Report on the familiy life training centres, Bungoma, Busia, Kisumu, Kiambu and Murang'a

(1)

Bureau of Eduaational Research Faculty of Education Uhiversity of Nairobi P«0» Box 30197, Nairobi, Kenya

Bureau of Educational Research, University of Nairobis and African Studies Centre» Leyden, Netherlands

Nutrition Intervention Research Project» Report No»4

REPORT CW THE FAMILY LIFE TRAINING CENTRES, BUNGOMA» BUSIA, KISIMI, KIAMBU AND MURANGA

1977

- is.a

(2)

List of tablea 2 Summary k Introduction 6 At tendances 8 Catchment area 12 Condition and progress of the ohildrert. ï4 Social background f>£ cases 23 Régional concomitants of malnutrition 3^ Notes 5B Appendix A: 40

Memorandum corscerning record forras

appendix Bt New record form Références

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l« A 1 1 endanc eus « 2» Attendo«ce rat.es»

5«, Oeeapancy rates and attosadantas/star.? ratics* 4« PereeBtag© distribution of' distaxsee® front thé

centres to thé hsioîs areiaf thé atieitcumg women« 5* Percentage distribution of cbildren,

a.g©d. 60 moîtths or youîsgers by âge«

6» Percentage distribution of' cfeildr-eiij ag@d 60 awmtfes or yoa»ger , by W/A at adns-Assi<ïîi« 7® Percentage distribution of ehilaren. aged

60 œonths or youngsz^ by veight gelas«,

8® Percentage distribution of' 2rid<f 3rd; and othsr cbildren, aged 6O moaths or yoiiagex", by ¥/Â afc admission»

9» Prédominant ethnie grotsps s>tt onding centres« 10» Percentage dâ-stribution o.f woass/i by

asarital s ta tos«

il* Pereexitag© of marrisd Vfosae» in and polygamotisr

12e Meaa number o,t" adulvs «ind chitdrsR ie. hotasehoîds of woraen axï.ersrtiMg courses» Percentage distrib«tt:lotî of wornen . preg^nancy»

P«re@ntage distribution of wo-ae» by 15« Percentage of msrried TOHS©H i-oceiving

frora

î6® Percentage distribution of Trossen by éducations

Î7» Sel«eted charaoterisiics of woraea att«adiag •Buiig-onsa FI.TC with gérerai «stimat«« for Western Province«

(4)

-„3-î8® Sôleotecî ehai-acteristies ot" wonr«*"* a.ttend±ng Busia PLTC with gênerai sstißsares for

19» Ss3.ect.ad cfeai'acterisfcj.cs o i' weisen attendisig Kisutnu FLTC with général esiisaatee for

Nyatiaa Province«

20® S«lected charaeteristics of women attending

Klöfflbu PLÏC witn .gênera^, estlïnates for

Central Province»

21« Sslected charactsristics aï" vomeu attoîtdi»g Muranga PLTC with général estimâtes for Central Proviac e®

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report 3,0 coneerned with the actlvities

19?6 <>£ the FamiÜy Life Traiaiag Centras In ßungotaa, Busia, Kisuffiu, Kiasabu and Maraaga« In thé course »f titis year 57 training courses wsre org.s.als@d which wer« attsnded by 84? vromen with 13^4 children under rive ye&rs of age« The Kiäumu ceatra accciaaiodated ïh larg^st atunbsr o£ imothers? and ch.±ldrsu (8?Ö) and t h® Siaa?bn centje the sosaliest number (268) v The «•iilissa of the Available aecoïassodation varied consid^rasbly, ai. KiiaUBits, aHd Bus ia t her© waè » shortage of" botising: tb® (largs) aecorosiodatioa s t Mtiranga was yelai-isreXy iif.tlo

The average nuiuber oF chaldLr«a accompanying; a varies cous i der *> hl y par cs»t-rs , gomething which is aot talsen into aeccn«* by tb« pr®s@nt daily allo-»

wances« Tb« nvuabei1 of mot h er s per s taf f raesiber as the sasie for MO* t ces.tres, escapt, ai, Kisusmi wfaer-e It is doublé

that of the othar cetitr^fc ä s-Ag^;estxng tb.at this c»ntrs is tüaderst-offe<i<»

<JK* v hè 1364 obildrea, f.gtsd 6ö toonlba or youöger, vb o 25?'« sut"3f'cre-d froei setrere pi"o

ess tbats (SOïC W/A) -whila a furtfear

Cross mild forms of malautritioa {bslo*r ÔO14 W/A Th® p<.i11c.y of ödsaifetiug psveraï cbi idren wïth o-aö iRothai is j y s t i r à e d by th« fi^dirig ihat +,*/<$ 2nd, Jrd» and

(6)

chlldx-en forra, thesselves, an undernourished group« Regrejtsbly t h» agas of the ehildre«, bat in particular the weights of the children wer® not reeorded accïsrately enough Tor purposss o£ evaluatrîaa* No conclusions car, foe draws abowt the progrès« of the efaildren dnring tbeir stay at the centres® Purthermore i t ïatsat b® noted th»t aom® of the social« démographie- and économie informa t i on in tb® record forais 1s inexact» Tb® view record forme recentiy snbajittsd by «s ar© ineani to overcom«? tbens shortcomingj?« W© recoîBœend t'hst th© âges of the

are reeordedf a® œuch as possible, to the Besrsst

and tfaat the weights of tle children ars reeorded to the B-ôarast 1OO gr» In a previous snemorandum we have already recomaieaded. that the h@ights of the ebi.ldren. arfe also reeorded*

The centres have to deal wlth very different populations which suggests that ia the different relions different catïses are responsible for malnutrition in yoang children» The rsajority of wotnen attending the centre® is Central Province face marital problème and/or a slaortage of land«. Many of the womets. at the Kisorou centre also have liftle OT »o land ajnd. nsany of the WOTOSB at thi* centre ars pregnant« Many ?aoth«r® at the Burigoma cer^tre are also pregnant and at this centre a large group is

(7)

3975 apd B j » m ineladied r0««J®tly ceatï^as la

also been opöned« tn «ri©£ , th*«fe

"" *" fi^ w j

wlth awiliiourlshod childrea for a 3 «rees co^strse prlraariiy

? j

consistiag, aatritlrrt and healtb éducation® Biiriog the stay at tb e «?«*ntro th© p'orfeers , und«sr t h©

of i hè »taf f i treat the malnouri^hed efalldz«» *rith tï» report i® cos5x^®i^sd with Ch«* ac-Tlvxtios «£ the fa r si f i va eautsrss during I97î> and cor» tas ns at* »üpIyöAis af tfee

, the condition u f the cbiiftres at '^^S *-^e stay p '* tas e«B.tres &n«i»

The report is bas^d on tb«» case record

that h&û been fiJlsd la for eseis wcipaK wbo «ras adaaitted T; o ifes cea.i'ï'©® with thfe ©3ce@pt3.ort of KiansHB. wh®re the s«

f'orsss Aad not b®«a f ilJ ed in duir3,iag the t^Lrst f 3.ve «noRtïis of tas ysar» On3y 236 records exlst-ed for th® 3^% ca»ss aiîmitteci f o thjs centr®, grixll a au^riciontly large BUêafoe for psijrpoaes ©f analysis«

An importaafe proviso, höw-avsr, musc fce îaad«s« Aitboûgh The

questions lu the record iorms eovsr s respectable Ar-ea

of iîîtsrest, siost. of th« i«for>natics\ eöllöctstl is »ol; table for a^ialysls, bscauise severai

(8)

-7-1. Number of courses 2» Ntiraber of woraen 3. Number of children 4. Number of children, 60 roonths or younger 1 o fi

a

il

157

277

236 (85%)

«J •H as à 12

148

208

187 (90%)

•s

§

3 (8 •ri 12

344

535*

516*

(96%)

,0

s

« •H 12

84

250

184

t«

e

s!

B

3

10

n4

305 24l

(79%)

H * +> O H

57

847

1575 1364

*Figures estimated from 238 record forms available out of 344 cases.

ftfct«,H<*-**c« *•«*«$ , 1» Number of women per cotirse 2« Number of children9 4 6O roonths , per course 3» Kumber of children, 4- 6O months, with one woman 4« Nuiaber of tnalnctirished children, ^6O months, per course« o m

14*3

21*5

.

