Associations between childcare practices and child growth, development and mortality among refugees in Kibondo Camps -Tanzania
In emergencies, despite food ration distribution, presence of feeding programmes and provision of free health cares, malnutrition and morbidity are still a problem that constitute a threat to child survival, growth and development, and information on childcare practices are scarce. In order to investigate the influence of childcare practices on child nutritional status, growth and development, morbidity and mortality, a cross sectional study was conducted in Kibondo refugee camps in Tanzania. Data were collected during the period between November 2000 and February 2001 in four refugee camps. The sample size comprised 364 pair mothers/children aged 6-24 months in 364 households living in the camps. A structured questionnaire with few open-ended questions was used as a guideline to data collection on childcare practices, anthropometry, food intakes, dentition, developmental milestones, morbidity and mortality. Data management, entry, cleaning and analysis was done using the Epi Info 2000 (version 1.0), the Nutrisurvey update 2000 and the statistical package for social sciences (SPSS version 8.0) packages. The nutritional status has deteriorated compared to previous surveys. About 6.3% (95% CI: 4.1-9.4%) of children were suffering from acute malnutrition or wasting, 28.5% (95% CI: 24-33.5%) were underweight and 42.7% (37.6-48%) were suffering from chronic malnutrition or stunting. High morbidity (65%) was found among children with high incidence of diarrhoea (48.2%). The Under five mortality rate was 0.75110.000 per day. The results of the study showed that household size and birth order, duration in the camp, household wealth, amount of financial support to the mother and availability of water in the household are the factors which affect household caring capacity. Childcare practices that showed associations with child nutritional status, growth, disease incidence and mortality of children are: time allocated by the mother to spend with the child, maturity of alternate caretaker, mother's work place (home or away), breastfeeding duration (including exclusive breastfeeding) and complementary feeding patterns (in terms of frequency of feeding, quantity, variety and fulfilment of recommended daily allowances), physical and environmental hygiene (cleanliness, sewage disposal, water utilisation) and family planning practices. In conclusion, the study revealed strong associations between malnutrition, growth failure, high morbidity and mortality and poor childcare practices but was not conclusive on developmental milestones. Specific programs aimed at promoting behaviour change and at empowering women caring capacity must be set and go alongside with healthcare services, food ration distribution for child survival, growth and development in the refugee camps.