論文の公開元へEffects of Maternal Nutrition Education on Children's Nutrition and Health in Nairobi, Kenya
概要
Introduction: Inadequate maternal nutrition knowledge on appropriate infant feeding may increase poor child health outcomes. Moreover, urban slums may pose risk to child health due to poverty, food insecurity, poor sanitation and high infections. As a result, African Population and Health Research Center (APHRC) conducted a home-based maternal nutrition education and counselling from 2012-2015. However, it’s not well known if mothers living in urban slums can adopt and practice healthy behaviours for longer because of other underlying risks.
Objective: The main purpose was to evaluate the effect of maternal nutrition education and counselling on child’s birth outcomes, linear growth from birth to five years and prevalence of anaemia at the fifth year, while assessing determinants of these health outcomes.
Methodology and analysis: This was a follow-up study of a randomized controlled trial (RCT) which was conducted in two urban slums of Nairobi, Kenya. A total of 1,555 pregnant women were recruited during pregnancy. However, about 1001 mother-child pairs remained in this cohort at birth. Data was collected twice during pregnancy and when the infants were 1, 4, 7, 9, 11 and 13 months old. A total of 438 mother-child pairs participated in the 2018 follow-up when the average age of the children was 55 months. The effects of the intervention on child birth outcomes, anaemia prevalence and linear growth was tested by constructing multivariate logistic regression and linear fixed effect models with adjustment of confounders.
Main results: The mean (SD) gestation age at birth of all the children was 38.4 (3.9) weeks and the mean birth weight was 3.24 (0.52) kg. A significantly higher proportion of preterm and low birth weight babies were born in the control (27.6%, 6.7% respectively) than in the intervention group (23.2%, 2.5% respectively). Moreover, child mean (SD) length one month after birth was 53.6 (4.2) with more stunted children in the control group, 124 (27.2 %), as compared to the intervention group, 93 (23.9 %).
Subsequently, length-for-age z-scores decreased from birth to the 13th month, mean (SD) -1.42 (2.04), with the control group (33.5%) reporting a significantly higher prevalence of stunting than the intervention group (28.6%). Conversely, the scores increased in the 55th month, mean (SD) -0.89 (1.04), with significantly more males stunted in the control group (16.5%) than in the intervention group (8.3%). At the mean (SD) age of 55.9±5.3 months, their mean (SD) haemoglobin was 10.71± 1.47 g/dL. A total of 33.9% had mild anaemia, 24.7% moderate and 1.2% severe with similar proportions in both study groups.
Overall the intervention group had lower risk for low birth weight, preterm delivery and stunting, while children born in Korogocho slums, maternal mid-upper arm circumference of <23cm, mother’s stature of <154 cm, child often vomiting/regurgitating food, being a male child, early weaning, absence of a home toilet, fully immunized child, non-anaemic mother, were some of the factors that increased the risk of poor birth and nutrition outcomes in children.
Discussion: The present study findings report a significant reduction of low birth weight, preterm births and stunting among under five-year-olds through offering personalized home- based nutrition education and counselling. Possibly, the intervention augmented maternal nutrition knowledge as demonstrated by better nutrition, good hygienic practices and adequate child feeding practices among the intervention group. Stunting prevalence was high from birth. Previous studies indicate that 20% of stunting can be attributed to small for gestational age hence, need to initiate nutrition interventions prenatally. Additionally, a high prevalence of anaemia was observed at the fifth year. The prevalence was above 40%, a cut off considered as a severe public health problem as classified by WHO.
Extant findings report that nutrition education and counselling was associated with an improvement in pregnant women’s diet by increasing their protein and calorie intake, increased child head circumference and birth weight, improved infant and young child feeding practices (IYCF). However, studies reporting the intervention effect on stunting and reduction of anaemia are inconclusive. Previous studies suggest that the contradictory findings are likely to emanate from differences in the duration and intensity of the nutrition counselling provided, the different set-ups for delivering education messages, mode of delivering nutrition education messages, differences in food security status and other underlying risk factors in the study areas. Besides, the present study identified predictors of poor child nutrition outcomes. Therefore, it is important to consider all these factors when implementing such interventions.
Conclusion: Findings from the present study proved that training community health care workers to deliver a personalized home-based nutrition education and counselling during antenatal and postnatal period was associated with an improvement in pregnant women’s nutrition status, improved child birth outcomes and reduced stunting among under-five years. Long-term benefits of this intervention on children’s health need to be elucidated. This finding demonstrates the potential effectiveness of actively engaging trained community health workers under the community health strategy to promote optimal antenatal and postnatal care services, especially in underserved settings such as among the urban poor populations.
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