Childcare practices, morbidity status and nutrition status of preschool children (24-59 months) living in orphanages in Kwale County, Kenya
Moyo, Burhaan Bakari
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ABSTRACT High adult mortality due to various causes like HIV and AIDS has led to an upward trend of the number of orphans and vulnerable children. Extended family networks have taken the responsibility of caring for these children but lack of adequate resources for their care has forced the caretakers of these children to take them to orphanages. As a consequence to the ever-increasing number of orphans, there has been mushrooming of orphanages in the country. Appropriate childcare practices have substantial consequences for growth, development and survival of infants and children. However, due to lack of adequate resources, children living in institutions are faced with practical challenges in being provided for their basic necessities including nutritious food and clothing. Most studies that have been carried out in Kenya have focused on children below five years who are under the care of their parents. Studies conducted in orphanages have concentrated on children above five years. Thus there is minimal information on childcare practices, morbidity status and nutrition status of preschool children living in orphanages. The purpose of this study was to determine the childcare practices, morbidity status and nutrition status of preschool children 24-59 months of age living in orphanages in Kwale County, Kenya. A cross-sectional analytical study was conducted on a comprehensive sample of 162 children and 45 caregivers, drawn from a sample of 14 out of the 21 orphanages in Kwale County, Kenya. Data collection tools included; a structured researcher-administered questionnaire for caregivers, Key informant interview (KII) guide and observation checklist. The data collected was analysed using Statistical Package for Social Sciences (SPSS) version 20.0 and anthropometric data of the children analysed using ENA for SMART (2011). WHO standards (2006) were used in interpretation of anthropometric data. More than a third (36.4%) of children were either single or double orphans. The rest (63.6%) were not orphans. The mean (SD) duration of stay in orphanages was 35.22+13.54 months. Majority (84.0%) of children had favourable caregiver to child ratio while a small proportion (16.0%) had unfavourable caregiver to child ratio. Supper provided a significant proportion (35.1%) of daily energy intake than both lunch (34.7%) and breakfast (11.4%). In terms of nutrition status: 15.4% of the children were stunted, 8.6% were underweight and 3.7% were wasted. Boys were more stunted, underweight and wasted compared to the girls (chi-square test; p < 0.05). A small proportion (6.8%) of children suffered from upper respiratory tract infection, 10.5% suffered from malaria and 0.6% from measles. Childcare (dietary) practices were associated with underweight (chi-square test; p < 0.001) and stunting (chi-square test; p < 0.001). Children who had been ill based on a two week morbidity recall were likely to be stunted (chi-square test; p < 0.001), underweight (chi-square test; p < 0.001) and wasted (chi-square test; p = 0.020). Institutional characteristics (caregivers trained on childcare) were associated with underweight (chi-square test; p < 0.001), wasting (chi-square test; p = 0.012) and stunting (chi-square test; p < 0.001). Duration of stay of the children in the orphanages was positively associated with underweight (p < 0.001) and stunting (p < 0.001). The results of this study can therefore be used to formulate and/or strengthen strategies or systems that address the needs of children in orphanages in Kenya and other developing countries. The government should ensure that registered orphanages have adequate resources to take care of children in orphanages. The orphanages should also encourage research activities to improve conditions in the orphanages.