NUTRITION STATUS AND ASSOCIATED MORBIDITY RISK FACTORS AMONG ORPHANAGE AND NON-ORPHANAGE CHILDREN IN SELECTED PUBLIC PRIMARY SCHOOLS WITHIN DAGORETTI, NAIROBI, KENYA.

BACKGROUND: Most of the nutritional surveys that have been carried out in Kenya have concentrated on children aged five years and below who are under the care of their parent(s). The HIV/AIDS, conflict, natural disasters, endemic diseases such as malaria and tuberculosis and rising poverty has claimed the health and lives of millions of productive adults, leaving their children orphaned and vulnerable. This has led to mushrooming of orphanages to take care of these orphans and vulnerable children in Kenya. OBJECTIVE: Compare the nutrition status and associated risk factors of primary school children living in orphanages and those not living in orphanages in selected public primary schools in Dagoretti Division, Nairobi. DESIGN: Descriptive cross sectional survey. SETTING: Four public primary schools in Dagoretti Division. Data were collected from school registers and directly questioning the students, parents/guardians or caretakers. SUBJECTS: Four hundred and sixteen, four to eleven year olds randomly selected orphanage and non-orphanage children who attended the same primary school. RESULTS: The orphanage children had a significantly higher rate of stunting and underweight (p < 0.05) than the non-orphanage children. The orphanage children had also a significantly higher rate of morbidity (p < 0.05) than the non-orphanage children. The orphanage children were more than three times more likely to take inadequate calories compared to the non-orphanage children. CONCLUSIONS: The main factors associated with the higher rate of malnutrition among orphanage children were high morbidity rate, inadequate amounts and diversity of foods served, low rates of vaccination and basic hygiene.

Nutrition Status and Associated Morbidity Risk Factors among Orphanage and Non-Orphanage Children in Selected Public Primary Schools within Dagoretti; Nairobi; Kenya

Background: Most of the nutritional surveys that have been carried out in Kenya have concentrated on children aged five years and below who are under the care of their parent(s). The HIV/AIDS; conflict; natural disasters; endemic diseases such as malaria and tuberculosis and rising poverty has claimed the health and lives of millions of productive adults; leaving their children orphaned and vulnerable. This has led to mushrooming of orphanages to take care of these orphans and vulnerable children in Kenya.Objective: Compare the nutrition status and associated risk factors of primary school children living in orphanages and those not living in orphanages in selected public primary schools in Dagoretti Division; Nairobi.Design: Descriptive cross sectional survey.Setting: Four public primary schools in Dagoretti Division. Data were collected from school registers and directly questioning the students; parents /guardians or caretakers.Subjects: Four hundred and sixteen; four to eleven year olds randomly selected orphanage and non-orphanage children who attended the same primary school.Results: The orphanage children had a significantly higher rate of stunting and underweight (p 0.05) than the non-orphanage children. The orphanage children had also a significantly higher rate of morbidity (p0.05) than the non-orphanage children. The orphanage children were more than three times more likely to take inadequate calories compared to the non-orphanage children.Conclusions: The main factors associated with the higher rate of malnutrition among orphanage children were high morbidity rate; inadequate amounts and diversity of foods served; low rates of vaccination and basic hygiene

Comparison of safety of glucose oral rehydration solution and maize oral rehydration therapy for home management of diarrhoea in Kenya.

Safety margins and variability in the composition of glucose and maize-based oral rehydration therapy (ORT) prepared by mothers in a rural district of Western Kenya, are reported here. In a 2-year longitudinal field study, packets containing glucose ORS and a home solution made with maize and table salts, were provided to the mothers of 6180 children in Kakamega District in two separate sub-locations. Experienced and trained field workers supported by community registered nurses provided training for the preparation and use of ORT during weekly visits to every household. On four occasions separated by 4-6 months, a 5 per cent random sampling was done of the home-prepared solutions actually used for the treatment of children with diarrhoea. The water used for preparing ORT was also sampled. Samples of 174 glucose-based ORT, 148 maize-salt ORT, and 201 samples of water were analysed. Only 2 per cent of the maize-based ORT were above 120 meq/1 sodium (i.e., the safe range of sodium concentration) compared to 17.8 per cent for glucose solutions (p < 0.001). Home water samples contained substantial amounts of salt, which could unpredictably affect the final composition of the ORT solutions. We conclude that maize-salt ORT had a better margin of safety than glucose-based ORS.

Vitamin A deficiency in pre-school children in Kenya.

