Complementary feeding practices and the anthropometric status of children aged six to 23 months among the pastoralist communities of Isiolo county, Kenya

Thesis (MNutr)--Stellenbosch University, 2015.ENGLISH SUMMARY : Introduction: Adequate nutrition is vital to a child’s development, with the period from pregnancy to two years of age being the most critical basis for future optimal growth, health and development. Current global public health recommendations on infant and young child feeding (IYCF) state that an infant should be exclusively breastfed for the first six months of life. Thereafter complementary foods should be introduced to the child’s diet while they continue breastfeeding up to two years of age and beyond. Timing, type and quality are important considerations in complementary feeding, and if compromised, often result in malnutrition and mortality. Aim: The aim of the current study was to determine complementary feeding practices and the anthropometric status of children aged six to 23 months among pastoralist communities of Isiolo County, Kenya. Methods: Cross-sectional analytical study. Two-stage cluster sampling methodology was used to select a sample of 288 mother/caregiver-child pairs from pastoralist communities. The children were aged from six to 23 months. The mothers/caregivers were interviewed through a researcher-administered questionnaire. Weight and length measurements of the children were taken to establish their anthropometric status. Ethical approval to conduct the study was obtained from Stellenbosch University (South Africa) and Kenyatta University (Kenya). Permission to conduct the study was obtained from the Kenyan National Council of Science and Technology and the Isiolo County Commissioner. Results: Overall, the prevalence of stunting and underweight among the children six to 23 months old was low according to the World Health Organization (WHO) classification for severity of malnutrition (19.1% and 7.3%, respectively) while the severity of wasting prevalence (5.2%) which, according to WHO thresholds, was medium. Of the children studied, 2.4% were overweight which was low. The percentage of children with stunting, wasting and underweight rates increased with an increase in age (measured in months). Complementary feeding practices were poor. Of the children participating in the study, 60.4% achieved minimum meal frequency, with 35.4% achieving minimum dietary diversity and 25.3% achieving the minimum acceptable diet. Significant relationships were found between socio-demographic factors (child gender, child age, caregiver’s age and caregiver’s education level), and complementary feeding practices (ρ < 0.05). In addition to this, there was a significant association found between child gender and anthropometric status, whereby female children were more likely to have better anthropometric status than their male counterparts (ρ < 0.05). Conclusion and recommendations: The study established that among pastoralist communities, poor feeding practices starts early, thereby predisposing older children (18 – 23 months) to nutritional inadequacies. Interventions need to put more emphasis on nutrition-specific and nutrition-sensitive strategies focussing on the critical period from gestation to two years. Improving education levels for women in pastoralist communities may have a positive impact on the anthropometric status of the child. Qualitative studies are necessary in order to identify specific sociocultural issues that might affect complementary feeding practices and anthropometric status such as gender bias in feeding practices.AFRIKAANSE OPSOMMING : Inleiding: Voldoende voeding is noodsaaklik vir ’n kind se ontwikkeling, en die tydperk vanaf swangerskap tot tweejarige ouderdom li die grondslag vir toekomstige optimale gesondheid, ontwikkeling en groei. Volgens huidige internasionale openbaregesondheidsaanbevelings oor die voeding van babas en jong kinders (“IYCF”) behoort ’n baba die eerste ses maande uitsluitlik borsmelk te drink. Daarna kan aanvullende voedsel by die kind se dieet ingesluit word, hoewel borsvoeding tot op twee jaar of ouer moet voortduur. Tydsberekening, tipe en gehalte is belangrike oorwegings in aanvullende voeding. Indien hierdie drie faktore in gedrang kom, lei dit dikwels tot wanvoeding en selfs sterfte. Doel: Die doel van hierdie studie was om die aanvullende voedingspraktyke en antropometiese status van kinders van ses tot 23 maande in die landelike gemeenskappe van die distrik Isiolo in Kenia te bepaal. Metodes: Die navorsing het uit ’n analitiese deursneestudie bestaan. ’n Respondentegroep van 288 moeder/versorger-kind-pare is met behulp van trossteekproefneming in twee stadiums uit landelike gemeenskappe gekies. Die kinders was tussen ses en 23 maande oud. Die navorser het aan die hand van ’n vraelys onderhoude met die moeders/versorgers gevoer. Die kinders se gewig en lengte is gemeet om hul antropometriese status te bepaal. Etiekgoedkeuring vir die studie is van die Universiteit Stellenbosch (Suid-Afrika) asook as Kenyatta-universiteit (Kenia) bekom. Die Keniaanse Nasionale Raad vir Wetenskap en Tegnologie en die distrikskommissaris van Isiolo het ook goedkeuring verleen. Resultate: Die voorkoms van dwergroei en ondergewig onder die kinders ses – 23 maande was oor die algemeen laag volgens die Wireldgesondheidsorganisasie (WGO) klassifikasie vir die erns van wanvoeding (19,1% en 7,3% onderskeidelik) terwyl die voorkoms van uittering (5,2%), volgens die WGO-standaarde medium was onder die kinders wat bestudeer was. 2.4% was oorgewig, wat laag is. Die persentasie wanvoede kinders het saam met ouderdom (in maande) toegeneem. Aanvullende voedingspraktyke was swak. ’n Totaal van 60,4% van die kinderdeelnemers het aan minimum maaltydgereeldheid voldoen, 35,4% was binne die perke van minimum dieetdiversiteit, en 25,3% het die minimum aanvaarbare dieet gevolg. Die studie het ’n beduidende verband tussen sosiodemografiese faktore (kindergeslag en -ouderdom, en ouderdom en opvoedingsvlak van die versorger) en aanvullende voedingspraktyke (ρ <0,05) aan die lig gebring. Benewens, was daar ’n beduidende verband gevind tussen kindergeslag en antropometriese status, waardeur vroulike kinders meer geneig was om beter antropometriese status as hul manlike eweknieë te hi (ρ <0.05). Gevolgtrekking en aanbevelings: Die studie het vasgestel dat swak voedingspraktyke in landelike gemeenskappe reeds vroeg in aanvang neem, wat gevolglik ouer kinders aan voedingstekorte blootstel. Daarom behoort intervensies sterker klem te plaas op voeding spesifieke en voeding sensitiewe strategiee wat fokus op die belangrike tydperk vanaf swangerskap tot tweejarige ouderdom. Die verbetering van opvoedingsvlakke onder vroue in landelike gemeenskappe kan ’n positiewe invloed op kinders se antropometriese status hi. Kwalitatiewe studies word vereis om te bepaal watter spesifieke sosiokulturele kwessies dalk aanvullende voedingspraktyke en antropometriese status raak soos byvoorbeeld geslag bevooroordeling in voedingspraktyke

