| dc.description.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. | en |