1.5 14*3

et •H n S CQ

12.3 15*6

1*3

11.9

0

Ë!»s

82 •ri

28.7

43.0

1.5

30.8

y f> B 6 Ti

7.0

14.9

2.1

9*8

«s

M ß

S

H S 11.4 24.1 2.1 | 16,2 î |

(9)

poorlv formulatea an<l cave i't--*t TO arisunaerala.acLj.ags atî*î irtAcev>~ac5es f sec acênaiJc A l * Ä.& âr as ins aoc aspects *î «s eoixeeriied "tï»xs reyort ï % laau.'teti to the £ew i,*eB«t. A! ic> u«*re n s o a l i v f - M e « ! 1 ** pa.i.'i «factorij To isspfove eu vois jn l~s>© ûevrts a i-evis«d sreeor-d

bas. already î>een â u b î n ï t t f r i *f* afcë, Mjni-stry (sea aypsö^lisr ß » »

Tfeiff r «s c or d l'or*» is short er- f.i.8t< tbe présent one but Bjo<~e rs

A Î. ,

Thra? cî-nfcres maîia^ed 4 o orgasui.« 12 courass« dursn.«

ons c u w t r e 11 ay?d tbe nfhor 10 oo!*ïs«s» î î j t o t a l , 5 courses >jfsre or^aTii^ed «hie h wor* oxtended by 84?

wili» j *>?5 cUildrei. of vhorn 87?^ w er s.- bO months «••-?" ©g® or >? ' ("'•"ablas 1 ) « '"fi •• « > &URSU so^tx-s admit tod a b en t J ^ C

550 cbiJdî-eî. d^r^«g ij.'7^ wMl«» thé jther senti

- tt(r>d half t b a f c nwnhsr 0? 3 c SB«

In iïtasîtbti r,ad teuren*,,**, fröre t h an LO*« of f. he childr-ei» olde; t h, 't n. CO ffi*t"ths^ A)s.«?/^as tr^s was 15%

10?ï ï n Bu«Ia and oail% 'J?' a^< K>âSif"u« ibe t.r©atœerifc and i bc *£4«ci")n«c at tï.s • p r t f t ' »s

at j'our g « -i-, Idrr-i, -f hè ?>,!.&• ^^Isei-nble ag^ ^«-oup» For this j sport % c r e e f - ^ r R t - ï4? on fehss®

on» lts ft-om "nal^sis. chil4rea ol<ier yeatrs k6f- »js-o i <• hs s &£ tj:** »f.ie^» ~ n ^ - :-a* «'d 'nlnerwj

'iije Iviautnu centre on a \ t i s ^ ^ adraita t ï < e greatast oi «nocL^r-s ï ^ £ > ) P»Ï' c's-ifj.» ft3'o%'«"1 ^y hu/n^oiiia l

( 1 2 ) aftji î'îtn Äuga { j î ''* P T î â i e * J 8 ' e n f c î * 5n Kiarabu a s » nhc^ï» b"*- t h

a)

*j-t" eUiJcLr p 'talPc' 3}* ris'S aves*«^«1 t »umher of o ^ i j ' j r r

-^ï'al accoup« nias e->cïi womaa sii« »s sj^.ra oi lass a ril order« f*rhere the lu'il er csT '»ofberij>er course i.

low .hsy a** e ac < ^npanae'ï ö-» maay childre.- , and t!nl& •• s yda -j.ciïlaj'l'y Sv in. C ent r i j P Z O ^ T U C - ^ , Tb 3 s ' r ^ n d . °>irh Li ' par tl v P. ^ssul- of ds t'*"er'»î'^'ô« i K ü V R i l a l j j e »ccoscwods L i *

(10)

-9-Table 3

Occupancy rates and attendants~gtaff ratios

Percentage of available

places occupied

Nuraber of malnourished

children, 4 60 tnonths,

per s taf f member

Nuraber of raothers per

ataff member

- «_K 0

to

s

m

955Ä

3.6

3.6 «t

iH

s

«

±12%

3.0

3.1

S n 3 B •rt 124% .

6.3 .

5.7

S) ,0 B •rt

38%

3.3

2.3 i

«s

₆₀

fi

e

£?

s

36^

4.0

2.9

(11)

'*" r 5v>t- > " a i -, iLr° c-» ji "*„ U' Ci,«ft*T

t ï-% - L?S!» <*•*>* - % »t a « L tl & 2?r 1 1 Li t5"*^

I h? i. «.si crl * f* fsietl^ 1.1 s? • ._".i,i'i, j,trc.isjf f i r ^ i J y 't o i t 3 i C \ '<;otl. , ' " UDO t , ; Ï , ^ 1 < ï n s ( » . 'J.T •> ?TI s « c u-r "i j 7 £ > t i a s t ü^l*i.*i'j j «î>^*i r

froir, 1 *-*» r« «sfctti of" *roc?~3,) ^ 11 c*vm < '"•* «.J^t, j^x^Jt,,? t h« «r »«3 io*a i*r«<t oli^?w-«'r -" st «/*-it cot'ree> as a-iso «a

•; i -?tóxi.s-»s f r: m « 2 » s w of IC

r ^„H*- -f ^ü -i t K i « u ,< « i f t l ^ c 2/' ,

t*jp%.icy ï a l « » * r »c-r«-5« t f i t 'iAt«"S. by dlv„aaa-2- the a

'rl*-«»* c* t .c apyft p-ft <° -.'i Ti't^ c~r t i c acct *>y*:"acioa availaî'

t i.« t ^ir»« jCïfupt. *n < t^n^1? t" b«2 '"s;'.!, '/"irjinït f x OL o

>.£&•' , J tU shv excfc,'* -'-•'> >i tl>o s .ir«r<î-* cîiiy-j wj th A «." uf or.ly ^ c ' j 4 ta'A«9 3^ '*> 41 'it ~ c-e^Y-1"®, Lfwo'o's/* j, !,<as hy tL«- /«sjtj,^s* ~*P ' ctóuo'S.i "i >^* v ^ % '>'uirf -*~M 1 s anti a-^t a aûls af fto>«e!y * « 4 ' «. r mor H* *£ f % »r'fc f ^ '*» 1*1 »' iâ's?« t , th<s

%i~r " «''^„r4" h"-* et ; t s r oc tu:» * o w e ^ r-f toÄ'löj:««- of £ 11 « U« •* ,jc «.* j,-j fcss.r»j^ ;ü " r »r i ^ ' i t«re ^ j t. r> aiïsiu j?a

-.4^

« or a f ' ^ ' e p u t * ä j "jOT*xt "a .o 'i ;AÏ •? 3 ^ î u. a coü s^*"0- s.»-* jocïv«"" -S-AO^ ör > » « . » • * « >c ^ TI-» -»a js^s «-jiaa s r^.ï'ftxîf j4 tut * h« i - j j r ' t - c - ^ , » - ';--*r1y tfe^i ' ïï® •vijs tb j! ^%'IA «or*v<-"€ fy~ «t «*ii f->« <- j « x'r "borra^*"' o/ S s. c ' • >«iîC '-ta l i or .xhxl-S • ' u ; > «, c « er •'tin ---'Ij1- ' *> *; ? ab' ' w*** ü & s ^ ' ä v .te,"1 1 «.-»ede

rt't;^ tde^Ci« ss<^t«f; A r t f j - c.-" >• ^ ' - ï c. ij a fe-a'ï i n * "vt,

Qff < ' * tl 'J j ft" IS;'5 O '"ï5 * " * >" „"• i- -K«"M «Gl*l C*i <"iT

b; tii-j . iX»t r K.''' fewj*. r v"?ji »-ï * ^'4fi ^^ «i/

/»ur»y««- t f «'.ainojrasl tfd ^011'"»^ p*r s *.«\,* s' c-I s ^ af i ißo-.n^rf 1^ ? i5,is c ' * » "ha B^.'b

, "^ - i »r 'i

(12)

•13-Table %

r«rc«3ïilû3'» disxribution of distances

frouî the centres "to ths hor^ a of t)ïö att-oncs-inc vromen î £ 0 ! & f fi î J$ „__J_J! O-4*9 1cm I 5 1 5*0-9*9 ! 12 j 10,0-2.4-, 9 1 1S 15,0-19.9 | >5 ! 2O «O- Ä Ç » 9 | 26 j 30* ! % » Total ! 100 1 ^ <8 § • -H S e> K | JJ* i-vj ! ça « s 26 17 ;-i9 I 15 j ^ ?, f -c *•? ; *•* y A -| | 2 ! 25 f Q T_ 9 * î : 1 j 7 i

!

loo loo !

