Nutritional Status of Under-five Children Living in.pdf

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INTERNATIONAL CENTRE FOR DIARRHOEALDISEASE RESEARCH, BANGLADESH

J HEALTH POPUL NUTR 2011 Aug;29(4):357-363ISSN 1606-0997| $ 5.00+0.20

Correspondence and reprint requests should beaddressed to:Ms Beatrice OlackKenya Medical Research Institute/Centers for Disease Control and PreventionPO Box 606 Village Market00621 Nairobi, KenyaCell: +254-733-747818Ofce:+254-20-2713008Email: [email protected]

Nutritional Status of Under-five Children Living inan Informal Urban Settlement in Nairobi, Kenya

Beatrice Olack 1,2, Heather Burke 2, Leonard Cosmas 1,2, Sapna Bamrah 3,

Kathleen Dooling 4, Daniel R. Feikin 2, Leisel E. Talley3, and Robert F. Breiman 2

Kenya Medical Research Institute, Nairobi, Kenya, 2International Emerging Infections Program,

Centers for Disease Control and Prevention, Kenya, Centers for Disease Control and Prevention,

Atlanta, GA, USA, and 4Peel Public Health Unit, Brampton, Canada

ABSTRACT

Malnutrition in sub-Saharan Africa contributes to high rates of childhood morbidity and mortality. Howev-er, little information on the nutritional status of children is available from informal settlements. During theperiod of post-election violence in Kenya during December 2007March 2008, food shortages were wide-spread within informal settlements in Nairobi. To investigate whether food insecurity due to post-electionviolence resulted in high prevalence of acute and chronic malnutrition in children, a nutritional surveywas undertaken among children aged 6-59 months within two villages in Kibera, where the Kenya MedicalResearch Institute/Centers for Disease Control and Prevention conducts population-based surveillance forinfectious disease syndromes. During 25 March4 April 2008, a structured questionnaire was administeredto caregivers of 1,310 children identified through surveillance system databases to obtain information onhousehold demographics, food availability, and child-feeding practices. Anthropometric measurementswere recorded on all participating children. Indices were reported in z-scores and compared with the WorldHealth Organization (WHO) 2005 reference population to determine the nutritional status of children.Data were analyzed using the Anthro software of WHO and the SAS. Stunting was found in 47.0% of thechildren; 11.8% were underweight, and 2.6% were wasted. Severe stunting was found in 23.4% of thechildren; severe underweight in 3.1%, and severe wasting in 0.6%. Children aged 36-47 months had thehighest prevalence (58.0%) of stunting while the highest prevalence (4.1%) of wasting was in children aged6-11 months. Boys were more stunted than girls (p


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In sub-Saharan Africa and in most developingcountries, extreme urban poverty is concentratedin temporary or informal squatter settlements andslum areas. Infrastructure is not keeping up withmassive urbanization throughout Africa. As a re-sult, each year a growing number of people livewithin informal settlements. Informal settlementsare made up of improvised dwellings often madefrom scrap materials, such as corrugated metalsheets, plywood, and polythene-sheets. They tendto be densely populated and characterized by limi-ted basic services and infrastructure for providingclean water, sanitation facilities, solid-waste man-agement, roads, drainage, and electricity, if anyis available at all. In concert with poverty, a numberof factors within informal settlements, includingovercrowding, substandard housing, unclean andinsufficient quantities of water, and inadequatesanitation, contribute to a high incidence of infec-tious diseases and to significant rates of childhoodmortality (5).

It is estimated that more than 60% of Nairobi resi-dents live in informal settlements (6) where pov-erty, combined with population density and poorsanitation, is readily evident. The 2008 Kenya De-mographic and Health Survey showed that 35.3%of under-five children were stunted nationwide,6.7% were wasted, and 16.3% were underweight(7). The report suggested that the greatest burden ofmalnutrition was in rural areas.

Kenya experienced a period of civil unrest follow-ing the December 2007 general election. The Kiberainformal settlement, the largest contiguous slum inAfrica, was a focal point for substantial post-electionviolence. The associated chaos disrupted sources oflivelihoods, reducing access of Kibera residents tofood and basic services. The emergence of inter-tribal hostilities in Kibera forced some residentsto move to camps of internally-displaced persons(IDPs) where they remained for several months.During the period of civil unrest, food shortagesand rising food prices were dramatic. News reports

from health facilities suggested that moderately-malnourished children were becoming severelymalnourished due to acute food shortages (8). Itwas anticipated that rates of malnutrition wouldcontinue to rise due to insecurity and lack of accessto food. In response to concerns about inadequatenutrition for children during the post-election vio-lence, we conducted an assessment to determinethe nutritional status of children aged 6-59 monthsin two villages in Kibera where the Kenya MedicalResearch Institute (KEMRI) and Centers for DiseaseControl and Prevention (CDC) are collaborating

on population-based surveillance for major infec-tious disease syndromes and for emerging and re-emerging pathogens. We compared data obtainedduring this survey with data from a nutritional sur-vey conducted in 2005 in the same villages beforethe start of the KEMRI/CDC surveillance activities.(Dooling Ket al . Unpublished observations).

