Childcare practices and nutritional status of children under five years old in Southland informal settlement Nairobi county
Abstract
Study Background: Child care practices play a major role in improving the nutritional
status of children under-five year old. Poor child care practices have been found to
contribute significantly to malnutrition leading to higher morbidity and mortality rates
in this age group. This study was undertaken to assess the effect of care practices in
Southland Informal Settlement scheme in order to understand how it influences
nutritional status of children.
Objectives: The main objective of this study was to assess child care practices and
nutritional status of under five year old children in southland informal settlement
Nairobi county.
Methods: This was a descriptive cross sectional study with sample size comprising of
248 children. The main aim was to establish the nutritional status of children below
five years old and to identify childcare practices provided to these children. The study
population consisted of children aged 0-59 months whose caregivers gave consent to
participate in the study. A Systematic Random Sampling method was employed and
households with children under five years old were registered. The data was collected
using structured questionnaires and focus group discussion guides. A total of 248
children were taken anthropometric measurements to determine their nutritional status
and their caregivers interviewed to give information about the child. Interviews were
also conducted among 21 caregivers in two focus group discussions.Descriptive
statistics were generated and the WHO anthro software version 3.2.2 was used to
convert anthropometric measurements into anthropometric indices of weight for
height (WHZ), Z scores, weight for age (WAZ),) and height for age (HAZ).The
Statistical Package for Social Sciences (SPSS) version 18 was used to analyze the
socio demographic/ socio economic data and care practices in order to establish the
associations between variables with nutritional status of children.
Results: Stunting prevalence among children (<-2 z-scores) was 31.9% with older
children most vulnerable in these age groups: 12- 23 months (46.3%), 24-35 months
(38.3%) and 36-47 months (28.4%) respectively. Male children were commonly
affected by stunting (33.6%) than underweight and wasting. Underweight (<-2 zscores)
was 9.7% among all the children with older children most affected in these
age groups 24-35 months (12.8%) and 36-47 months (10.4%) with female children
most affected by underweight (10.3%). Wasting was the least (<-2 z-scores) 6% with
older children most vulnerable as well in these age groups 24-35 months (8.5%) and
48-59 months (7.7%) and 36-47 months and male (7.6%) children most affected by
wasting than female( 4.3%) children. Various types of variables were tested to
establish significant difference. The chi-square test used to find association at
significance levels showed positive relationship between stunting and the following
childcare practices; weight at birth (p=0.015); breast feeding (p=0.006); duration of
breast feeding (p=0.004); how food was served to child to eat (p=0.057) and the
households income (p=0.015). Wasting showed positive relationship with breast
feeding (p=0.028); alternative caregiver when mother is sick or away (p=0.001) and
underweight was only positively associated with types of common illnesses
(p=0.004). Other factors tested to establish the determinants of child nutritional status
was water, sanitation and hygiene practices which showed no significant difference
with child nutritional status. It is important to note that malnutrition prevalence
among children in Southland slum settlement was nevertheless well below the
national levels.
Conclusions: Prevalence of malnutrition was high among the study children with
chronic malnutrition more pronounced among older children between 12-47 months.
Male children were most affected by stunting than female children. Wasting and
underweight was more pronounced in the female children.
The factors found to be associated with nutritional status of children and stunting
were; weight at birth; breast feeding and duration of breast feeding; how food is
served to the child and household income. Wasting showed positive relationship with
breast feeding, alternative caregiver when the mother is sick or away. Underweight
showed associated with common childhood illness.
Water, sanitation and hygienic practices were not associated with child nutritional
status, however there was high proportion of children with stunting (60.9%) and
underweight (29.6%), evidenced by the proportion of children who had diarrohea
(17.4%) during the study. There was also evidence of strained sanitation facilities in
the study area with households to latrine ratio exceeding the population of over 1,600
people with a total of 243 pit latrines during the time of the study
Recommendations: The Nairobi County should put measures in place to empower
caregivers in the Informal Settlements through finance for the needy to improve and
sustain their income generating activities in view of improving their household
income in order to protect child nutritional status and prevent malnutrition.
Community health workers (CHWs) deployed in southland slum community should
intensify health and nutrition education activities and address feeding practices
targeting mothers and other caregivers. The focus areas should be on growth
monitoring, breastfeeding promotion and infant and young child feeding as
recommended by WHO/ MOH enhanced by Ministry of Health.
The Nairobi County and the area chief should oversee the welfare of the slum
dwellers in a bid to improve household to latrine ration with central focus on all
initiatives toward promoting hygiene practices and sanitation. These can be achieved
through provision of plastic containers per plot for solid waste, which is emptied at an
affordable fee to enhance hygiene practices.
Publisher
University of Nairobi