The Effectiveness and Challenges of Food by Prescription (fbp) -firstfood ® in the Management of Moderate Malnutrition among Under-five year old Children in Karemo division, Siaya County, Kenya.

Abstract

Malnutrition in children remains as a significant global problem, accounting for up to 56% of the 10.6 million child deaths annually in developing countries. Kenya like many sub-Saharan African countries has had the highest case fatality of malnutrition, AIDS and tuberculosis (TB). Various interventions have been put in place to combat the under-five malnutrition in line with the realization of millennium development goal (MDG) number 4. Nationally, the Kenya‟s Ministry of Health (MoH) in collaboration with international and local agencies has been rolling out a “ready to use food therapy” programme dubbed “Food by Prescription (FBP)” since the year 2006 targeting moderately malnourished children. This product is locally manufactured by Insta Products and comes in form of pre-cooked corn soy blend porridge flour. Despite the roll out of this programme, very little is known about its effectiveness in improving nutritional status of moderately malnourished children which was one of its core mandates. This study sought to assess the effectiveness of FBP (Firstfood) in the management of moderate malnutrition (MM) among under-five year old children in Karemo division of Siaya District. The study design was a prospective cohort to allow comparison of the anthropometric measurements at baseline and three months later at exit to test for any significant improvement. Three months was recommended by the product guideline to allow for any meaningful change in nutritional status and the children were exited regardless of the outcome. A total of 215 children with MM (Z score <-2) and their primary caretakers were recruited. Stratified sampling technique was employed to proportionately allocate facility sample sizes, and convenient sampling to recruit the participants from the five study sites. Mixed design of qualitative and quantitative techniques was used. Quantitatively questionnaires were administered alongside taking anthropometric measurements [weight, height and Mid Upper-Arm Circumference (MUAC)] of the children both at enrollment/baseline and exit. STATA10 was used to analyse data whereby a paired T test was used to compare means of Z scores, and of individual anthropometric measurements at baseline and exit. Association of exit Z score was also performed against individual categorical variables. The findings revealed a significant increase in w eight and MUAC at exit with P value < 0.001. There was positive improvement in height though Z score was not statistically significant. On the socio-demographic variables, breastfeeding was significantly associated with improvement at P value < 0.001. Overall 43.5% of the participants recovered from moderate malnutrition to mild or no malnutrition excluding 8.5% who were enrolled with mild malnutrition. 45% did not improve while 3% developed severe malnutrition. Inadequate FBP staff, poor nutritional counseling and FBP education as well as FBP (Firstfood) sharing among members of the household emerged as main barriers to moderate malnutrition recovery. Other factors included stigma associated with FBP (Firstfood) seen as food for HIV positive thereby keeping others away from using the food or going for refill. Failure to thrive was also attributable to the short (3 months) follow up period. This study recommended the need for exit package information to be delivered through more counseling and education, regular home follow up visits to monitor the administration of FBP. Programmatically, there was need to increase the duration of FBP supply from 3 months to at-least 6 months to allow meaningful improvement before exit. More trained staff were needed to dispense FBP (Firstfood). There was need to avail FBP to other clinics like the Maternal and Child Health (MCH) to de-stigmatize its association to HIV infected patients. Further studies were recommended to enhance understanding on the FBP (Firstfood) needs for the HIV positive compared to the HIV negative under-five children in order to establish differences in calorie needs and recovery rates