Fruit consumption and nutritional status of children aged 6-59 months across agro-ecological strip connecting Kakamega and Siaya Counties, Kenya

The level of child undernutrition remains unacceptably high throughout the world. High prevalence of undernutrition in Kenya is attributable to deficiencies in macro and micronutrients; deficiencies of vitamin A, iron and zinc in the diet are still widespread and a common cause of excess child morbidity and mortality. Further, there is high prevalence of undernutrition and morbidity among children aged 6 to 59 months in agro-ecological strip connecting Kakamega and Siaya Counties. An alternative approach to combating undernutrition in the region could be through consumption of locally available diverse fruits. However, there is scarce information on fruit consumption and its relationship with nutrition status among children in the region. Therefore the objective of this study was to establish the relationship between fruit consumption and nutrition status of children aged 6-59 months across agro-ecological zones connecting Kakamega and Siaya Counties. A cross-sectional analytical design was applied. Measured variables were demographic and socio-economic characteristics, children fruit consumption, morbidity and nutrition status. Stratified random sampling of 371 children aged 6-59 months was done in the agro-ecological zones (UM1, LM1, LM2, LM3 and LM4). However a total of 344 primary caregivers of the children consented to participate in the study; 124 and 220 children from Kakamega and Siaya Counties respectively. A structured questionnaire, 24-hour dietary recall, 7-day food frequency questionnaire, anthropometric measurements, observation checklist and Focus Group Discussion guide were used to collect quantitative and qualitative data. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 18.0. The dietary data was analyzed using South Africa MRC Food finder 3 software (2013) while anthropometric data was analyzed using ENA for SMART software (2011). Pearson’s correlation co-efficient and spearman’s rho were used to establish relationships between variables. Results showed low fruit intake among children (mean of 92.5grams per day and frequency of 1-2days/week). 21% of the children did not consume any fruit in a week. Commonly consumed fruits were banana, mango, avocado, orange and guava. Fruit intake contributed a mean of 55% of total vitamin C and 31% to beta-carotene intake. Significant correlations were observed between on-farm fruit species diversity (rs=0.204), amount spent on fruits (rs=0.249) and number of days fruits are bought in the household (rs= 0.267) with children fruit intake. The prevalence of wasting, stunting and underweight was 2%, 20%, and 8% respectively with more boys being undernourished than girls though the difference was not significant. Mother’s age had a significant correlation (r = 0.141) with MUAC while children’s age was inversely correlated to WAZ (rs = -0.109) and WHZ (rs=-0.109). Household monthly income had a significant relationship with WAZ (rs = 0.127) and HAZ (rs = 0.159). About half of the children were ill two weeks prior to the survey with symptoms such as fever, cough with difficult breathing, vomiting and diarrhea. Low fruit intake was observed among children who were ill. A weak negative correlation was observed between morbidity and MUAC (rs= -0.129) and WHZ (r =-0.153) of children. Percent fruit contribution to biotin and total carotenoid intake among children who consumed fruits, had significant weak positive correlations with WHZ (r =0.308 and r=0.204 respectively) and WAZ (r=0.207 and r=0.180 respectively) suggesting that children who consumed more of these nutrients from fruits had better nutrition status. This study recommends that the government through the Ministry of Agriculture in the Counties to formulate and implement policies on fruit production by households to ensure availability of fruits. The Ministry of Health could also educate caregivers on the importance of incorporating fruits in children’s diet.