i i

, — . — »„..__- — „

ö w A d g «8 •r! Ö

37 %

33 4

II 36

7 30

5 20

6

ion jioo

i

(13)

i- caches C»2«Tln oits'-r ratio, t-*« m-tsber os' se'>c?vjrs 53 « stritt aiatïthev sbc«-*s ïïir'il&r ai t" f er o t. c »F &TÎ'* is 2*3 aïi'ï. at the h.iofKl>v 0^0 M<.ir«m£ 1 c^ïïtre? «md 3 « i and 3«6 si ßuexE and d y T» ge-va» ^t KJauraxt rcr TCH s r ^ f f 'Kösc*b*r ars 5«? « o t t e r s , »Incat twic.e *>!« •i.j.nb«'» «*t '*he »t centres and wh«n tue wie.***' c«ïx"cres ar* taken as a of a «ïispar i s oa a« 3.;icr«ai«e ia st-af^ -AT t>ss Rfaua appcôrs

Eacb F a m i l y L i f e TrtmtiJzsg Centre is m« an t t o s«-rv-p. disrrict a»<ï i t is rh<ö hope- o r tlte *'iïtjsiry of So Seyviceö Ihat tïitimately sa,ch district wil j have i-ts cnfn centra« Jf &nâ feben thes^ c o w t s e a «i«rve tbs d i s t r ^ o i , u i1 fondant f> shouXa eoa*f- from all diataiicas a/id, not >»r>3y trotr« a iimited ar«a ni^arby . fox eacîi cas« the h.o8>&

s3 had hetA retorde^ an 'l waœ ioc-ated on ^h«s 1:5O»COO

o t' rh« ar e a eonc*«"r4®d» rbe dista.ï.o©ia between t!h« l '-oiie ai ea and 1 lie c«»tt'e w<?r« ïneaa.-'j'tód ia a Sitratghfc ij.rsf csnd aj e lösten In tafele A » Siuos ch^y wer® »aeasjii*<îd e« the v r ow f i l e s tb«5 ac t«, a l difltenoe« fast had to fo®

\i j ^ u.rpnp;n r l e a r i ^ eaccsetS in drawiïif crises jfr-om all he <ï;»trt<;t' airi, ta a gr^at.fcf «y X^â^er dTtt«nt.

i n t e w d e a * Hovever, % r the Mui.-aa.ca

£ruti« w i l h i n i- radius, of 10 Ivm is sje^r«>me3y t h a t 3 1: in© XKiueds nie «surr oun», ing ar*a « oceui'^ «r r h a t * h* r "Ie of tb** c e n t r e o'ïjatua^ tv- ;s not t-fs^il^ •ac.c'jpi cd»

«, i chnK^jt sresSc." t.hiv Bus J a e n -i K^HEsl"i3 c^nti^ss & more rcssttr-j eten« Afc fusies ?(•*% o- tiv «a

tr-o"i ff, d i s t a n c « of !e«ss xh^n ? !c^5 s.t K jt s H f a i s a fnrther »J0-^ ---nd i« Kiatibu v^ i'urtnar

f ""••»," A' ss th"'fa li* H*s away^ -\poarsfttiy f b-e EnsaAa rp-rtt.-i h a n , as y»{ , t, <* t lost l t s iïaec<? oï bei^? «s. part n t t h t > rjîldsîosi hospîtejL ""> «h-* r îi 11 once b*lor>goâ and ir, grounds» i ï A» a t j j , i si ,«nf»t*sd. FOT- boi-h cenfcres 7

(14)

îr.akt-

-13-Tabie 5

Percentage distribution of ehlldren? aged 60 montha or younger, by age

12 months or youixger 13-24 months 25-36 months 37-60 months Total « 5 0 W ß Ö

(5

25T

30

25

20

100

«s

-ri W 3 CQ 23 36 21 20 100

3 s

3 «t •H üri 29 35 21 15 100 S .n E <8 •rl t4 23 23 19 35 100 SS 60 fl si h

»

a

23 26 20

31

100

(15)

.14-throughotït the district particularly sine© thé Kiarabu centre has thé lowsst attendance figuras of ail centres® The catchiaeat area of this centre, however, seems naturally liœited by its geographical location with the Rif t Valley to thé west? thé Àberdare forest's to thé North? large commercial tea and coffee estâtes to thé East and Nairobi te? thé South*

€ ond i t i. SH-SHâ-^ESSEÊSâ^-H^^JÈIîS^SliiâîlSî1

At the time of admission to the centre and at the

time of" discharg® all children are weighed» These wcights are «ecessary to judge the condition of the chiidrsn at adm±ssi<sB and to asssss tfeeir progress during tbs stay at the centre» Sisce both the condition at admission

aads to a .issssr e3ttentt weight gain need to foe interprétée! witfeth® help of ag<e norms it is equaliy important that

the age- of the children is recorded accurately»

Ages of* the children were <iuly recorded .at" saeh csntre and the »amber of osrsEai&sicms is minimal s T&e recorded age« are, feowö-rer« f ar froas précise judged by the Tact tb«t saor-e

thaa %0?é ©f the ehildren had th©iï* age recorded in füll years whereas on a cb.ane© basis this sfeould be B%« Althoiigh a number of" mothers will^ of course, not ba ablo to give the esract age of birthdate of the ehildf to our ascperiesce sioäct raothers after careful qxt.estio'ning ar® able to givs at least tbe month of birt3as partlcularly for the ir yotingest chi.ldr>eM.e Adjmittedly they of ten hav© ïaor© difficull in provixiding this inforaiation for their eider children but with more effort préciser information could be colleeted» Tfee âge distribution of the childraa st the different centres shows only staalî différences (table 5)« About 2?!& of thé children is a.g©d 1 year or yonnger, 3O% are between 1 and Z years of age and a further 20% ars

between 2 and 3 years of age« The only différence between thé châtres ia that t her s are slightly nore old©r ehildrtri adfsitted ia Kiambu and Muranga« This doos not œe©n that i a Ceatra3, Province older childr®» are mor<» often snalnourishe<j

(16)

-15-Table 6

Percentage distribution of children, aged 60 months pr jrounger^rby..ff/J^_at^radmission

-39%

40-59%

60-79%

80*+

Total £ O 60 K 3

n

2 26 *2 30 100 (vJ •H 3} *3 « 2 20 55 23 1OO

d

j3 B -H M

16

42

27

15

100 jj

,0 S •rt tó 2

15 ^9

3%

100 e &o ö (S

^

J3

s

3

25

40

32

i©o

^N N—*Ö fi <JJ « ••w« 1 32 67 100

(a) from CBS

(17)

rather this i® caoeed toy the fact that the mothers in Kiarabu and Murasga are, on average, accompanied by mors chiidrsîi (table 2}« This tend® to raise the age of the ehildratu

Th® weigfets of most children «rere also r«eordsd systematic&J "!

although in the tfare© c^Btres ia W®st®rn Kenya only 80-05% of the chiîdreri had jbotfe admission &nd discharge waight r@cord©d» a percentage tbat could be improved» Th© acctïraey with which the weigkts wer© r©corded leaves reason f©r serions doubt» Th® condition of the cfeildren at

the time of admission to the différant contres„ expressed as a percentage of the e3£p<sct©d w@ight for age (W/A), is shown i» table 6» ït should b® raalished that this perceat-ag

(W/A) i®7 on averag®, 100% for Ëuropean childrea and, on

average» lies betwssm 80-»9û?4 for Kenyan childrea (CBS, 1977»)-Children witfe W/A below 80% ar« geesrally regarded as

roalxtourished aad whea W/A drops below 6O?é children ar® ccmsidered to be in sévère condition» Cases trith a W/Ä below 39% a^-e extremely rare®

these extreiae cases, ©nly 1""}% of th© children bave a W/A of 39% or lass, esecept at KisuEiU wher© i6?4 of the ohil<ir8ïi fall in thia grotip, an aiaazingly high percentage« The percentage of children that are severaly saalnoiarislaad (is?/A bsiow 6O?é) is f'airly constant over the centres with 30%, «axcepting Kiâurau where this percsntags is tisarly doublcd« ït is? olv coto*sef possible that the

children adtrsitted t« the Kisamu centre are g©ßeraI3y in much poorer conditioa than at tb© other centres

a recsBt national surv«y (CBS, 19??fa) did ngt_ find iîicid&ïïc® »f ssv®ï"®ly malnot^rished chiXdren ia Nyanz» province« It i® mor© likely thst a systesiatie measureraent erroi- is œad©«, This i is al^o sugg«sted by the reported we ight gains »

The weight gains or the chiltlren at the different centres are listed in table ?« To pr< vide som© perspective to figures it. ssiay b© pointed otn that between the ags® af' ï

(18)

