% response rate which was considered adequate for analysis of the findings. The sample size was through systematic simple random sampling method. The researcher interviewed mothers presenting to the clinic until the sample size was achieved. Data collection was primary and the researcher administered questionnaires and interview guides. Data was analyzed using SPSS version 26. Presentation was on tables, frequencies and percentages. Bivariate analysis was done, having Pearson correlations coefficients and multivariate analysis was done through multiple linear regression, with ANOVA and regression coefficients. The findings of the study showed that there was a positive significant relationship between Socio-economic factors, training factors, health facility, and effectiveness of family MUAC programs (p <.001). Only mothers’ characteristics was not significantly correlated to effectiveness of MUAC programs. The study recommendation and conclusion aimed at training mothers to capacity build on using the family MUAC program, and to know the features and indicators to look for in enhancing nutritional surveillance and early detection of malnutrition among children under five.
Assessment of Knowledge, Attitude and Practices on Kenya’s Breast Milk Substitutes Act (2012) Among Nurses in Mbagathi and Pumwani Hospitals, Kenya
(KeMU, 2021-09) Nyaboke, Clement
International Code on marketing BMS was developed by the World Health Organization, to protect lactating mothers and healthcare personnel from commercial pressure by BMS manufacturers. Nursing officers are obligated to promote, encourage, protect and acquaint themselves with their obligations in accordance with this Code. The research problem in this study was based on the scarce empirical evidence about the information and knowledge of the recommendations of the International Code on BMS by health workers in Kenya responsible for counseling mothers of new-born babies on breastfeeding. The main objective of this study was to determine the knowledge, attitude and practices of BMS Act among nurses at selected hospitals. The specific objectives were; establish demographic characteristics of nurses in Mbagathi and Pumwani Hospitals, Nairobi County, to assess the knowledge level of Nurses on the Kenya’s Breast Milk Substitute Act; determine the attitude towards Kenya’s Breast Milk Substitute Act and to examine the practices of the Kenya’s Breast Milk Substitute Act among nurses in Mbagathi and Pumwani Hospitals, Nairobi County. This study adopted a cross-sectional descriptive research/study design. Simple random sampling was used to include nurses in the study. Yamane formula was used for the simple random sampling technique method to come out with a sample size of 200 Nurses for study. The study used questionnaire as the primary data collection tool. Descriptive statistics and chi-square tests were used to analyses data with the help of SPSS. The study found that majority (83.9%) of the respondents was Female. Majority (85%) were young being aged under 40 years. Slightly above half (49.7%) were married. All the respondents were trained with majority (65.6%) having acquired a college certificate. Over half (56.5%) of the respondents had more than 6 years of working experience. Majority [168, 90.3%] had a high knowledge on Kenya’s BMS Act. The vast majority [185, 99.5%] of the respondents had a positive attitude towards BMS. Majority [153, 82.3%] of the respondents had good practices in regards to BMS practices. The level of education and nurses’ knowledge were significant (p=0.000) in the study. The study therefore concluded that nurses had high knowledge, positive attitude and good practices regarding their role in EBF promotion and discouraging use of breast milk substitutes in line with the BMS act. The study recommended that; the government and other private organizations should carry out mass education to create awareness on BMS, in order to adopt the recommended infant and young children nutrition practices as postulated by the World Health Organization (2017). Policies and programs should be implemented to support breastfeeding initiatives for the purpose of upscaling exclusive breastfeeding in Kenya.
Assessment of Nutrition and Dietary Practices Among Patients with Gastrointestinal Symptomatology at Kenyatta National Hospital, Kenya
(KeMU, 2025-10) Ndirangu, Faith Wambui
Gastrointestinal Symptoms (GIS) represents a range of disorders with unclear pathophysiology, presenting symptoms such as abdominal pain, ulcers, cramps, constipation, nausea, and vomiting. The disease is linked to multiple factors, including genetics, environment, infections, immune dysfunction, and altered gut microbiota. The rising incidence of GIS globally—affecting over 6.8 million individuals—is attributed to increased urbanization, industrialization, and consumption of processed foods. Sub-Saharan Africa, despite reporting an increase in GIS cases, has limited published studies on the condition, highlighting the need for localized research. The study investigated the dietary habits, nutritional status, and food choices of patients with GIS attending Kenyatta National Hospital (KNH). This study assessed 200 randomly selected GIS patients diagnosed by 2023. It aimed to determine their socio-demographic characteristics, dietary patterns, the influence of food choices on disease progression, and their nutritional status. Findings indicated that females (57%) were more affected than males, though gender did not show a statistically significant association with GIS (p=0.76). The majority (40%) were aged above 34 years, and most patients (72.5%) lived in urban areas. Socio-economic factors such as marital status, education, and income had significant associations with GIS (p<0.05). Over 45% of respondents were well-educated and self-employed, and 22.4% reported a history of cigarette smoking. Dietary analysis revealed that 87% of respondents used sugar in beverages, and 87.9% preferred home-cooked meals, with only 8.1% eating in hotels. The most common foods reported to trigger GIS included beans (76.6%), spicy foods (14.1%), chapatti (13.8%), soft drinks (5.8%), and oranges (4.1%). Similarly, intolerable foods identified were legumes (28.9%), chapatti (10.4%), milk (5.8%), and oranges (5.2%). Foods that brought relief included cabbage (23.3%), potatoes (10.75%), milk (8.3%), and carrots (6.2%). Nutrient intake assessment showed excessive consumption of macronutrients compared to recommended daily allowances (RDAs): carbohydrates (154%), protein (193%), energy (127%), and fiber (211%). Consequently, 69% of participants were overweight or obese (BMI ≥26.38 kg/m²), though none were morbidly obese or underweight. Regression analysis showed a significant relationship between BMI and calorie intake (p=0.003), while the relationship between BMI and food frequency was not significant (p=0.680), contrary to most prior research. The study recommends that GIS patients regularly consult nutritionists to receive updated dietary guidance, control portion sizes to reduce excess macronutrient intake, and engage in at least 30 minutes of exercise daily. Weight reduction and careful food selection, avoiding foods that aggravate symptoms, are essential. Additionally, the Ministry of Health (MOH) should develop dietary prescriptions for GIS patients and integrate GIS management strategies into national health policy guidelines.
