"When I Eat Well, I Will Be Healthy, and the Child Will Also Be Healthy": Maternal Nutrition among HIV-Infected Women Enrolled in a Livelihood Intervention in Western Kenya

Links between Household-Level Income-Generating Agricultural Intervention and the Psychological Well-Being of Adolescent Girls in Human Immunodeficiency Virus-Affected Households in Southwestern Kenya: A Qualitative Inquiry

BACKGROUND

Adolescent girls may experience poor psychological well-being, such as social isolation, shame, anxiety, hopelessness, and despair linked to food insecurity.

OBJECTIVES

This study aimed to investigate the experiences with and perceived effects of a household-level income-generating agricultural intervention on the psychological well-being of adolescent girls in human immunodeficiency virus (HIV)-affected households in southwestern Kenya.

METHODS

We conducted 62 in-depth interviews with HIV-affected adolescent girls and caregiver dyads in Adolescent Shamba Maisha (NCT03741634), a sub-study of adolescent girls and caregivers with a household member participating in Shamba Maisha (NCT01548599), a multisectoral agricultural and finance intervention trial aimed to improve food security and HIV health indicators. Participants were purposively sampled to ensure diversity in terms of age and location. Data were audiotaped, transcribed, translated, and uploaded into Dedoose (Sociocultural Research Consultants, LLC) software for management. Data were analyzed thematically based on reports from Dedoose.

RESULTS

We found evidence that a household-level structural intervention aimed at increasing food and financial security among persons living with HIV can contribute to better psychological well-being among adolescent girls residing in these households. The intervention also affected: 1) reduction of social isolation, 2) reduction of shame and stigma, 3) increased attendance and concentration in school, 4) improved caregiver mental health, and 5) reduced parental aggression and improved household communication. These associations were reported more commonly among those in the intervention arm than the control arm.

CONCLUSIONS

This study extends existing research by demonstrating how multisectoral structural interventions delivered at a household level can improve the psychological well-being of adolescents. We recommend that future research test livelihood interventions designed specifically for adolescent girls that integrate food-security interventions with other elements to address the social and psychological consequences of food insecurity holistically. This trial was registered at clinicaltrials.gov as NCT03741634.

"I Found Out I was Pregnant, and I Started Feeling Stressed": A Longitudinal Qualitative Perspective of Mental Health Experiences Among Perinatal Women Living with HIV

Globally, depressive symptoms among pregnant and postpartum (i.e., perinatal) women living with HIV (WLWH) are alarmingly high and associated with poor outcomes such as suboptimal adherence to antiretroviral therapy (ART), and early cessation of exclusive breastfeeding (EBF). Few qualitative studies have described the experience of perinatal depression among WLWH to identify the underlying social-structural determinants of poor mental health and potential strategies to intervene. We conducted a longitudinal qualitative study applying semi-structured interviews with 30 WLWH at three timepoints (28-38 weeks pregnant, 6-weeks postpartum and 5-7 months postpartum) to understand mental health experiences of perinatal WLWH in western Kenya. Financial insecurity emerged as the central theme impacting the mental health of women across time. Financial insecurity was often attributed to the loss of employment, related to pregnancy and the demands of breastfeeding and caring for an infant, as well as a lack of support from male partners. The loss of income and subsequent financial strain contributed to worsening levels of food insecurity and relationship stress and challenged engagement in HIV care. In this way, increased financial strain during the perinatal period negatively impacted the mental health of perinatal WLWH. Our findings suggest support to meet basic needs and remain engaged in HIV care during pregnancy and postpartum could improve perinatal mental health for WLWH in this setting.

The Role of Targeted Nutrition Education of Preschoolers and Caregivers on Sustained Consumption of Biofortified Orange-Fleshed Sweetpotato in Kenya

BACKGROUND

Persistent prevalence of high malnutrition in poor households in developing countries calls for enhancement of cost-effective nutrition interventions among the vulnerable groups. One responsive way is to promote regular consumption of home-grown biofortified foods, particularly in the micronutrient-deficient groups. Previous nutrition interventions have targeted adults with behavior change education, but have rarely explored the potential of nutrition education of preschoolers as change agents.

OBJECTIVES

This study sought to assess the effect of nutrition education targeting preschool children and their caregivers on their consumption of vitamin A-biofortified orange-fleshed sweetpotato (OFSP) in rural farm households in Homa Bay County, Kenya.

METHODS

A total of 431 preschooler-caregiver pairs from 15 village-level clusters were recruited into a randomized controlled trial. The sample was randomized into 1 control (3 villages) and 3 treatment groups (4 villages each). Treatments involved channeling nutrition education to preschoolers through their learning materials (preschooler treatment); the caregivers through their mobile phones (caregiver treatment); and to both preschoolers and their caregivers simultaneously (integrated treatment). Baseline and follow-up household-level surveys were conducted with the caregivers, and consumption data were collected from the preschoolers using a child dietary diversity register. Class teachers sought 24-h consumption recalls of the preschoolers for 19 consecutive schooldays.

RESULTS

The results of a zero-inflated Poisson regression showed that the phone-mediated and multichanneled nutrition education approaches significantly increased the number of days of OFSP consumption. The integrated nutrition education approach significantly increased the preschoolers' likelihood to consume OFSP, number of OFSP consumption days, and likelihood to consume it more than once per week by 11%, 77%, and 20%, respectively.

CONCLUSIONS

Nutrition education through OFSP-branded preschoolers' learning materials and phone-mediated messages provides effective nudges to the caregivers to feed their preschoolers regularly with OFSP. This could have implications for realizing sustainable nutrition programs in biofortified crop-growing areas.