Dietary patterns and nutritional status of pre-school children in Nairobi.

OBJECTIVE: To determine the dietary patterns and nutritional status of pre-school children in Nairobi, Kenya. DESIGN: A cross-sectional study. SETTING: Pre-schools in Nairobi, Kenya. SUBJECTS: Three hundred and four pre-school children (149 males and 155 females) aged three to five years were assessed. RESULTS: About 96% of the children had been breastfed 46.7% of them for 12-24 months (46.7%), and the mean breastfeeding duration was 20.17 months. The most commonly consumed foods on a daily basis were fruits, vegetables bread, ugali, porridge and milk. The level of malnutrition was low with underweight at 16% stunting 4.3% and wasting 1.0%. The factors that positively correlated with child nutritional status were the age of the mother and father. CONCLUSIONS: The children were consuming a variety of foods both at home and in school, and this together with the high literacy levels the parents/guardians could have contributed towards the good nutritional status.

Child care practices and nutritional status of children aged 0-2 years in Thika, Kenya.

OBJECTIVE: To assess time allocation for child care and the nutritional status of children aged 0-2 years. DESIGN: Cross sectional descriptive survey using a structured questionnaire and taking of anthropometric measurements to determine the nutritional status of children aged 0 to 2 years. In addition, two day (10 hour) observations were conducted in a subsample of households to assess time allocation for the main child care activities. SETTING: A low-income peri-urban section of Thika town (in Makongeni estate), Kenya. SUBJECTS: A random sample of 150 mothers and their 0-2 year old children. RESULTS: Mother's knowledge about child care influences the amount and type of care that is given to children. Time taken to perform various activities was also found to vary with the mother's education level, her occupation, number of children less than five years in the house and the child's age and birth order. Comparatively, children who were malnourished (stunted) had less time devoted to them for breastfeeding, food preparation and feeding. Although mothers were the primary caregivers, the responsibility of care giving was shared with other household members as well as with neighbours. CONCLUSION: The amount and type of care that a child receives is determined to a large extent by the mother and caregivers knowledge.

Prevalence of vitamin A deficiency among pre-school and school-aged children in Arssi Zone, Ethiopia.

OBJECTIVE: To investigate vitamin A status of pre-school and school aged children in the study area. DESIGN: Cross-sectional. SETTING: Arssi, Ethiopia. SUBJECTS: Four hundred and two children. RESULTS: Night blindness, Bitots spot, corneal xerosis, corneal ulceration and corneal scar were observed in 7.2%, 2.2 %, 0.2%, 0.5%, and 0.5% of the children respectively. The prevalence of xerophthalmia was higher in school aged children than pre-school children (P< 0.0001). Based on the WHO recommended cut-off level, serum retinol levels were in the "low" range (<20 microl/dl) in 51% of the children. CONCLUSION: The results indicate that vitamin A deficiency (VAD) is a public health problem in Arssi, with higher prevalence among school aged children than pre-school children.

Dietary patterns and dental caries in nursery school children in Nairobi, Kenya.

OBJECTIVE: To determine the dietary patterns and the prevalence of dental caries among nursery school children in Nairobi. DESIGN: A cross-sectional study. SETTING: Nursery schools in Nairobi, Kenya. SUBJECTS: Three hundred and four nursery school-children (149 males and 155 females) aged 3-5 years were assessed in 1997. RESULTS: There was a high consumption of fruits, vegetables and milk on a daily basis. There was also a high consumption of snacks both at home and at school. About 96% of the children had been breastfed, while 41% had been bottle-fed. The prevalence of dental caries was high at 63.5% and a mean decayed, missing and filled teeth index (dmft) of 2.95, with the d-component comprising 96% of the total dmft. Only 1.3% of the children had filled teeth. Increasing age was the most predictive factor in dental caries. CONCLUSION: The high consumption of refined foods and snacks, as well as the high prevalence of dental caries raises a strong public health concern. It is recommended that dietary counselling and preventive oral health programmes should be initiated and the already existing ones strengthened and incorporated in primary healthcare programmes. There is also need for policy makers to come up with guidelines on advertisements promoting cariogenic snacks.

Maternal nutritional knowledge and the nutritional status of preschool children in a Nairobi slum.

Most nutrition education programmes in Kenya operate on the premise that nutritional knowledge can have an impact on children's nutritional status. It has, however, been argued that nutritional knowledge among low income groups is unlikely to have an impact, hence, the need to establish whether there is a relationship between nutritional status and maternal nutritional knowledge. In a cross-sectional survey carried out in a Nairobi slum (Kibera), nutritional status of 363 children aged six to 24 months was measured and nutritional knowledge of their mothers assessed. Makina village was randomly selected as the study site and all consenting households were involved in the study. The study established that most mothers (97.5%) have access to nutrition education. Prevalence of stunting (86.2%) and underweight (58.4%) was high but that of wasting (1.9%) was low. There was no significant relationship between the nutritional status of children and overall nutritional knowledge. Unexpectedly, a negative relationship was found between nutritional status and mothers' ability to recognise clinical signs of malnutrition, knowledge in the weaning process and dietary management during sickness. Knowledge on frequency of feeding was, however, positively related to nutritional states. In conclusion, nutritional knowledge alone is inadequate in ensuring young children's nutrition security and, hence, for nutrition education programmes to have a positive impact, facilitational strategies must be incorporated.