Investigating Multiple Overlaps in the Determinants of Risk Factors of Anaemia, Malaria, and Malnutrition, and their Multimorbidity, among Children aged 6 to 59 months in Nigeria

Background: In the last ten years multimorbidity in children under the age of five years has becoming an emerging health issue in developing countries. The absence of a proper understanding of the causes, risk factors, and prevention of these new health disorders (multimorbidity) in children is a significant cause for concern, if the sustainable development goal 3 of ensuring healthy lives and the promotion of well-being for all especially in the associated aim of ending preventable deaths of new-borns and children must be achieved by 2030. In the past, most studies conducted in Nigeria and some other least developed nations of the world focused on these multiple diseases by employing conventional analytical techniques to examine them separately as distinct disease entities. But the study of multimorbidity of anaemia, malaria, and malnutrition has not been done, especially in children. Aim: This study aims to investigate the multiple overlaps in the impact of individual and contextual variables on the prevalence of anaemia, malaria, malnutrition, and their multimorbidity among children aged 6 to 59 months in Nigeria. Methods: The study used two nationally representative cross-sectional surveys, the 2018 Nigeria Demographic and Health Survey and the 2018 National Human Development Report. A series of multilevel mixed effect ordered logistic regression models were used to investigate the associations between child/parent/household variables (at level 1), community-related variables (at level 2) and area-related variables (at level 3), and the multimorbidity outcome (no disease, one disease only, two or more diseases). The interaction effects between child's sex, age, and household wealth quintiles and the outcome while accounting for some covariates in the model were also investigated. Results: 48.3% (4,917/10,184) of the sample of children aged 6-59 months cohabit with two or more of the disease outcomes. Child's sex, age, maternal education, mother’s anaemia status. household wealth quintiles, the proportion of community wealth status, states with high human development index, region, and place of residence, were among the significant predictors of MAMM (p<0.05). There was a significant interaction effect between a child's age and wealth status when some other covariates were accounted for. Conclusions: The prevalence of MAMM observed in the sample is large, with almost half of the children living with two or more of the diseases at the time of the survey and several potentially modifiable risk factors have been identified. If suitable actions are not urgently taken, Nigeria’s ability to actualise the SDG 3 will be in grave danger. Therefore, possible actions to ameliorate this problem include developing and implementing a suitable policy that will pave the way for integrated care models to be developed

