ABSTRACT
Marginal mixed farming households are prone to frequent drought and hardly meet their food intake requirements which make the under-five children more vulnerable to malnutrition. The purpose of this study was to establish the determinants of nutritional status of children aged 6-59 months in marginal mixed farming households in Ntugi location, Tharaka Nithi County, Kenya. A sample of 106 households was randomly selected for data collection. Structured questionnaires, key informant guide and focus group discussion guide was used to collect data on demographic and socio-economic characteristics, feeding practices, water and sanitation, morbidity status and health seeking behavior. Statistical Package for Social Sciences (SPSS) version 20 was used in descriptive and inferential analysis. Anthropometric data was analyzed using ENA for SMART and interpreted using WHO (2006). The average household size was 5 members while the mean maternal age was 27.31 0.60years. More than half (67%) of mothers had not completed primary education. The mean household income was Ksh.  7, 279 mainly (53.6%) from sale of farm produce. The mean household productiosn from  previous  season  was  236.89   22.21  kg of cereals/grains  and 259.78 21.68 kg of legumes/pulse. Continued breastfeeding rate at one year was 92.3% and 66.7% for two years and above. All breastfeeding infants aged 6-8 months met the minimum meal frequency requirement. Less than half (47.3%) of the children had minimum dietary diversity. Minimum acceptable diet rate was 21.2% and 25.0% for breastfeeding and non-breastfeeding children respectively. Majority (81.2%) of the children who were sick two weeks prior to the survey had fever. Sixty five (65%) percent of the children were fully immunized while 61.1% of children aged 6-11 had received vitamin A supplementation within the last six months. Use of bush to dispose human waste was at 15.5%. The study showed that the stunted children were 32.1%, 20.2% were underweight and 7.3% were wasted. The morbidity status in the last two weeks prior to the survey was at 29.4%. The Pearson’s chi-square test showed that there was a significant association between the age of the mother and wasting for children aged 6–59 months (p = 0.008). Further, the study established that underweight and wasting was associated with household size (p = 0.009 and 0.029 respectively). Seasonal household food production was also associated with underweight of children. The County Government of Tharaka Nithi needs to domesticate National Agricultural Sector and Extension Policy through legislation to improve and sustain food production in marginal mixed farming households in the County. A longitudinal study on household determinants of under-fives nutritional status is recommended for further study.
CHAPTER ONE: INTRODUCTION
             Background to the Study
Malnutrition among children under-five years is increasingly becoming a health concern globally. Its effects are not only long term but also severe and costly. Nutrition status for under-fives reflect among other things, the level of socio- economic developments, feeding practices, their morbidity status, sanitation conditions and health seeking behavior. Malnourished children are prone to diseases, have low cognitive ability, their growth is impaired and have shorter life expectancy compared to well-nourished peers (Myalew, 2014; WHO, 2012). According to Lumey et al. (2010) malnutrition contributes significantly towards under-five morbidity and mortality in developing countries.
Management of malnourished children drains household’s resources and reduces its productivity in the long run. According to Garcia et al. (2013), children from poor households, those who are poorly cared for, and those whose mothers have low level of education are highly at risk of stunting. Devlin et al. (2012) shows that malnutrition diminishes gross domestic product. Nations allocate huge budget on health care and special education to the stunted children. Globally 26% of children aged 6-59 months are stunted and 143 million children are underweight in low and middle income countries (WHO, 2012). In Kenya, the proportion of under-fives who were stunted declined from 35% in the year 2008 to 26% in the year 2014. In the same period the proportion of wasting for under-fives decreased from 7% to 4% while that of underweight dropped from 16% to 11% (Kenya National Bureau of Statistics (KNBS) and International Classification of Functioning (ICF) Macro, 2015). In children, malnutrition is most likely to strike those who lack nutritionally adequate
diets; those who are not protected from frequent illnesses and those practising poor health behaviour (Jehn and Brewis, 2009).
In 2011, Famine Early Warning System Network (FEWSNET) reported serious food security risks persisting across much of Arid and Semi-Arid land (ASAL) in Kenya, and particularly in the marginal mixed farming. Ntugi Location is in Tharaka South Sub-County which is mostly a marginal mixed farming zone. Marginal farming communities in Eastern region of Kenya depend mostly on the short-rains agricultural season to meet their household food requirements. According to the World Food Program (WFP), successful harvest is thus critical if households are to produce adequate food reserves to carry the family throughout the year (WFP, 2011; Olwande, J., & Mathenge, M., 2010). Understanding the determinants of nutritional status of children aged 6-59 months at household level in marginal mixed farming livelihood provides insights in designing interventions for reducing the high levels of under-five malnutrition in these zones and by extension in Kenya.
             Problem Statement
According to International Center for Research and Development (ICRD), nutritional status of children is an outcome of many intertwined factors, including nutrient intake, health, parents’ economic status and behavioral factors governed by parental preferences (ICRD, 2012). A study by Kanjilal et al., (2010) on nutritional status in Sub-Saharan Africa and India revealed the importance of household level determinants of children’s nutritional status.
Most of the households in the marginal mixed farming in Tharaka Nithi County face critical food shortage (WFP, 2011;FEWSNET, 2013). Mid Upper Arm Circumference (MUAC) from Early Warning System (EWS) bulletin by National Drought Management Authority (NDMA) consistently showed about 15% of under-fives are at risk of malnutrition in marginal mixed farming zones in Tharaka sub-County (NDMA, EWS 2013). Ntugi Location is in the Marginal Mixed Farming zone of Tharaka South Sub-County.
The Positive Deviant Inquiry (PDI) study in Ntugi Location established that 27.8% of the children aged between 6 and 36 months were stunted (Plan International, 2011). According to Kenya Demographic and Health Survey (KDHS), stunting rate for under-fives in Tharaka Nithi County was 32.9%, 10.8% for underweight and 3.3% for wasting (KNBS and ICF, 2015).
Although the outcomes of malnutrition in under-five children are well known, determinants of malnutrition have not been exhaustively studied. The PDI and EWS show high level and risk of malnutrition in the area, but the determining factors at the household level are not explored by these studies and surveillance systems. It is at the household level that human behavior which affect nutritional status of children mainly occur. An understanding of determinants of under-five nutritional status is a key component in designing long term interventions. This study, therefore, established the determinants of nutritional status of children aged 6-59 months in marginal mixed farming households in Ntugi Location, Tharaka Nithi County.
             Purpose of the Study
The purpose of this study was to establish the determinants of nutritional status of children aged 6-59 months in marginal mixed farming households in Ntugi Location, Tharaka Nithi County, Kenya.
             Objectives of the Study
The objectives of this study were to:
- Establish demographic and socio-economic characteristics of marginal mixed farming households.
- Establish feeding practices of children aged 6-59 months in marginal mixed farming households.
- Assess morbidity status, water and sanitation, and health seeking behaviour among the children aged 6-59 months in marginal mixed farming households.
- Assess the nutritional status of the children aged 6-59 months in the marginal mixed farming households.
- Establish the relationship between demographic, socio-economic characteristics, feeding practices, morbidity status and nutritional status of the children aged 6-59 months in marginal mixed farming households.
             Hypotheses of the Study
The study hypothesized that:
Ho1: There is no relationship between demographic, socio-economic characteristics and nutritional status of children aged 6-59 months in marginal mixed farming households.
Ho2: There is no relationship between feeding practices and nutritional status of children aged 6-59 months in marginal mixed farming households.
Ho3: There is no relationship between morbidity status and nutritional status of children aged 6-59 months in marginal mixed farming households.
