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Globally, child malnutrition and poor cognition issues of public health importance. Sub Saharan
Africa records the highest levels of malnutrition with 39% of children being stunted, 4%
underweight and 10% wasted while in Kenya, 26% are stunted, 4% wasted and 11% underweight.
Most growth faltering in children occurs after the six months of life when exclusive breastfeeding
has been stopped, exposure to diseases is high and demand for nutritional needs increases due to
rapid growth and development. Nutrition in the first 1,000 days of life is key in child’s ability to
grow but after the second year of life, malnutrition can be been linked to reduced cognitive
outcomes, poverty, low human capita, reduced school and work performance. Compared to
developed nations, there is limited documented data on the relationship between child nutritional
status and cognitive development in developing countries. Kenyan Government integrated
Community Health Workers into the health system through the Health Community Strategy
program whose main aim was to ensure improved nutritional status and cognitive development
among all children. But since its launch in 2007, there has been limited studies on the effectiveness
of CHWs yet that finding could be key in upscaling the program. In 2013, World Vision trained
the CHWs in the Health Strategy program and used them to implement the Timed and Targeted
Counselling nutrition intervention in Kisumu County. The trained CHWs delivered key nutritional
messages on nutritional status and cognitive development at a particular time during child’s growth
as they engaged and counseled caretakers on health status of their children from time of delivery
until child was two years old. CHWs in Migori County which was the comparative group did not
receive any specialized training from World Vision on timed and targeted counseling. Trained
CHWs have the potential of improving the nutritional status and cognitive development among
children. The objective of this study was to establish the impact of CHWs on the nutritional status and cognitive development of children in Katito in Kisumu County with a comparison at Kegonga
Ntimaru in Migori County. Quasi experimental study design was used with secondary baseline
data obtained from World Vision database and endline data collected and analyzed. WHO Z scores
computed child’s underweight, overweight, stunting and wasting status while Bayleys Scale of
Infant Development Kit assessed the Cognitive scores of children with categories computed using
the Bayleys composite score. Food Frequency questionnaire collected data on dietary intake and
nutrient inadequacies were computed based on the Recommend Daily Allowances. Qualitative
data collected information on the perception of CHWs’ knowledge on nutritional status and child
cognition. STATA 13.1 and NVivo 7.0 analyzed quantitative qualitative data respectively.
Descriptive statistics summarized data into frequencies, means and standard deviation. Chi-square
and independent sample t-test assessed the relationship between two variables while Multinomial
logistic regression analyzed the relationship among variables. The level of significance was set at
p<0.05. At baseline, there was no significant difference in the levels of underweight and
overweight (chi2=8.73, p=0.068), wasting (chi2=0.25, p=0.885) and stunting (chi2=2.79, p=0.25)
among children at Katito and Kegonga Ntimaru sites. After three years of intervention
implementation at Katito, the prevalence of underweight reduced by 21.6%, overweight increased
by 8.3% (chi2=21.55, p<0.001) and wasting reduced by 26% (chi2=22.54, p<0.001). Only 61%
and 48% of children were exclusively breastfed in Katito and Kegonga Ntimaru respectively. A
total of 43% of children in Katito and 50% at Kegonga had inadequate iron sources from their
diets. Only 5% and 34% of the children had cognitive scores that were below average at Katito
and Kegonga Ntimaru respectively (Chi2=15.8537, p<0.001). The CHWs were perceived to be
knowledgeable on child nutritional status but had little knowledge on key foods for child cognition.
In Katito, it was found that exclusive breastfeeding was linked to child underweight and overweight status (Chi2=27.13, p=0.04) while stunting was linked to duration of breastfeeding
(Chi2=16.72, p=0.033). Children with cognitive scores that were above average had 8 times less
Relative Risks of being underweight compared to those with scores that were below average [RRR:
0.194: 95% CI: 0.06-0.624; p=0.0006] while those who were exclusively breastfed had 0.02 times
more Relative Risks of being severely wasted compared to those who breastfed for 3 months
[RRR: 0.028: 95% CI: 0.05-2.64; p=0.03]. The presence of CHWs led to reduced prevalence of
underweight but increased the overweight status of same population thus concluding that double
burden of malnutrition is already existing in communities with children at early age at higher risk.
This study recommends the use of CHWs to implement nutrition interventions and that
interventions to focus on child overweight. Further research on nutritional outcomes and cognitive
development at early age of growth is also recommended. Nutrition interventions to target this age
period as is the window period of opportunity |
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