Dietary habits, pregnancy weight gain and birthweights in a highland population of Kenya.

In a prospective study of the effects of micro-nutrient supplementation during pregnancy in a cohort of healthy, non-anaemic antenatal outpatients of a small hospital in highland Kenya, research was also carried out on dietary habits, weight gain and birth-weights. Participants were enrolled at a mean gestation of 29 weeks (s.d.2.37). Special consideration was given to the dietary intake of the micronutrients most important to erythropoiesis, namely iron, folate and vitamin C (the main promotor of iron absorption). It was found that 74% consumed an inferior diet with regard to these micronutrients. The mean birth-weight of infants born to participants was 3178 grams (s.d. 398 grams). Only two variables were found to be significantly associated with birth-weight; mothers' weight gain on enrollment and mothers' weight gain during one month of the last trimester (p < 0.05). It appears that the dietary intake during pregnancy in this population was lacking in important micronutrients, and it is recommended that antenatal clinics prioritise nutrition education during pregnancy.

Dietary considerations in designing nutrition intervention programmes in rural areas of Kenya.

A comparative study was carried out in three localities in Kenya: Kwale, Mbooni and Lwak in an attempt to identify dietary factors important in designing community based nutrition interventions. The data indicate geographical differences in age at weaning, reasons for termination of breastfeeding, the variety in the diets consumed and the nutrient intake adequacy. However, there was no difference in the duration in breastfeeding and, for children above 6 months (a period when weaning is recommended) rarely was there any food termed as "baby food" but children consumed bits and portions of the family food. In all the localities, there was no statistical difference between households with malnourished children and those without in most of the factors. Households with children admitted in the nutritional rehabilitation centres in the localities were, however, different in most of the characteristics examined. It is concluded that dietary interventions should be targeted to households and not children, mothers' care and nutrition are of paramount importance if the nutrition condition of their children is to be improved and, planning of nutritional interventions should be specific to the districts.

Sexual abuse of children as seen at Kenyatta National Hospital.

A retrospective study of 21 sexually abused children admitted to the Kenyatta National Hospital, Nairobi, Kenya, between January 1984 and December 1985 is presented. The peak incidence of sexual abuse was in the age group of 10-15 years (38.1%) followed by the 5-9 years age group (28.6%). Strangers and people familiar to the child were equally implicated as assailants. Fourteen out of the twenty one (66.7%) victims, presented with injuries ranging from perineal tears (19%), vaginal tears (19%), recto-vaginal fistulae (RVP) (4.8%) and vesico-vaginal-fistulae (VVF) and abdominal haematoma (4.8%). The victims presented to hospital within two days of the event usually accompanied by their mothers.

PIP: American studies report that 15% of reported child abuse case involve sexual abuse. Sexual abuse can be sexual molestation, sexual intercourse, and/or family related rape. Sexual abuse cases frequently come to the attention of hospital emergency care departments. Few reports appear in the medical literature on sexual abuse in Africa, although the media reports on its occurrence. This retrospective study provides information on the incidence and demographic characteristics of children admitted to Kenyatta National Hospital in Nairobi, Kenya, for sexual abuse. Records were obtained on rape or sexual abuse diagnosis cases between 1984 and 1988 for the following variables: age and sex of victim, time lapse before medical treatment, perpetrators relationship to victim, type of injury to victim, and person accompanying child to the hospital. The results reveal that 21 cases of children ranging from 4 months to 18 years were reported. In 19 cases, information on the assailant's character was unavailable. 66.7% of the victims were 5-15 years, and all were females. 15 (71.4%) were admitted within 2 days of the incident. 10 (47%) were sexually abused by strangers, and 11 (53%) by someone known such as a friend or relative. 19 incidents occurred after dark while on as parent-motivated errand. The place of victimization was usually close to the victim's home in cases where the assailant was known. The youngest children sustained the most severe injuries. Injuries included RVF and VVF, labial and perineal lacerations, hymenal tears, vaginal and perineal tears, abdominal injuries, and genital infection. Three children aged 4 6, and 7 showed evidence of previous coital experience. 5 children were without injuries. 19 patients stayed for 3 days or less; the other 2 with severe injuries stayed longer. 11 cases were brought by the mother. Case studies of the 4-month-old and the 9-year-old are presented. Discussion focuses on the nature of incestuous relationships and the character of the assailant. Prospective studies are needed, and prevention involves a massive public education effort.

Battered baby syndrome at Kenyatta National Hospital, Nairobi.

Thirty children presenting with Battered Baby Syndrome over a five year period were studied retrospectively. The male:female ratio was 1:1.1. The majority (60%) were aged 0-11 months. 14 children (46%) were abandoned while six (20%) had multiple fractures, six (20%) multiple bruises and bites, and four (13.3%) had other forms of abuse. Twelve (40%) children were malnourished while eight of the babies (26.6%) were small for gestational age. Children were most frequently brought to hospital by the police or their mothers. The children were most frequently abused by their mothers either through abandonment or through physical battering. Details of mothers of the 14 abandoned children were unknown. Among the mothers of the other children, nine mothers were single, seven married and living with spouses and one stepmother. Two children (6.6%) died while the fate of two others was not known. Three children were sent home without intervention of the social worker, while twenty three children were discharged following intervention of the social worker; fourteen sent home, nine to a childrens' home and one through the juvenile court.