Childcare practices and nutritional status of children under five years old in Southland informal settlement Nairobi county
Study Background: Child care practices play a major role in improving the nutritional status of children under-five year old. Poor child care practices have been found to contribute significantly to malnutrition leading to higher morbidity and mortality rates in this age group. This study was undertaken to assess the effect of care practices in Southland Informal Settlement scheme in order to understand how it influences nutritional status of children. Objectives: The main objective of this study was to assess child care practices and nutritional status of under five year old children in southland informal settlement Nairobi county. Methods: This was a descriptive cross sectional study with sample size comprising of 248 children. The main aim was to establish the nutritional status of children below five years old and to identify childcare practices provided to these children. The study population consisted of children aged 0-59 months whose caregivers gave consent to participate in the study. A Systematic Random Sampling method was employed and households with children under five years old were registered. The data was collected using structured questionnaires and focus group discussion guides. A total of 248 children were taken anthropometric measurements to determine their nutritional status and their caregivers interviewed to give information about the child. Interviews were also conducted among 21 caregivers in two focus group discussions.Descriptive statistics were generated and the WHO anthro software version 3.2.2 was used to convert anthropometric measurements into anthropometric indices of weight for height (WHZ), Z scores, weight for age (WAZ),) and height for age (HAZ).The Statistical Package for Social Sciences (SPSS) version 18 was used to analyze the socio demographic/ socio economic data and care practices in order to establish the associations between variables with nutritional status of children. Results: Stunting prevalence among children (<-2 z-scores) was 31.9% with older children most vulnerable in these age groups: 12- 23 months (46.3%), 24-35 months (38.3%) and 36-47 months (28.4%) respectively. Male children were commonly affected by stunting (33.6%) than underweight and wasting. Underweight (<-2 zscores) was 9.7% among all the children with older children most affected in these age groups 24-35 months (12.8%) and 36-47 months (10.4%) with female children most affected by underweight (10.3%). Wasting was the least (<-2 z-scores) 6% with older children most vulnerable as well in these age groups 24-35 months (8.5%) and 48-59 months (7.7%) and 36-47 months and male (7.6%) children most affected by wasting than female( 4.3%) children. Various types of variables were tested to establish significant difference. The chi-square test used to find association at significance levels showed positive relationship between stunting and the following childcare practices; weight at birth (p=0.015); breast feeding (p=0.006); duration of breast feeding (p=0.004); how food was served to child to eat (p=0.057) and the households income (p=0.015). Wasting showed positive relationship with breast feeding (p=0.028); alternative caregiver when mother is sick or away (p=0.001) and underweight was only positively associated with types of common illnesses (p=0.004). Other factors tested to establish the determinants of child nutritional status was water, sanitation and hygiene practices which showed no significant difference with child nutritional status. It is important to note that malnutrition prevalence among children in Southland slum settlement was nevertheless well below the national levels. Conclusions: Prevalence of malnutrition was high among the study children with chronic malnutrition more pronounced among older children between 12-47 months. Male children were most affected by stunting than female children. Wasting and underweight was more pronounced in the female children. The factors found to be associated with nutritional status of children and stunting were; weight at birth; breast feeding and duration of breast feeding; how food is served to the child and household income. Wasting showed positive relationship with breast feeding, alternative caregiver when the mother is sick or away. Underweight showed associated with common childhood illness. Water, sanitation and hygienic practices were not associated with child nutritional status, however there was high proportion of children with stunting (60.9%) and underweight (29.6%), evidenced by the proportion of children who had diarrohea (17.4%) during the study. There was also evidence of strained sanitation facilities in the study area with households to latrine ratio exceeding the population of over 1,600 people with a total of 243 pit latrines during the time of the study Recommendations: The Nairobi County should put measures in place to empower caregivers in the Informal Settlements through finance for the needy to improve and sustain their income generating activities in view of improving their household income in order to protect child nutritional status and prevent malnutrition. Community health workers (CHWs) deployed in southland slum community should intensify health and nutrition education activities and address feeding practices targeting mothers and other caregivers. The focus areas should be on growth monitoring, breastfeeding promotion and infant and young child feeding as recommended by WHO/ MOH enhanced by Ministry of Health. The Nairobi County and the area chief should oversee the welfare of the slum dwellers in a bid to improve household to latrine ration with central focus on all initiatives toward promoting hygiene practices and sanitation. These can be achieved through provision of plastic containers per plot for solid waste, which is emptied at an affordable fee to enhance hygiene practices.