The association between utilization of preventive child health services and the nutritional status of children under three years in Kibera, a spontaneous urban settlehent of Nairobi, Kenya

Abstract

Between February and May 1989 a cross-sectional survey was conducted to assess the coverage and accessibility of the available preventive child health services in a spontaneous settlement of Nairobi. In particular, the survey investigated whether there was any association between nutritional status of children under three years and their utilization of preventive child health services. The study took place in Kibera, a peri-urban area of Nairobi and a sample of 478 children was surveyed. The results showed that 22 % of the study children were malnourished (~ 80 % Weight for Age) and there was an increasing trend of malnourishmerit from the age of six months until eighteen months. Eighteen per cent of the ~tudy children were found to be stunted and five per cent wasted. viii The majority of the study children (79 %) had a Child Health Card at the time of investigation. The majority of the study children (71 %) were fully immunized. This lS a high coverage compared to the national coverage rate of 51 % (UNICEF, 1989) Well nourished and moderately malnourished children had a better immunization status than severely malnourished children. Malnourished children in this study also participated less frequently in the growth monitoring programme than well nourished children. The difference in utilization of growth monitoring services was found to be due ,in part, to age. Utilization of growth monitoring services decreased sharply with age, while the nutritional status of children also deteriorated with age. With increasing age of the child the utilization of preventive child health services decreased. Makina children visited the Child Welfare Clinic an average of eight times in their first year of life, three times in their second year of life and less than once per year thereafter. Younger mothers made more use of preventive child health services than older mothers. ix The researcher analysed whether the positive association between nutritional status of children under three years and their utilization of preventive child health services could be due to income or maternal care. Although household income was associated with the nutritional status of children under three years, there was no relationship between household income and utilization of preventive child health services. With respect to maternal care, the two variables; employment of the mother and caretaker of the child were neither associated with the nutritional status of the child nor with their utilization of preventive child health services. In contrast the educational level attained by the mother (also a variable of maternal care) was positively associated with the immunization status of the child.