Table -7

Percentage distribution of children, aged 60months oryounger, by weight gaina

¥eight loss of 1.1 kg or more Weight loss -1.0 kg; no weight gain » weight gain 0„l-0„2kg "

Weight gain 082-l«Okg Weight gain 1*1-1 «5kg Weight gain 1»6 kg + Total a H

g»

§

CQ 2

30 _

64

2 2 100 « •ri 32 3 S 0

m

•ri S W A |

5

33 45

7

10 100

-3

1 11 9 î - «& •ri i*S ~ 10

f

40

31

26

1OO 53 20

17

10O tu bo fi a 3" S

-6

74

9

11

100

(19)

-18-and 5 years the average child gains frora 150-300 gram per month®. ït should also be pointed otit that maay tnarasmie

childrea do not sfeow quiek istprovement btit f irst have to get aecustomed to the diet at the centres» Kwashiorkor patients will start witb. loosiag oedema, th©reby leosing weight

before they start to gain» Wexgirt gsiias foetwssra, 5OO and 1OOO grasas are gen&rally conaidersd as cjaite satisfactory and a weight gain of 1^5 kg* duriag a 3 veek period is very high and excoptional» Anything o-rer 1»5 kg. should be ragarded tvith suspicion« Waight lossss of more than l, O kg» should also ba considère d as diubious and in both cases ons would. strongly suspect measurentent errors«

Against the background of these ceasideratiocta maay weight gaine reported from the centres appear to be axaggsrated8 When all gains of mor® than l»? kg and all losses of more

tfaan l »O kg« ar© brought together only Bungosim has an acceptable rate of » suspicions' score® (%5O« Ths largest percentage of » swspioions » s«ores ar« f ovaiiL at the

centres in Buaia C 15%), Kisumu (2?^)» aad Kiambu Ânother curions fixtding ie that the esütrss in Kiasabu and Mtsraaga are surprisingly sfeecessful« At centres otily 3~1O% of the eijildresi aiad© laasatisfactory progrsss (20O grams or leas, th» average weight gain per 2nonth af ter l year of ag©)« Cossparad with contres elsewhere this is a Tery low figure, other studies haTing fotind from lO»20Jé of childre» wh©? despitg ell efforts , show laek of satisfactory procrées» It is isdeed s«rprising that these thrae centres aseperienc© so few setback® with tfeeir patients-. A third sturprising fiading is th© high psrcentag© of

childrea that œake xmsatisfactory procréas at Buag©asa and Busia

All thi» leads us to ®uap®ct the preseae© of serioaa meastirament errorss particularly at Kisusra, for which

w® can suggest tbcr©e soïirc@3a Firstly? at certain centres it has bée» the habit to us® diffsrsnt w®ighiBg scales at admission and at discharge t an unrsliable

(20)

Table 8

Percentage distribution of 2nd, 3rd and ötfaer

çhildren agjed 60 months or younger^ by w^4. at admission

-39%

40-59% 60-79% 80%+ Total d E 0 W) £3 03 -10 40 50 100 <8 •H 33

o

..

5

37

58

lOO H

a

3 w •rt X X X X X *3

£t

£ os •H -7

40

53

1OO

ca

fcjj Ö

«a

S-*

s

-17

45

38

100

v

Oj ^C<

e

«

»

1

32

67

100 (a) from CBS <1977b).

(21)

-20-wfeea the tw© sscales are not la agreeaissît vith

ether» W© suspect that ifeis pr@e©dt£re bas inereased

tbe ireight gains la Kisusou aad Kiaefbïî aad bas decrsased

thaai at Busia« ÂAOtSssr socrce ©f «rror lies in thé

tendeacy to e sseaswe ir®igb.ts to thé ssarest poisad or kilo« This ssay easily 3.ead to errors to the order ©f

50O-80O grara^ partiaularly if thé rouadiiag le doa«

dowaward© at adssdüssiöa smà upwardg at dischar^®* Tfeâs meaas that in. »&y sas©® thé œ^astsreajent ®rror will b© larger tfeasa. th« acteal vei$ht gai» of tfee ehlld» À third eatase lie© iïi shesr «arelsssAeas» in soœe oas©s admission weigîits or 10 or 20kg» wer« reeordsd witîi discharge weights «f 15 o^ 25&g« « f igïir©® tiiat ars to©

couvenient to bs acceptable« On the basis of thés©

considérations we are foreed to csmeltîu!© that tîa®sa

«eight gains are sot raliabl® ©aotîgfe t© b© socepted ®std that thé performamce or th« eeatres^ as £ar as weight

increas® of «hildren is eoMC©rîied, remaias tiskßowxi» The ©steat t® wtoieh W/A &nâ weight gaiaa ov©r a short perioct ar® affeoted by assasureraest errors diffsr® considerafoly* A sseastrremeztt err«>r of 5OO gr« with a 3 y©ar- old ehild welghiiîg 12»5 &S® will retrait la an ©rror of '*$> in W/A but siay sasily result in aa er-ror of 50-1OO% in weiglît gain ©Ter a pœrtod ©f' ,1-â moaths» Measuresjsat ©ri~ors tfaer©f©re ©asily invalidât« wsight gains wîiile thé

W/A figures snay s£ill b© meaaiugfol« ïn faott thé W/A

are fairly coîîstaat ovsr thé centras (table 6} at the Kisswu ceatre wfeore m©asiïres2*mt errors weres in all liïselifeoodj so large that e\'-®a th© W/A distribution ^ras seriously affected® For thia rsasoa this oestre is

exclud©d froaa the followiug«

Ths policy of the FLT programme is t© adsait Bjotïiesrs to

tae o entres not witte just OEI« ehild but trith siblings

as well« Th© argwmesit «sied ia dsf®HJ8e of this admission policy is that it is often diffieult for th© mothers to lâave the siblings at hots® but &lso that it is •«rary likely that th® oth©r cftildrön ar® al»©

(22)

-Aï-Table 9

Prédominant ethnie groups attending centres

Bttngotna Ltxhya

-Busia - Luhya - 79% Luo

-Kisurau - Luo - 1OO% Kiarabu - Kikuyu - 93% Muranga - Kikuyu - 95%

(23)

-22-Table 8 shows that the latter is iadeed the cas®«. 3üa thi.« table the W/A «iistritratioa is given fer the Stad, 3rd and oth©r childreja resiaiïiiïig af ter the ehild with the lowest W/A in. each fasaily ba0 fo©@a. $®leet©d out,) togethar • with W/A distr'ibatioa ©f the rural ehiicJ popu-lation in général (CBS, 1977&)* Th® condition or the

*ace©Hipa»ying* children remains . signif ieantly below that of the général ©hild population® In faet 119ê o£ thes® children amst ba cla@sifi«id aa ^eTörely raialaourisbed whil® 42^ fall bstween 6O and S0% aad can b® ragarded as less ) se-r©rely saalnourishedc Apparently these aiblings, by

theaiselves, also fcrss a group of sEalnotn-lehed èhildrs»»'

potent ially ©taad to bejaefit from a stay at the c0ntre«

Soplal

Malnutrition refaits from aa ia»i4iott® relatiom b®twe©n dietary inadequacy and in£©ctioas, ®ft©n. agg*"avato4 by social facters ©tich as fwrerty, ignoraHce. or family

in&tability« Tfa® relatioxisïiip ©f malautritiori with -rariotas social factors is9 Itowcnrer, far fr@m sample aad tauch

taor© eossplear tfean i® oft en. réalisée«, Différant oas©0 corne

from strikingly dif^ereat social background and ther© is reasoa to beliair® that causai rslatioüs öiffer coa~

araong g®©graphical arsas and aaoiag eultaral As ahowa b©l©w, there ar0 différence B ia the social backgroïsaê of the ©sses attendiœig the different esmtroSj althcsiagjh the sseaaing &f these diife:r®:ac©s requires further aaalysi.^«, Ïa oa® way, kow^Tsr, the

figures casa b® tak@a straightforwardi Tfe^y Indicate what

attsad the eentres, aad how theso differ, which i® of direct importance for the training provided at the iadividual ceatrss»

-Ethnie gacfe ©en.tr© cat©rs predorainaatly for ©ne ethnie gr<mp (tabl© 9)« The oT^rwhelmiïsg Esajority of the saothers Baag«MBa cestr© ar® l«ohya| at thé Kisuîmi. eeatre

(24)