Assessment of Vitamin A Routine Supplementation and Diet Rich in Vitamin A on Nutrition Status in Under Five Years of Age in Wajir East Sub-County
(KeMU, 2020-11) Abdi, Nuria Ibrahim
The deficiency of Vitamin A increases child vulnerability to stunting whose effects are permanent if not managed early and spilling over into adulthood. The study aimed to measure the outcome of vitamin A routine supplement and diet rich in vitamin A on morbidity and nutrition status (stunting) in under-fives months children in Wajir East Sub-County. The study design was descriptive cross-sectional survey. The target population was children under-fives months and the sample size was 207 however there was a non-response of two making the response rate 99.03% which is still considered valid. Interview schedule was used to gather information from the caretakers and mothers of under-fives children in the study and anthropometric measurement was used to collect data on height/length for age of the target children. The respondent was selected randomly. SPSS (Statistical Package for Social Sciences) was used to evaluate statistics. Permission was obtained from respondents. Research approval, ethical clearance and research permit were granted by Kenya Methodist University and National Council of Science, Technology and Innovation respectively. The routine coverage for under-fives was found to be 51.2%. Study findings also revealed the prevalence of stunting was high at 63.4% among children who did not receive vitamin A supplement as compared to those who were supplemented (36.6%). Further analysis indicated that there was substantial (0.036) association between the supplement and nutritional status of the target group. The study concludes that the outcome of the vitamin A routine supplementation had effect on both occurrence of morbidity and children nutritional status in Wajir east. The study recommends the need for the national, county government and health stakeholders to strategies and put more effort to accelerate and establish platforms that enhance service delivery at the community level such as Baby Friendly Community Initiative through community strategy to address the poor coverage and insufficient doses , and also to improve availability of the vitamin A stocks at the health facility level since it’s one of the factors that is highly influential in supplementation as identified in the study.
Child and Maternal Related Factors Associated with Malnutrition among Under Fives in Bosaso, Puntland Somalia
(KeMU, 2024-05) Ali, Yasir Dahir
Undernourishment is one of the foremost reasons of disease and mortality among children under the age of five in Sub-Saharan Africa. Significant illnesses and deaths across the world have been associated with malnutrition, accounting for 52.5% of all deaths among young children across the world. Approximately 45% of all mortalities among young children in Somalia are due to under-nutrition. In Puntland, 11% of children are wasted and in Bari, where Bosaso is located, 37% of children are underweight. This research aimed at assessing child and maternal related factors associated with malnutrition among children under five in the Bosaso region, Puntland-Somalia. A descriptive cross-sectional study design with the purposive method of non-probability sampling was deployed. The target population included children aged between six to fifty-nine months attending the maternal and child health clinic (MCH) and pediatric outpatient clinic at Bender Qassim Hospital in Puntland, Somalia. Main data was gathered using a questionnaire using drop and pick approach, while the anthropometric assessment was done using a height board and electronic weighing scales. Data was analyzed in SPSS version 25 with descriptive statistics and a chi-square test used to test associations between study variables. A total of 159 children were selected for the study. More than half (54.1%) were females. Most (54.7%) of the caregivers did not attend school. Most (72.3%) of the children reported not having diarrhea while more than half (64.8%) did not contract respiratory a fortnight before the study. More than half (51.6%) of the children of the children had a z-score of above - 2SD while 30.2% and 18.2% were moderately and severely wasted respectively. Exclusive breastfeeding is connected with the nutrition status of children. There is a significant connection between nutrition status and exclusive breastfeeding, x2 (1, N=159) = 14.92, p =0.05. The caregiver's monthly income is associated with the nutrition status of the children. There is a significant relationship between nutrition status and monthly income, x2 (1, N=159) = 11.82, p =0.05. The majority (69%, n=29) of severely wasted children had caregivers earning less than 100 US monthly. The study concluded that the child factor associated with malnutrition is exclusive breastfeeding while the maternal aspect connected with malnutrition in children under 5s includes monthly income. Besides, the level of malnutrition is still a community well-being concern. There is a need to generate more cognizance of the importance of exclusive breastfeeding for women of reproductive age. Sustainable sources of livelihood need to be enhanced to boost the average income of a household. Also, there is a need to strengthen active case findings of children with malnutrition so that they can be admitted to nutrition programs for management
Comparative Analysis of Diarrhoeal Morbidity and Complementary Feeding Practices Among Children 6-59 Months In Rice Growing Regions of Kirinyaga, Kisumu and Kwale County
(KeMU, 2024-09) GODANA, HALIMA
Globally, diarrhea remains a significant public health concern, affecting an estimated 2.5 billion children under five annually and contributed to 10% mortality in 2015. In Africa, approximately 696 million under-fives contract diarrhea each year, with Kenya experiencing a high burden, as 25% of deaths in this age group are attributed to diarrhea, in 2011, deaths of under-fives due to diarrhea was 38,822 .Proper complementary feeding is essential for child’s health, inadequate practices can lead to malnutrition and disease. This study aimed to investigate the prevalence of infectious diarrhea and complementary feeding practices among children aged 6-59 months in rice-growing regions of Kirinyaga, Kisumu, and Kwale. Objectives included assessing morbidity rates of infectious diarrhea, evaluating complementary feeding practices, gathering demographic and socioeconomic data from caregivers, and analyzing sanitation and food hygiene practices. Method: Cross-sectional descriptive study design was used. Fichers formular was used to get the sample size which was 384 for each region, Kisumu, Kwale