Effect of Maternal and Child Health Service Utilization and Feeding Practices on Morbidity and Nutritional Status of Infants in Kwale County, Kenya

Abstract

Availability, access and appropriate utilization of maternal and child health services remain a major challenge in most developing countries including Kenya. This hinders Kenya’s achievement of Sustainable Development Goal number three. Proper care during pregnancy, delivery and nursing periods is important for a mother and her baby. Kwale County has a higher fertility, malaria and stunting rates among children under five years and a lower hospital delivery in comparison to national levels. After introduction of free maternity care, it has not been established if there is an improvement in antenatal care utilization and its health outcomes. This study sought to determine maternal and child health service utilization and infant feeding practices among mothers and their effect on morbidity and nutritional status of infants in Kwale County, Kenya. A prospective cohort approach was used. Purposive sampling was applied in picking health facilities. Systematic random sampling technique was used to select expectant mothers at a pregnancy of 20 weeks and above. Recruitment was based at health facilities while follow up was at facilities and home visits. Upon recruitment, a follow up was done at an interval of four months. At baseline, socio-demographics, and first antenatal care visit were taken while targeted study variables were measured during follow-ups. Chi square tests were used to test for significance between variables of interest. Logistic regression tests were used to test the odds of early or late antenatal care initiation against different study indicators. Two hundred and eighty mothers were recruited. All mothers made at least one ANC visit with 19.6% starting in the first trimester. The proportion of mothers who attended ANC clinics for four or more times during their entire pregnancy was 34.3%. Majority (78.4%) believed exclusive breastfeeding until six months is not sufficient to provide all nutrients for proper growth. There was a significant statistical association between maternal level of education and ANC initiation (p = 0.001), high parity (p = 0.0001), place of delivery (p = 0.012) and use of modern family planning methods (p = 0.0001). Mothers without formal education were four times (OR = 4.687; CI 1.765 – 12.447) more likely to initiate ANC clinics later compared to those with secondary or tertiary education. Multiparous mothers were three times (OR = 2.775; CI 1.107 – 6.960) more likely to initiate ANC later as compared to those without children. Mothers without any formal schooling were seven times (OR = 6.982; CI 1.527 – 31.926) more likely to deliver away from health facilities as compared to those with primary or secondary education. Stunting (p = 0.001) and underweight (0.009) were significantly associated with gender. Boys were 1.7 times (RR = 1.690; CI, 1.240 – 2.304) more likely to be stunted as compared to girls. Age of infant at introduction of complementary food (p = 0.032) and breast-feeding initiation (p = 0.02) were significantly associated to infant anemia. Infants who were weaned early were 1.7 times (RR = 1.735 CI 1.111 – 2.707) as high as the of risk of anemia among those who were weaned at the right time. The risk of anemia among infants who were fed on less or equal to three types of foods was 1.6 times (RR = 1.579 CI, 1.408 – 1.772) high as compared to those fed on more than three types of foods. Dietary diversity was significantly associated to stunting (p = 0.0001; RR = 1.902 CI; 1,310 – 2.761) and underweight (p = 0.009; RR = 2.364 (1.172 – 4.769). The risk of being stunted or underweight among infants whose diets were not diversified was 1.9 and 2.4 times as compared to infants whose diets were diversified. There was no significant association between MCH service utilization and morbidity as well as nutritional status. Timely initiation and appropriate ANC attendance was low. Knowledge and practice of infant feeding was poor. Educating the community on the importance of timely and optimal ANC and infant feeding practices would be vital in improving maternal and child health outcomes in Kwale County.