Factors Associated With Nutritional Status Of Children Aged 6-59 Months In Maikona Ward Of Marsabit County, Kenya

Abstract

Despite substantial presence of humanitarian and other aid agencies, Global Acute Malnutrition rates remain high in arid and semi-arid regions of Kenya including Marsabit County. Children below five years are at the greatest risk of malnutrition with dire consequences yet the causes are largely preventable. Trends in malnutrition status have shown deterioration in the recent past in Marsabit County. In order to address this problem there is need to identify the specific factors contributing to the high Global acute malnutrition rates. It was against this backdrop that this study was designed. A Cross-sectional study was conducted among 204 children aged 6-59 months old. Multistage cluster sampling procedure was used to select the study households. Maikona ward was purposively selected. Maikona and Kalacha locations were conveniently sampled. Proportionate to size sampling was employed to determine the number of households to be interviewed in all the villages within the two locations. Structured questionnaire, Key informant interviews, observation checklists and Focus Group Discussion Guides were the tools used for data collection. Statistical Package for the Social Sciences version 20 was used for data entry and analysis. Data analysis included use of descriptive statistics for socio-demographic data, proportions and simple counts for categorical data and measures of central tendency (means and median) and dispersion (range, standard deviation) to summarize continuous data. Chi-square tests and Fishers Exact Tests (where applicable) were used to test for significant differences between proportions of categorical variables. Pearson correlations coefficient described the relationship between continuous variables with continuous outcome variables (nutritional indicators) in terms of Z-scores. Odds ratio were used to test the likelihood of malnutrition depending on different exposure factors. All statistical tests were considered significant at p<0.05. The mean household size was 5 people and the ratio of male to female in the study population was 1:1. Dependency ratio of the study population was 1:6. Majority (70.8%) of the study population had no formal education. Over a third (41.4%) of the caregivers/mothers were aged between 25-34 years. Literacy levels was low among the caregivers with most (86%) having no xii formal education. The main household source of water was protected wells (65%) and 62.3% of the respondents did not treat water for consumption by the children. Over a third (43%) did not have access to latrines and most of them used bushes. Global acute malnutrition rate at 29.9% was high and presents a critical nutritional situation. Underweight was 27.9% and stunting was 18.1%. Early initiation to breast milk was a common practice at 85%. The mean dietary diversity score of the children was 3.07 (SD 1.1) food groups, which is below the recommended threshold of at least 4 food groups. More than two thirds (67%) of the children had low dietary diversity scores. Fruits, vegetables and eggs were the least consumed food groups. Morbidity prevalence among the children was 38% based on a two week recall. The most common illnesses was Upper respiratory tract infections (61%) followed by diarrhea (24.5%). Majority (69%) of the caregivers were conscious and positive about health seeking behavior with low than a third (30.8%) not seeking medical help for their children. Over a third (38%) of the caregivers had low nutritional knowledge with 46% having average knowledge scores. The qualitative discussion revealed that inadequate household income, lack of enough food and cultural barriers were major constraints to availability and utilization of complementary foods for children. In conclusion, factors that are significantly but negatively associated with the nutritional status of the study children include; low dietary diversity scores (p=0.046), poor nutritional knowledge (p=0.045), lack of continued breastfeeding (p=0.023) and lack or poor consumption of vitamin A rich fruits and vegetables (p=0.001). Socio-demographic factors, morbidity status, water sanitation and hygiene seem to have no influence on the nutritional status of the study children. The study recommends therapeutic and supplementary feeding programmes as a short term alternatives to address the high Global acute malnutrition rates observed; for the long term capacity building on appropriate complementary feeding and nutritional interventions such as water sanitation and Hygiene and agricultural practices for dietary diversification is recommended. Other recommendations include nutrition/health education aimed at discouraging cultural practices that prohibit consumption of foods that are beneficial to the nutritional status as well as health of young children.