-as-Percentage distribution of wosaea by marital atattis __..__

Single Married

Separat e d/Di vor eed Wi dowed Total Ö

g

0 t«

ff

s

n

il

81

5

3

100 «s •H «1 S

4

90

3

100 3 H 3 •H W

4

96

0 0 100

s

A

s

«J •ri

w

27

55

16

2 100 «5 fcô PJ Jjj | S

9

70

15

6

100

f

(25)

mothers are Kikuyw» Oaïy sfc Bugsia is there a

group of L u o mothers bssides the ssajor group of Luhya attendants® This is & favourable situation whsa coœpared with 1: hos« réhabilitât.! OH centres which are fr@qB©îît«sd by different ethnie groupa* If, a« is true in most urban

a COH3JP0Ï». -foofl cu3 t«rc i.® "*ar,ïï*ng thfc teschin^ ris

soattered or not applicable f.o gsany of the att^mdaniiy « The attendants at tiae FLT ceotres, liowever^ to.av® a «osMison faod cultare aad the teaching caa be eiore spécifie an«i still be and®rstandab3 e to oa@ and alla Ho«-©T«rä as Tar 4.ss the national prograaaaed is concercted, it. sust os kefst is mtT that tfce centres catsr for attendants with dif.ferlng food habits» The Kikuyst dist coBsists largely of zsixsd stew» and is potentially baiaacsd«, The eissphasis in the teachir<§ sîiould probably be on the required asaoaaT® of food ana on tbs preveatiou of iafsctious cïlsease* The Lshya asid Lts o diet lasually oaasists of a low-proteia stapla f o i-d

with a re3i®î^, tbs type of diet ethiek, is oftea noï

partic«iarly for ebildres«, Is tMs cas© the teaching shou.'.-t esspfeasise the need of praparang balaaced me&ls^ pret'erafcly mixed stews»

Tîie marital and faB>iXy situation of the aiothers attssading "kiflJi *fta ^i^"2^®2"®0* e entras shows considérable variation* ïn the

Western cezitres (Dtragossa* Basia assd Eisuœ«) mora than of thé womea are tnarried while this percentage is 7O in

a»<î 5^ ia Kiambts (table 1O}«, Ât this last centre of thé œothars are siaglâ whâi© i6^ ar® separates! fr« m th©ir h-usband«, la Mts,raBg«, fewer ot thé mothars are «2..«g:3-i (9%) bat, lîke in Kiambu, .15% of tfeera ar© jsep®r@,t@d»

Clearly aany motîier'S ai thé castres la. Central Provinc.«? f. «--; frosB broken. faiailisss, sucb cases S©SÎB to present thöHaselvr-far legs at xhe Bungotea a&d Busia csntr© aad are virtu&lij

in K

thé woae» atfcfcîîdiag thé centres tîts of poly.gamj? varies fpr«,<atiy aad in Eaagossa sppr-oaches

(table 11} a ïfc is a~.so bigh aa!O»g thé mothers in Busaa a«d Kisumu but is lass MBong the asotfeers ia Centrai Pro%*iiicec Whereas in Bungosra !»ore than half of thé rsarrJed women ai- c

(26)

Table 11

Perceatage of œarried womea ia monogareous and in polygamoua tutiona

Monogamous Polygamous Total S

o

«

4l

59

100

e

•ri 05 jj O)

65

35

100

£ & •H

66

34

100 cf •u 3 tf -r» 74 26 100

a

60

^

(S ' 9

s

91

9

1OO

\

_\

\

_\

\

\ Table 12

Mßan nuœber of adults and ofeildren

In hOTiseholds of women attending courises

Total Adults Ch-ildren ratio î children/ adults «J S ô &s 0 JJ tQ

6«4

2*6

3.8

1.5 t8 •ri sa 3 cq 6W4 2«8

3«6

s*^ g 3 w •ri W 7*0 2*8 4*2 1«3 I 1*5

j

13 «Q S SS •rf

w

6«3

2«0

4»3

2.2 (3 60 <3

L_

7.7

3.1 4„6

1.5

. *

(27)

-26-iîî poîygamotis tiaions, this is oae tfeird in Bus la

r

quartar ia Kiaaabtt but le»s th*œ

An important factor in the .amottzyK of care

_{4»**iKaf t&f}

ss^||

give to the indiviâaal child iS the sia® o: the ^.wjjfe«^ of ,a<

to« The

Kiaisbu

^ thô* œother hâraSifï a»ao% ffie,

si« P l ' s w ji l N

f o f?.^s at ÎMaa^ngà celtr«*

.

t

Kiarobtt jwhere it i* 2.' Tfee s

except

hcrasehold afs sucto probafoly teilis lit t là abottt th© demandas

" { y» I '\ -, « t W-site '*

l

adu

.s living i»

wlth

Pregnaacy IK œaay African cultures thé oceiîrreace of

in youog childrsn is often relat®d to thé birtto of a

?

youïîger sibliïag

1

® In i'aet, th© birth of a yotmgar

is only ©ne in a series of steps of increasing psycfeological

distance between thé yotmg child and its moth@r» The first

break in this relation oecars at weanin^ aad when thé

mother becoœes pregaant she tends to pay less attention

to thé child, partictilarly onc® thé neset sibling is born«

The présent record forras do not contain sufficient

informatic-on these relatiinformatic-ons except informatic-on thé incidence of

pregnaa-cies aaaong thé mothers admitted (table 13)» Thers are

significant différence® araong thé centres in this

placpd upon the nsother«

?

To havo »ever a j

s

i 4 5 ^ 1

the hotiaehold t»ay be a burdëÉ but* They* may also <

i

looking af ter t«^ chilore» „anöiwijh ot

4

aec„

It is therefore more interesting to compare the ratio

children/adttlts (table Î2) « This ratio is reiaarkably constant,

1.3 - i«5j over the centres except in Kiaaibu where it

reaches 2»2» This last findiatg is closely r«lated to our

earlier conclusion that in Central Province nsany mothers

come from broken families, ïn Kiaraba many women not only

have to take care of more children but, in all ükelihood,

also with less h©lp than the »otïisrs at

!

the""«o'ther' cintres»

(28)

-27-Pregnant Not pregnant Total es 0 CO 32

68

100

(Ö •H §

n

21 79 1OO Si H Jj. as

«J

40

60

100

«

.0 f ti S •H 21

79

10O 03 & S 1O 90 100 «^lvtr«\buJkrio»v

less tïian 1 acre available 1 acr© or mora available Total « 0 È$) S 92 100 0$ •ri •3 A 16 84 100 § Ö ee •ri 41* 59** 100 s»

5

S o5 •rt

w

83

17 100

«

ß ^$ |j 3

s

43

57 , 100

*includes those women who reported to have *llttle* land

**±nclud©s t hos© wamsiss wfeo

(29)

-28-respect; particularly in Kisumu many mothars are pregnant, but also in Bungoma, whereas in Muranga this figure ia definitely low* The fact that in Kisumu and Bungoms pregnancies seem to play a greater rol« in malnutrition than elsewhere is probably related to a traditional belief about the harmfulness of a pregnaney, which holds that the'heat' of the womb of the mother is actually a danger to th« youngest living child* Whatever the explana-tion it is certain that in these two centres many of the wonen are pregnant and this should be taken into account in the teaching while considérable attention might also be paid to antenatal care in these two centres»

I* i* generally assumed thai poverty plays a major rôle in the causation of malnutrition not only among town dwellers but also among rural habitants» There are several reasons to be cautions with this assumption, not the least

being that more than one investigation has failed to deroonstrate such a relationship. Nevertheless, the.-, rôle of resources in malnutrition can not be ov«rl«AfcelK~In the rural situation the most important single economie resource is land. Table 14 shows the proportion of women at the centres who have no land or less than l acre available, Since the data tended to be f ar fronr reliable, no fi»**1 differenti^ation is used than the one employé^ in the table s It is, nevertheless, quite clear that i» Bnngoma and Buaia l the women have more land available than in the o t her centres,

In Kisumu and Muranga, but particularly in Kiambu many mothers have less than l acre or no land at all* In Kiambu this applies to 83% of the mothers and this high

percentaget without doubt, reflects the présence of tea estâtes in the area where many of the women work as casual or permanent labour»

Support- Since in most families the husband handles the proceeds ed;iby the

husbana of% cash crops or other money income his support,

particularly in finaneial matters, is important« Firstly a distinction needs to be drawn between »arried women living with thèir husbands and separated women. To start

(30)

Table 15

Percentage of married woaen receiving helpfrom husband

,.

