Feeding Practices, Hygienic Practices, Morbidity Patterns and Nutrition Status of Children Aged 6-23 Months in Daycare Centres in Mwea, Kirinyaga County

Abstract

Inadequate dietary quality, frequency and diversity lead to under-nutrition, the most prevalent form of malnutrition with its indicators being stunting, wasting, and underweight. Over 2 million children below five years die annually due to malnutrition, which is particularly severe during the period of complementary feeding between 6 and 23 months. This is a public health problem of concern in sub Saharan Africa. Nutritional status assessment of a child is an important aspect of gauging childcare feeding practices of parents and/or caregiver which may lead to malnutrition, the precursor to morbidity and mortality. Scientific evidence on nutritional status of children in daycare centers is scanty, consequently masking detection of possible dangers in nutrition and health trends. Daycare centers have been linked to poor nutritional status. The main objective of this study was to determine the feeding and hygienic practices; morbidity patterns and nutritional status of children aged 6-23 months in day care centers in Mwea, Kirinyaga County. Twenty day-care centers in Mwea constituency, Kirinyaga County were selected and adopted a cross-sectional design. Data was collected using focus group discussions, observation checklists and structured questionnaires. Data from the questionnaire was entered and analyzed using SPSS version 17. Chi square was used to determine association between the various variables in the study. Anthropometric data were analyzed using ENA computer software version 2010 and SPSS was also used in analysis of other variables. A P-value of <0.05 was used as the criterion for statistical significance. Data of FGDs was transcribed, coded and manually analyzed based on themes developed from the responses and objectives of the study. Majority of mothers were aged between 20 and 34 years and did casual work (47.3%) with an average household size of 3-4 members. Most of the households purchased their food (90.3%), others obtained it from farming (7%) and donations (2.3%). The main types of food fed to the children were cereal grains and tubers (72.1%), dairy products (76.2%), breast milk (64.2%), flesh foods (32.7%), vitamin A-rich fruits and vegetables (75.2%). Early initiation of complementary feeding was practiced by 44.4% of the care givers. The child dietary diversity score was significantly associated with nutrition status (P= 0.038: OR 1.935; CI 1.039-3.603). The minimum acceptable diet was achieved by only 18.9%, while minimum meal frequency was achieved by 53.1%. Under-nutrition was indicated by wasting-9.7%, stunting- 24.2%, underweight- 6.1%; and overweight- 30.3%. Factors found significantly associated with nutrition status include child age category (AOR = 13.860, C.I, 2.658-72.265, P= 0.002); mother age category (AOR = 0.175, C.I, 0.052-0.592, P = 0.005); education level of mother (AOR = 9.849, C.I, 1.332-72.837, P = 0.025) and household size (AOR = 20.376, C.I, 2.695-154.027, P = 0.003). In terms of morbidity in the previous two weeks prior to start of this study, 66.7% of the children had suffered from diarrhea, 71.8% from fever/cough, 38.9% had vomited and 25.6% had suffered skin infections/allergic conditions. This happened despite 41.2% of caregivers using soap and water to wash during preparation of food and when feeding. Those who were eligible and had dewormed were 69.8% and 30.2 % had never been dewormed. Those who had been given vitamin A at 6 months represented 96.9%. Those who received full vaccination for their age category represented 95.8% meaning that the caregivers followed medical advice from clinicians well. About health-seeking behavior, 51.3% sort help from public hospitals/clinics while those xix who went to private entities were 15.4%. The findings suggest that there is significant association between dietary diversity, minimum acceptable diet, stunting, wasting, and underweight among 6–23-month-old children in daycare centers. Results of this study may help restructure day-care centers’ protocols as well assist other stake holders to sensitize caregivers on better ways to minimize cases of malnutrition.