In rural African towns such as Emali and the surrounding counties, deterioration in food security is evident due to severe rainfall deficits over the last several years in this semi-arid climate. The 2008-09 Kenyan Demographic and Health Survey (DHS) indicated that 38% of preschoolers in the Emali region are chronically malnourished defined by height-for-age Z scores <-2 SD. Malnutrition during childhood results in increased morbidity, and impaired physical and mental development, which together have a negative impact on health and productivity in adulthood.
In an effort to combat malnutrition among preschoolers, ChildFund began supplying two daily meals to preschoolers attending their Early Childhood Development Centres in Emali and surrounding counties in 2002. However, the nutritional status of the preschoolers is unknown. Therefore, the objective of this study was to assess the anthropometric and selected micronutrient status from fasting blood samples of the 514 preschool children from 23 preschools, along with their socioeconomic, health and hygiene characteristics. We also assessed and evaluated the dietary adequacy of the school meals currently provided to the children by ChildFund, which is assumed to provide the majority of energy and nutrients, for the purpose of providing recommendations to enhance the energy and nutrient supply.
Of the preschoolers, 55% and 41% were from the Kamba and Maasai tribes, respectively. Almost 50% of Maasai households were in the lowest wealth quintile, had no education, or access to improved toilets compared to <2% of Kamba (P<0.001). Among the Kamba children, the prevalence of stunting was higher compared to the Maasai children (20 vs. 13%; P=0.027), whereas wasting was higher in the Maasai than in the Kamba (6 vs 11%). Chronic infection affected at least 28% of the preschoolers in each tribe. The prevalence of anaemia was much higher in the Maasai (39%) than the Kamba preschoolers (6%), most of which was attributed to iron deficiency based on depleted iron stores and elevated tissue iron levels. Only 12% of the Maasai and 7% of the Kamba children had zinc deficiency, and vitamin A deficiency was also low in both tribes (<22%).
Each school supplied the children with two meals, UNIMIX, a fortified cornsoy blend porridge and Githeri, a traditional meal based on unrefined maize and kidney beans. For the majority of children (3-5 year olds), the energy supplied by the school meals met approximately 40-47% of their age- and sex-specific estimated energy requirements. The median supply of iron, zinc, vitamin A, vitamin B6, folate, and vitamin B12 for the combined meals either met or was above the RNI for children 4-6 years of age, indicating the supply was likely to be adequate. The supply of niacin and thiamin were at a level between the EAR and RNI, while the remaining nutrients (i.e., vitamin C, calcium, riboflavin, and vitamin D) were all below the EAR for a child aged 4-6 years. There was marked variations in the energy and nutrient supply from the meals across school, attributed to the varying thickness of the porridge (i.e., amount of water used) as well as the portion sizes served to the children.
In conclusion, anemias together with chronic infection were highly prevalent among the preschool children and stunting and wasting was of medium risk. The current diets of the children were predominantly plant-based and lacked the energy and many of the nutrients required for optimal growth and development. This study also highlighted the need for standardised school meal recipes. In addition, dietary diversification and modification strategies including the addition of animal protein, fruit and vegetables to the school meals will serve to increase the energy and nutrient supply to the children and improve their current nutritional status.
