Stunted-overweight And Feeding Practices Among Children 6-59 Months Old In A Well-baby Clinic: The Case Of Kenyatta National Hospital, Nairobi, Kenya
In Kenya, weight of under five year old children is taken monthly as routine growth monitoring procedures. Linear growth of the children is however not monitored unless under special circumstances yet the early stage of life is a period when growth is very critical and if retarded, it may never be reversed in lifetime. World Health Organisation has recommended that Weight for- Height be also monitored in well baby clinics but this is yet to be implemented fully in Kenya. In fact the indicator of stunting, that is, height-for-age z-score has not been used in well baby clinics. Furthermore, no efforts have been focused on children who may be stunted and overweight at the same time. Currently, only malnourished children in paedriatics wards are assessed for stunting but the well babies are assessed for weight only. This study was therefore endowed to assess the prevalence of stunted-overweight and feeding practices among children attending the well baby clinic in Kenyatta National Hospital. A cross sectional survey employing both descriptive and analytical methods was conducted at Kenyatta National Hospital. A pretested structured questionnaire was used to collect both qualitative and quantitative data from a sample of 330 mothers/guardians with infants and young children aged 6-59 months attending the well baby clinic at the hospital. Information was sought on demographic and social-economic characteristics of the household, child feeding practices and health, morbidity experience and immunization status. Anthropometric measurement included the weight and height of the children. Qualitative data on feeding practices 'were collected through the Key Informant Interviews (KII), Focus Group Discussion (FGD) and observations. Key informant interviews were used to obtain information from health service providers while a focus group discussion was used to collect information from the mothers/caregivers. Data analysis was done using Statistical Package for Social Sciences (SPSS) and EPI-INFO programs. Univariate analysis was used to assess the association between nutritional status and feeding practices. The WHO reference Z-scores-for-age was used to assess the Body Mass Index -for-age (BMI) of the children. A significantly high proportion of the study children were males as compared to females (x2 p-value<. 000,95%: CI =1.39 - 1.5). The number of children attending the clinic drastically decreased with age from 81.4 % at infancy to 1.5 % at 36-59 months old. Most of the children (92.7%) fell in the "window of opportunity" category, (the period < 24 months of age). Overall, 15% of the children were stunted and 12% were at risk of being stunted. There was no significant difference in stunting between boys and girls. The prevalence of overweight and obese children was 11.8 % while the prevalence of stunted overweight was 3%.Those underweight but also stunted were 4.9%, while 7.1% were stunted but with normal weight. There was a highly significant correlation between stunting and the body mass index of the children (p= 0.000). However, there was no significant relationship between stunted-overweight and feeding practices among the children. It was estimated that only weight but not length of the children was routinely assessed and a total of 328 (99.4%) children did not have their length recorded at birth. The assessment of stunted overweight using weight-for-age showed that 9.4% of the children had normal weight-for-age but were stunted. Those who were stunted overweight and stunted-underweight using weight-forage were 2.7% and 2.9% respectively. The ratio for the undernourished (14.3%) and over nourish (14%) was 1:1 when the weight for age was used. In conclusion, there is some coexistence of stunting and overweight (3%) among children 6-59 months of age in the well baby clinic at Kenyatta National Hospital. This could possibly be higher if a higher sample were obtained from the age group of 24-59 months, as this age group was not well represented among the children attending the well baby clinic. Feeding practices are not significantly associated with stunted-overweight probably because of the small number of stunted overweight children obtained. There is need to conduct a comprehensive community-based growth monitoring research to provide for more explanation on prevalence of stunted-overweight and its determinants. We recommend for routine monitoring of linear growth among under fives alongside weight monitoring.