Exploring the paradox: double burden of malnutrition in rural South Africa

PhD, Faculty of Health Sciences, University of the WitwatersrandBackground: In low- to middle-income countries, rising levels of overweight and obesity are a result of multiple transitions, in particular, a nutrition transition. Consequently, in these countries, metabolic diseases are contributing increasingly to disease burden, despite the persisting burden of undernutrition and infectious diseases. Understanding the patterns and factors associated with persistent undernutrition and emerging obesity in children and adolescents, and concomitant risk for metabolic disease, is therefore of criticial importance. This should contribute to public health policy on interventions to prevent adult disease. Aims: To better understand the double burden of malnutrition in a poor, high HIV prevalent, transitional society in a middle-income country; In so doing, to inform policies and interventions to address the double burden of malnutrition. Methods: A cross-sectional growth survey was conducted in 2007 targeting 4000 children and adolescents 1-20 years of age living in rural South Africa. The survey was nested within the ongoing Agincourt Health and Socio-demographic Surveillance System, which acted as the sampling frame and also provided data for explanatory variables. Anthropometric measurements were performed on all participants using standard procedures. In addition, HIV testing was done on children aged 1 to 5 years and Tanner pubertal assessment was conducted among adolescents 9-20 years. A one-year follow-up of HIV positive children included a matched control group of HIV negative counterparts. Data collection involved both quantitative and qualitative methods. Growth z-scores were used to determine stunting, underweight and wasting and were generated using the 2006 WHO growth standards for children up to five years and the 1977 NCHS/WHO reference for older children. Overweight and obesity were determined using the International Obesity Task Force cut-offs for BMI for children aged up to 17 years and adult cut offs of BMI =25 and =30 kg/m2 for overweight and obesity respectively for adolescents 18 to 20 years. Waist circumference cut-offs of =94cm for males and =80cm for females, and waist-to-height ratio of 0.5 for both sexes, were used to determine central obesity and hence metabolic disease risk in ix adolescents. Descriptive analysis described patterns of nutritional status by age, sex, pubertal stage and HIV status. Linear and logistic regression was done to determine predictors of nutrional outcomes. A p-value of <0.05 was considered statistically significant. Results: Prevalence of undernutrition, particularly stunting, was substantial: 18% among children aged 1-4 years, with a peak of 32% in children at one year of age. Stunting and underweight were also substantial in adolescent boys, with underweight reaching a peak of 19% at 14 years of age. Concurrently, the prevalence of combined overweight and obesity, almost non-existent in boys, was prominent among adolescent girls, increasing with age, and reaching a peak of 25% at 18 years. Risk for metabolic disease using waist circumference cut-offs was substantial among adolescents, particularly girls, increasing with sexual maturation, and reaching a peak of 35% at Tanner stage 5. Prevalence of HIV in children aged 1-4 years was 4.4%. HIV positive children had poorer nutritional outcomes than that of HIV negative children in 2007. The impact of paediatric HIV on nutritional status at community level was, however, not significant. Significant predictors of undernutrition in children aged 1-4 years, documented at child, maternal, household and community levels, included child’s HIV status, age and birth weight; maternal age; age of household head; and area of residence. Significant predictors of overweight/obesity and risk for metabolic disease in adolescents aged 10-20 years, documented at individual/child and household levels included child’s age, sex and pubertal development; and household-level food security, socio-economic status, and household head’s highest education level. There was a high acceptance rate for the HIV test (95%). One year following the test, almost all caregivers had accepted and valued knowing their child’s HIV status, indicating that it enhanced their competency in caregiving. Additionally, nutritional status of HIV positive children had improved significantly within a year of follow-up. Conclusions: The study describes co-existing child stunting and adolescent overweight/obesity and risk for metabolic disease in a society undergoing nutrition transition. While likely that this profile reflects changes in nutrition and diet, variation in infectious disease burden, physical activity patterns, and social influences need to be investigated. The findings are critical in the wake of the rising public health importance of metabolic diseases in low- to middle-income countries, despite the unfinished agenda of undernutrition and infectious diseases. Clearly, policies and interventions to address malnutrition in this and other transitional societies need to be double-pronged. In addition, gender-biased nutritional patterns call for gender-sensitive policies and interventions. The study further documents a significant role of paediatric HIV on nutritional status, and the potential for community-based paediatic HIV testing to ameliorate this. Targeted early paediatric HIV testing of exposed or at risk children, followed by appropriate health care for infected children, may improve their nutritional status and survival