Husband provides help

Husband does not provide help Total 6$ Ë O 60 H ta 83 17 100 « "0 3 ffl 83 17 10O f £ g « •H b* 95 5 1OO f- i!

af

A

s

•H « 95 5 . 100 <ö ÏM <d g 3 S

76

24

_

100 î i . > •

i c

no éducation Standard 1-4 Standard 5 or more Total

a

e

o

M » 5 « * * * * (0 •ri î^

a

75 11

14

100

0 JJ to •rt M 45 34 21 100 îJ «0

g

(S •ri 65 11 24 1OO 18 60 S «S L Jj S 64 22 14 100

* Bungoma omitted because of incomplete records

(31)

-30-with the latter groap, &® & «île thsy no long©!* reçoive

any help from their husbaads» Qaly tte-ee ©ut of a total

of 4l separat©«! woroen atteadiag thé eactrss received any

assistance« Althougii thia do@s aot warrant the conclusion that ia général «jjsarated husbands ao losigsr support

tfeeir familis^a thia ^Tindiag is »ot siar pris ing« Âmoag thé

î?osaeîi wh.o ar*© livlîxg witfe their 3taa®b&a.ds b©tw®©u. 5~2^%

report tfeat fee do®s aot pro-rid© ajay fc©lp (table 1 5 ) « Tîais perceaatag© is JhishetóéiB Muranga s««l is i75^ in BizBgoraa and In KisuEou and Kiaœïm thé pereastas© is rathcr lows

i bat in Kiambu reiatively maay women ar© separ-atad

¥3j©n th.« women w&o rsc@iT© a© support f^ora thelr

husband are ccmfoined with thos© who ar© ©ither single,

separate«* or divorced, this total coastitutes thé following of thé woia®a attenäing the ceatras;- Bungoma

, Bnsia (2?^)? KisiOBra (9^) l Kiambm (49^) and Muraaga 1 1 is ©l@ar that for the wome» in. Central Province lack o£ marital support i& à far more common profeleœ than in thé Westera centres, pertieularly

Formai AS regards th« level of @<t«catioxi reaefe©«! by thé inothers atteadirag th© eexitr©ss table 16 shows that in Basia, Kiamb«

and Mraranga fe©tw@®a 65 aad 75$> hâve a©v®r attende«! school, In KiSBtiau, howsver^ 55^ ©^ thé wossiea hav« r©ceived soœ©

éducation, 2î?i haviag at least r©aeli®d standard 5» This

does not nec©s@arily aseaa that the w-ome» at Kismni are less iö.aeed of instruction tîjaa the nsothers in the other c©Btr®So It i® itnlikely that tkay ha^r® isaraed nmch ab0ut child ÄHtritioa duriag their schoolyears« Wever th® les s»

the question remaias why the y are mor© edacatea than the

mothers at the o t her centres«

Op to aow we hav® rafraisaed ferons drawiaag soaclwsion® abo«t the ea«B®0 of majüautEffeiena ia the différant r©gi©îis ia

«rhich tfee centres ar® sitaated« For exatapl©, giv«ü the

fiïMting that in B«»gossa 60?é of the asarrieé taothers are partners ia polygsuMcras uaion®, wber©as in the other c®ntr®®

(32)

-3l-Tabie 17 . ^ „ Selected efcaracteristics of wornen attending Bangoma FLTC witfe général estimâtes for Westera Province«. _ »«____

Birngonia Western Provincô FLTC eetimate

Percentage'of women tbat are single, séparated, eîivorced or widowed Percentage of "iaarried women in polygasaous unions

incidence of pregnancies Percentage of women with ao formai éducation

13.59«

(b)

52%

not

avai-labié

18.5*

Ca) 3c;=4«3? P<

(b) xSlS.è? p<

(c) s =16.9î P<*001

(33)

-32-this figure is mueh lower, ose is ©asily tempted t© conclïide that in this région polygatsy plays a more important rola i» causing malnutrition than elsewhere» Such a conclusion woulâ, how©-ver, be unjuatified» It might just as weljL b® that tb« iaeidoae© e£ poiygaasy as auch is taucb. higfeer in Buagoma than ia t h© other districts (which« i»dsed, it ia)® Only when th© figures for th.© taotïifer® atteadiag the eeatres differ frora tlïose of all mother® i» tha r@gi©a is tij.e:re reason t«? stispset that a partioular factor, such as polysaasy, is involved ia the cassation of malnutrition Such a coBjparison is difficult to draw because information OB the général population of mothers ±& searce« The

ïategrated Hural Sttrrey (CBS, 197?a) protride® aom&

figtire» f ©r th« rural population of different préviaXea and tliis is the cloaest on© can gat at an astiraate ©f eertaiB characteristics of the wonsen of ehildbearing a ge ia th© districts surrouadias tfee centrer* Table l? through

21 present a comparison of the womea attendiag the centras (FLTC figures) with woa»©n in genera! ia th© particular provisee (populatioa figure©}« The incidence ©f pragnaneios has been estimated frosn census data reported by Osainde

be kapt in »ind that these data are only approximation» and that also for other reasons conclusions caa only b© tentative and hâve ta taken with considérable reserve«

The woasen adaiitted to th±s ©antre differ on thr©e oounts 'rros th® woraen in général i.» Westera Province and they

cossrpos© a mixed group of case® aaiong which three typss are predomiaaat » Firstly thsre is a grotap of wostea from foroken families» secoadly there ia & group of wosnen who are married but in poiygasroias ïmions • Thirdly ther© is a group of womea who are moaog&mously szarried but wh© ar© pregnant« This sstggestts that in this région several cau@e^ar© respensibl® for raalnutriti©» amoag youag children and that thé staff ai thé ©entre Sta-re to cop© witfe a relatively fe©±erog©n©ows groap of mother®»

(34)

Table 18.

Selectsd characteristics of «rooien attending

JBusia FLTC|Xitwith gener_al es[timate8_if'or_Wegterat Province Busia Western Province

' egtjuaate

Percentage of wom«m that 3.0% 13.5% are single, separated}

divorced or widowed (b) Percentage of married 35^ wotnen in polygamous vinions

• , (c)

Incidence of pregâaneies 2î?6 18,5?»

fj\

Percentage of women 75% 69%

with no formai éducation

')

(a) x,,=0»8%| not ' significant

(b) X2=1»3Ó| n. a

(e) x

2

aO»8O| nis«

(dl ) x =2

9

93| n,s»

Table 19 ' ' ""

-Selected characteristics of wöbiëh attending Kisumu FLTC wi th .generajL

Kisumu Nyanata Province

FLTC e_j8timate '

(a)

Percentage • of women that 4% 9^

are single, separated,

divorced or widowed

Percentage of married 34% 54%

women ia: polygamcras

liai ons ..

incidence of pregaancies

Percentage of women

with no formai éducation

40% 45%

17%

(c)

'

89%

<d) (a) Xp=6„7| p<«ÔI (b) xj*38;3; P<v001

(c) xS83»0; p<.001

(d) x =440»5lp«.OOI

(35)

»

Butf-La Tiie circamatancée of t&« womea &tténditt£ this eéntrè

» ^ -""*"» •'U"'>«"4^[ >-i ^i ••^•OT^ <f •^W*i.»-»'*c ***•

:ai?lej ^.^

not

^i^g^g^ f^.«« t&^-.gttaeerfti' • ' -

s ;

' - - -

--f^'...-Erom tfe« faet tï»at tfeey

aot significant* Tïiig,

i»S fi»€i»^» Whareas at the other csatres

are rëpeatedXy jfotatjsi betw«en- tlt© ^tt«adaat«

popalatiöB, at tJii«-contre tk® .motïterA are

jüa rsspeet of eaarital

éducation er the

**oi- diffar»»e«f* is- sot**

what it -mi98««t». at

**rslatioa feetwosa eitbar of the*e foor vw|^blf»-«aé.**

**existe thàt otfeer factor* a»o 'iawi|>]bK^**

existtes relatioBSÏiips and ia this ca«e it ±« beet io4

**reserre jnâgâœ@Rt* / j**

-' .

.

.Ki,-s«ómt. Th« vornan attenâiag tbe Kistianî seatr®

population in

The

of aGEs.-merr±©d. womea iet «e loï? a,s to b«

insignif icant fo^t it also app«ars - tfeat aaong

«t tîj® eeatr<» ttuupe 'is « leway iH«i,d»e

_{TT-W-I-IHTI^^-PIJ-U}

•auœrjt.'wg aad tîsat th«y ar© »gg**

•f'is'-stiy that tîjes® Tariable» jasre.mot

anâ. saeoaély tbttt 4a so

t® gepd h®ßit& «moag

«œt^iysis rev«al@<â that tfeer© ±M a

beiag «ÈoaogamsBasiy amartriôé and tîiat

a* tua tto®- -®f a4aoUsâ<jm t®- tb»/ e«&tré*

*feat- «m iape^taaat group ®f cases '

Ia-S9ô3a®gaa»«»

(36)

•sr-Table, 20»'''' ' ' . ' " ' ' ' ","; """ ' ' , ' . . Seîrectêll charaeteirisiies : of Women' attending Kiambu FLTC

.estiraateg;:.for- C e t r a l - Proyin&e •.. . •

Kiambu Central P* ovine»/ .

