Childcare practices and psychomotor development in children 0-36 months in Mwea Division-Kirinyaga District-Kenya
In September-October 2002 a descriptive cross-sectional survey aimed at assessing the awareness of psychomotor stimulation practices in 0-36 months old children drawn from households under a Community Based Nutrition Programme/Family Life Training Programme zone was conducted in Mwea division-Kirinyaga District. The principal tool of investigation was a structured questionnaire that was administered to mothers of 0-36 months old children. Methods used for investigation were anthropometric assessment, observation of motor, cognitive and social skills on the study children, observation of maternal activities, timing of childcare activities and focus group discussions. Purposive sampling was done at the programme level and random sampling at the household level giving a sample size of 348 households in which there had to be a child aged between 0-36 months. In any household with more than one child in this age category, simple random sampling was done to avoid bias. Data was collected with the assistance of four field assistants and SPSS computer package was used for data entry and analysis. Nutritional status indices were computed using the Epi- Info programme. Analysis was mainly descriptive with chi-square and correlation tests to assess the level of significance between proportions. The study established that awareness of psychomotor stimulating activities is lacking in the study community. Observation of maternal activities however showed that there were psychomotor related activities, which the population could not relate to the development of children. For example play to many mothers was there for its own sake but not to exceed a certain age limit. For those who provided playthings (23.1 %), this was mainly to distract the attention of the child. Teaching of skills was reported to commence when the child achieved movement and language skills. Skills taught were not cognitive challenging as they involved simple physical activities including speaking (63.0%), singing (22.6%), sweeping (1.6%) carrying dolls (2.5%), walking (10.3%). Of the psychomotor acti vities observed, holdi ng and carrying chi Id took relati vel y more time compared with the other psychomotor activities perhaps why gross motor ability ranked higher than either fine motor and cognitive abilities. Low achievement in psychomotor skills by those children who were confined indoors was significant suggesting that lack of experience could be contributing to the poor achievement. Many mothers however pointed out that they were too busy to play with or teach skills to their children. Very few activities were regarded as childcare activities nalllely:- food preparation, feeding, bathing, breastfeeding and washing child's clothes. These activities were not significant with maternal characteristics but breastfeeding and feeding were significant with the age of the child. The study established that Mwea was better off compared to the national figures in the prevalence of malnutrition. The global stunting malnutrition, (28.1 %) is lower in comparison to the national figures (33%). Global underweight (18.1 %) and global acute malnutrition (6.6%) are lower than national figures (22%) and (6.7%) respectively. This may be a suggestion that the Community Based Nutrition Programme on their fight against malnutrition have had a positive impact on nutritional status of the children. Though the sample size was small to make conclusive decisions, stunted children achieved lowest in psychomotor abilities compared to the underweight or wasted children. Nutritional status by gender indicated boys to be better off than girls. Observation showed boys being breastfed more than girls and getting relatively larger portions of food. This may suggest the community is still clinging to the age-old beliefs that boys are superior to girls. However, this gender disparity was not significant with psychomotor abilities. The study established that (96.2%) is socio-economically poor and majority (72.1 %) were not aware of time saving methods while the rest (27.9%) could not afford the time/labour saving devices. Of the caregivers identified in the study area, housegirls, though in very few households (I. I%) were found to contribute more positively to the nutritional status and psychomotor development of study children. Apart 'from the CBNP that offers nutritional approach to eradicating malnutrition and child growth monitoring services, the only other institutions offering pre- and post-natal services for 0-36 months old children are the health institutions in or around the irrigation scheme area. However, services are hampered by the long distances to travel, lack of proper means of transport, cost of services and lack of enough equipment and manpower. It is therefore recommended that the study community is made aware of chi Idcare practices and thei r value. Awareness of psycho-sti mulati ng activities and how they contribute to the Iife-long productivity of the child (economically, culturally and socially) would perhaps change the attitude accorded to the child.