and Kirinyaga respectively. Simple random sampling was used to obtain 30 households with child under five years who were interviewed in each cluster. Semi-structured questionnaire was the tool used for data collection which was administered to the caregiver. Ethical consideration was followed where informed consent was obtained from caregivers before the interview. Data entry and analysis was done using SPSS version 26. Information on diet diversification was collected using a 24-hr recall questionnaire as well as a 1-week food frequency interview questions, these were analyzed by calculating diet diversity score. Descriptive statistic was used to analyze general questionnaire. Chi square was used to compare the findings between the three counties. Results: 60.2% of household head in all the three counties had primary level as the highest education level attained,33.8% were farmers while 24.0% were casual labors, the two making most occupations of the household heads.61.7% earning monthly income less than ksh 10,000. 42.9% of mothers from Kwale and 36.1% from Kisumu County introduce complementary feeding late after 6 months, compared to Kirinyaga where 36.9% of mothers, start complementary feeding starts at 6 months. Caregivers from Kwale county feeds children once a day at (66.7%) and also twice a day at (56.4%) compared to Kirinyaga and Kisumu where feeding was done more than twice a day at 42.1% and 38.9% respectively, boiling was the predominant method used in preparation of complementary foods across the three counties. On the aspect of diarrhea morbidity, in the last two weeks Kwale County recorded the highest cases of diarrhea in children at 42.5% compared to Kirinyaga (31.8%) and Kisumu (27.5%) and most of this cases did not seek treatment (42.9%) for kwale. A cross the three counties high number of children feed less than normal when they are having diarrhea (59.5%) and they lost weight (62.3%). Tap water was majorly the source of water both during wet and dry season across the three counties at 33.3% and 31.1% respectively. A cross the three counties 45.9% of the households did not have a place for hand washing. When asked about hand washing at the five critical times, 64.6% of the respondent from Kwale county did not wash hands after visiting toilet,40.5%, did not wash hands before handling foods, 41.1%,did not wash hands before feeding children and 48.5%did not wash hands after handling dirts. 95% of the households in Kwale County do open defecation indicating why their diarrhea cases were high. Conclusion: .The practice on complementary feeding was fair, most of the basic criteria of complementary feeding were adhered to, timely introduction, frequency and amount of feeding. Kwale County reported high cases of diarrhea and was doing very poorly in terms of water and sanitation. The study recommends more health education to be given to pregnant and lactating mothers across the three counties on recommended infant young child feeding and Kwale County to be more sensitized on good hygiene and sanitation practice.
Comparative Study of Rice Bran Utilization And Anthropometric Profiles of Children Aged 6-59 Months in Rice-Growing Counties Kirinyaga, Kisumu and Kwale in Kenya
(KeMU, 2024-09) ODINGO, SYLVIA KAVAI
Undernutrition is a critical global health issue, responsible for over half of all deaths among children under five. In developing countries, an estimated 143 million children are underweight, with Kenya reporting 82,000 annual deaths, significantly affecting vulnerable rural populations. This study provides a baseline assessment of the nutritional status of children aged 6-59 months in the rice-growing regions of Kirinyaga, Kisumu, and Kwale counties in Kenya. The study aimed to establish the prevalence of undernutrition and to determine whether rice bran is could be utilized in complementary feeding practices within these communities. This baseline data is crucial for designing and introducing a rice bran feeding trial to potentially improve child nutrition outcomes. Simple random sampling selected 30 households with children under five years in each cluster. Using a cross-sectional study design, data collection involved semi-structured questionnaires administered to caregivers per region. A total of 1,218 children were assessed between January and march 2023, the sample sizes included about 423 (34.7%) children in Kirinyaga, Kisumu (32.3%), and Kwale 401 (32.9%). Anthropometric measurements of weight, height and mid upper arm circumference (MUAC) were taken using standardized equipment. The ENA for SMART application was used to analyze anthropometric data, interpreted using WHO standards (2006). Comparing underweight prevalence of this study with the Kenya Demographic Health Survey (KDHS) 2022 report, Kwale had 14%, Kirinyaga 6%, and Kisumu 4%, while this study’s prevalence was 9.6% KWwale,4.7% Kirinyaga and 1.5% in Kisumu. Severe Stunting rates were also Slightly lower: Kirinyaga (12.1%), Kisumu (11.1%), and Kwale (17.1%) compared to the reported KDHS 2022 Severe stunting prevalences of Kiriyanga 11%, Kisumu 9% and Kwale 23.0%. For severe Wasting, Kirinyaga was 3.7%, Kisumu 2.2% while Kwale gave 5.2% Prevalence. High rates of malnutrition were observed, particularly in Kwale, where severe stunting affected 17.1% of children, severe wasting was present in 5.3%, and edema was recorded in 12.9% of cases. In all the three selected Rice growing areas the male children had a significantly higher frequency of stunting, Compared to female children. Further results indicate that while awareness of rice bran is relatively high in some regions—77.6% in Kirinyaga and 70.8% in Kisumu—it is overwhelmingly perceived as animal feed rather than as a food supplement for humans. A minority of participants across all regions agree that rice bran is a nutritious food product with significant health benefits. Only 19.6% of the total respondents agree with this statement, while 34.0% remain neutral, and a substantial 46.7% disagree. Regionally, Kwale has the highest agreement (27.4%), followed by Kirinyaga (24.6%) and Kisumu (6.1%). This indicates a general lack of recognition of the health benefits of rice bran among the communities. A majority of respondents perceive rice bran as best suited for feeding animals, with 55.3% agreeing with this statement. County governments in Kirinyaga, Kisumu, and Kwale should implement agricultural policies promoting rice bran awareness and its nutritional importance among farming households and consumers. Further research is recommended to explore the long-term effects of rice bran consumption on child nutrition and to identify the most effective strategies for its integration into local diets.