' , ... .eatimate .„_ '

Percentage '.of women t|»at. 4594

are siiiglè,;' separated, '•'

diTorced or wido-wed-. . . • • • ~. . •. • Percentage of snarried ' ' 26% ' 22% women i n polygamous • • • • • : • , • • . . r -unions ._{... • ..' . .. •. •}_,-•:_{•• . .. .• • . - .} Incidence of pregnancies 21$ 'c . . ; ' • • . . „ . • . . . . ' • . . . ' f J A ,

Percentage of wbnien with ' ' 65?a ' 68% l ; '"''"' • ' "~\ n o formai éducation ; . - . . . - . v . . - • •••. . - . • - : • • • <

(a) xf=37»4j p<«001

(b) 3£ =0,5* n»s f d ) -5?^*—O-'O* «'"s . , • • . • • • • . . - . .

x

2

=0.3; n

e

s

Table. 21 .. . , . ... ., ..

Selécted charatoristics óf woœea attending Muranga PLTC

Percentage of' women 'that are 30?4 single s sèpar-a-tëdy divoïrced • ' or widowed . . . . . ' • . . • Percentage of marrièd' wómen 9^

in pplygamo.us. unions

Incidence of" pregnancies '• " "-10J6 Percentage of womèn vith"t>o '

formai éducation . 64^ 22?S i n / /*O 2O% : Wo <,d>' ." (a) x?« 9*05 p < «01 (b) x*» 8.0ï p < . 0 1 (c) x„= 6.95 p < « l O (d) 2c = 0«7| n»se

(37)

-36

fonnd« NearXy half af t h© ssotfe©r0 arc not marrie«!, not only the highert parcôatage ,of ail contres fout &i®& 2$% higher than in thé province® Ât the saai© t ira« thsrs are n© différence® in ®d«catioH ©r the incidence of polygaœy and prcgnaneies» Th© isufprsssion distisactly gaineâ fy&m thés® figttres is that thé majosr fact©r behiad laany cases is tbat of woman who iiava to ©op@ for th©ai®©lv©s and their cfaiiddren vith little help, financial ©r othex-wise» This discription, of course t fits mny of the women labour ing at the tea estât©® aad who often hav© to l®ave their childrea «acared for during thé

(Table 21}

or hâve a huaband who do©® nçt support thsia and it appears that this, jus t as in Kiambw, is the maia feackgronnd factor« The losr incisî©ace ©f pregaanoies and of poiygamons

with this 3 It appears that a relatively large gromp

are sdîieated or not« Th® relatio® batween malntitritioa and

(38)

jaalsratrit.ieEU Ttïis eostrary f iïidiag jSraLS.t fcrobatyiy foe isterpreted ia tïse context ©f .faiaily stability, aad it- sHggests 'thai i» .Central Proviace thô institution

(39)

Kotes

(1) Ia the large saajority of" ca,ses the

'briagiag the child fco the centre is the sB0tfaer of the childe For t-hat r eas on chroughout tais rej.ort tiie WOHSSK axtendi'OK toe contres are also rsfsrrad to as 'otofhers* incladiag "chose cases «s-feer© tbs

is not the natur&l aiother of the ( 2 ) Sinee chiJdrea old@:r tïiaa 6

froKs tfeis aad f^rtbsr calcnlatioas the actual o,

of cbildren accoap^iag the airsrage aso t her is Jiigher» Tîiis figure can be eosaputod frosa table i and. sh.ows the ciiff' eresces between th« centree to be evexs Eore strifcing-i Buiigosna C l « 8 } ^ Bus la ( I . 4 ) j Kisuœu (l »6) f Kia»bu 1 3 «O j and Muranga C.2-'"*^

(3) Children wer e considère«! to b« jaalsiourishsd if thexr wsigfat feil below 80% of the weight that tould bs ©xpected for the ir ags according to th« AA^"*''-1"'r~~

staridards (W/A bslow 30^},

( % ) After eorssultatioÄ with the supervisors or their ï

assistants the accommodation at the contes was sstimatecl to b® as followso Bxingoraa; 15 «nothors and 25

Easiaî 11 mothers n ad 22 childrenj Klstumu: 2%

and 36 cfaildrenj Kiambtt; 8 aiothors arid 32 chlldreai Muranga; 52 motbers and 80 ehildrei«» Although, in cas® ©mergeiiey? 20 .r.&tbsors osay be adasitted at Su* la and up to kO raothers at Kisumu, thèse Isst figures c an KO t be regarded as the ^ oraal capaciîy of thèse centres«

(3) The staffraernbers which are inciucîed i« th«se cospti are tbe supervisors, assistant supervisors and bous«i~ mothers« Other persousael such as watchmsn or statiemlm axa not included because t h a j «sually do not talce pari la thé course« The actual maabers «iiïring 59?6 were (4 starfmembers) f Bu a i a < 4 U | Kisuîaiî ( 5 ) | Kiaa-ibu ( 3 ) and Mur saga ( % ) »

(40)

(6) The parc«*?tage ,if cbx3ren who îv^â th®I

reeorded. 1rs f u » l yesrfc <L fr'ers ccmsd.tf&rabiy j>er clinxc wîîlcîx in i î s a i f is an ar «usaient tb at fc*te qaa.li.ty of

th±s JLufürraa^ioa cuatd b« improvfed» ai leasx, at

jtj centra« T« o i"I|ra.re& are nuagoina (^

f - ' j L ) « The pn«;»Ibi.lity «xisïs ihat otlier factor« than ?

condition of t.hè cliild siave also i»f!.u«ae»d atlmissioii

tô tb.® een.±.re ( A ® u ccncrefe ascarapi©, it Sa±|th be possible t ha t at kisuiau, for os« rosjsoa or of all sBOtfe®rs with jaölAoax'isïied. chilciran t&e oiies tend to fr*-quoat the cenir& more or «*rcf

®ore for Adœls?a.oiî;* Kc-wsser, 11 is clif^'ic^It co se«* whicb extraneous factoss c ouï d b« responsable ro&4 *;ho fiadiags ia th Is section«

e-as be expected t; o oecuar- o\< tbr e e groisnds^

irs cirawlïig cases frosj al13 over ths d j s l r i c l «

asost o<dsos ai'o refcrsr&d Dy profös&ios»! workers so t*i01, neitisei"' csographical disssTsce nor kr>.o^l,edge of the ',e-jr- ' offers a likely alfcentai Lva explasus^icn« It is of ec«œt-u

ïï;le t o Ifi-ATe hwr n«>mc f"«.« a /» -, *s I'aii s,« secsA tlïis could exj^ladn 'Cfee ofos^rvsd da,fr«*i snses«.

littls rsasoïi to assuwe cbar these suotber« are d froïs aay pas* t ir u 3 ar grouj» otb®r char fchat Ois sot o£ the findir»gs is also s u b j e c t t,o fciii«;

(41)

a.*-«.

re i lEiitry aa<f. Disro'isvft-ö Record FT&.TS ily Lifs Traiuir-g

TU s errtry a?.-,r! 41 :?<&!• -.or g® rsoox'd r'oydss pr&*»®at3y i», at the Passiiy Lif« Tr&:ixiing tVattr«^ ars generalij bat suf-fer sons® shos^castings» ïkâ staff' at tis <jscss3.osaal3.y ooKtpl&i^ abêtit tfa« îemg-'-h o£' thé foras

tb® lack of clarlïy ox' certaisa ^u»atxonsa "^s.

