Complementary Feeding Knowledge, Attitudes and Practices among Care-Givers of Children in Out-Patient Therapeutic Programmme in Nairobi City County, Kenya

Abstract

Complementary feeding is the greatest contributor to health and nutrition status of infants and young children. Malnutrition remains one of the greatest concerns in Sub-Saharan Africa region. In Kenya, national findings show inappropriate complementary feeding practices. Out-patient therapeutic programmes (OTPs) have been established to address severe acute malnutrition (SAM) among children 6-59 months of age. There are 6 OTP centres in Kamukunji sub-county in, Nairobi County. There is limited information on the knowledge, attitude and practices on complementary feeding among the caregivers of the children admitted into OTP centres. The main purpose of this study was to determine the knowledge, attitudes and practices (KAP) on complementary feeding among care-givers of children 6-23 months of age admitted into OTP centres in Kamukunji sub-County. The study adopted a cross-sectional analytical design. An exhaustive sample of 200 caregivers from four OTP centres in Kamukunji sub-county participated in the study. Data was collected from the caregivers using structured researcher-administered questionnaires and focus group discussion (FGD) guide, and from OTP programme staff using Key Informants Interview (KII) guide. Data was analysed using SPSS software (version 22). A p-value of <0.05 was used as the criterion for statistical significance. Caregivers’ mean score for knowledge on CF for children with normal nutrition status was 6.11± 2.33, out of a total score of 12, while for feeding children with Severe Acute Malnutrition (SAM) was 8.7± 2.63 out of a total score of 10. Eighty-eight percent (88%) knew the guidelines on how to give Ready-to-use therapeutic food (RUTF) to a child with SAM, 78% knew the time of introduction to complementary feeding, 100% knew that a child should be breastfed before administering the RUTF and 21% knew that breastfeeding should be increased and additional nutritious food given to a child during illness. For attitudes, the mean score was 24.1±11.73 out of 85 and 79.7% had a positive attitude towards the high nutritive value and the potential of RUTF to cure SAM, 67.5% had a positive attitude towards continued breastfeeding, and 61% had a positive attitude towards the recommended daily dietary intake for of RUTF. Almost all the caregivers (98.5%) introduced their children to complementary feeding at 6 months of age. Seventy-three percent of the children ate the recommended amount of RUTF per day. Maternal time constraints, low socio-economic status, and leakage of RUTF at the household through sharing were major barriers to optimal feeding for children with SAM. Lack of commitment in attending MIYCN education sessions was a major reason for low knowledge on complementary feeding for children with normal nutrition status. It is recommended that the Ministry of Health scale up Behaviour Change Communication (BCC) interventions for care-givers of children 6-23 months of age with a focus on complementary feeding knowledge, attitudes and practices specifically dietary diversity. The study findings may be utilized by the Ministry of Health at National, County and Sub county levels and the agencies dealing with child survival to establish strategies focusing on enhancing infants and young child nutrition among severely malnourished children through appropriate feeding. The findings also provide valuable information on the research efforts to rehabilitate children with SAM.