CHAPTER ONE: INTRODUCTION         Background to the study

Infants and young children 6-23 months of age are within the vital window of opportunity for foundational growth and development and hence they need good nutrition to achieve this requirement (WHO 2008a). During this stage, sub-optimal nutrition greatly compromises childhood developmental milestones and may cause permanent nutritional and health complications in future. These include cognitive, physical and physiological complications (WHO, 2008a). Indicators to complementary feeding practices include timely introduction of solid, semi-solid and soft foods at 6 months of age, with increasing amount and frequency. Minimum meal frequency is defined as: two times foor breastfed infants 6–8 months; three times for breastfed children 9–23 months; and four times for non-breastfed children 6–23 months. The practices also include dietary diversity (comprising of at least 5 out of 8 food groups). The food groups include breast milk, grains, roots and tubers, legumes and nuts, dairy products, flesh foods (meat, fish, organ meats and poultry), eggs, vitamin-A rich fruits and vegetables and other fruits and vegetables) (WHO/UNICEF, 2017). The breast milk during this period provides half of the infant’s energy (Victora et al., 2008).

Children born in urban informal settlements in Kenya are often at risk of sub-optimal breastfeeding and complementary feeding practices thus increasing their risk of mortality and delayed psycho-motor development (Concern Worldwide, 2014). Additionally, compromised sanitation within the settlements exposes infants and young children further to higher risks of infectious diseases, thus strengthening the vicious cycle of malnutrition (Korir, 2013). Limited resources and unsustainable

household income are prevailing circumstances in these settings and this reduces the caregivers’ food purchasing power, thus limiting their ability to diversify the child’s diet (Kimani-Murage et al., 2011).

Half the number of children’s death worldwide is as a result of malnutrition. Three million children die annually from under-nutrition. In 2017, UNICEF analysis showed that 51 million children 0-59 months of age suffered from wasting, of which 16 million were severely wasted, these translating to 7.4% and 2.4% respectively. Of the 51 million children, 25% were from Sub-Saharan Africa (UNICEF, 2017). In Kenya, 61% of children 0-5 months of age are exclusively breastfed, 26% of children under five years of age are stunted and 4% are wasted (Kenya National Burea of Statistics, 2015). More than 420,000 children suffer acute malnutrition in Kenya, of which 73,000 are severely malnourished (Save the Children, 2017). The highest prevalence of acute malnutrition is in Arid and Semi-arid Lands (ASAL) areas, urban informal settlements and areas with high prevalence of HIV and AIDS such as Homa-bay (26.0%), Siaya (23.7%), Kisumu (19.3%) and Migori (14.7%) (Kenya Aids Strategic Forum, 2018). Between January and May 2017, 42,579 children were treated for severe acute malnutrition from ASAL, Urban informal settlements, and refugee camps. In 2017, SAM rate in Kenya was at 7% while that of MAM was at 25.4% (UNICEF, 2017).

In Nairobi, the Global Acute Malnutrition (GAM) rate stood at 4.6% in May 2017. The SAM rate was at 0.1% while MAM rate was at 4.5%. The GAM rate for the Nairobi informal settlements combined was at 4.6%, which was equal to the entire county’s GAM rate. Kamukunji sub-county had the highest prevalence of wasting and

severe wasting at 9.6% and 1.9% respectively, which was far above the global and national rates (Concern Worldwide, 2017).

The United Children’s Fund (UNICEF) organization developed a programme focusing on integrated management for acute malnutrition, which entails the use of therapeutic nutrition supplements adapted to the progressive treatment and management of acute malnutrition (UNICEF, 2012). This was operationalized in 2009 in Kenya. Out-patient Therapeutic Programme (OTP) centres were established to provide treatment and nutritional rehabilitation services for severely acute malnourished children 6-59 months of age without complications (Concern Worldwide, 2011). The children are treated with a specified number of take-home Ready-Use Therapeutic Food (RUTF) issued according to their body weight, along with specialized routine medication. This RUTF is an energy-dense, micronutrient- rich fortified paste, mixed with peanut paste, oil, sugar and dry milk products, procedurally used to manage and rehabilitate severe acute malnourished children. These children are reviewed on a weekly basis at the facility where they receive their weekly re-fills of RUTF, and are followed-up at community level until they recover from acute malnutrition. The OTP centres are located within the residence of the children in order to reach as many children with SAM as possible (Concern Worldwide, 2012). Kamukunji subcounty has six OTP centres namely; Bahati, Majengo, Eastleigh, Biafra, SOS and Moi Forces. The first five centres are surrounded by a dense population of people, with low socio-economic  status, dwelling in informal settlements. Children in these informal settlements are at great risk of malnutrition (Korir, 2013). This study was motivated by the many cases of severe acute malnutrition (SAM) among children in Kamukunji sub-County, being

area with the highest caseloads of acute malnutrition of all other informal settlements in Nairobi (MOH, 2017).

Despite various strategies implemented by the Ministry of Health and implementing partners in the management of acute malnutrition and sensitization on Maternal, Infant and Young Child Nutrition (MIYCN) at facility and community level, malnutrition rates still remain high in Nairobi, with Kamukunji having the highest caseloads among urban informal settlements (MOH, 2017). In a coverage survey by Concern Worldwide, the study established that only 47% of children with SAM were admitted to OTP, and one of the barriers was that most of the mothers (whose children were not admitted) did not attribute malnutrition to sub-optimal complementary feeding (Concern Worldwide, 2017). This may be an indicator that insufficient knowledge and inappropriate attitude of caregivers towards complementary feeding practices is a barrier to access and utilization of OTP services for treatment of acute malnutrition (Agozie et al., 2012). It is against this background that this study was conducted. A search through available literature did not reveal any information on caregivers’ knowledge, attitudes and practices on feeding a child with severe acute malnutrition.

1. 1. This material content is developed to serve as a GUIDE for students to conduct academic research work
2. 2. As a source for additional understanding of the subject.
3. 3. As a source for ideas for your own research work (if properly referenced).
4. 4. For PROPER paraphrasing (see your university definition of plagiarism and acceptable paraphrase)
5. 5. Direct citing (if referenced properly)
Thank you so much for your respect to the authors copyright.