Impact of the early childhood development programme on the nutritional status of pre-school children in Kaiti and Kilungu divisions in Makueni district, Kenya

Abstract

A comparative cross sectional survey on the impact of the early childhood development programme on the nutritional status of pre-school children (36-59) months was carried out in Kaiti and Kilungu divisions in Makueni District Kenya during the months of August and September 2004. Households were drawn from two divisions, one participating in the early childhood development Health and Nutrition pilot and one not participating in the health and nutrition pilot. The main objective of the study was to assess the impact of the ECD program on the nutritional status of pre-school children (36 - 59 months) in Kaiti and Kilungu divisions in Makueni district. Specific objectives were to assess the demographic and socio-economic characteristics of households whose children are either participating or not participating in the ECD health and nutrition programme; determine the morbidity pattern of the study children who either are participating or not participating in the ECD health and nutrition programme; evaluate the nature of ECD activities and level of participation by households whose children are either participating or not participating in the ECD health and nutrition programme; and compare the nutritional status of children 36-59 months who are either participating or not participating in the ECD health and nutrition programme in the two areas. The principal tool of investigation was a structured questionnaire that was administered to mothers and other caregivers to the children. Methods used to collect data were anthropometric measurements, focus group discussions and key informant interviews. The study district was purposively selected while the divisions, locations and sub-locations were randomly selected. All villages in each sub-location were sampled. Proportionate sampling was used to get the number of households to be sampled in each village with children aged 36-59 months based on the calculated sample size of 280 households. One half of the study households (140 households) were systematically selected from the study area. In households where there was more than one child aged 36-59 months, one child was randomly picked as the index child. Data was collected with assistance of field assistants who were trained on sampling methodology, administration of the questionnaire, taking anthropometric measurements and conducting focus group discussions. The SPSSIPC+ computer package was used for data entry and analysis. Nutritional status indices weight-for-age, height-for-age and weight-for-height were computed using the EPI -Info programme. The average household size was 4.5 and 4.9 persons in the project and nonproject areas respectively. Nearly half of the respondents (49.2%) had primary education while 25.7% had no formal education. The average size of land owned was 2.0 acres and 1.75 acres in the project and non-project areas respectively. Casual labour was the most common source of income in the project area. Majority (80.5%) of households in the project area were in the low-income group compared to 19.5% in the non-project area. More than half (67.1%) of the pre-school children in the project area were not enrolled in early childhood development centres. Chronic malnutrition among the study children was higher than the provincial prevalence of 21% reported in the 2003 KDHS. The prevalence of malnutrition in the study area was 30.8% stunting, 17.1% underweight and 4.3% wasting. This however, was comparable to the national prevalences of 30.3% for stunting, 20% underweight and 6% wasting (KDHS, 2003), but an improvement when compared to the 35.1 % underweight and 22.4% wasting reported during the baseline studies carried out by the Ministry of Education in 1997. Prevalence of stunting however remained the same. The results of the study also established that there was no significant difference in the prevalence for malnutrition (stunting, wasting and underweight) between the two areas. However, the prevalence for stunting in the project area (35.7%) was much higher than in the non project area (25.7%), although the difference between the two figures was not statistically significant (p=0.069). The prevalence for underweight in the study area was 17.1%, with 0.7% of the children being severely underweight (weight for age of <-3SD). This prevalence was slightly lower than the national figure (20%) and that for Eastern province (21%), but was much higher than that observed during the early childhood development baseline (10%). Moderate and severe wasting in the project and non-project area was 6.4% and 2.1% respectively. The prevalence for moderate and severe wasting in the project area (6.4%) was similar to the national figure (6%), higher than the provincial figure (4.2%), but lower than the baseline figure for the district (10%). A higher proportion of males were stunted in the project area (13.6%) compared to the non-project area (7.1 %). The same applied for females with 11.4% of the project females being stunted compared to 8.6% in the non-project area. However, these differences were not statistically significant (p=0.172 and p=0.573 respectively). For children between the ages of three to four years, the stunting levels were lower in the project area (6.4%) compared to the nonproject area (10%). For the age group 4-5 years the stunting levels were higher in the project area (18.6%) compared to the non-project area (5.6). Here, the difference was highly significant (p=0.01O). Underweight levels on the other hand were higher in the age group 3-4 years in both the project area (13.6%) and non-project area (7.1 %), compared to the age group 4-5 years with underweight prevalences of 5.7% and 6.4% for project and non-project areas respectively. These differences however were not statistically significant. More than half of the children in the project area (63.6%) and 34.3% in the non-project area were reported ill within 7 days preceding the survey. Symptoms of upper respiratory tract infections and skin disease were the most common in both study areas. Finally, no significant difference was noted in the nutritional status of pre-school children in both areas contrary to what may have been expected. Therefore, the alternative hypothesis is rejected and the null hypothesis that "there was no difference in the nutritional status for the pre-school children in the two areas" accepted. Chronic malnutrition among children is still a problem as reflected by the high prevalence of stunting observed among the pre-school children. This may have been aggravated by the withdrawal of the School Feeding Programme by the MOEST from the ECD centres. The results of this study show that the study population exhibits a young age structure with a high dependency ratio and large household size. It is therefore concluded that the large household sizes have a negative implication on nutritional status of the study children and food security of the households and this is aggravated by the small land holdings. Thus, adequate food for the households cannot be produced. The data also suggest that there was no significant difference in the morbidity patterns for project and non-project children as incidences of ARIs, malaria, skin diseases and diarrhoea that were most prevalent among the project and nonproject children affected them in a similar way. Participation by the community in ECD activities was minimal. This is reflected by the number of children who were not enrolled in ECD centres (67%) hence were not benefiting from ECD health and nutrition services such as deworming, Vitamin A supplementation, and growth monitoring. It is therefore recommended that the pre-school education programme should involve the community more actively in ECD activities such as nutrition education programmes, growth monitoring, deworming, Vitamin A supplementation and create awareness on the importance of the ECD programme to the community. More parents should be encouraged to enrol their children in the ECD centres so that they can benefit from the health and nutrition programme of ECD. It is also recommended that public health measures to control malaria, ARIs and diarrhoeal diseases such as hygiene, sanitation, prompt treatment and use of insecticide treated mosquito nets be encouraged as possible ways of contributing to reduction of malnutrition in the area.