Nutritional Status of Public Pre-school Children in Embakasi Division, Nairobi County: A Comparative Study Across Socioeconomic Groups

Abstract

UNICEF defines care as all behaviors performed by caregivers that affect the nutrient intake, health, and the cognitive and psycho-social development of the child, including maternal health. Most of the time, the caregiver is the mother. It is however necessary to broaden the focus beyond the mother in order to include fathers, siblings, older relatives and institutions such as childcare centers. Nutrient adequacy is essential for fostering growth especially among children. With increased early enrollment of children in care institutions, it is paramount that children receive appropriate care to ensure healthy growth. The purpose of the study was to generate data on the role of school and home environment and diets to the nutrition of the preschoolers. The study examined the relationship of child, school and household characteristics with nutritional status- underweight, stunting and overweight/obesity among public pre-school children from two geographic clusters within Embakasi Division, Nairobi County. The two areas were classified into low and medium socio-economic status. Ten public preschools- five each from low and middle socio-economic areas participated in the study. Multistage sampling was used to select schools and children who participated in the study. The study sample comprised a total of 292 children, made up of 154 (53%) from low socio-economic area and 138 (47%) from medium socio-economic area. Child, school and household data were collected using structured questionnaires. Food frequency questionnaires were used to collect data on. school and household food variety and diversity and the household assets index checklist was used to collect data on household socio-economic status. Results from the study indicate that generally, there are no statistically significant differences between schools, Children and households from low and medium socio-economic areas. The children's age at the time of the study was 6.0 years (SD 1.0) for those from low-socio economic area and 5.9 years (SD 1.0) for children from medium socio economic area. However, some differences were noted in the following parameters: 1. Child-level characteristics were statistically significantly different between the two groups with respect to age, number of siblings and weight. Children from low socio-economic group enrolled in school at an older age 4.30 years (SD 1.2), compared to those from medium socio economic area 3.9 years (SD1.2) (p=0.012); and children from low-socio-economic area had more siblings (mean 2.7; SD1.6) than those from medium socio-economic area (mean 2.1; SD1.8) (p=0.006). There was also significant differences in weights of children from the two groups, with children from medium socio-economic area weighing more (mean 20.04kgs; SD 3.67) than those from low socio-economic area (mean 19.21kgs; SD3.14) (p=0.040). There were no significant differences in weight and height for age and BMI for age between children from the two socio economic areas. 2. In the household and parental characteristics, differences were found on household economic status index (p=O.OOl), mother's age (p=0.059), mother's level of education (p=0.05), and hours parents spent at work (p=0.001 for mothers and p=0.013 for fathers). 3. There were no significant differences in the school and home food variety and dietary diversity scores betweenthe two socio-economic areas (p=0.551 and p=0.272, respectively). 4. Based on the multivariable analysis, the factors associated with weight for age among preschool children in the study included age at first enrolment in school and school dietary diversity score. Children -first enrolled in school at older ages were more likely to be underweight than their counterparts first enrolled at younger ages, controlling for other factors included in the regression model. 5. Household socio-economic status, home dietary diversity and school dietary diversity were associated with height for age among children in the study, but these relationships were only marginal in statistical terms. Higher household socio-economic status (p=.054) as measured by the assets' index and home dietary diversity (p=.085) were associated with a higher likelihood of recording normal height for age among the children in the study. 6. Home dietary diversity was the only factor that was associated with BMI for age among preschool children in the study, even though this association was also only marginal in statistical terms (p=.,070). Children from homes with a higher dietary diversity were more likely to be obese than their counterparts from other households. The study concluded that there is no statistically significant difference in nutritional status among children from low and medium socio-economic groups. However, school food diversity, parental and household characteristics; and child's age at first enrollment in school are associated with nutritional outcomes in both low and medium socioeconomic groups. There is no standardized guideline for feeding in public preschools. The recommendation based on the findings of the study is that the Ministry of Education should put in place a guideline for preschool feeding. Both schools and households should be educated on importance of and encouraged to increase food diversity. Schools should engage services of qualified dietitians to audit school menus for dietary content suitability and adequacy. Key Words: Nutritional status, Socio-economic status, Food diversity, household assets index and association.