Determinants of Non-Compliance to Iron Folic Acid Supplementation during Pregnancy. A Case Study of Nyeri County, Kenya
(KeMU, 2020-11) Ng’ethe, Henry Mburu
In the World, a deficiency of iron is the most common nutrition disorder affecting more than 30% of the global populace more so children and women. Countries in the developing world are working in programs on implementing the Iron and folic acid supplementation although the effectiveness of curbing anemia is usually affected by non-compliance to iron and folic acid supplements by women who are pregnant. In Nyeri County, anemia among pregnant women has continued to rise. The purpose of the study was to determine the determinants of non-compliance to iron folic acid supplementation during pregnancy in Nyeri County. This was a mixed methods study. The study targeted pregnant women. A sample of 385 pregnant women were calculated using the modified formulae by Fisher. The study employed the use of a structured researcher administered questionnaire. Themes and patterns were derived from the qualitative data, categorized through content analysis and then tabulated. SPSS version 20 for windows was employed for data analysis. Descriptive statistics and chi-square tests were used to analyze the data which was presented in form of frequency and percentage tables, bar graphs and pie charts. The study found that Majority (56%) of the participants in the study indicated that they had at one time forgotten to take iron folic acid supplement (IFAS). The results showed that the bulk of the respondents (55%) had acceptable levels of hemoglobin (121 g/l and 150 g/l). Chi-square tests showed a significant relationship (p=0.018) between compliance to IFAS and prevalence of Anemia. About 53% of the respondents indicated that they were not aware of the benefits of IFAS. About 56% of the respondents indicated that they had not been counselled on the dietary sources of iron and folic acid. All respondents agreed that IFAS supplements were available at their health facility when they needed them. A greater number of respondents 80% indicated that the waiting time when getting IFAS supplements was high. Results showed that 66% of respondents indicated that they were informed about IFA Supplements and where to get them. In Nyeri County, the study found out that the prevalence of non-compliance in women who were pregnant was high. However, IFAS non-compliance did not contribute to child mortality. Mothers understanding on the benefits of IFAS was poor and generally, current health care support system for the IFAS program is good. The study recommends that pregnant women should be sensitized about the importance of complying to IFAS.
Determination of Prevalence and Risk Factors Associated With Malnutrition among the Elderly in Kiambu County
(KeMU, 2021-09) Kamwana, Wambui Mary
Nutrition among the elderly persons is associated with the quality of life (QoL) and functional quality. Malnutrition is prevalent among the elderly who are a particularly vulnerable group. Studies show that up to half (6-48%) of elderly Africans in SSA are underweight. The percentage of older people at risk of malnutrition in most Kenyan Counties has increased to 29.6% from 20.1% in 2015 (Waudo et al., 2018). Kiambu County is one of the areas with a higher number of elderly people and one of the areas most affected by the malnutrition in this age group. This study sought to determine the prevalence of malnutrition among the elderly and its relationship with socioeconomic status, meals patterns and nutritional status. The objectives of the study were to find out the prevalence of malnutrition among the elderly, establish the relationship between socio demographic and socio-economic characteristics and malnutrition among the elderly, to assess the effect of dietary practices on malnutrition among the elderly and determine the risk factors associated with malnutrition among the elderly. The study adopted a cross sectional descriptive design and the tools included Mini Nutritional Assessment (MNA) tool, tapes for measuring the Mid- Upper Arm Circumference and Calf Circumference, Weighing Scale and a dietary questionnaire. The study found that prevalence of malnutrition in the sample stands at 42%; 22% were at risk of malnutrition while 36% had normal nutrition status. Among the socio-demographic characteristics, gender (p=0.001) and education level (p=0.035) were significant. There was a significant relationship (p=0.000) between socio economic status and the nutrition status of the respondents. Skipping of meals (p=0.003) and number of meals (p=0.042) were significant in the dietary practices domain. Regression analysis showed that socio-economic status (p=0.000) was significant. This study revealed a 42.0% prevalence of malnutrition in the elderly. This was higher than most of similar studies reviewed and it indicates a public health problem that needs urgent attention. Overall, analysis showed that socio-economic status to the most important risk factor of malnutrition among the elderly. The lack of adequate income and reduced physical function to pursue employment meant that majority of the respondents were of low socio-economic status. The study therefore recommended that health policy makers should incorporate and include planning for the elderly as they have done with other vulnerable groups like children less than five years. Efforts should also be initiated to help the elderly to adopt healthy life style practices especially with regards to their food intake.
Dietary and Nutritional Risk Factors for Inflammatory Bowel Disease: A Case at Kenyatta National Hospital in Nairobi, Kenya
(KeMU, 2025-10) Onono, Rebecca Kivuli
The increasing incidence of Inflammatory Bowel Disease (IBD) is linked to changing diets, environmental exposures, limited diagnostic access, and treatment costs. Lacking clear guidance, many patients adopt restrictive diets that can harm their health. Nutritional interventions should therefore go beyond meeting energy and nutrient needs to support disease management. Growing evidence shows that certain foods influence inflammation, underscoring the importance of individualized, evidence-based dietary strategies for IBD care.To identify, understand and evaluate the Dietary and Nutritional Risk factors associated with Inflammatory Bowel Disease. This study used an analytical observational design with a hospital-based cross-sectional approach at Kenyatta National Hospital. Quantitative data were analyzed using SPSS version 26. Descriptive statistics were used to summarize socio-demographic, clinical, and dietary characteristics of participants. Group differences for categorical variables were assessed using χ² tests (with Fisher’s exact test where expected cell counts were <5). All tests were two-sided with α=0.05. Missing data were handled by pairwise exclusion for all inferential analyses; for descriptive summaries, available-case denominators are shown. Specifically, for the binary endpoints Core IBD Therapy and Adjunct Comorbidity Care, records with missing values in the outcome or any included covariate were excluded pairwise from the relevant analyses. Use of core IBD pharmacotherapy was higher in IBD than GD (100% vs 75.3%; p<0.001). IBD patients more frequently reported therapeutic supplements (62.5% vs 39.2%; p=0.016) and preventive supplements (40.0% vs 15.2%; p=0.003). Restrictive therapeutic diets were common (47.5% IBD vs 34.2% GD; p=0.159). Diarrhea was more frequent in IBD (75.0% vs 50.6%; p=0.011); vomiting did not differ. Rates of documented nutritional deficiency (~60%) and malnutrition (~40%) were similar across groups. Diet intake patterns showed high reliance on staples and plant based proteins, with selective avoidance of animal fats and some animal proteins. IBD patients reported greater dietary variety, consuming more fruits, vegetables, dairy, and healthy fats compared to those with gastroesophageal disorders, who tended to restrict foods to prevent reflux. This reflects IBD patients’ active dietary management to control symptoms and maintain nutrition. They also relied more on supplements and therapeutic diets, such as low-residue or lactose-free plans, to ease gastrointestinal discomfort. Despite occasional food aversions and reduced diversity, most maintained adequate caloric intake, with only severe cases requiring medical nutrition support—highlighting the importance of individualized dietary care in managing IBD.
