The study identified various factors affecting nutritional status among children <5 years which need to be adequately addressed. This included both pre-natal and post-natal factors as well as infant and young child feeding practices. Therefore consistent follow up of pregnant mothers from the antenatal period and post-natal care of the children <5 years needs to be enhanced.
Under-nutrition was the predominant form of malnutrition among the study participants. However, the rising number of cases of over-nutrition point to the growing trend of double burden of malnutrition. Among the undernourished, we found that stunting was the most common form of malnutrition, followed by children who were underweight and wasting being the least common among the study population. Stunting was common among cases of under-nutrition and over-nutrition alike. Stunting is a chronic form of malnutrition that results from prolonged non-adherence to proper dietary requirements to meet the body’s physiological needs. These findings were similar to those of a demographic and health survey carried out in the Western Kenya in 2014 [6]. Other studies carried out in Burundi and Uganda also had similar findings [10, 11].
Deworming of children >1 year of age was also found to be protective of under-nutrition. This finding was in line with another study done in India among pre-school children which showed substantial weight gain among children who were dewormed [12]. This is because intestinal nematodes affect absorption of both micro and macronutrients which are vital for a child’s growth. However, current systematic reviews show little benefit is derived from mass deworming. They show that children found to be worm infested are the ones that gain weight more significantly compared to non-worm infested children [13, 14].
Proper breastfeeding practices for children are advocated for by WHO [15]. Children that are breastfed up to 2 years of age show quicker linear growth than those breastfed for shorter durations [2]. Feeding practices such as bottle with nipple feeding, breastfeeding within thirty minutes of delivery, exclusive breast feeding for 6 months and cessation of breastfeeding at 2 years were also assessed during the study. However, they were not statistically significantly associated with under-nutrition. In contrast, the giving of pre-lacteal feeds adversely affected nutritional status and predisposed the children to under-nutrition. This has also been shown by other studies [16] [17] [18]. This could be due to the fact that pre-lacteal feeding affects the quality and quantity of breastfeeding which in turn affects the nutritional intake by the child. As such, proper education on feeding practices during post-natal period should be enhanced.
Children with under-nutrition were also shown to be more likely to have delayed developmental milestones. This finding was consistent with other studies [19] [20, 21]. This could be because they lack the macro and micronutrients necessary for normal growth and development. Children with prematurity and low birth weight also had higher odds of under-nutrition. These findings were similar from a review done in several countries [22]. This could be due to the fact that they require more nutrients for catch-up growth which if not provided in adequate quantities leave them vulnerable to develop under-nutrition. These children should therefore be followed up more closely.
We also found that lack of parental formal education was linked to development of under-nutrition with paternal illiteracy being shown to have a greater influence. This finding concurred with other studies [23] [18]. This could be due to the fact that the community being a patriarchal society, the fathers control the family’s resources. As such, lack of formal education could mean no formal employment and by extension no regular source of income to provide for their families.
Our study also showed that the cases of over-nutrition were also high despite the hospital serving a population of predominantly low socio-economic status. This clearly points to the double burden of malnutrition that is supported by other literature based on a critical review done in other lower middle income countries [24]. This is a new development over the last couple of decades that needs to be further explored to halt and decrease the burden of cases of over-nutrition.
During the study period, children aged less than 12 months were more likely to be over-nourished. This finding was similar to another study carried out in Kenya in 2009 [25]. This could be due to the fact that younger children are more likely to receive more attention and feeding effort from their parents as compared to older children. Male gender was also positively associated with over-nutrition. A study carried out in Kenya in 2016 had similar findings [26]. This could probably be due to the value and cultural preferences placed on the male child. As such, they are likely to be better fed as compared to the girl child. This has also been shown in other Sub-Saharan African countries [27]
Children who came from households in urban areas and those who came from families with higher average monthly income had higher odds of over-nutrition. This finding was similar to other studies [25]. This could be due to the higher levels of income which increase their ability to provide more than enough nutrition for their growing children.
Maternal lack of formal education also increased the chances of developing over-nutrition. This finding was contrary with other studies carried out in Sub-Saharan Africa [27]. High birth weight was also linked to increased chances of over-nutrition. This has also been shown by other studies [27, 28]. However, the exact mechanism of this link has not yet been clearly described.
The study had some limitations. It was a hospital-based case control study and as such, its findings cannot be generalized to the entire population of under-five children in Western Kenya. The data collected on some of the variables could be susceptible to recall bias more so if the child was brought in by a guardian.