Dietary management of diarrhea among children aged 0-59 months in Makadara-Viwandani informal settlement, Nairobi city county, Kenya

Rebecca Nyatich; Isaac J.M. Mwanzo; Eunice N. Njogu; Ephantus Kabiru

doi:10.51867/ajernet.7.3.8

Authors

Rebecca Nyatich Department of Community Health and Epidemiology, School of Public Health, Kenyatta University, Nairobi, Kenya https://orcid.org/0000-0001-8841-765X
Isaac J.M. Mwanzo Department of Community Health and Epidemiology, School of Public Health, Kenyatta University, Nairobi, Kenya https://orcid.org/0000-0002-7423-6134
Eunice N. Njogu Department of Community Health and Epidemiology, School of Public Health, Kenyatta University, Nairobi, Kenya https://orcid.org/0000-0002-0704-1679
Ephantus Kabiru Department of Community Health and Epidemiology, School of Public Health, Kenyatta University, Nairobi, Kenya

DOI:

https://doi.org/10.51867/ajernet.7.3.8

Keywords:

Caregivers, Diarrhea, Dietary Management, Feeding Practices, Informal Settlements, Malnutrition, Oral Rehydration Solution, Under-Five Children, Nairobi City County, Kenya

Abstract

Diarrhea is the world's second biggest cause of death among children below the age of five years, causing approximately 1.5 million deaths annually. In Kenya, it is the third leading cause of illness and death, with a case fatality rate of up to 21% and accounting for around 9% of deaths among children under five years. This study determined the dietary management of diarrhea among children aged 0–59 months in Makadara-Viwandani informal settlement, Nairobi City County, Kenya. A descriptive analytic study design was used, involving 159 caregivers with children aged 0–59 months. Caregivers were selected through cluster sampling at village level and simple random sampling at household level. Data were collected using a pre-tested semi-structured questionnaire, focus group discussions, and anthropometric measurements conducted according to WHO Child Growth Standards (2016). Quantitative data were analyzed using the Statistical Package for Social Sciences (SPSS), with chi-square tests used to assess relationships between dependent and independent variables. Qualitative data were analyzed using thematic content analysis, while nutritional status was expressed as Z-scores using a -2 SD cut-off. The results showed that the prevalence of underweight was 10.7%, stunting 10.1%, and wasting 6.3%. Malnutrition among children under five was significantly associated with diarrhea, with children experiencing diarrhea being 1.8 times more likely to be malnourished than those without diarrhea. Caregivers demonstrated good knowledge of oral rehydration solution use during diarrheal episodes, adhering to recommended administration of 10 mL and 20 mL oral rehydration solution for under-fives. The findings indicate that strengthening appropriate dietary management during diarrheal episodes can contribute to improved nutritional outcomes among children under five. The study recommends that healthcare professionals, together with Community Health Volunteers (CHVs), organize and conduct community-based training for caregivers to improve feeding practices of children under five during diarrheal episodes.

Downloads

Download data is not yet available.

References

Aghsaeifard, Z., Heidari, G., & Alizadeh, R. (2022). Understanding the use of oral rehydration therapy: A narrative review from clinical practice to main recommendations. Health Science Reports, 5(5), e827. https://doi.org/10.1002/hsr2.827

Alam, J., Nuzhat, S., Billal, S. M., Ahmed, T., Khan, A. I., & Hossain, M. I. (2023). Nutritional profiles and zinc supplementation among children with diarrhea in Bangladesh. The American Journal of Tropical Medicine and Hygiene, 108(4), 837-843. https://doi.org/10.4269/ajtmh.22-0532

Bado, A. R., Susuman, A. S., & Nebie, E. I. (2016). Trends and risk factors for childhood diarrhea in sub-Saharan countries (1990-2013): assessing the neighborhood inequalities. Global health action, 9, 30166. https://doi.org/10.3402/gha.v9.30166

Brown, K. H. (1994). Dietary management of acute diarrheal disease: Contemporary scientific issues. The Journal of Nutrition, 124(8 Suppl.), 1455S-1460S. https://doi.org/10.1093/jn/124.suppl_8.1455S

Carter, E., Bryce, J., Perin, J., & Newby, H. (2015). Harmful practices in the management of childhood diarrhea in low- and middle-income countries: A systematic review. BMC Public Health, 15, 788.