Effect of Marketing Strategies on Post-Pandemic Reopening Performance of Star-Rated Hotels in the South Rift Circuit, Kenya
(KeMU, 2024-09) NG’ETICH, PAUL K.
The hotel industry in Kenya, as well as across Africa, is fiercely competitive and plays a crucial role in bolstering the nation's economy. It serves as a vital source of foreign exchange, employment opportunities, and revenue. Nevertheless, the advent of the global Covid-19 pandemic has left an indelible mark on the hotel industry, not only in Kenya but worldwide. The imposition of travel restrictions, the need for social distancing, and a substantial decrease in visitor numbers have severely impacted their operations. With the widespread roll-out of mass vaccinations, hotels and the broader tourism sector are now able to reopen. However, their performance during this reopening phase is hampered by a slow recovery in the sector. This is due to persistent travel restrictions in some countries, a sluggish containment of the virus, reduced traveler confidence, and a challenging economic climate. For Kenya's classified hotels that rely heavily on international travelers, the current reopening conditions appear unpromising and could potentially undermine their competitiveness unless they undertake assertive marketing campaigns. This study sought to investigate the marketing strategies employed by star-rated hotels and their impact on their post-pandemic reopening performance in Kenya. The study had the following objectives: to assess the influence of technology-enabled service differentiation strategies on the reopening performance of the hotel industry in Kenya in the post-pandemic context, to examine the impact of product innovation strategies on the reopening performance of the hotel industry in Kenya in the post-pandemic context, to evaluate the influence of market diversification strategies on the reopening performance of the hotel industry in Kenya in the post-pandemic context and to analyze the effectiveness of market growth strategies on the reopening performance of the hotel industry in Kenya in the post-pandemic context. The research drew guidance from the Marketing Mix Theory, Ansoff Growth Matrix Model, and Service Marketing Theory. It employed a cross-sectional survey research design, targeting 47 hotels, lodges, camps, and guest houses in the South Rift Circuit, encompassing Nakuru and Narok counties, using a census approach. Data was gathered through questionnaires administered to the marketing managers of these hospitality establishments. Qualitative data was analyzed through thematic and content analysis using Nvivo, while quantitative data was coded and subjected to analysis through SPSS computer software version 24.0, employing both descriptive and inferential statistics. The findings revealed that Market Growth, Product Innovation, Technology Strategy, and Market Diversification all had a significant impact on the post-endemic opening public presentation of star hotels in the Circuit of Southern Rift, Kenya, supported by beta values of 0.807, 0.286, 0.365, and 0.318, respectively. In light of these findings, the study recommends that hotels should prioritize continuous staff training in technology applications, provide tailored services to both individual and group clients, diversify their markets to tap into more potential local and international markets, and emphasize market growth strategies. Additionally, introducing flexible pricing options for clients would facilitate convenient service bookings.
Effectiveness of Community Health Promoters in Mitigating Malnutrition Among Children Under 5 Years During Drought Periods in Isiolo County, Kenya
(KeMU, 2025-10) Njambi, Njeri Elaine
Malnutrition remains a leading cause of child morbidity and mortality, particularly in drought-prone, low-resource settings such as Isiolo County, Kenya. Despite national efforts through the Integrated Management of Acute Malnutrition (IMAM) and the IMAM Surge strategy, malnutrition rates in the county continue to surpass national averages. Community Health Promoters (CHPs) are critical frontline actors in detecting, referring, and educating communities on child nutrition; however, evidence on their effectiveness during emergencies remains limited. This study assessed the capacity and challenges of CHPs in mitigating child malnutrition during drought periods. A cross-sectional mixed-methods study was conducted among 380 CHPs selected through multistage sampling. Data were collected using semi-structured questionnaires and analyzed through descriptive statistics and thematic analysis. Findings revealed that although most CHPs had received basic nutrition training, only half had undergone refresher or Surge-specific training, and 43.4% expressed confidence in identifying malnutrition cases. Referral mechanisms were widely practiced, with caregiver acceptance rates reaching 97.4%, yet logistical, financial, and supervisory challenges hindered consistency. High workloads some CHPs covering over 100 households further reduced service quality and morale. Socio-cultural barriers, including traditional beliefs, gender dynamics, and language differences, also limited program uptake. The study concludes that CHPs are indispensable in combating malnutrition during droughts but are constrained by systemic, operational, and cultural barriers. Strengthening their effectiveness requires continuous capacity building, equitable workload distribution, logistical and financial support, culturally responsive community engagement, and integration of CHPs into formal health systems through mentorship and supportive policy frameworks.
Evaluation of The Determinants of Uptake of Oral Rehydration Salts And Zinc in The Management of Childhood Diarrhea in Navakholo Sub County; Kakamega County
(KeMU, 2024-09) MUHANDE, KHAYERI IRENE
Diarrheal diseases remain a major public health issue in Kenya, contributing significantly to illness and death among children under five years old. The use of oral rehydration salts (ORS) and zinc is globally recognized as the standard treatment for managing acute diarrhea in young children; however, the adoption of these treatments is still inadequate. This study focused on assessing the factors influencing the use of ORS and zinc for treating childhood diarrhea in Navakholo Sub County, Kenya. It employed a cross-sectional design, targeting caregivers of children under five years old in the area. Data was collected through simple random sampling, with a total of 247 participants selected from a population of 22,363 children in that age group. Data was collected using interviewer administered structured questionnaires and analyzed using descriptive and inferential statistics. Chi-square (X2) and logistic regression analysis were performed to identify the factors associated with the uptake of ORS and Zinc. A two-week diarrhea prevalence was 27.9% with 74% of the caregivers providing ORS, 55.1% providing zinc. Utilization of ORS and zinc was low as a home management intervention for acute diarhoeal illness with caregivers demonstrating inadequate knowledge, attitude and practice. Caregivers demonstrated moderate knowledge, positive attitudes, and suboptimal practices regarding the use of ORS and zinc. The study established that uptake of ORS and zinc was hindered by stock-outs, product expiry, and affordability issues, particularly for zinc. However, high availability of ORS through government facilities and Community Health Volunteers (CHVs) promoted its use. Mapping revealed geographic disparities in diarrhoea distribution across the wards with varied uptake of ORS and zinc. The findings suggest the need for multifaceted interventions to improve caregiver knowledge, strengthen the supply chain, and enhance the availability and accessibility of ORS and zinc, particularly in underserved areas. Targeted behavior change communication and strengthening of the community health system are recommended to increase uptake of this life-saving treatment for childhood diarrhea in Navakholo Sub County.
