Child Care Practices and Nutrition Status of Children (6 - 30 Months) In Home-Based and Centre-Based Child Care Centres In Embakasi East, Nairobi, Kenya.

Abstract

Introduction: Home-based childcare centres and centre-based childcare centres play a part in improving the nutritional status of children under three. Childcare centres in the informal settlement have unclear childcare practices, including poor knowledge of caregivers on feeding practices, hygiene practices, and dietary requirements for children per day, which are contributors to undernutrition and overnutrition, resulting in increased risks associated with mortality and morbidity among children under the age of three. The study objectives assessed the socio-demographic characteristics of children, parents, and caregivers, as well as their dietary patterns and practices, children’s nutritional status, and hygiene practices in both home-based and centre-based childcare settings. Methods: The study employed a descriptive cross-sectional research design to establish childcare practices and nutrition status among children (6 - 30 months) in 26 childcare centres (13 home-based and 13 centre-based) in Embakasi East, Nairobi, Kenya. Quantitative data were analyzed descriptively using proportions, and a Chi-square test was used to determine association between variables, and a p-value of < or = 0.05 was considered significant. The ENA/Epi Info software was used to calculate z-scores based on sex, age, and anthropometric measurements. The childcare centres were selected from all home-based and centre-based childcare centres in the Uthabiti Childcare network in Embakasi East. All 325 children in the childcare centres met the inclusion criteria; 69 available parents and 26 caregivers were included in the study. Results: Findings show most Parents (97%) and caregivers/centre owners (78%) were aged 28-47 years. More than 50.7% of parents had secondary education, while 42% of caregivers had secondary education. The children had an almost equal gender distribution (49.2% female, 50.8% male). Over half (54.8%) of the children were aged 24-30 months, while 45.2% were 6-23 months. Most parents (63.8%) packed food for their children. Carbohydrate-rich foods were predominant (36%), with daily consumption of cabbage and porridge. Most children (96%) were fed rice, beans, and other vegetables. Animal protein consumption was low: Only 39% of centers offered eggs, 35% milk, 23% beef, and 10% sardines (omena). The overall prevalence of Wasting was 11.4% (7.7% severely and 3.7% moderately wasted), stunting was 39.4% (27.4% were severely and 12% moderately stunted), and Underweight was 23.4% (12.3% severe and 11.1% moderately underweight). Children in centers that practiced handwashing had lower rates of stunting (6.1% severe, 1.8% moderate; p < 0.000), wasting (6.1% severe, 1.5% moderate; p < 0.004), and underweight (8.9% severe, 8.3% moderate; p < 0.03). In contrast, centres that did not practice handwashing showed higher rates of undernutrition: 21.2% severe stunting, 10.2% moderate stunting, and 8.9% severe underweight. Stunting was also higher (16.6%; p<0.000 in centers that used chemicals to treat water, while potty use was linked to lower stunting (9.8% severe, 4.3% moderate; p<0.0005) and wasting (4.3% severe, 1.8% moderate). Conclusion: Children’s diet was mostly carbohydrate-rich foods with little protein-rich foods and fruits. There is a need to provide a diversified diet, and caregivers need to ensure meal provision as per WHO requirements. Findings found that poor handwashing practices, hence recommends caregivers' education on hygiene practices. The stunting, wasting, and underweight rates exceeded national averages of 18%, 5%, and 10%, respectively.