https://doi.org/10.1186/s12889-015-2127-1

Claudine, U., Kim, J. Y., Kim, E. M., & Yong, T. S. (2021). Association between sociodemographic factors and diarrhea in children under 5 years in Rwanda. The Korean Journal of Parasitology, 59(1), 61-65. https://doi.org/10.3347/kjp.2021.59.1.61

Coe, N. B., Konetzka, R. T., Berkowitz, M., Blecker, E., & Van Houtven, C. H. (2021). The effects of home care provider mix on the care recipient: An international systematic review of articles from 2000 to 2020. Annual Review of Public Health, 42, 483-503. https://doi.org/10.1146/annurev-publhealth-090419-102354

De Vita, M. V., Scolfaro, C., Santini, B., Lezo, A., Gobbi, F., Buonfrate, D., Kimani-Murage, E. W., Macharia, T., Wanjohi, M., Rovarini, J. M., & Morino, G. (2019). Malnutrition, morbidity and infection in the informal settlements of Nairobi, Kenya: An epidemiological study. Italian Journal of Pediatrics, 45(1), 12. https://doi.org/10.1186/s13052-019-0607-0

Duguma, N. A., Bala, E. T., Abdisa, B., Adula, T., Adeba, E., & Egata, G. (2024). Caregivers' knowledge, practice, and associated factors toward oral rehydration salt with zinc to treat diarrhea among under-5 children in Burayu Town, Oromia, Ethiopia: A cross-sectional study. Health Science Reports, 7(1), e1817.

https://doi.org/10.1002/hsr2.1817

Gaffey, M. F., Wazny, K., Bassani, D. G., & Bhutta, Z. A. (2013). Dietary management of childhood diarrhea in low- and middle-income countries: A systematic review. BMC Public Health, 13(Suppl. 3), S17. https://doi.org/10.1186/1471-2458-13-S3-S17

Gemede, H. F., Ayele, K., & Demisew, M. (2025). Maternal knowledge and practices on complementary feeding and associated factors in Sedal District, Western Ethiopia. Food Science & Nutrition, 13(5), e70286. https://doi.org/10.1002/fsn3.70286

George, N. S., Phiri, S. S., Shomuyiwa, D. O., Mwaba, M., Imoke, F. I., Kaniki, I. H., Oji, G. M., & Iseghehi, L. (2025). Strengthening access to zinc and oral rehydration solution for childhood diarrheal treatment in Africa. Global Health Research and Policy, 10(1), 65. https://doi.org/10.1186/s41256-025-00428-8

Ireri, R., Nyanchoka, A. M., Mburu, M., Ndungu, J., & Kiarie, M. S. (2021). Determinants of nutrition status in children aged 6-59 months in Kiandutu informal settlement, Thika, Kenya. Proceedings of the Nutrition Society, 80(OCE1), E3. https://doi.org/10.1017/S0029665121000045

Kantri, W., Harahap, R., & Budiman, M. (2022). Nutritional status and diarrhea in toddlers aged 0-59 months. Muhammadiyah Medical Journal, 3, 60-66. https://doi.org/10.24853/mmj.3.2.60-66

https://doi.org/10.24853/mmj.3.2.60-66

Kenya National Bureau of Statistics (KNBS). (2010). Kenya Demographic and Health Survey 2008-09. KNBS and ICF Macro.

Kukeba, M., Lukman, S., Darcha, R., & Doat, A. R. (2021). Caregivers' knowledge, attitude and practice regarding diarrhoea in children under five years old in Sub-Saharan Africa: An integrative narrative review. Asian Journal of Pediatric Research, 7(4), 1-27. https://doi.org/10.9734/AJPR/2021/v7i430220

Lamberti, L. M., Ashraf, S., Walker, C. L. F., & Black, R. E. (2016). A systematic review of the effect of rotavirus vaccination on diarrhea outcomes among children younger than 5 years. The Pediatric Infectious Disease Journal, 35(9), 992-998. https://doi.org/10.1097/INF.0000000000001232

Lamberti, L. M., Fischer Walker, C. L., & Black, R. E. (2012). Systematic review of diarrhea duration and severity in children and adults in low- and middle-income countries. BMC Public Health, 12, 276. https://doi.org/10.1186/1471-2458-12-276

Manetu, W. M., Ondimu, K. N., & Karanja, A. M. (2025). Socio-demographic factors of diarrhoea among children under five years in Matungulu and Mavoko Sub-counties, Kenya. Advances in Infectious Diseases Therapy, 2(1), 1-6. https://doi.org/10.52106/2769-2787.1009

