stunting and wasting in children under 2 in a semi-nomadic pastoralist population in kenya...

©2013 International Medical Corps

STUNTING AND WASTING IN CHILDREN UNDER 2 IN A SEMI-NOMADIC PASTORALIST

POPULATION IN KENYA

Amelia Reese-Masterson Nutrition, Food Security & Livelihoods – International Medical Corps

Masumi Maehara

Graduate Intern – London School of Hygiene and Tropical Medicine

Correlations, Risk Factors, and Implications


Outline

• Background

• Objectives

• Literature Review

• Methodology

• Findings & Interpretation

• Limitations

• Recommendations


Background

The HiNi program – Efficacy-proven nutrition interventions

– HiNi in Kenya - 11 interventions across 5 counties

– We began supporting HiNi in Samburu in 2011

Samburu – The Rift Valley region of Kenya

– Arid/semi-arid land

– Semi-nomadic pastoral community

– Ianottie & Lesorogol 2014


Samburu County


Objectives Overall Aim: To identify socio-economic and health-related risk factors associated with stunting and wasting in children 6-23 months in the Samburu population

Specific Objectives

– To investigate factors (and effect size) associated with stunting, wasting, and both

– To investigate the relationship between stunting and wasting

– To provide evidence-based recommendations to inform nutrition programs in this population/region


Literature Review (1)

STUNTING

Maternal height Wasting Zinc inadequacy Environmental enteric dysfunction Previous stunting Birth outcomes (preterm, SGA)

WASTING Intrauterine growth restriction (IUGR) Seasonality (less strong for stunting) Infectious disease Poor IYCF (non-exclusive BF, poor complementary feeding) Diarrhea Dietary inadequacy Poor WASH practices Underlying factors: socioeconomic status, maternal education, child age, occupation


Literature Review (2)

STUNTING

WASTING

Delayed/poor neurological development Poor educational attainment hampered economic growth Increased risk of cardiovascular disease, overweight/obesity later in life Poor Reproductive Health outcomes

Mortality (wasting has double the risk as stunting, stunting + wasting is highest risk) Susceptibility to infections (pneumonia, measles, other) Diarrhea


Methodology (1)

• Merged SMART survey data from Samburu, 2013

– Anthropometric dataset

– Household dataset

– IYCF dataset

• Adjusted for cluster sampling methodology


Methodology (2) Stunting = LAZ <-2

• Chi-squared test • Univariate logistic regression (p<0.10) • Multivariate logistic regression (adjusted Wald

test due to sampling, p<0.05)

Wasting = WLZ <-2

• Chi-squared test (p<0.10)

Correlation between LAZ & WLZ

• Pearson’s correlation coefficient – strength of linear correlation

• Compared predictors of LAZ and WLZ to identify any common predictors

Both LAZ & WLZ • Chi-squared test – association between stunted + wasted children and explanatory variables


Findings & Interpretation


Descriptive Statistics: Household

43%

57%

Household size

2-5 people >5 people

69%

31%

Household head occupation

Livestock herding Others

n=277 in merged dataset


Descriptive Statistics: WASH

0

20

40

60

80

100

Before eating Before cooking After defecation After cleaningchild

% Hand washing at critical moments

Yes

No

Only 13.22% of caretakers washed hands at all 4 critical moments



0

10

20

30

40

50

60

70

80

Total treated Total not treated Safe Unsafe

%

Water source and treatment

Treated Not treated



Yes 39%

No 61%

Access to toilet

Open pot 68%

Closed pot 32%

Water storage


Descriptive Statistics: Child Health

02468

10121416

% Morbidity

0 50 100

Vitamin A supp

Deworming

Measles

OPV

BCG

Vaccination, vitamin A supplementation,

deworming


Descriptive Statistics: Child Health

0

10

20

30

40

50

60

70

No Yes

%

Health seeking behavior

76%

11% 9% 4%

Care sought if child sick (n=71)

Public clinic

Herbal remedies

Traditional healers

Others


Descriptive Statistics: Household Food Security

55% 40%

5%

Household dietary diversity

≤3 food groups 4-5 food groups

6+ food groups

01020304050607080%

Main food source


Descriptive Statistics: IYCF

90.31

9.69

73.57

26.43

INITIATION OF BF FEEDING 3 DAYS AFTER DELIVERY

Breastfeeding

<1 hr >1 hr BM only Non-BM items

61%

34%

5%

Dietary diversity (6-23m)

1 or less 2 food groups 3 or more


Univariate Findings: Wasting

• Prevalence of wasting (WLZ <-2): 8.81% (only 2 cases severe)

• Lack of access to toilet facilities significantly associated wasting (p=0.09)

• Wasting increases with increasing age, with 18-23 month old children at 10% (not significant)

• No other variables were significant


Univariate Findings: Stunting

Child age (months)

n Median LAZ1 (IQR) Moderate stunting (%)

Severe stunting (%)

6-11 59 -0.87 (-1.53, -0.38) 10 (16.95) 0 (0.00)

12-17 69 -1.19 (-2.06, -0.48) 12 (17.39) 6 (8.70)

18-23 99 -1.59 (-2.31, -1.09) 30 (30.30) 6 (6.06)

Stunting median z-scores (IQR) and prevalence, by age groups (n=227)

1Based on the WHO Child Growth Standard

Overall stunting prevalence was 28.19% in this population


Association Between Risk Factors and Stunting: Unadjusted and Adjusted

Variables OR (95% CI) P-value aOR (95% CI) P-value (Wald)

Hand washing at critical moments

No Yes

0.47 (0.21-1.07)

0.07*

0.51 (0.23-1.17)

0.11

Fever/Malaria No Yes

0.26 (0.08-0.89)

0.03*

0.26 (0.07-1.00)

0.05**

Livestock herding Yes No

1.22 (0.73-2.02)

0.43

1.16 (0.72-1.88)

0.52

Child sex Male Female

0.69 (0.36-1.34)

0.27

0.68 (0.33-1.99)

0.28

Child age (months) 6-11 12-17 18-23

1.73 (0.71-4.19) 2.8 (1.16-6.77)

0.22 0.02*

1.62 (0.65-4.02) 2.51 (1.00-6.35)

0.15


Univariate findings: stunting & wasting in same child

No livestock Own livestock Total

Not stunted + wasted 40 (93.02) 180 (97.83) 220 (96.92)

Stunted + wasted 3 (6.98) 4 (2.17) 7 (3.08)

Total 43 (100.00) 184 (100.00) 227 (100.00)

P-value=0.03

Chi-squared test of livestock by stunting + wasting (n=227)

Double burden of stunting + wasting significantly more common in those who do not own livestock


Limitations

• Cross-sectional

• Low statistical power

• Info on micronutrient deficiencies, maternal nutritional status, maternal education, pregnancy outcomes, socio-economic status not available


Recommendations

Program Specific

• Address poor WASH practices among Samburu

• Address access to health care for pastoralist communities

• Improve dietary diversity among children under two

• Increase integration in RH, WASH, health, and nutrition programs to address multifactorial risk factors


Data/Measurement-Related

• Consider powering SMART to look at stunting as well

• Adjust reporting functions in ENA to include stunting

• Ensure data quality (unique IDs to linking datasets)

• Improve M&E integration: RH, WASH, nutrition, infectious disease

• Trials needed to determine best measurement of wasting (MUAC vs. WHZ) in pastoralist before meaningful work on stunting + wasting

Recommendations


Thank you!

stunting and wasting in children under 2 in a semi-nomadic pastoralist population in kenya...

Healthcare