Evaluation of the Relationship between Dietary Patterns and Colorectal Cancer among Meru County Residents
(KeMU, 2018-09) Kinanu, Grace Safari
Colorectal cancer (CRC) is the fourth leading cause of death and third most commonly diagnosed cancer around the globe. Although diet plays an essential role in the development of colorectal cancer, there is little information on the role of diet in the rising CRC cases observed in Meru. The study sought to determine whether there is a connection between dietary patterns and colorectal cancer etiology in Meru County. The research was a retrospective case control study design involving 25 CRC patients and 50 CRC undiagnosed participants as controls. All stable CRC patients receiving treatment in the three cancer treatment and palliative care centers in Meru County between April and June 2017 were included in the study. Each CRC patient was identified and matched with two persons from the general population according to similarity by sex, date of birth, and place of residence. A food frequency questionnaire was used to collect data which was then averaged to daily consumptions. The data was analyzed using t-test, Chi-square and Odds Ratio. The study revealed that dietary patterns of Meru County residents include moderate intake of fruits (2.5 servings), vegetables (4.0 servings) , and starch staples (9.2 servings), low intake of pulses (1.5) , white meat (1.2), milk and its products(1.3) , and nuts and seeds (0.3) ,and high intake of red meat (5.1 ) servings for daily pattern intakes with no significant statistical difference between dietary patterns of CRC and non CRC persons (p- values > 0.05). No statistical association was established between dietary patterns of red meat and risk of developing CRC (p- values > 0.05) on chi-square test and Odds ratio (within the 95% CI). Our study therefore indicates that, there is no conclusive evidence associating dietary patterns and colorectal cancer etiology and incidences in residents of Meru County. This research recommends that other causes of cancer be explored so as to establish evidence based conclusions on the main causes of colorectal cancer in Meru County
Factors Associated With Anaemia among Pregnant Women: A Case Study of Mandera County Referral Hospital
(KeMU, 2020-11) Mohamed, Abdirizak Haji
Anaemia is the most common medical related disorder during pregnancy, and has become a major health related problem in a large number of developing nations, mainly where deficiency in nutrition, worm infestation and malaria are common. Both pregnant and non-pregnant women are affected by this disorder. Even so, most women lack adequate knowledge regarding causes of anaemia in pregnancy as the most commonly cited cause is inadequate iron. This study sought to determine factors associated with anaemia among pregnant women in Mandera referral Hospital. The study adopted a descriptive cross sectional research design. The study targeted a population constituting of pregnant women aged 15-49 years in Mandera Referral Hospital. At the time of the study, the hospital had an estimated number of 3651 pregnant women, and these formed the target population for the study. The study adopted simple random sampling and convenience sampling techniques. The study used a questionnaire to collect primary data. Data analysis was carried out using SPSS Version 22.0. The analyzed data was then presented in frequencies, cross tabulations and tables, which were accompanied by appropriate descriptions in line with the objectives. The study findings showed that most of the respondent were in their second or other pregnancies as they had been pregnant before [205, 65.7%] compared to those in their first pregnancy [107, 34.3%] (p =0.000). While on the stage of their pregnancies, slightly more than half [161, 51.6%] were in their second trimester compared to 25.3% in their first trimester (p >0.05). Half of the respondents indicated that they had two pregnancies, 80(25.6%) had three pregnancies. That majority (68.9%) of the respondents were not aware of iron (p value <0.05) and further that 44.2% of the respondents knew the sources of iron compared to 55.8 who neither knew or not sure on the sources (P value >0.05). Majority (199, 63.8%) faced challenges to access and availability of iron rich foods. Most women (249, 20.2%) were aware of Vitamin A, further 96.2% were not aware of the various sources of Vitamin A, and these responses were significant at 5%. Majority 46.2% and 42.3% took foods rich in Vitamin A on weekly and daily basis. The study recommends that there should be interventional measures to educate mothers and initiate importance of iron folic acid supplements as this would be vital in prevention of Anaemia during pregnancy.
