Malnutrition, dietary diversity, morbidity and associated factors among schoolchildren in Kibwezi District, Kenya
In Kenya, information on the nutritional status of schoolchildren is scanty. This study assessed malnutrition levels (stunting, underweight, thinness, and anemia and serum RBP levels), dietary diversity and morbidity among children in Kibwezi district and served to provide baseline information for a randomized controlled trial of the effect of provitamin A biofortified cassava on vitamin A status of primary school children in Kenya. A cross-sectional survey was conducted in three primary schools selected based on an estimated prevalence of Vitamin A Deficiency of 50%, size of the school and willingness to participate. Information on household socio-economic and demographic characteristics and children’s morbidity burden was collected using pre-tested questionnaires and trained interviewers. A fourteen day recall period and a 24-hour recall period was used for morbidity and individual diversity score respectively. Blood for RBP and haemoglobin analysis was drawn by qualified and trained technicians. Descriptive statistics were computed for demographic and socio-economic data. Logistic regression and bivariate correlation analyses were performed to establish relationships. A P-value of <0.05 was considered significant in all the analyses. In total, 423 pupils (52.2% males and 47.8% females) were included in the study. Mean age of the children was 9.3 ± 2.3 years. The mean household size of 7 (±2.2) members was significantly higher than the national figure of 4.6 for rural areas (t420 = -130.544, p= 0.000). The age dependency ratio was 149. Anemia was detected in 10% of the children of which 4.7% were mildly anemic, 5.0% moderately anemic and only 0.3% severely anemic. Non anemic children were less likely to fall below the 50th percentile of the population serum RBPP. xv Prevalence of underweight was highest (31.7%) followed by thinness (28.9%) then stunting (18.0%). There was no significant association between the sex of a child and the nutritional status (χ2 =0.444, df = 1, p =0.504). Children under the care of their mothers were less likely to have poor nutritional status. The mean IDDS was 3.3 ±1.0 food groups. At the 5% level, the proportions of children that had low, medium and high IDDS did not differ significantly between the schools (χ2=8.367, df=4, P>0.05). The main source of income for the household was a significant predictor of individual dietary diversity (OR=1.4; 95%CI=1.3, 2.6). Children from households with permanent employment being main source of income were likely to have a higher IDDS. Of the 423 children, 22.0% were sick in the two weeks preceding the survey of which only 52.2% sought medical intervention. The mean number of times a child was sick in the two weeks was 1.06 (±0.25) times while the mean number of days per occasion of illness was 3.15 (± 2.4) days. Educational level of the caregiver, hemoglobin and dietary diversity score were strong predictors of morbidity status of a child (p<0.05). The study concludes that anemia is of mild public health significance among schoolchildren. Malnutrition measured by stunting, underweight and thinness is widespread among the schoolchildren. There is poor diet quality evidenced by low individual dietary diversity. Educational levels of the caregiver and dietary diversity are a determinant of child morbidity. Moreover, there is a high rate of disease burden among schoolchildren.