OBJECTIVE: To determine the prevalence of vitamin A in pre-school children in Kenya. DESIGN: Cross-sectional survey. SETTING: Fourteen districts randomly selected from the eight provinces in Kenya. SUBJECTS: Six thousand four hundred and twenty five pre-school children (3298 boys and 3127 girls) aged 6-72 months in 27 clusters randomly selected from fourteen districts. MAIN OUTCOME MEASURES: Serum retinol levels and xerophthalmia were determined using High Pressure Liquid Chromatography (HPLC) and ophthalmological assessment respectively. RESULTS: The mean serum retinol was 0.84 mmol/l +/- 0.58 SD. The mean serum retinol by sex was 0.82 +/- 0.51 SD and 0.87 +/- 65 SD (p=0.005) for boys and girls respectively. Over seven per cent of the children were severely vitamin A deficient (<0.35 mmol/l) and 32.9% had marginal vitamin A deficiency (0.70 mmol/l). In the age group six to eleven months, 11.2% and 40.7% of the children were severely and marginally vitamin A deficient, respectively. Clinical examination results indicated that 0.1% of children had corneal xerosis (X2), and one per cent of the children had Bitot's spots (XIB). Geographically, the results show that the problem is most prevalent in Kwale, Mombasa, Kitui, Baringo, Kisumu, Kisii, Bungoma, Garissa and Mandera. CONCLUSION: This survey demonstrated that regardless of the assessment method used, vitamin A deficiency is a significant public health problem in Kenya which requires urgent interventions. The group at highest risk was children aged six to twenty three months. Boys were at more risk than girls.

Prevalence of malnutrition in Kenya.

BACKGROUND: Prevalence of malnutrition among pre-school children can be used to determine the need for nutrition surveillance, nutritional care, or appropriate nutritional intervention programmes. Such data also indicate the target groups and where interventions are required. OBJECTIVE: To determine the at risk groups, extent and magnitude, and regional distribution of malnutrition. DESIGN: A cross sectional study. SETTING: The survey was conducted in 14 districts representative of the eight provinces of Kenya. SUBJECTS: Six thousand, four hundred and nineteen children (3294 males and 3125 females) aged six to 72 months selected using the cluster sampling technique from eight provinces were studied. MAIN OUTCOME MEASURES: Anthropometric measures of height/length and weight were used to do the assessment. RESULTS: The prevalence of stunting, wasting and underweight were 37%, 6% and 27% respectively. Stunting was highest among the 12-23 months age group (44.8%). A statistically significant difference (p = < 0.005) was found between boys and girls with regard to stunting. This difference was more remarkable when the two were stratified by age group where 29% of the boys were stunted compared to 20% of the girls. Geographically, it was found that there exists great regional disparities with a low (22.6%) in Kiambu and a high (56.5%) in Kwale districts. CONCLUSION: These results show that malnutrition is still a serious public health problem in Kenya and requires urgent attention. The problem since the first survey in 1977 shows an upward trend, suggesting deterioration over the years. Well thought out and targeted intervention programmes are long overdue. The results of this survey and others emphasize the importance of having a well established surveillance system which would ensure necessary and timely action.

PIP: This cross-sectional study examined the prevalence, severity, regional differences and age-sex distribution of malnutrition in Kenya. About 6419 children (3294 males and 3125 females) from 14 districts in Kenya were examined using two anthropometric measurements: weight and height. The three nutritional status indicators used were stunting, wasting, and underweight, with an overall prevalence of 36%, 6%, and 27%, respectively. Findings indicated that stunting was lowest among the 6-12 month age group and highest among the 12-23 month age group, with a prevalence 15 times higher among boys. On the other hand, both growth stunting and wasting were most serious between 12 and 23 months of age, similar to previous reports. The most pressing form of malnutrition in Kenya is protein-energy malnutrition, which largely affects infants, preschool, and school children. Regional disparities in malnutrition were also observed, with a low malnutrition rate in Kiambu (22.6%) and a high malnutrition rate in Kwale (56.5%) districts. This study, as well as the results of previous findings, confirms the seriousness of malnutrition in Kenya. This paper suggests the implementation and development of monitoring and evaluation mechanisms to assess the impact of implemented program activities, particularly in districts with high malnutrition rates.

Bancroftian filariasis: profile of serum antifilarial antibody and circulating parasite antigen.

Forty-five serum specimens collected from persons living in a filaria-endemic community in Maili Nane, Coastal Kenya were analyzed by ELISA for levels of isotype specific antifilarial antibody and by Og4C3 ELISA for circulating parasite antigen. Mean levels of IgG1, IgG2, and IgG3 were lower in microfilaraemic persons than in amicrofilaraemic individuals. In contrast, mean levels of antifilarial IgG4 were significantly higher in microfilaraemic persons (p = 0.0374). Serum samples from all microfilaremic persons were positive for circulating antigen as were 15% of samples from amicrofilaremic and asymptomatic persons. The Og4C3 antigen assay may have value as a technique for identifying and targeting communities for control efforts.

Maize-salt solution in the treatment of diarrhoea.

In a block-randomized trial we compared the efficacy of citrate-containing glucose electrolyte solution (GES) versus maize-salt solution (MSS) in the treatment of children with mild and moderate diarrhoeal dehydration and acidosis. One hundred and fifteen children aged 3-59 months were entered in the study; 56 received GES and 59 MSS. Fifty-one (91%) of the 56 children given GES and 52 (88%) of the 59 children given MSS were successfully rehydrated with improvement in metabolic acidosis within 24 h. Initial hypokalemia in children treated with maize-salt solution was not corrected during the first 24 h of therapy. The children were, however, clinically asymptomatic after treatment. Carefully prepared maize-salt solution may be used successfully in mild and moderate dehydration in the home, as an alternative to the preferred glucose electrolyte formula.