Factors Associated With the Diet Quality of Mothers and Infants'Birth Weight at Lodwar Referral Hospital in Turkana County-Kenya
(KeMU, 2024-09) EKIRU, EROT JOHN
Maternal factors, especially dietary aspects before and after pregnancy, have been shown to impact maternal outcomes over the years. Low birth weight, small for gestational age, and preterm babies have been linked to dietary consumption of the mother during gestation. To help lower these rates of early childhood mortality research was paramount in this sector, especially in low-income countries that have recorded high prevalence of adverse birth outcomes. Maternal nutrition has been spearheaded as a public health concern since it determines the outcome of an individual from childhood up to adulthood and above. The prevalence of low birth weight at Lodwar County, Referral Hospital in Turkana County stands at 14%. The research objectives were to assess the socio-demographic characteristics of mothers, to assess the dietary habits of mothers, to determine the prevalence of low-birth-weight infants born to mothers, and to assess maternal nutritional knowledge of the mothers attending Lodwar Referral Hospital. The main goal was to determine the factors associated with the diet quality of the mothers and the infants' birth weight in Turkana County. The study used a longitudinal study design and involved 500 mothers. The overall response rate was 93 per cent of the mothers who attended ANC in the hospital in 2024. The data was collected using pretested and structured questionnaires. SPSS version 29 was used for analysis. A log-binomial model was used to estimate the adjusted risk ratio and its 95%CI of the risk factors for low birth weight. Multi-collinearity was checked using the variance inflation factor (VIF) at a cut-off point of 8 and multi-collinearity found. Result: The overall incidence of low birth weight was 14% (95% CI: 11.1, 17.4%). The incidence of low birth weight was 18.4 and 9.8%among respondents. The difference in low-birth-weight incidence is statistically significant(p-value=0.006). The risk factors of low birth weight were maternal illiteracy (ARR:1.8,95%CI:1.01,3.3), and low monthly family income<5000 Kshs. (ARR:1.6,95%CI:1.07,2.2), food taboos during pregnancy, (ARR:0.47,95%CI:0.28,0.78), and diet meals number<5 (ARR:1.9,95% CI:1.05,2.61). The results showed that the prevalence of low birth weight was 14% which included 245 mothers of the total number of respondents. Conclusion: Low birth weight was significantly higher among the respondents, who had poor diet quality, and low demographic and economic status. The recommendation was to promote better diet quality and exclusive breastfeeding knowledge, government empowering mothers with financial training programmed mothers support group and further research to be conducted in Turkana to reduce high prevalence cases of low birth weight in Turkana.
Factors Influencing Breastfeeding Practices among Somali Women: A Case Study of Bulla Adaan, Garissa County
(2021-04) Khadijanimo, Hussein Ahmed
Breastfeeding has always been the ideal feeding practice for infants. Despite efforts by the county and national government as well as non-governmental organisations, breastfeeding uptake in Garissa County was low. The main objective of the study was to factors influencing breastfeeding practices among Somali women of reproductive age in Bulla Aadan, Garissa County. The study used a descriptive cross-sectional survey design. The target population for the study included mothers in Bulla Adaan in Garissa County. Yamane Formula was used to calculate a sample size of 373 respondents. A questionnaire was used to collect data from the mothers. Quantitative data was analyzed by use of descriptive statistics such as frequency distribution and percentages whereas qualitative data was analyzed by the use of content analysis. Chi-square tests were conducted to test for relationships. Analysis was conducted with the aid of SPSS. Results were presented in form of tables and figures. The study found that majority of the respondents had poor breastfeeding practices. Majority of the respondents had high knowledge of breastfeeding. Findings also showed that majority of the respondents had negative attitudes towards breastfeeding. There was a significant relationship between knowledge of breastfeeding and breastfeeding practices. There was also a significant relationship between attitudes towards breastfeeding on breastfeeding practices. The study concluded that although women of reproductive age in Bulla Aadan, Garissa County had high breastfeeding knowledge, they harbored negative attitudes which resulted in poor breastfeeding practices. It was recommended that the government and other private institution in the health sector should carry out mass education particularly the women on the importance of breastfeeding to the infants as this has more benefits to both the mother and the infant as well as the society. The aforementioned institutions should educate the mothers and the communities at large on the avoiding retrogressive cultural activities on infant feeding as this has profound effects on their general health and wellbeing.
Factors Influencing Mixed Feeding Practices among Infants below 6 -Months in Wajir County, Kenya
(KeMU, 2024-09) Ibrahim, Khadija Mohamed;
In Wajir County, around 749 infants under six months die annually. The 2014 Kenya Demographic and Health Survey (KDHS) revealed that just 32% of babies in this age group are exclusively breastfed, while many mothers introduce supplementary foods prematurely. This study aimed to examine the factors influencing mixed feeding practices among babies under six months in Wajir County. The study systematically examined infant feeding practices, assessed socio-cultural influences, evaluated maternal skill, and studied economic factors affecting mixed feeding. The research employed the Theory of Planned Behavior, the Interactive Breastfeeding Theory, and the Theory of Reasoned Action (TRA). A descriptive cross-sectional design was utilized, focusing on a quantitative data collection approach. The study examined 802 mothers of infants under six months, utilizing a sample size of 260 individuals. Data was processed using SPSS version 26 for analysis. Data were analyzed using univariate analysis and this enabled the researcher to achieve descriptive statistics. The study found that 63.1% of mothers had low knowledge of mixed feeding practices, with a mean knowledge score of 6.8 (SD=1.7) out of 12. Significantly, 58.8% of mothers practicing mixed feeding were unemployed (χ2=109.780, p<0.001). 97% relied on market purchases for food, and 40.1% were moderately food insecure. Cultural factors played a role, with 81.3% reporting taboos affecting infant feeding (χ2=17.431, p=0.001). Despite recommendations, 79.8% introduced complementary foods at 6 months, while 20.2% introduced them earlier. Based on the findings, it can conclude that maternal knowledge of mixed feeding practices in Wajir County is generally low. Economic factors, particularly unemployment and food insecurity, significantly influence mixed feeding practices. Cultural beliefs and taboos play a substantial role in determining infant feeding choices. Despite health recommendations, a considerable proportion of mothers introduce complementary foods earlier than the recommended 6 months. These factors collectively contribute to suboptimal mixed feeding practices among infants below 6 months in the study area. The study therefore recommended that health authorities should intensify education programs to improve maternal knowledge of mixed feeding practices. Local governments need to launch economic empowerment initiatives to tackle unemployment and food insecurity. Community leaders should work together with health professionals to overcome cultural taboos affecting infant feeding. Healthcare providers ought to enhance counseling regarding the appropriate timing for introducing complementary foods. Policymakers should create targeted interventions that promote optimal mixed feeding practices, taking into account the unique socio-economic and cultural context of Wajir County.
