Ecology of pre-school malnutrition in peri-urban Nairobi
This case control study determines maior factors that could be used to predict households at risk of having malnourished pre-school child- reno The investigation was carried out in an urban squatter settlement of Nairobi. Kenya. with an approximate population of 45.000 people. To determine the nutritional status of pre- school children and establish the prevalence of .. malnutrition in the locality. anthropometric mea- surements were obtained on a randomly selected sample of 957 children less than five years of age from 633 households. These measurements included determination of precise age. height and weight. Using weight-far-age and comparing obtained values with the National Center for Health Sta- tistics (NCHS) reference population. children below 70% of the NCHS median were selected as the cases for study. These were doubly matched for age and sex with normal. healthy children (80-110% of NCHS median) from the same population. A total of 64 cases and 128 controls were thus identified. Variables used for comparing these two groups included socio-economic status. environmental sanitation. personal circumstances and household diets prevalent among pre-school children zero to 6~ months of age. Compared to the NCHS reference population. 346 (36.2%) of the general child popu- lation had a weight-far-age ratio below 80% of the standard: 258 (27.0%) had a height-far-age ratio below 90% of the standard (stunted): and 47 <tot of (4.9%) had a weight-far-height ratio below the f\. standard (wasted). The m a j or Lt y of the malnouri- shed children (59.4%) were in their second and third years of life. A wide variety of locally grown foods was .. available at the open air market serving the area. Food prices were 30% below those of markets in the high socio-economic status areas of the city. The diets of most households comprised mainly of "ugali" and "sukuma wiki" (stiff maize porridge and kale). About 55% of households had incomes below KSh 800 per month earned from unskil led job catego- r f es , casual labour or small businesses. The aver- age household size comprise-d five members. all living in a single room. The environment generallv was unsanitary with no proper sewage and waste disposal facilities. Using 'discriminant analysis'. income of the head of household. number of children under fjve yea rs , education of head of household and the mother, marital status of the mother and income or the mother were found to be major risk factors determining whether a child would be at risk of being malnourished. With these factors. the per- centage of malnourished and wei I-nourished child- ren correctly classified was 68%. Income generating activities targeted to exploit the skills and time available to mothers, child spacing to ultimately reduce family sizes. practical nutrition education and eradication of ill iteracy through integrated efforts of all con- .. cerned and interested organizations. would be feasible interventions to reduce malnutrition in this community.