MATERIALS AND METHODS

This cross-sectional study was conducted in Kiberaduring 25 March4 April 2008. The study was con-ducted in two villages (Gatwikira and Soweto)where KEMRI/CDC has conducted population-based surveillance for infectious disease syndromessince 2005 (9) which, during the time of the nu-tritional study, included biweekly household visitsto detect acute diseases, such as pneumonia, diar-rhoeal diseases, and febrile illnesses (10).

A week-long intensive training (including anthro-pometric measurements) was held for field work-ers to prepare for the nutritional survey. Childrenaged 6-59 months are considered to be particularlysusceptible to acute nutritional stress; thus, survey-ing this age-group provided an indication of theseverity of undernutrition among all people livingin a geographic area under similar conditions. Us-ing the KEMRI/CDC population-based surveillancedatabase, we selected all households within thesurveillance area with at least one child aged 6-59months for inclusion in the survey. Trained fieldworkers then visited all the selected households. Ifno one was in the home during the initial visit, tworepeat visits were made to all eligible households.The survey covered all children aged 6-59 monthscurrently present in the surveillance area. Due to thepost-election violence, approximately two-thirdsof the residents had left Kibera and had not yet re-turned; so, they could not be surveyed. In addition,of 1,476 children present in the surveillance area,1,310 (89%) were available at the time of visit tothe home during the survey. A structured question-naire was administered to caregivers of children to

obtain information on household demographics,socioeconomic factors, availability of foods, andchild-feeding practices. To assess whether malnu-trition was linked to morbidi-ty, we analyzed cor-responding data (for each surveyed child) collectedduring home-visits for the disease surveillance.

Anthropometric measurements were taken for allchildren, aged 6-59 months, included in the cross-sectional survey to assess their nutritional status.Length/Height Board of the United Nations Chil-drens Funds was used by the field workers after un-


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2030

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6 -11 12 -23 24-35 36-47 48-59

% s

t u n

t e d

Age (months)

Overall (n=1,245)Males (n=592)Females (n=653)

Fig. 3. Prevalence of stunting by gender

stunting was significantly (p


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and malnutrition. Concepts, evidence and case stud-ies. New York, NY: United Nations Childrens Fund,1994:2. (Urban examples no. 19).

6. Mugisha F. School enrollment among urban non-slum, slum and rural children in Kenya: is the urbanadvantage eroding? Int J Educ Dev 2006;26:471-82.

7. Kenya National Bureau of Statistics. Kenya Demo-graphic and Health Survey 2008-2009: Kenya Na-tional Bureau of Statistics, 2010:141-50.

8. United Nations Childrens Fund. Kenya civil unrest:UNICEF responds to the immediate needs for chil-dren and women affected by post-election violence.Nairobi: United Nations Childrens Fund, 2008:3.

9. Feikin DR, Audi A, Olack B, Bigogo GM, Polyak C,Burke H et al . Evaluation of the optimal recall periodfor disease symptoms in home-based morbidity sur-veillance in rural and urban Kenya. Int J Epidemiol 2010;39:450-8.

10. Feikin DR, Olack B, Bigogo GM, Audi A, Cosmas LAura B et al . The burden of common infectious dis-ease syndromes at the clinic and household levelfrom population-based surveillance in rural and ur-ban Kenya. PLoS On 2011;6:e16085 [doi:10.1371/journal.pone.0016085].

11. World Health Organization. Child growth standards:length/height-for-age, weight-for-age, weight-for-len-

gth, weight-for-height and body mass index-for-age:methods and development, Geneva: World HealthOrganization, 2006;306-7.

12. World Health Organization. Anthro for personalcomputers. Version 2. Software for assessing growthand development of the worlds children. Geneva:World Health Organization, 2007. (http://www.who.int/childgrowth/software/en).

13. Mittal A, Singh J, Ahluwalia SK. Effect of maternalfactors on nutritional status of 1-5-year-old childrenin urban slum population. Indian J Community Med 2007;32:264-7.

14. Wamani H, strm AN, Peterson S, Tumwine JK,Tylleskr T. Boys are more stunted than girls in sub-Saharan Africa: a meta-analysis of 16 demographicand health surveys. BMC Pediatr 2007;7:17.

15. Wells JC. Natural selection and sex differences inmorbidity and mortality in early life. J Theor Biol 2000;202:65-76.

16. Pelletier DL, Frongillo EA Jr, Schroeder DG, Habicht JP. The effects of malnutrition on ch ild mortal-ity in developing countries. Bull World Health Organ 1995;73:443-8.

17. Nti CA, Lartey A. Effect of caregiver feeding behav-iours on child nutritional status in rural Ghana. Int JConsum Stud 2007;31:303-309.

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Nutritional Status of Under-five Children Living in.pdf