| dc.description.abstract | Safe water, improved sanitation, hand hygiene and infant feeding are community-based interventions that have been implemented to improve malnutrition and diarrhea and bidirectional diarrhea- malnutrition outcome among under-fives. Nevertheless, their benefits are limited in informal settlements. About half of under-fives from developing countries lack hand washing facilities; 37% and 63% are exclusively breastfed and receive any breast milk within 6-23months
respectively. Study aimed to develop a framework for community based interventions for the prevention of malnutrition, diarrhea and bidirectional diarrhea- malnutrition among under-fives. Findings of the study provides other researchers and readers with useful information for reference and suggest critical policy ideas through its recommendations. A cross-sectional study design using mixed methods, was conducted in hospitals and communities. The sample comprised 105
under-fives and their care-givers, 6 pediatric unit in-charges, 20 community health promoters(CHPs) and 2 sub county community health service coordinators (SCCHSCs) participated. Specific objectives were to determine occurrence of malnutrition, diarrhea and bidirectional diarrhea-malnutrition among under-fives; identify practices that are associated with risks and to develop a framework of community based interventions for prevention of
malnutrition, diarrhea and bidirectional diarrhea malnutrition. Objectives one and two were implemented in the hospitals; the second and third objectives were addressed in the community. Care givers CHPs and SCCHSCs were included through census and purposive sampling methods while pediatric unit in-charges were selected purposively. Data was collected using semi structured questionnaires, interview guides and focus group discussions. Quantitative and qualitative data
were analyzed using descriptive and inferential statistics and content and thematic analyses respectively. The results showed that 52 and 53 under-fives had malnutrition and diarrhea respectively. The high occurrence of malnutrition and diarrhea ranging between 71.7% and 78.85% was among the ages 6-23 months; other groups had 13.46- 18.87% < 6 and 7.69- 9.43% 24-59 respectively; 56.67% with MUAC < 115mm were females. Fisher’s exact test of association
between malnutrition and gender revealed a statistically significant relationship at 5% significance level (P-value < 0.05). Of the 33 cases with bidirectional diarrhea-malnutrition, n=28 (84.85%) were aged 6-23 months and 21 (63.64 %,) had diarrhea then malnutrition; 38% with malnutrition and 73.58% with diarrhea had their fingernails untrimmed; under-fives of caregivers who experienced water shortage were 5.4 times more likely to have bidirectional diarrhea -malnutrition
(OR=5.40, 95%CI=1.49-19.59, P-value=0.01; 67.3% -83.02% of under-fives with malnutrition and diarrhea respectively were on complementary feeding, 36.54% and 37.7% with malnutrition and diarrhea respectively lived in households not treating drinking water. Community health assistants had inadequate knowledge on early initiation of breast milk, Complementary feeding, construction of any type of latrine where there is none. In conclusion, occurrence of malnutrition
and diarrhea is high in age groups 6-23 months; caregiver practices like partial adherence to hand washing, failure to trim fingernails of under-fives are risks for malnutrition, diarrhea and bidirectional diarrhea malnutrition and a framework for strengthening community based interventions has been developed. This study recommends that national and County governments should put in place strategies that focus on prevention of bidirectional diarrhea malnutrition
among under-fives; studies be conducted to determine if the practice of complementary feeding among caregivers is associated with malnutrition and diarrhea and the developed framework should further be validated in other settings to ensure wide utilization in the region for prevention of bidirectional diarrhea malnutrition among under-fives. | en |
