| dc.description.abstract | Background: Malnutrition is a worldwide public health problem that affects the growth and development of children under the age of five years. It is also associated with a high morbidity and mortality in this age group. Furthermore, it reduces child immunity and this makes children susceptible to a number of infections such as pneumonia, tuberculosis and diarrhea which increases the mortality rate of children.
Severe malnutrition is a common condition among children admitted to hospitals in East Africa. Previous studies conducted have also shown that in the hospital setting, especially the pediatric medical wards, children under five years old with malnutrition have occupied nearly all the beds to the extent that other patients with acute and chronic illnesses suffer as a result.
Objectives: To determine the prevalence of malnutrition and related factors among children aged 6-60 months admitted at the Siaya district hospital pediatric ward.
Design: This was a descriptive cross sectional study.
Study Area: The study was conducted at the Siaya District Hospital pediatric ward.
Subjects: Children admitted to the Siaya District Hospital pediatric medical ward and a sample of 115 children was arrived at using the prevalence of acute malnutrition in Kenya which is currently at 7%.
Sampling methods: Systematic sampling using the admission register was employed in each of the subdivisions in the pediatric ward that was visited. Purposive non probability and systematic probability sampling was utilized.
Instruments: Questionnaires, direct observation and key informant interviews
Tools: Anthropometry screening tools were used for nutritional assessment. Salter scales were used for weighing the children and length mats were used for taking length/height of the children. Descriptive statistics was used to summarize the data. Frequencies of all the variables were generated and used for checking the outliers.
The World Health Organization, (WHO)Anthro statistical programme was employed to convert raw anthropometric measurements of weight and height /length of the children into anthropometric measurements of weight for age Z scores,(WAZ) weight for height Z scores, (WHZ), and height for age Z scores ( HAZ) and was compared with the WHO reference data.
Results:
Morbidity: The top five illnesses responsible for study children's admissions were malaria, respiratory tract infections, pneumonia and bronchitis, anaemia, malnutrition mainly kwashiorkor, marasmic kwashiorkor, diarrhoea and vomiting. Prevalence of malnutrition: Stunting prevalence of 14.2% for severe stunting and 27.4% for moderate stunting indicates that these children were subjected to.long term chronic malnutrition. The prevalence of underweight was 11.3% for severe underweight and 24.3% for moderate underweight which is a composite index for both wasting and stu~ting. The prevalence of severe wasting was 14.2% and 18.4% for moderate wasting.
Quality of food: The meals served were inadequate and did not meet the standards of a balanced diet, and it was also noted that meals had inadequate micro and macronutrients. The study also found that meals served were not diverse and also not served frequently.
Per capita allocation: Each patient admitted to the pediatric wards is allocated 39 Ksh and 50 cents per day.
Conclusion: The prevalence of severe wasting was 14.2% and 18.4% for moderate wasting this was higher than that of a similar study done in Siaya District Hospital; (Bern et al, 1997) which stood at 11 %.In the current study severe underweight prevalence was 11.3% and 24.3% for moderate underweight. This was equal to a similar one done in Siaya District Hospital which had a prevalence rate of 25%,(Bern et al,1997).
1n the current study, the findings for severe stunting was 14.2% and 27.4% for moderate stunting among the study children. This too was higher compared to the study done in Siaya District Hospital which had a prevalence of 18%,(Bern et al,1997). There was a highly significant increase in wasting with children's age, (P<O.OOI) for both boys and girls in the study. Most of the stunted, wasted and underweight children were from homes that had two or more cows as compared to those who came from homes that had none. This could be because the cows found in that area are local breeds with verypoor yields that the poor people chose to cling to.Malaria was the highest cause of morbidity among the study children.
The study established that the only factor that had linear correlation with the nutritional status of children was morbidity. The overall quality of the diet of children in this study was inadequate. Apart from the low energy and protein intake; children also had undesirable intakes of essential vitamins and minerals. The inadequacy in quality could be due to inadequate budget for patient food and low priority for nutrition as part of medical treatment and failure to adhere to the hospital menu. The per capita consumption for patients in the pediatric ward was 39ksh and 50 cents per patient . per day. The study also found that hospital staffandthe DHMT have their tea breaks, monthly meetings and other guests foods catered for under patient's budget.
Recommendations: The trained medical staffs should be involved in sensitizing the population on the basis of integrated management of childhood illnesses (lMCI). There is need for the District Health Management Team (DHMT) to involve a quality assurance team consisting of a clinician, nurse, nutritionist and community health worker in identification and management of malnutrition among children admitted at the facility. Feeding of sick children should also be in line with the recommended guidelines.
There is need for more qualified nutrition personnel at the facility who will be involved In assessment of nutritional status of children on admission during hospitalization and upon discharge. The nutritionist should also be actively involved in supervision of meal preparation and service. The DHMT should have a separate budget for their staff teas/ meals and should also increase the funds they allocate to food and nutrition during budgeting to increase the per capita day allocation for children admitted in the paediatric ward. All children aged 6-60 months admitted in the pediatric ward should be provided with the recommended toto diet, (K.N.H 2012). Feeding frequency should also be increased in line with the MOPHS guidelines for feeding sick children. | en_US |