Marew, A., Jebero Zaza, Z., Birhanu, S., Belachew, A., & Kasse, T. (2025). Delays in health care seeking for diarrheal disease and associated factors among caregivers of under-five children in northwest Ethiopia: A mixed-method study. BMC Public Health, 25(1), 138. https://doi.org/10.1186/s12889-025-21300-x

Mberu, B., Simiyu, S., Gutema, F. D., Sewell, D., Busienei, P. J., Tumwebaze, I. K., & Baker, K. K. (2024). Landscape analysis of the Kenyan policy on the treatment and prevention of diarrheal disease among under-5 children. BMJ Open, 14(8), e081906. https://doi.org/10.1136/bmjopen-2023-081906

Muhande, I. K., Mapesa, J., & Ouna, B. (2024). Evaluation of the determinants of uptake of oral rehydration salts with zinc in the management of childhood diarrhea in Kakamega County. International Journal of Community Medicine and Public Health, 11(10), 3758-3764. https://doi.org/10.18203/2394-6040.ijcmph20242851

Ndou, A., Lebese, R. T., Tshitangano, T. G., & Damian, J. U. (2021). A descriptive cross-sectional assessment of caregivers' knowledge and practices regarding the prevention and management of diarrhea among children under the age of five in Thulamela B Clinics, South Africa. International Journal of Environmental Research and Public Health, 18(18), 9452. https://doi.org/10.3390/ijerph18189452

Nemati, K., Michael, Y. Z., Hhando, B. P., Jatosh, S., Houpt, E. R., Mduma, E., & DeBoer, M. D. (2025). Catch-up growth following early-life stunting in a low-resource area in rural Tanzania: The MAL-ED Metabolic Study. BMJ Open, 15(8), e100955. https://doi.org/10.1136/bmjopen-2025-100955

Nesa, M. K., Babu, M. R., Tasnim, S., & Uddin, M. J. (2026). Assessment of undernutrition among under-five children in developing countries: A systematic review and meta-analysis. Health Science Reports, 9(3), e72087. https://doi.org/10.1002/hsr2.72087

Njeru, P. M., Kariri, J. M., Murigi, M. W., Waweru, H. M., & Muriithi, F. M. (2017). Management of diarrheal diseases among children under five years: A case study of mothers at Kakamega County, Kenya. International Journal of Community Medicine and Public Health, 4(8), 2762-2767.

https://doi.org/10.18203/2394-6040.ijcmph20173319

Ogunyinka, I. A., Oshikoya, K. A., Yusuff, K. B., Tahir, Y., Yahaya, M., Adeniye, S. B., & Oforkansi, I. E. (2023). Determinants of caregivers' knowledge and practices regarding childhood fever management in a developing setting: A multicentre cross-sectional assessment. Frontiers in Pediatrics, 11, 1119067. https://doi.org/10.3389/fped.2023.1119067

O'Reilly, C., Alberti, K., Olson, D., & Mintz, E. (2018). Diarrheal diseases. In D. Townes (Ed.), Health in humanitarian emergencies: Principles and practice for public health and healthcare practitioners (pp. 310-335). Cambridge University Press. https://doi.org/10.1017/9781107477261.023

Pradhan, S. K., Pati, S., Sethy, P., Dhusiya, H. R., Panda, A., Pandit, D., Kshatri, J. S., Kanungo, S., & Pati, S. (2025). Adherence to oral zinc supplementation in the management of acute diarrhoeal disease among under-five children: A systematic review and meta-analysis. Epidemiology and Infection, 153, e129. https://doi.org/10.1017/S0950268825100733

Stark, J. F., & Stones, C. (2019). Constructing representations of germs in the twentieth century. Cultural and Social History, 16(3), 287-314. https://doi.org/10.1080/14780038.2019.1585314

UNICEF. (2017). Progress on drinking water, sanitation and hygiene: 2017 update and SDG baselines. UNICEF & World Health Organization.

Walker, C. L. F., Rudan, I., Liu, L., Nair, H., Theodoratou, E., Bhutta, Z. A., O'Brien, K. L., Campbell, H., & Black, R. E. (2013). Global burden of childhood pneumonia and diarrhoea. The Lancet, 381(9875), 1405-1416. https://doi.org/10.1016/S0140-6736(13)60222-6

World Health Organization & United Nations Children's Fund. (2013). Ending preventable child deaths from pneumonia and diarrhoea by 2025: The integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD). World Health Organization.