School-based baby care and nutritional status among children under 5 years in Embakasi constituency, Nairobi County. A comparative study across socio-economic status

ODEK IRENE M. OA56/69320/2011SUPERVISOR: PROF WAMBUI KOGI- MAKAU

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INTRODUCTION:

Kenyan population was 38,610,097 people by the 2009 census.

32.3 percent of the population are urban dwellers.

Nairobi has a total population of 3,138,369. The total number of children less than 5 years

and in preschool is 2,247,071.The number of preschool children in Nairobi

County was 155,936 . (KNBS, 2009 census report.)

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INTRO CONTINUED..

Malnutrition essentially means “bad nourishment”.

Clinically, malnutrition is characterized by inadequate or excess intake of protein, energy, and micronutrients such as vitamins, and the frequent infections and disorders that result.

Intake of nutrients leads to malnutrition in the form of wasting, stunting and underweight, and excess consumption resulting in overweight and obesity.

(WHO: Global Database on Child Growth and Malnutrition.1997)

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INTRO CONTINUED..

In early childhood, malnutrition leads to reduced physical and mental development.

Stunting, for example, affects more than 147 million pre-school children in developing countries, according to SCN's World Nutrition Situation 5th report.

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PROBLEM STATEMENT: The prevalence of childhood overweight and obesity

has increased worldwide in recent decades. Historically, a heavy child meant a healthy child, and

the concept “bigger is better” was widely accepted. Today, this perception has drastically changed on the basis of evidence that obesity in childhood is associated with a wide range of serious health complications and an increased risk of premature illness and death later in life. (Onis M et. al 2000)

A lot of emphasis has been put on malnutrition as a result of inadequate intake, with little focus on over nutrition as a form of malnutrition; and more so the role played by schools in accelerating the pandemic

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JUSTIFICATION:

Very little has been done to identify the contribution of diets provided in pre schools to the under and over nutrition among children.

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STUDY AIM

To contribute towards better understanding of the contribution made by preschool diets.

STUDY PURPOSE

To examine the inter relationship between school nutrition, socio economic status and other factors that influence the nutritional status of children less than 5 years.

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OBJECTIVES OF STUDY:

Main Objective:

1.To determine the contribution of foods offered in school based baby care facilities to dietary intake and nutritional status of children less than 5 years in Embakasi Constituency, Nairobi County

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OBJECTIVES CONTINUED…

Specific Objectives:

1.To determine the extent to which diets given to children in pre schools contribute to their nutritional status.

2. To demonstrate the role of socio economic status to children’s nutrition.

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Specific Objectives Cont...

3. To assess the influencing of day care environment to the nutritional status of children.

4. To assess child care practices at day care facilities.

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RESEARCH QUESTIONS:

1. Does the food given to children in baby care centres meet their recommended daily intake?

2. To what extent do school diets contribute to children’s under or over nutrition?

3. To what extent does socio economic status determine a child’s nutrition?

4. What are the preschools’ consumption patterns?5. How do factors like age of parents, a child’s birth

order and child’s birth weight determine the nutritional status of children?

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RESEARCH HYPOTHESES:

1. Diets offered in school based baby care programmes contribute to the over and under nutrition of children less than 5 years of age.

2. Socio economic status affects the nutritional status of children.

3. Factors other than school diet and socio economic status influences the nutrition of children

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LITERATURE REVIEW: Introduction -Socio economic Status -Urbanization Day care institutions -Diets in day care facilities - Recommended dietary intake Stunting -Causes of stunting

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Literature Review

Underweight in children-Causes of underweight Overweight and obesity in children-Causes and consequences of overweight

in childrenPromoting healthy habitsGaps in knowledge

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STUDY AREA STUDY SITE:

• The study area will be Embakasi constituency of Nairobi County.

• The study site will be pre schools located in Nairobi’s Embakasi constituency, and households of the preschool children.

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STUDY POPULATION

• The study population shall comprise of children less than 5 years attending preschool in Embakasi constituency.

• Other background information significant for the study shall be collected from the children’s parents or care givers.

• Information on school diets shall be collected from the schools’ staff responsible for meal planning and preparation.

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STUDY DESIGN:

The study will be a cross sectional descriptive and analytical survey.It is a comparative study across socio economic status among the

residents of Embakasi constituency, to assess the socio economic contribution to children’s nutrition.

The study population generally comprises low and middle income households. Therefore the region shall be divided into three strata:

1. Medium- high income, 2. Medium income3. Low income.Comparisons will be made on the basis of the above geographical

categories and not comparison of nutrition in schools.Some information like the child’s weight at birth, birth order among

others, shall be collected retrospectively from parents and care givers of the children.

