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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. O A56/69320/2011 SUPERVISOR: PROF WAMBUI KOGI- MAKAU. INTRODUCTION:.
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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. O A56/69320/2011 SUPERVISOR: PROF WAMBUI KOGI- MAKAU
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.)
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)
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.
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
JUSTIFICATION: • Very little has been done to identify the contribution of diets provided in pre schools to the under and over nutrition among children.
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.
OBJECTIVES OF STUDY: Main Objective: • 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
OBJECTIVES CONTINUED… Specific Objectives: • 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.
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.
RESEARCH QUESTIONS: • Does the food given to children in baby care centres meet their recommended daily intake? • To what extent do school diets contribute to children’s under or over nutrition? • To what extent does socio economic status determine a child’s nutrition? • What are the preschools’ consumption patterns? • How do factors like age of parents, a child’s birth order and child’s birth weight determine the nutritional status of children?
RESEARCH HYPOTHESES: • Diets offered in school based baby care programmes contribute to the over and under nutrition of children less than 5 years of age. • Socio economic status affects the nutritional status of children. • Factors other than school diet and socio economic status influences the nutrition of children
LITERATURE REVIEW: • Introduction -Socio economic Status -Urbanization • Day care institutions -Diets in day care facilities - Recommended dietary intake • Stunting -Causes of stunting
Literature Review • Underweight in children -Causes of underweight • Overweight and obesity in children -Causes and consequences of overweight in children • Promoting healthy habits • Gaps in knowledge
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.
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.
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: • Medium- high income, • Medium income • 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.
SAMPLE SIZE The 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.
SAMPLE SIZE KEY: 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 occurred by 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).
SAMPLING CRITERIA Inclusion 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.
Methods of Data Collection • Interviews • Observations • Use of documentary sources • Taking of measurements
DATA COLLECTION TOOLS AND EQUIPMENT • Structured Questionnaires. • 24 hour recall. • Weighing Scale. • Height Board.
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.
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.
