Factors associated with nutritional rehabilitative effectiveness of corn soy blend in children aged 6-36 months at Mukuru, Nairobi
Child malnutrition is the underlying cause of 3.5 millions of deaths in young children under five years of age in developing countries. Progress in addressing ibis through improved feeding of children has been insufficient. One way of addressing malnutrition is through supplementation with nutrient rich foods. This study determined the level and factors associated with rehabilitative effectiveness of corn soy blend in children aged 6 - 36 months in a supplementary feeding programme based at Mary Immaculate Nutrition Centre, Mukuru, Nairobi. The study conducted, between September 2011 to April 2012, applied two phases; i) a cross sectional study with an analytical approach of the household demographic and socio economic characteristics, food security and health factors, utilization and compliance to the use of corn soy blend by mothers/caretakers, dietary intake and morbidity experience of the children and ii) a retrospective study on weight gain, length of stay in the programme as compared to the recommended performance indicators. A total of 150 children participated in the cross sectional study through exhaustive sampling. Mothers of the children were interviewed using a pretested semi structured questionnaire to obtain information on the children and their households. Eleven mothers were interviewed using a focus group discussion guide, and 5 key informants were interviewed to obtain data on their experience and perceptions related to the feeding programme. Data for 153 children was collected from records of children in the feeding programme in the previous one year up to October 10th 2011, for the retrospective study. Data was coded, entered and analyzed using means and standard deviation for continuous data, proportions and frequency distributions for categorical data. T test. analysis of variance, correlations and Chi - square were used to test for significant differences and associations between group characteristics at p values < 0.05 and generalized linear model regression was used for inferential statistics. Most of the mothers were of primary level education (57.7%) and not employed (61.7%) in any income generating activity. Stunting, underweight and wasting were very high in the study children at admission and after three weeks in the programme at 48%, 39% and 22% respectively. However, the mean z scores for stunting, underweight and wasting increased significantly by 0.68, 0.59 and 0.23 respectively after 3 weeks in the programme. Nevertheless, the mean daily weight gain was lower than 5g at 1.65g/kg body weight and mean length of stay was longer than the recommended 4 weeks at 12 weeks. This may be attributed to diet inadequacy of the children, not using CSB flour as recommended by 54.5% of the mothers and missing supplementary feeding programme (SFP) sessions or illnesses. Though CSB contributed 33 -55% of Kilo calories, Iron, Vitamin A and Zinc, only half of the children (54%) had consumed a diet that was adequate in KCalories, 91 % in protein, 80% in Vitamin A, while no child consumed a diet adequate in bio available iron and zinc. The study established that almost half of the respondents missed the SFP sessions at least once in the previous month. Most of the children (73 %) had experienced an ailment in the previous 2 weeks. The factors associated with dietary intake were distance to water source (r=-0.170, p=0.039), household size (r=-0.234, p=0.004), marital status (X2=11.218, p=O.016), and gender of the household head (X~5.875, p=O.047). The factors associated with the child's progress in the SFP were the employment status of the mother and length of stay of the child in the programme (Fishers Exact Test =11.389 p=O.020); employment status and change in WHZ (X2=3.335, p=O.05) and WAZ scores (X~5.041, p=O.025); person who fed the child and change in W AZ (Fishers Exact Test =12.034, p=0.021 )and WHZ scores (Fishers Exact Test =8.296, p=O.027). The lack of association or correlation between dietary intake of energy and Vitamin A and child nutritional status except for protein intake that was significantly associated with change in HAZ scores, is attributed to low and inadequate intake of energy, protein, iron and zinc in the diets of the study children. Length of stay, household dietary diversity and occupation of the mother had significant effects on change in WHZ scores (X2=4.979, p=O.026), (X2=3.853, p=O.05) (X2=9.512, p=O.002) respectively. While length of stay had significant effects on change in HAZ scores (X2=9.182, p=O.002). The study concludes that employment status (whether a mother is employed or not) and household dietary diversity are important for progress of a child who is wasted in a SFP. The duration of stay of a child in a SFP is also important for the child's progress with respect to stunting and wasting. Smaller, male headed and monogamous households are significantly associated with high dietary diversity. High dietary plant proteins and CSB significantly impact stunting positively but not wasting and underweight, while a diet of low to average energy, vitamin A, iron and zinc, despite the contribution of CSB supplement has no significant effect on progress of children who are wasted, stunted or under- weight. It is recommended that nutrition education and other interventions for the mothers whose children are in a SFP, should emphasize on the importance of household dietary diversity for the child's nutritional progress and the importance of the mother's presence in caring and feeding the child.