Complementary feeding practices and the anthropometric status of children aged six to 23 months among the pastoralist communities of Isiolo county, Kenya

Amunga, Dorcas P. A. (2015-03)

Thesis (MNutr)--Stellenbosch University, 2015.

Thesis

ENGLISH SUMMARY : Introduction: Adequate nutrition is vital to a child’s development, with the period from pregnancy to two years of age being the most critical basis for future optimal growth, health and development. Current global public health recommendations on infant and young child feeding (IYCF) state that an infant should be exclusively breastfed for the first six months of life. Thereafter complementary foods should be introduced to the child’s diet while they continue breastfeeding up to two years of age and beyond. Timing, type and quality are important considerations in complementary feeding, and if compromised, often result in malnutrition and mortality. Aim: The aim of the current study was to determine complementary feeding practices and the anthropometric status of children aged six to 23 months among pastoralist communities of Isiolo County, Kenya. Methods: Cross-sectional analytical study. Two-stage cluster sampling methodology was used to select a sample of 288 mother/caregiver-child pairs from pastoralist communities. The children were aged from six to 23 months. The mothers/caregivers were interviewed through a researcher-administered questionnaire. Weight and length measurements of the children were taken to establish their anthropometric status. Ethical approval to conduct the study was obtained from Stellenbosch University (South Africa) and Kenyatta University (Kenya). Permission to conduct the study was obtained from the Kenyan National Council of Science and Technology and the Isiolo County Commissioner. Results: Overall, the prevalence of stunting and underweight among the children six to 23 months old was low according to the World Health Organization (WHO) classification for severity of malnutrition (19.1% and 7.3%, respectively) while the severity of wasting prevalence (5.2%) which, according to WHO thresholds, was medium. Of the children studied, 2.4% were overweight which was low. The percentage of children with stunting, wasting and underweight rates increased with an increase in age (measured in months). Complementary feeding practices were poor. Of the children participating in the study, 60.4% achieved minimum meal frequency, with 35.4% achieving minimum dietary diversity and 25.3% achieving the minimum acceptable diet. Significant relationships were found between socio-demographic factors (child gender, child age, caregiver’s age and caregiver’s education level), and complementary feeding practices (ρ < 0.05). In addition to this, there was a significant association found between child gender and anthropometric status, whereby female children were more likely to have better anthropometric status than their male counterparts (ρ < 0.05). Conclusion and recommendations: The study established that among pastoralist communities, poor feeding practices starts early, thereby predisposing older children (18 – 23 months) to nutritional inadequacies. Interventions need to put more emphasis on nutrition-specific and nutrition-sensitive strategies focussing on the critical period from gestation to two years. Improving education levels for women in pastoralist communities may have a positive impact on the anthropometric status of the child. Qualitative studies are necessary in order to identify specific sociocultural issues that might affect complementary feeding practices and anthropometric status such as gender bias in feeding practices.

AFRIKAANSE OPSOMMING : Inleiding: Voldoende voeding is noodsaaklik vir ’n kind se ontwikkeling, en die tydperk vanaf swangerskap tot tweejarige ouderdom li die grondslag vir toekomstige optimale gesondheid, ontwikkeling en groei. Volgens huidige internasionale openbaregesondheidsaanbevelings oor die voeding van babas en jong kinders (“IYCF”) behoort ’n baba die eerste ses maande uitsluitlik borsmelk te drink. Daarna kan aanvullende voedsel by die kind se dieet ingesluit word, hoewel borsvoeding tot op twee jaar of ouer moet voortduur. Tydsberekening, tipe en gehalte is belangrike oorwegings in aanvullende voeding. Indien hierdie drie faktore in gedrang kom, lei dit dikwels tot wanvoeding en selfs sterfte. Doel: Die doel van hierdie studie was om die aanvullende voedingspraktyke en antropometiese status van kinders van ses tot 23 maande in die landelike gemeenskappe van die distrik Isiolo in Kenia te bepaal. Metodes: Die navorsing het uit ’n analitiese deursneestudie bestaan. ’n Respondentegroep van 288 moeder/versorger-kind-pare is met behulp van trossteekproefneming in twee stadiums uit landelike gemeenskappe gekies. Die kinders was tussen ses en 23 maande oud. Die navorser het aan die hand van ’n vraelys onderhoude met die moeders/versorgers gevoer. Die kinders se gewig en lengte is gemeet om hul antropometriese status te bepaal. Etiekgoedkeuring vir die studie is van die Universiteit Stellenbosch (Suid-Afrika) asook as Kenyatta-universiteit (Kenia) bekom. Die Keniaanse Nasionale Raad vir Wetenskap en Tegnologie en die distrikskommissaris van Isiolo het ook goedkeuring verleen. Resultate: Die voorkoms van dwergroei en ondergewig onder die kinders ses – 23 maande was oor die algemeen laag volgens die Wireldgesondheidsorganisasie (WGO) klassifikasie vir die erns van wanvoeding (19,1% en 7,3% onderskeidelik) terwyl die voorkoms van uittering (5,2%), volgens die WGO-standaarde medium was onder die kinders wat bestudeer was. 2.4% was oorgewig, wat laag is. Die persentasie wanvoede kinders het saam met ouderdom (in maande) toegeneem. Aanvullende voedingspraktyke was swak. ’n Totaal van 60,4% van die kinderdeelnemers het aan minimum maaltydgereeldheid voldoen, 35,4% was binne die perke van minimum dieetdiversiteit, en 25,3% het die minimum aanvaarbare dieet gevolg. Die studie het ’n beduidende verband tussen sosiodemografiese faktore (kindergeslag en -ouderdom, en ouderdom en opvoedingsvlak van die versorger) en aanvullende voedingspraktyke (ρ <0,05) aan die lig gebring. Benewens, was daar ’n beduidende verband gevind tussen kindergeslag en antropometriese status, waardeur vroulike kinders meer geneig was om beter antropometriese status as hul manlike eweknieë te hi (ρ <0.05). Gevolgtrekking en aanbevelings: Die studie het vasgestel dat swak voedingspraktyke in landelike gemeenskappe reeds vroeg in aanvang neem, wat gevolglik ouer kinders aan voedingstekorte blootstel. Daarom behoort intervensies sterker klem te plaas op voeding spesifieke en voeding sensitiewe strategiee wat fokus op die belangrike tydperk vanaf swangerskap tot tweejarige ouderdom. Die verbetering van opvoedingsvlakke onder vroue in landelike gemeenskappe kan ’n positiewe invloed op kinders se antropometriese status hi. Kwalitatiewe studies word vereis om te bepaal watter spesifieke sosiokulturele kwessies dalk aanvullende voedingspraktyke en antropometriese status raak soos byvoorbeeld geslag bevooroordeling in voedingspraktyke.

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