Introduction: Adherence to dietary prescriptions among patients with chronic kidney disease is known to prevent deterioration of kidney functions and slow down the risk for morbidity and mortality. This study determined factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis. Methods: A mixed-methods study, using parallel mixed design, was conducted at the renal clinics and dialysis units at the national teaching and referral hospitals in Kenya from September 2018 to January 2019. The study followed a QUAN + qual paradigm, with quantitative survey as the primary method. Adult patients with chronic kidney disease on hemodialysis without kidney transplant were purposively sampled for the quantitative survey. A sub-sample of adult patients and their caregivers were purposively sampled for the qualitative survey. Numeric data were collected using a structured, self-reported questionnaire using Open Data Kit "Collect software" while qualitative data were collected using in-depth interview guides and voice recording. Analysis on STATA software for quantitative and NVIV0 12 for qualitative data was conducted. The dependent variable, "adherence to diet prescription" was analyzed as a binary variable. P values < 0.1 and < 0.05 were considered as statistically significant in univariate and multivariate logistic regression models respectively. Qualitative data were thematically analyzed. Results: Only 36.3% of the study population adhered to their dietary prescriptions. Factors that were independently associated with adherence to diet prescriptions were "flexibility in the diets" (AOR 2.65, 95% CI 1.11-6.30, P 0.028), "difficulties in following diet recommendations" (AOR 0.24, 95% CI 0.13-0.46, P < 001), and "adherence to limiting fluid intake" (AOR 9.74, 95% CI 4.90-19.38, P < 0.001).

This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Globally, about 55 million children under the age of 5 years (10%) are undernourished. Of these, 19 million suffer from severe acute malnutrition (SAM). [1] SAM contributes to about one million deaths every year in children under the age of 5 years. [1,2] Most SAM cases are from sub-Saharan Africa and South Asia. [3] The prevalence of SAM is generally higher in emergency contexts and contributes to about half of the deaths in children under the age of 5 years in refugee camps. [4] Initially, therapeutic feeding centres treated SAM cases through inpatient care. They admitted all children with SAM, with or without medical complications. This approach was associated with high mortality and default rates. [4] To address setbacks associated with this approach, the community-based management of acute malnutrition (CMAM) model was globally adopted in 2007 and implemented the same year in Kenya. [5,6] CMAM entails treatment of SAM cases at community level using ready-to-use therapeutic foods. In this model, SAM cases without medical complications are treated as outpatients in an outpatient therapeutic feeding programme (OTFP) and those with medical complications are treated as inpatients at stabilisation centres (SCs). [7] Programmes that integrate the CMAM model in an existing health system are referred to as integrated management of acute malnutrition. [5] In Kenya, such integrated programmes are implemented in both rural areas and refugee camp settings using the same national treatment guidelines. However, despite successes being reported through the implementation of the CMAM model, poor treatment outcomes, such as high default rates and long recovery periods, are still being reported. [2,4,8] Studies from paediatric clinical settings suggest that carers' lack of understanding on the nature of treatment may contribute to poor adherence to treatment modalities. [9,10] No studies have assessed carers' understanding of the nature of treating acute malnutrition in a refugee population. The aim of this study was therefore to describe carers' knowledge of treating SAM at the Dadaab refugee complex. Methods Study setting The study was conducted between 21 May and 31 July 2015 at the Dadaab refugee complex in Garissa County, Kenya. The complex consists of four refugee camps, namely Hagadera, Dagahaley, Ifo I and Ifo II. The majority (97.5%) of the refugees are of Somalian nationality. [11] Two camps (Ifo I and Hagadera) were randomly selected from the four sites. At the time of the study, Hagadera had a population of ~106 751 adults and 21 351 children under the age of 5 years, while the Ifo camp had a population of 84 269 adults and 16 854 children under the age of 5 years. [12,13] CMAM services were provided by the International Rescue Committee and Islamic Relief Kenya. Each camp had a CMAM Background. Severe acute malnutrition causes half of the deaths in children under the age of 5 years in refugee camps. Objective. To describe carers' ...

Severe acute malnutrition (SAM) contributes to about one million deaths annually in children under the age of 5 years. Secondary acute malnutrition is common in children with underlying medical conditions. It may pose a great risk in developing severe illness during SARS-CoV-2 infection among children. Proper implementation of nutrition care process is critical in management of secondary acute malnutrition among children in clinical settings. Eight months old male admitted with meningoencephalitis; septic shock, anemia, rickets, osteomyelitis, severe malnutrition and severe SARS-CoV-2 pneumonia complications. On admission, body temperature was 370C, random blood sugars were 17.5mmol/L and with saturation of 98% on room air. He had a body weight of 5.5kg on admission with a z-score of -3sd. Nutrition focused physical examination revealed severe loss of muscle mass and adipose tissue. Nutrition prescription of high calorie high protein diet providing 846 calories and 22.3 g of protein per day was prescribed. The feed of choice was fortified blended flour (FBF) porridge which was administered via nasogastric feeding tube. After fourteen days of nutrition care in the unit, the patient had a weight gain of 100g. The average weight gain rate was 1.29g/kg/day. This case report documents challenges in nutrition management of secondary acute malnutrition with SARS-CoV-2 pneumonia in resource limited clinical settings. The review of existing guidelines and disease specific nutrition commodities in the management of secondary acute malnutrition in clinical settings is recommended. Keywords: Enteral nutrition, Nutrition care process, Secondary acute malnutrition, SARS CoV2 infection, Covid19