Predictors of Neurodevelopmental Outcomes Among Acute Malnourished Children Under Five Years, in Nairobi Informal Settlements

Abstract

Methodology: A comparative, cross-sectional, hospital-based study was conducted in Viwandani and Korogocho informal settlements in Nairobi. The study compared three groups of children under five: those who had never experienced acute malnutrition, those with a first episode, and those who had relapsed. Both quantitative and qualitative methods were employed, utilizing purposive sampling. Neurodevelopmental outcomes were assessed using the Malawi Developmental Assessment Tool (MDAT). Quantitative data were collected through structured and semi-structured questionnaires and analyzed using STATA version 17.0. Qualitative data were collected through Key Informant Interviews (KIIs), Focus Group Discussions (FGDs), and In-depth Interviews (IDIs), and analyzed thematically using NVIVO software. Results: The prevalence of acute malnutrition relapses in Korogocho and Viwandani during 2024 (January to December) was 41.01% (n=260) out of 634 acute malnutrition cases. The prevalence of Moderate Acute Malnutrition (MAM) and Severe Acute Malnutrition were 31.55% (n=200), and 9.46% (n=60) respectively. Significant predictors of relapse included household food security [AOR=1.817; CI: 0.868, 3.802; p < 0.05], wealth quintile [AOR=2.051; CI: 1.077, 3.903; p < 0.05], handwashing practices [AOR=0.993; CI: 0.526, 1.876; p < 0.05], decision-making on small purchases [AOR=3.445; CI: 1.174, 10.112; p < 0.05], antenatal visit coverage [AOR=1.830; CI: 0.996, 3.363; p < 0.05], dietary diversity [AOR=1.393; CI: 0.752, 2.584; p < 0.05], and breastfeeding initiation [AOR=3.425; CI: 1.620, 7.244; p < 0.01]. The prevalence of poor neurodevelopmental outcomes among children under five years was 44.57% (n=119). Children with acute malnutrition relapse had the highest rate of poor neurodevelopmental outcomes, 53.93% (n=48). Relapses were significantly associated with poor neurodevelopmental outcomes and were 2.082 times at risk of poor neurodevelopment than children without relapse or with normal nutrition [COR=2.082; CI: 1.113, 3.895; p < 0.05]. Maternal postpartum depression and child maturity at birth also predicted neurodevelopment [AOR=3.618; CI: 1.860, 7.038; p < 0.001] and [AOR=2.930; CI: 1.205, 7.123; p < 0.05], respectively. Conclusion: Acute malnutrition relapses are prevalent in Nairobi informal settlements and significantly predict poor neurodevelopmental outcomes. Targeted interventions addressing identified risk factors are crucial to improving child health and development.