Factors associated with the nutritional status of children (6-30 months old) in home-based and centre-based child care centres in Embakasi East, Nairobi, Kenya

Abstract

Introduction: early childhood nutrition plays a fundamental role in children's development, growth, and health. However, poor caregiver knowledge of childcare practices and hygiene contributes to malnutrition and increased mortality and morbidity risks. This study therefore investigated sociodemographic, dietary patterns, feeding, nutrition, and hygiene practices in home- and centre-based childcare for children 6 to 30 months in an informal settlement in Nairobi, Kenya. Methods: a descriptive cross-sectional mixed-methods study assessed childcare practices and nutrition among children (6-30 months) in 26 Embakasi East centres. Dietary patterns were determined using a structured 24-hour recall questionnaire, capturing foods provided and feeding frequency, defined by how many times children were fed at the childcare centre. Data were analyzed using proportions, Chi-square tests (p ≤ 0.05), and ENA/Epi Info for z-score calculations. Results: most parents (97%) and caregivers/centre owners (78%) were aged 28-47 years. More than 50.7% of parents and 42% of centre owners/caregivers had secondary education. There was almost equal sex distribution (49.2% female, 50.8% male). Children (54.8%) were aged 24-30 months, while 45.2% were 6-23 months. Carbohydrate-rich foods were predominant (36%): animal protein consumption was low: only 39% of centers offered eggs, 35% milk, 13% fish, and 10% sardines (Omena). Most parents (63.8%) packed food for their children. The overall prevalence of wasting was 11.4%, stunting was 39.4% and underweight was 23.4%. Low prevalence of stunting, wasting, and underweight amongst children who practiced handwashing respectively; (6.1% severe, 1.8% moderate; p<0.000), (6.1% severe, 1.5% moderate; p<0.004), and (8.9% severe, 8.3% moderate; p<0.03), compared to centres that did not practice handwashing: 21.2% severely, 10.2% moderate stunted, and 8.9% severe underweight. Conclusion: the study finds poor dietary patterns, inadequate feeding practices below WHO´s recommended three meals, and compromised nutrition status, with children mainly consuming carbohydrate-rich foods in this study. Centres using potties and proper waste disposal recorded slightly lower malnutrition. Strengthening diets, feeding practices, and hygiene can improve the nutritional outcomes of children.