Factors influencing nutritional status of infants in informal settlement of Obunga Kisumu city, Kenya

Abstract

Undernutrition is common in children under five years of age globally, especially infants, due to their high nutrient needs for growth and development, which increases their susceptibility to infectious and chronic diseases. Informal urban settlements are characterized by high levels of poverty, making them high-risk areas for infant undernutrition. They tend to bear a high burden of undernutrition with varied context-based risk factors. The main objective of this study was to identify factors influencing the nutritional status of infants in the informal urban settlement of Obunga, Kisumu County. The specific objectives were to: explore the community perception of factors influencing the nutritional status of infants; assess the nutritional status of infants; and assess the relationship between socio-demographic, economic, and health-related factors and the nutritional status of infants in the informal urban settlement of Obunga. A cross-sectional mixed-methods study design was used. Purposive sampling was used to select participants for three focus group discussions, each with between 12 and 14 participants, for a total of 40. Infants 0–12 months (n = 124) were randomly selected from a list of 186 infants in Obunga. Data on perceptions of undernutrition and potential localized influencing factors was collected using a focus group discussion guide and analyzed using thematic analysis. A consolidated, structured questionnaire was used to collect quantitative data. Descriptive statistics were used to establish the prevalence of undernutrition, and regression analysis was used to identify factors associated with undernutrition. Results showed that undernutrition was perceived to be due to exclusive breastfeeding, giving too little food, a lack of a varied diet, intestinal worms, low income, carelessness of caregivers, diseases, and giving birth too soon. Stunting was perceived to be due to cold weather or eating cold foods. Prevalence of stunting, wasting, and underweight, were 27.9%, 15.7% and 19.7%, respectively. The prevalence of multiple anthropometric deficits was stunted-wasted 7.4%, stunted-underweight 13.1%, wasted-underweight 14%, and underweight-wasted and stunted 7.4%. Risk of stunting increased with age of infant (AOR=1.16*; 95% CI: 1.01-1.34). Diet diversity and minimum meal frequency was low but did not influence nutritional status. Risk of wasting was associated with diarrhoea (3.57*; 95% C.I:1.05-12.12). Risk of underweight was influenced by age of infant (AOR=1.27*; 95% CI: 1.03-1.57), mother‟s age (AOR= 0.83**; 95% CI: 0.73-0.94) and caregiver being employed (AOR= 6.07*; 95% C.I:1.54-23.93). Risk of being stunted-underweight increased by not handwashing after visiting the toilet (AOR= 0.18*; 95% C.I:0.03-0.86) and having grandmother as caregiver (AOR= 6.15*; 95% C.I:1.09-34.73). Risk of underweight-wasted decreased with increasing mother‟s age (AOR= 0.82*; 95% C.I:0.71-0.95) and increased with caregiver being employed (AOR=5.22**; 95% C.I:1.16-23.53). Risk of stunted-wasted (AOR=9.07**; 95% C.I:1.73-47.51) and stunted-underweight-wasted (AOR= 9.07*; 95% C.I:1.73-47.51) was associated with diarrhoea. Community perceptions, mother‟s age, handwashing after visiting the toilet, caregiver being employed, having grandmother as caregiver and diarrhoea are significantly associated with undernutrition in Obunga and should be addressed when designing community based nutrition interventions in this and similar populations.