Influence of Dietary Intakes, ‘WASH’ and Diarrhoeal Morbidity on Stunting mong Children below Five Years in Kaptembwo and Milimani, Nakuru County
(KeMU, 2021-09) Ayienda, Daniel Matoke
Stunting is a form of undernutrition in which affected children are too short for their age. Stunting affects 21.3 % of children under five years globally. The prevalence of stunting in sub-Saharan Africa in 2019 was 34%, while Kenya’s national average is 26%. The prevalence of stunting in Nakuru County is 28%, in which 9% are severely stunted. The high prevalence of stunting in Nakuru prompted this cross-sectional study with an analytical design in Kaptembwo and Milimani estate. The study aimed at establishing the contribution of water, sanitation and hygiene towards episodes of diarrhea and if these factors have influence on stunting. Objectives of the study were to determine the socioeconomic status, to evaluate the dietary intakes of children below five years, to determine the water, sanitation and hygiene practices, to determine the diarrheal morbidity of children below 5 years, and to determine the level of stunting of children below 5 years. The study included 314 children (0-59 months) sampled using systematic random sampling. Data was collected using questionnaires programmed in Survey CTO platform, which had been installed in mobile phones and or Tablets. Descriptive data was analyzed using SPSS version 22 software while Stata was used for regression analysis. Other statistical tests such as t-test and chi-square test were also used. The mean age of sampled children was 24.5months while their mean height was 81.82cm. The mean maternal age was 28.5 years. 19.1% of the mothers were single while 80.89% were married. 32.69% of mothers had at least secondary education. 10.81% of mothers in Milimani had university degree compared to 1.01% of mothers in Kaptembwo. The dietary intakes, dietary diversity and food frequencies of children sampled in the two study areas was not any significant P>0.05. The mean dietary Intakes (energy (Kcal)) was within the recommended dietary intake (RDI). Diarrhoea morbidity was high in Kaptembwo (38.61%) than in Milimani (16.96%). High diarrhoea episodes were associated with eating vended foods e.g. (Nuts; Coef. = -1.313667, Githeri; Coef. = 0.4715581). Low diarrhoea episodes were associated with deworming within 3 months (coef. = 0.8902153) and use of ORS (coefficient. 1.000825). However, the level of stunting was high in Kaptembwo than Milimani. Stunting levels for children were measured and classified based on z-score cut-off less than -2 SD of height for age (HAZ). Among the 314 children, 162 (51.59%) were male and 152 (48%) were female. Of the 202 children sampled in Kaptembwo, 25% were stunted, while of the 112 children sampled in Milimani, only 3.33% were stunted. The percentage of boys stunted in Milimani was (5%) while the percentage for boys stunted in Kaptembwo was 30%. The percentage of girls stunted in Milimani was 1.67% compared to 20% in Kaptembwo. Of the stunted children, boys accounted for a higher percentage (35%) than girls (26.67%). However, the Average stunting percentage was 14.17%. Results further showed that the risk of stunting increased with gender, age, and decreased with increase in hand washing. Maternal age, Education level, marital status did to influence stunting, P=0.097, P=0.016 and P=0.0285 respectively. Dietary intake did not have significant influence on stunting of children of all ages. Diarrhoea had very significant influence on stunting between 21-27 months P=0.004 and a general influence across all age groups P=0.050. Government at both levels should make deliberate efforts towards making basic utilities such as safe drinking water and good sewerage systems available for the people and further carry out public education on good sanitation and hygiene practices.
Influence of Psycho-Social Factors on Skin Bleaching Among Women in Nairobi County, Kenya.
(KeMU, 2024-09) ABDILLE, NASTEHA MOHAMED
Skin-bleaching refers to using beauty products like creams and soaps to whiten the skin. Past studies have indicated that skin-bleaching products have negative implications for the user. However, many women in Nairobi County continue applying skin-bleaching products despite evidence that they are harmful. Empirical evidence shows that little attention has been paid to demographic characteristics, body image, and peer pressure as significant factors influencing the continued behavior of skin bleaching among women living in Nairobi County. The current study examined the influence of psycho-social factors on skin bleaching among women in Nairobi County. The study’s objectives were: To examine the influence of demographic characteristics on skin bleaching among women in Nairobi County, to establish the influence of body image on skin bleaching among women in Nairobi County, and to find out the influence of peer pressure on skin bleaching among women in Nairobi County. Objectification and Social Learning theories were adopted to guide the study. The study used descriptive design incorporating both quantitative and qualitative approaches. Purposeful sampling was used to recruit 123 women purchasing skin-bleaching products from shops retailing cosmetic products within Nairobi County. Self-administered questionnaires were used to collect quantitative data from the 123 participants while interviews involving 10 participants were conducted to collect qualitative data. The data collection tools were piloted using data collected within Nairobi CBD to ensure their validity and reliability. Quantitative data were analyzed by the use of descriptive statistics such as frequencies, mean, percentage, and standard deviation, and the use of correlation to test the significance of the relationship between the dependent and independent variables. The findings were presented in bar charts and tables. Qualitative data were analyzed thematically and presented in verbatim. The findings based on the responses indicated that the average score of the aggregate items measuring different independent variables were; demographic characteristics (3.06; indifferent), body image (2.94; indifferent), and peer pressure (2.91; indifferent). The scores indicate that demographic characteristics, body image, and peer pressure did not have a strong influence on skin-bleaching. Further correlation analysis denoted a 0.194 correlation between body image and skin bleaching with a p-value of 0.031. This was an indication of a statistically significant and positive relationship between body image and skin-bleaching. The correlations for demographic characteristics and peer pressure were 0.065 and 0.058 with p-values of 0.478 and 0.526 respectively. The figures indicated that demographic characteristics and peer pressure did not have a significant relationship with skin-bleaching. Regression analysis revealed that body image was a significant predictor of skin bleaching with an adjusted R-square value of 0.030 and p-value of 0.031. It was concluded that peer pressure and demographic characteristics did not have a significant relationship with skin-bleaching while body image had a significant influence on skin-bleaching among women in Nairobi County. The findings have added knowledge in the area of skin bleaching within Nairobi and may help psychotherapists and other helpers in designing tailor-made interventions to empower women address body image challenges and desist from bleaching themselves. Further studies focusing on other possible predictor variables of skin bleaching to be conducted within Nairobi and other counties in Kenya.