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SAMPLE SIZEThe sample size is determined using Robert Magnani’s formula (1997). n = D [(Zα + Zβ) 2 * (P1 (1 - P1) + P2 (1 - P2) / (P2 - P1)2] 2[(1.645+0.840)2* (0.1(1-0.1) + 0.3((1-0.2) / (0.3-0.1)2] 2[6.175*0.09+0.21/0.04]=92.6=93 per data cell. For the 3 cells= 3*93=279. With 5% attrition=293. Total Sample size=300.

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SAMPLE SIZEKEY:n = required minimum sample size per survey round or comparison group,D = design effect (assumed in the following equations to be the default value of 2),P1 = the estimated level of an indicator measured as a proportion at the time of the

first survey or for the control area,P2 = the expected level of the indicator either at some future date or for the project

area such that the quantity (P2 - P1) is the size of the magnitude of desired change and ability to detect,

Zα = the Z-score corresponding to the degree of confidence with which it is desired to be

able to conclude that an observed change of size (P2 - P1) would not have occurredby chance (α - the level of statistical significance), and Zβ = the z-score corresponding to the degree of confidence with which it is desired

to be certain of detecting a change of size (P2 - P1) if one actually occurred (β-statistical power).

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•KENYAConvenience Sampling

•NAIROBI COUNTY

Convenience Sampling

3. EMBAKASI CONSTITUENCYPurposive Sampling

4. PRESCHOOL CHILDREN UNDER 5 YEARS.

Purposive Sampling

5. LIST ALL PRESCHOOLS FOUND IN THE CONSTITUENCY (SAMPLE FRAME).Cluster Sampling

6. CLUSTERING OF PRESCHOOLS GEOGRAPHICALLY/SES.Purposive Sampling

7. SELECTION OF SCHOOLS FOR SAMPLE COLLECTION. Simple Random Sampling

8. SELECTION OF STUDY SAMPLES. Systematic Random Sampling

SAMPLING PROCEDURE

SAMPLING CRITERIAInclusion criteria• Children aged under 5 years and attending preschool institutions in

Embakasi.• Children in pre schools and also feeding on the school meals.• Children under 5 years and parents or care givers who agree to participate

in the study.

Exclusion criteria• Children in preschools but do not consume food prepared in school.• Children aged more than 5 years.• Children within the study age group but not enrolled in preschools.• Children under 5 years and their parents or care givers who refuse to

participate in the study.

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Methods of Data Collection

• Interviews• Observations• Use of documentary sources• Taking of measurements S

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DATA COLLECTION TOOLS AND EQUIPMENT

Structured Questionnaires. 24 hour recall. Weighing Scale. Height Board.

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School Characteristics:

Number of children in preschool.

Amount of school fees paid

Number of children in the school feeding

programme

Content of school menu

Under nutrition

Over nutrition

Child Characteristics:

Weight at birth

Breastfeeding duration

Known health complications

Birth order

Number of siblings

Stunting

Over weight/obesity

Under weight

Household Characteristics:

Area of residence

Weekly expenditure on food

Size of the household

Level of education of the parents-mother

Employment status of the parents-mother

Over nutrition/overweight

Under nutrition/underweight

Stunting

Dummy Analysis

Data Quality Control

• The research assistants will be well trained in correctly filling out the questionnaires to enhance accuracy and validity.

• The principle investigator will countercheck the questionnaires daily to ensure that each question is answered as expected.

• Data will be carefully entered into the computer and cleaned by a data entry clerk.

• Statistic checks for errors will be done by examining frequency distribution on all variables for to extract entries that will be improbable or not logical.

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Research Ethics

• Authorization to conduct the study will be sought from District Education Officer in charge of Embakasi region.

• A research permit will be obtained from Ministry of Science and Technology.

• Informed consent will be sort from the schools, parents and children participating in the study.

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Study Time Plan

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ITEM AMOUNT UNIT COST(Ksh) TOTAL COST (Ksh)

PersonnelPrinciple Researcher

Transport 2 300 600Airtime 14 100 1,400Supervisor

Per diem 2 8,500 17,000Transport 2 1,000 2,000Enumerators

Allowance to be paid 5 for 14 days 1000 70,000Data entry clerk

Allowance to be paid 1 for 14 days 1500 21,000

Sub total 112,000

Stationeries

Copies of thesis 3*1000 3000Binding of the dissertation 3*500 1500

Paper (photocopy/printing) 2 reams (1000 sheets)

10 10,000

Pens 10 20 200Pencils 10 30 300Rubber 5 30 150Sharpener 5 30 150Sub total 28,800

Grand total 140,800

BUDGET