An assessment of the nutritional status and childcare practices of children under five years of age in selected childrens' homes in Nairobi

Abstract

Children in need of special protection (CNSP) are vulnerable to malnutrition and poor health because of the difficult circumstances in which they live. Appropriate health and childcare practices are critical in enhancing the nutrition and health status of children. In Kenya, much is not known about the health care given to CNSP under institutional care. The aim of the study therefore, was to investigate the childcare practices of feeding and health-seeking behaviour in childrens' homes. In addition, the study assessed the morbidity, immunization and nutritional status of the children and investigated factors that influence nutritional status. The study adopted a descriptive-cross-sectional design, which was undertaken in selected childrens' homes in Nairobi. Data was collected through structured questionnaires, anthropometric measurements and desk reviews. The study findings indicated that abandoned children formed the biggest proportion (45%) of children admitted to the homes while, finance was the major challenge faced in managing most (90%) of the homes. Personality traits were favoured in employment of direct caregivers by the homes as compared to professional qualifications, with commitment required by many (46.2%) homes. Only in a minority 38.5% and 23.1 % of the homes were the caregivers trained in basic nutrition and childcare courses respectively. In 30.8 % of the homes, one caregiver took care of an average of 10 children. Most (77.8%) of the homes used formula milk which is the ideal breast milk substitute, though the mode of feeding was inappropriate as many (55.6%) homes practiced bottle-feeding. Many homes (55.6%), introduced complementary feeding at the age of 4 months, earlier than the recommended age of 6 months. All the homes provided a diversity of foods which were energy dense during complementary feeding. However, foods given to children aged two to five years were deficient in vegetables and fruits that translates to deficiency in minerals and vitamins. Half the homes fed the children five times a day. The health seeking practices of the homes were generally appropriate with many (69.2%) having dispensaries within them. More than half the homes practiced appropriate health promotion measures such as the use of impregnated bed nets and regular de-worming of children. However, growth monitoring practice was inadequate as many homes (53.8%) stopped monitoring the growth of the children immediately after the measles immunization. Most (81 %) of the children were fully immunized for age. The morbidity burden amongst the children was high as eighty (40%) of the children were sick in the two weeks preceding the study. The most prevalent disease conditions included coughs/colds (25%) and diarrhoea (10%). The children suffered from high levels of malnutrition with 32.7% stunted, 26.8% underweight and 15.3% wasted. Growth monitoring was found to be associated with the childrens' nutritional status, at p = 0.004. Gastro intestinal conditions, bronchitis, skin conditions and diarrhoea were found to pre-dispose the children to wasting. There was no significant association between overall morbidity and the nutritional status of the children (p> 0.05). This study highlights the need for greater attention to the situation of children living in childrens' homes. The homes should be empowered to employ more and better trained personnel in childcare.