Nutritional Management of Childhood Diarrhoea in Korogocho Slum Nairobi County, Kenya

Special Article - Malnutrition

Ann Nutr Disord & Ther. 2017; 4(2): 1046.

Nutritional Management of Childhood Diarrhoea in Korogocho Slum Nairobi County, Kenya

Mwaniki M¹ and Kimiywe J²*

¹Kenyatta University, Department of Community Health, Kenya

²Kenyatta University, Department of Food, Nutrition and Dietetics, Kenya

*Corresponding author: Judith Kimiywe, Kenyatta University, Department of Food, Nutrition and Dietetics, Nairobi, Kenya

Received: March 09, 2017; Accepted: May 30, 2017; Published: June 06, 2017


Background: Diarrhea is the second leading cause of death in children under five years old worldwide. Diarrhea is the third most common cause of mortality and morbidity in Kenya, with a case fatality of up to 21 percent causing approximately 9 percent of deaths in children less than five years of age. The primary focus of diarrheal disease control programs has been on improved case management through the promotion of oral rehydration therapy, while nutritional management has been relatively neglected.

Objective: The purpose of this study was to determine caregivers’ knowledge on nutritional management of childhood diarrhea and assess nutritional status of the children.

Methodology: This was a descriptive cross sectional survey that was carried out in Korogocho slum, Nairobi County. Semi structured interviewer administered questionnaires and focus group discussions were used to collect data. Cluster sampling was used where several steps were taken in selecting the sample. Participants of focus group discussion were selected through purposive sampling. A sample size of 354 caregivers was selected. Chi square was used to test for statistical associations.

Results: Almost a third of the respondents (32.5%) had secondary education. Only 7.3% of caregivers had high level of knowledge on nutritional management of childhood diarrhea. Prevalence of diarrhea was 17.8%. Most of the caregivers (61.3%) gave less amount of solid food, however only 13.9% reduced amount of breast milk. Some caregivers had used food remedies such as sorghum or wheat porridge to manage diarrhea. Underweight, stunting and wasting levels among study children were 16.6%, 29.1% and 7.6% respectively.

Discussions and Conclusions: The level of wasting was higher in children who had diarrhea two weeks preceding the survey (14.29%) compared to those who didn’t have diarrhea (6.2%). The study demonstrated that caregivers’ were not well informed on optimal feeding, zinc supplementation, and growth monitoring of children during diarrhea.

Keywords: Diarrhea; Nutritional management; Children under five years; Slum


APHRC: African Population and Health Research Center; EBF: Exclusive Breast Feeding; FGD: Focus Group Discussion; MOH: Ministry of Health; SPSS: Statistical Package for Social Sciences; WHO: World Health Organization.


Diarrhea is defined as having loose or watery stools at least three times per day, or more frequently than normal for an individual [1]. It now causes about 11 percent of child deaths worldwide, 90 percent of these deaths occur in sub-Saharan Africa and South Asia [2]. Diarrheal disease cause nearly one in five children deaths-about 1.5 million each year, around 760,000 children are under five. It is second to pneumonia, which together with diarrhea account for almost 40 percent of all child mortality across the globe every year [1]. Africa and South Asia account for more than 80 percent of all child deaths resulting from diarrhea [3]. In addition, 75 percent of these deaths occur in only 15 countries with Kenya ranked at number 10 in this list [4]. There are three clinical types of diarrhea: Acute watery diarrhea, acute bloody diarrhea also called dysentery and persistent diarrhea [5].

The primary focus of Diarrheal Disease Control (CDD) programs has been on improved case management through the promotion of Oral Rehydration Therapy (ORT), while nutritional management has been relatively neglected [6]. Poor child feeding practices in particular during diarrhea, are important determinants of growth faltering and malnutrition [7]. This study addressed the gap which is the focus on Oral Rehydration Treatment (ORT) of diarrhea without integrating nutrition management to prevent malnutrition.

Children with severe acute malnutrition complicated by diarrhea have a higher risk of death than those who do not have diarrhea [8]. According to the maternal, infant and young child nutrition, national operational guidelines [9], it is recommended that children less than six months of age should be breastfed more frequently, emptying one breast at a time, take zinc tablets, vitamin A supplement (50000IU) and ORS solution as instructed by the health care worker. Children above six months of age should take extra foods, breastfeeding, fluids, soups, fermented milk, fruit juices and safe water. Children should take small amounts of foods they like most, a variety of nutrient rich foods, breastfeeding and take antibiotics only when there is blood in the stool. After illness or during recovery, the child’s nutrition and health status should be monitored every month during recovery period, take extra breastfeeds and use extra rich foods that are energy dense. Children aged 6-8 months should be fed 2 times a day. Children aged 9-11 months should be fed 2-3 meals plus 1-2 snacks preferably fruit or milk based while children aged 12-59 months should be fed on 3-4 meals and 2 snacks preferably fruit and milk [9]. The common causes of acute watery diarrhea are viral, bacterial, and parasitic infections. Rotavirus and Escherichia coli are the most common etiological agents of diarrhoea in developing countries [10].

Caregivers play a central role in the effective management of childhood diarrhea. Correct home treatment with oral rehydration and adequate food is crucial to prevent deterioration of the child’s condition [11]. Childhood diarrhea is an important cause of malnutrition, which can be worsened when caretakers limit nutritional support. Some caregivers perceive feeding during diarrhea to be harmful. Most caregivers discontinue normal feeding or give less food. Misperceptions of the role of feeding during diarrhea pose a significant health risk for children. Continued feeding during diarrheal episode and continuing or increasing breastfeeding is critical for breaking the vicious cycle of diarrhea and malnutrition [12]. Continued feeding is associated with better clinical outcomes and better recovery of the intestinal function. Thus continuation of feeding during diarrheal episodes is an important component of the Integrated Management of Childhood Illness (IMCI) [13]. The purpose of this study was to determine caregivers’ knowledge on nutritional management of childhood diarrhea and assess nutrition status of the children.

