Feeding practices and nutritional status of Children 6-36 months in muslim and christian Households: a human rights perspective (a case study of Kibera in Nairobi, Kenya)

Abstract

The right to adequate food and nutrition is a powerful tool to combat malnutrition and hunger worldwide. Current thinking views integration of human rights into nutrition programming as an essential component in which the involvement of different levels of groups of citizens, as perceived in the hierarchy referred to as "duty bearers" is critical. Breastfeeding as one of the seven globally recognized essential nutrition actions has for a long time been considered key in mitigating negative outcomes, such as malnutrition and poor health among the younger children. The belief that the rights of mothers to breastfeed their infants, and even the rights of babies to be breastfed, is rapidly emerging hence, should be seriously considered as a human rights issue. Observations suggest that religious teachings, based on the Holy books, have an influence on the duration of exclusive and total breastfeeding. Given the scenario described above, a study was carried out between August and September 2004 in Makina village in Kibera Division, Nairobi. This study was cross-sectional and comparative in nature with the objective "to determine the influence of religion on the feeding practices of children 6-36 months in Christian and Muslim households in Kibera and assess how these practices impact on the children's right to food and nutrition". This study was conducted among 320 systematic randomly selected Muslim and Christian mother and child dyads. The findings would indicate the worth of partnering with faith-based organizations in the promotion of breastfeeding and propagation for appropriate childcare practices that would lead to the actualisation and fulfilment of the right to food and nutrition.

The findings of the study show the following: The study area had a heterogeneous community in terms of ethnicity but was more homogenous in terms of socio-economic and demographic characteristics. There was no significant difference between the family size in the Christian and Muslim households. Majority of the Muslim (96%) and Christian (94%) index children were breastfed. A significantly higher proportion of Christian children (56.87%) than Muslim children (43.13%) were introduced to complementary foods in less than four months (X2=6.05; P=0.0139).The mean duration of exclusive breastfeeding in Muslims and Christians was 3.91±2.03 and 3.23± 2.02 months respectively. There was a significant difference (t=3.019; P=0.003) in the mean exclusive breastfeeding duration between the Muslim (3.91±2.03 months) and Christian (3.23± 2.02 months) children. The first main complementary food given to both Muslim and Christian children was cereal based porridge (44.4% Muslim and 49.4% Christian children), followed by mashed tubers and roots (17.5% Muslim and 15.6% Christian). Almost half of all the study children were fed using spoon and cup (50.9%) and one fifth (2l.9%) used spoon and bowl. Among the Christians, 53.8% and 17.5% used spoon and cup and spoon and bowl respectively, whereas among their Muslim counterparts 48.1% and 26.3% used spoon and cup and spoon and bowl respectively. A significant proportion of Christian (53.8%) children were fed using cup, compared to their Muslim (48.1%) counterparts (X2=6.57; P=0.0104). More Muslim children (1l.3%) were bottle fed compared to their Christian counterparts (6.9%), but the difference was not significant (X2=l.86; P=0.173).

The duration of total breastfeeding and exclusive breastfeeding for Muslim children was longer than for the Christians. This indicates that Muslims in Makina are better duty bearers compared to their Christian counterparts; though the goal of exclusive breastfeeding for six months had not. been accomplished in both religions. Exclusive Breastfeeding is acknowledged to be the optimal way of both feeding and caring for young infants; therefore, obstacles to breastfeeding often serve as a human being's first hindrance to adequate nutrition, food, and care. The prevalence of long term deprivation (stunting) of the right to food among the Christian (34.2%) and Muslim (28.3%) claim holders (children) was not significant (X2 =0.20; P=O.655). The percentage of children who showed indications of effect of short term violations (wasting) was 5.7% among the Christians, and 6.9% among the Muslims (X2 = 0.200; P=O.66). There was no significant difference (X2= 0.254; P=0.614). in the prevalence of underweight among the Muslim (12.6%) and Christian (10.8%) children. Underweight is considered to be evidence of fluctuations in unmet right to adequate food. Stunting, wasting and underweight levels indicate failure of duty bearers (not only mothers) at different levels of the society, such as family, community and government to meet their obligations to claim holders. Mothers' fortnight recall indicated that more than half of the children (54.7%) had been sick in the last two weeks prior to the survey period, 56.3% were Muslim and 53.1% were Christian children. More Muslim (57%) mothers, compared to their Christian (42%) counterparts reported that their religion played a role in influencing their child feeding practices, this difference was significant (X2=8.45; P= 0.03). The recommendation of exclusive breastfeeding for six months

was echoed in both the Muslim (20%) and Christian (4.4%) households (X2=42.38; P= 0.00). Majority of the mothers (64.0%) in the study households reported their religion recommended total breastfeeding duration of two years, as a way of fulfilling their children's right to food . • Child-feeding practices in·Makina are generally poor irrespective of religious influence. This is because breastfeeding is acknowledged to be the optimal way of feeding and caring for young infants and is critically important for infant development, including mental development, while also providing benefits to the mother, thus, the right of mothers to breastfeed their infants deserves to be accepted as a human right in early infancy. In early infancy, Muslim mothers in Kibera are better duty bearers of their children's right to food, by having longer exclusive breastfeeding and total breastfeeding durations compared to their Christian counterparts. This study therefore concludes that the children's right to food and nutrition is violated as indicated by inappropriate breastfeeding and complementary feeding practices, this in turn infringes on other rights such as the right to optimal quality of life, education and health. The study also implies that there is great value in Faith Based Organizations partnering with humanrights and other organizations working with the community in the promotion, protection, facilitation and fulfillment of adequate food as a human right. This can be done through communitybased activities which target appropriate complementary feeding, exclusive and total breastfeeding for six months and two years respectively. This is critical because religion can havea positive influence on the actualization and operationalization of the right to adequate food andnutrition, of children, 6-36 month in Makina. Religion can thus, be used effectively for the promotionof the right of the child to adequate nutrition.