|dc.description.abstract||The present picture in the nutrition space in Kenya indicates that trends in nutritional status of the under five-year-old children have significantly deteriorated after initial improvement in 1982. National statistics indicate that one out of every three children in Kenya is not growing and developing as expected for their age (UNICEF, 1999). Similarly, one in every five children in Nyanza does not live to see its fifth birthday (KDHS, 1993). It has also been documented that a staggering 115,000 under five year olds are denied their right to survival each year (GOK/UNICEF, 1998).
It is in the light of the foregoing that this current study was undertaken to establish the nutritional performance in Primary Health Care (PHC) in Nyanza with special reference to Kisumu District. The district has apparently been one of the PHC model regions in the country.
The study aimed at accomplishing the following objectives:
1. Establish the nutritional status of the under five-year-old children in the study community.
2. Determine the relationship between the nutritional status and the incidence of infections amongst the under five years olds.
3. Identify how PHC has responded to meeting the food security needs of the study communities.
4. Determine a trend analysis in nutritional status of the under five-year-olds between 1982-2000.
5. Examine the effectiveness of nutrition education programmes with a view to charting out innovative strategies for change.
This study made use of both qualitative and quantitative approaches to data collection. The method of sampling used was multi-stage. The study population consisted of the following categories of people, namely: household members, under five-year-old children, women groups, non governmental organizations, government ministries handling nutrition issues, and mothers attending health care centres. In total, seven hundred and fifty respondents participated in the study.
Data collected were processed and analyzed both qualitatively and quantitatively according to the objectives of the study. Frequency distribution of samples, cross tabulations was utilized to analyze quantitative data. Both quantitative and qualitative data were thus combined foe an in-depth analysis of sampled data and conclusions drawn.
The study found out that despite the implementation of PHC in the Kisumu Primary Health Care region, the district depicts adverse infant/child health and nutrition problems thus calling for special attention. Overall, 31.1 percent of the children were stunted. The highest prevalence of stunting was found among the age group 12-23 months old. This suggests that this age group should be targeted for interventions. Similarly, 15.2 percent were established to be underweight while 9.1 percent were wasted.
It was equally evidenced from the study that a network of nutrition risk factors interacted to influence the child's nutritional status amongst some of which were noted to be; poverty, access to health care, the incidence of infectious diseases, parental demographic factors, the HIV/AIDS, caring capacity of the mothers and the food security status. Almost all the variables in the data set had significant effect on the child's nutritional status.
Nutrition education did not appear to cause substantial behavioural change. One reason why nutrition education had not succeeded in impacting change was that messages were not well-formulated and that there was an over-emphasis on "do 's and don 'ts". It was therefore recommended that community-based participation in the formulation of concepts and messages should form an indispensable part of future nutrition education programs.
In the meanwhile, if nutrition education and intervention programs are to make significant changes towards influencing health-changing behaviours, then multi-sectoral and multi-dimensional approaches are deemed necessary. Nutrition programming therefore needs to be integrative and holistic in nature. In view of the above findings, this study concluded that the provision of PHC has been inadequate both in impact and sustainability and that a new paradigm shift is essential. It is in this light that integration of Human Development Approach (HDA) in nutritional development is deemed feasible in producing sustainable effects||en_US