Materials and Methods

The study used a descriptive cross sectional design to determine the knowledge regarding nutritional management of childhood diarrhea at home among caregivers of fewer than five years and determine the nutrition status of these children.

The dependent variable was caregiver knowledge on nutritional management of childhood diarrhoea. To measure knowledge, a correct response in the questionnaire was given a score of one, and incorrect one, a score of zero. Percentages using an index of Ashur’s criteria [14] were used for describing level of knowledge. By this criterion, below 40 percent score of the respondents was considered low level of knowledge, 40-59 percent was considered average level, a score of 60-80 percent was considered high level, while above 80 percent was considered very high level of knowledge.

Child malnutrition was indicated by three anthropometric indices: height-for-age (H/A), which indicates the level of stunting, weight-for-age (W/A), which indicates the level of underweight, and weight-for-height (W/H) which indicates the level of wasting. Socio economic variables included; marital status, religion of the caregiver, caregiver’s education level and occupation of the caregiver. Demographic variables included caregiver’s age, child sex, child age, child birth order, number of children under five years of age, and diarrheal occurrence.

The target population was caregivers who had children 0-5 years old in Korogocho slum, Nairobi County. The inclusion criteria for the study participants was caregivers who had at least one child who was 0-5 years old, had resided in Korogocho slums for at least six months and was willing to participate in the study. Caregivers with children who were suffering from other illnesses were excluded, because this could have affected food intake and hence the nutritional status of the child.

Sampling technique for the study

Cluster Sampling was used to select eight villages namely: Ngomongo, Ngunyumu, Highrigde, Grogan, Gitathuru, Kisumu Ndogo, Nyayo and Korogocho in slums of Nairobi. Simple random sampling was done in a single step with each subject selected independently of the other members of the population. Lottery method of simple random sampling was used to pick respondents from each village, study subjects then were selected by systematic random sampling from the population by selecting every 8th subject from the list. According to APHRC [15] the estimated number of households in the larger population of Korogocho was 18,537. The estimated number of households reported with under five who had diarrhea, that is 3140 was divided by the desired sample size that is 354, to yield a sampling interval of 8. Purposeful sampling method was used to select the participants for focus group discussions. A total of 354 mothers with children less than five years were sampled for the study.

Data collection

A questionnaire with both open-ended and close-ended questions was used to interview the caregivers on two aspects; (i) The Socio- Demographic Characteristics domain contained questions related to caregivers’ age, marital status, employment status, educational level and household income level, number of children less than 5 years-of age in the family, age and sex of child. (ii) The Knowledge domain which included questions regarding caregiver knowledge on nutrition management of childhood diarrhea.

Pretested focus group discussion guide was done in the three villages on groups of 8-12 women whose children were below five years of age. Participants were recruited with help of the Community Health Volunteers following administration of the informed consent.

Anthropometric measurements were performed by standard methods according to WHO Child Growth Standards for growth monitoring [16]. The weight of the children was taken in light clothing using a digital scale to the nearest 0.1kg. The length of children 0-23 months of age and length of children above 2 years were measured to the nearest 0.1cm. Mid-Upper-Arm Circumference (MUAC) was measured midway between the tip of the shoulder and the tip of the elbow to the nearest 0.1cm.

Pretesting of the questionnaires and anthropometry measurements was conducted on 10% of the study sample, and these were excluded from the study.

Data management

Coding, entry and analysis was done using SPSS software version 20. Chi square was used to test the association among variables. The confidence level was set at 0.05 (95%) as recommended for most descriptive researches [17]. Descriptive statistics such as percentages and frequencies were used to describe the data while tables and charts were used to represent the results. The qualitative data, from the focus-group discussions, was categorized and analyzed using thematic content analyses. The nutritional status data was compared with WHO Child Growth Standards [16] and presented as Z-scores with cut off point of -2 SD using indicator of weight for age, weight for age and weight for height in order to get those children who were wasted, underweight or stunted respectively. Child anthropometry was analyzed using ENA for Smart software. Z-scores were calculated for height-for-age, weight-for-height, and weight-for-age using computer-based software ENA for Smart. Mid-Upper Arm Circumference (MUAC) : <11.5cm: Severe Acute Malnutrition, 11.5-12.4cm: Moderate Acute Malnutrition, 12.5-13.5cm: risk of acute malnutrition and >13.5cm: child well nourished. Children with Z-Score below < -2SD and/or MUAC below 12.4cm were taken to be malnourished.

Ethical considerations

Ethical clearance to conduct research was grant by Kenyatta University Ethical Review Committee, a permit to carry out the study was also given by the National Council of Science, Technology and Innovations of Nairobi, Kenya. Consent for participation was sought from the Ministry of health, the selected health facilities and mothers of children 0-59 months old.


Socio demographic characteristics of caregivers

A total of 354 caregivers (age 17-55 years) distributed within five out of the eight villages of Korogocho slum were interviewed. Attributes such as age, level of education and marital status are presented. Most of the caregivers were of the age 21-30 years. Majority of the caregivers (89.3%) were mothers, grandmothers were 3.4%, while other caregivers were 7.3%. Female caregivers were 346 while male caregivers were eight (Table 1).