^a

» ecoaxsted »isrious profclsss in aaalysia dafcs b«caöse svauy of' -ehe quesstiosus •w®ra iaaecurst© had aot been Ciii.ee ia«

Te oor view • t&ö : resorâ foras s©rv® • tfer ®o ï*aa4'feiè.ïiè to toep track of the. patients .'»ad tfe« op «rations - o f •

the oliîîie« Secoadly they help th© • staf f at • the ' e®ixtres to gain iasigfet ist© . tue p«rs©aaî eireaustaaes ©f' the

attesdiB® aotîiers» ThdJrdly tfeeyiar® s »©«.esisary tooi for tl-i«- assessasnt eT iadividual sasss aad the e-valmaf i©a of tbe centros »

partlcularly as regards thé last two . - faractien«, Th® shortcoEiiags . of thé présent form» are- described détail below, felloweïi by semé suggestions for ( ~ ) as îis K«*t unusual witîi gi>vernî»Nfâ^t forœs«

formSj too teach informât i«m is c©lleet©^ information that serves aeithsr thé need for .vital • information n&T thé need of th® staff &ad which is aise« not sscessary fer svaltsatio ( - } Thre® copies of tîie record ' foï*as pressntly îia^ô to be filled in, osie 'to r «mais at tfee «eatre cas for thé CDU 's office asd oue for thé îîiaistry, Tîiis invoîves a ^ considérable araoont of work for th.« staff a©t only/also

(42)

( - ) Certain questions are aaibxgous and not d®fiaed

cJearly enough» Thés© questions are interpre t ®d diffarexkxl by différent s tsffmeiafoers a ad diffsreat ssotfaer-s«, Conse-qu.en.tly thé replies are of litlle use to otber »taffsnetabex or replacements whsn they consult the files aad are also o£ Utile use in évalua t ive STrcliss^

{-) In this coaüeetioß fchere also Baisses an adeqaat© instruction for ih« staff how to Till in thé forma in gênerai or certain qcwtions ia particular«,

The abova criticisœs are concarnsd witfa thé questionnaire as sxich but ws ax-e also or thé opinion that thé data collected for ©«tcorae évaluation are œ©agr©<* Th« weights of the efeildren ar® .recorded only at admission aad ai discharge and we caïuiot ©scape thô impression tliat thé t>re,ights are oft sa nieasured less ôarefully aad ies®

accurately thas is necsssary« We regret that thé heights o t the cbil'tren are not œeasur-ed because heigbt is

an important indicator of xmtritionaî status*

To rectify thèse sbort.cosjiïjgs a n<sw record forias secsss required» We saelose a draft o£ a possible record form

A

t ha c is ooïiSï^rabl^ reduced in sîze, inquirdlng after thé nscst pertinent inf orraatiôn only« We bave also taken earo •co raak® the questions as elear as _ possible aad as; certain points instructions to t fee staff sre included» Lagt bnt no c lasst answers are provided with îaost of the questioat-so that they only need to b® ticfe-ed In t h® appropriât® therefcy red^cing writiag to a

For purposes of évaluation we recoüsraend tîsat thé weight« of tbs ch.ildren are recorded at least on<<ce a woek» Tliis will Tjot only help thé staff to ®ss@ss thé progrès» of

•fcà'H^

ittdividual caseis bat «nap at thé sasEe/sarve a® an «décati o

A-situation for th® aiother and woald provide useTuJ data for future stu.dy» To otir viaw Ifc 1s also jaecassary that •* Iseigbts of *ie cbildrs« are r-acordeds at least o?»@s,

(43)

as accirï'&f il-v as po»riblc-s t' i - r s x ï y ov pr* v-idlr^- in*-. CA i

m vh i-ue^i at,o i^ïsc; « » i e t - t a , ccc«4. lly b*, «*•

' vo po i ä n « - n--»»« hè. rai-s^d T ^ » ^ g ? '• ,7 p*- c c e dur1 «» r + v n ^ I . ^ rie°„ i i -,cgf c -1 ?» -»

oacJi c% n. t r r pvovtc«-» lts o,« ^W-fvK. J d ^ n t , , ' ypcd » 7 2. «f Coarxi O i - n » 3 n . ' j c » l ' . ^ « 5 . s o, s, * , >r< •• ».y i^<ü to » of l > ? e a V tarit.-, «.uôf f-^- c,,,ïi c,*-^;

ia--slïxesî 'i h t j u t j a > o'*" ^.ïia pj>6a*»i; . ' - i T 3 5 "j ^poi t^irt requise d c ari'l'oi 7 tcplji^ ar, J. -l~^-y- '•*},„* ' cvr es.*** > e i »

seeiï'Aj pj'<#* er a'^ ,. -> t'isït, r s - th*> t a t ,'s~-~- t ^ >-$-?; «f -a •jvo?'^, c&nli'f^, 2 •v * r'» :'}uO- vcnccr î^'ie-" "1^1 ' •*• 'i » oaj ty nsr-^ t Isa''" { Itrro f e r n * :»T f l ll^-ï io f ^ r c * a r * , cai.e* J i H*" rcci' l Kit en a cojr, at c hf» i * at- - i.n ot.e rr*py f»*- i 'i**

(44)

C «m er a C BÖ (,197?b>v Tne P -ar A l <~f" Oliede I is ^ »•>' a n \ï / * J^HT'™? i, , i2ZiT UT' Vol ar d ^^ raming , C s r - « ; ? 5 \ K » S » Odwgo

(45)

Ministry of Social Services

Family 'Life Training Centres; Case No»

CASE RECORD FORM _{This form filled by:}

i u.

Instructions;

For each woman who is admitted record the following information. Answers are provided with most of the questions and where this is the

case, the answer must be ticked in the empty box next to it» (-) When a respondent gives a clearcut answer which, does not

fit one of the answer catégories, the answer 'other' should be ticked»

(-) When, on the other hand, no clearcut answer is given or. when a respondent refuses to answer a particular question, the answer 'janknown* should be ticked»

(-} When a question has not beeil asked at all, nothing should be written down and none of the answer boxes should be ticked» A. Centre Date of admission Date of discharge Referred by Name Designation O09

J_J

00*.

Please record the following information for the wbman who is admitted

Name: ooc 'a n o «ö 007 Division Location Sublocation Village Chief Distance 5 i i 1 ; 1 '\ 1 ^

1

ïribe

is this address situatedi in town in a village on the land other unknown /

2

3 t

à

008

f

i

' .-ri; .M

u3

B'

r* roman catholic protestant tnuslim other none unknown /

Z

3

4 jr

B

ett Edüeationfaas t fora i attended } no éducation standard 1-2 standard 3-4 standard 5-7 any éducation af ter primary unknown

i

2

3

4 r

9

(46)

Ask her the foliowing questions in order: PO you have a husband ? yes

If ,.ye»«fill in below ty i, B*

i *

**^^ 1i»^^4».A«Jj Marne nuspanct

Are you and

f !' a ' 'i ! t' ""^

, . "fc , , ,- , .: . f

your husband staying together7 yës,together separated divorced husband working elsewhere unknown

1 ;

2

3 i

4 9 «a

Do«* your husband hâve any other wives?

» yes no unknown 1 2 9 «H

Does your husband provide any support(money, £oodtclothes) for thé children?

yes

very little, not much no unknown 1 2 3 9 i > ^ ^"^m 2 | j M* "' ' J"|| ' ' * é liai* BlrtM * •* ! s-ï H ||(

divteifc^lllf^Ïlifed? ' ?

j" iiöglel ' J T

¥

^ J J^

1 eï|àrated " '

jdivoircea '' '; :5^

widowed i ' 4 . unknown 9 B14

Ask all. £)MH*e- womcn who are not or no longer living wit h a husband (i»e„ who are single, «aparated,divorced or widowed):

Are you presently living with a man (a male friend) yes no unknown T. Z

9

If yes to this last question

Does hè provide support for the faraily? yes very little, not much no unknown

1

2

3

9

_t>\8

(47)

-3-(including the woœan herself) What is the total number of adults

(anyone over 16 years of age) living in your household?

Who are they; in what relation do they stand to this woman?

What is the total number of children living in your household,including the children admitted to the centre

How many of these children are your own children,how many of these children did you give birth to ?

Are you pregnant?

What does your work consist of throughout the montha? (Ask each of the four alternatives ar.b,c and d *

in turn and record the reply for each of .them)

1

2

3

4 j5_

2

3 4 5 6

-7

8 9 *

woman herself

if more continue on the lef t side of this page

1

2

3

4

5

6

6 yes

no

unknown

1

2

9

7

8

9

9 * •

*

«0

0» 0»!

«n

(a) work in the household?

(b) work in the shamba?

(c) casual labour? (c) permanent job?

yes

no unknown

yes

no

unknown

yes

no unknown

yes

no unknown 1 2 9 1 2

9

1

2

9

1

2

9

»9» »W vssr •a6

* If the number is greater than 9tfill in the correct

(48)

Do you have any land available and if yes approximately how many acres?

no land

1 acre or less more than 1 acre more than 3 acres y es t but approximate size unknown 1 2

3

4

9

»s*. Ir tï«w$6 is «ay important information about this case which ha« »tôt yet been recorded please describe below,together with any other remarks you wish to make

How many children were admitted with this woroan?

1 2 3 4 5

6

7

«a«

The following questions regard the children admitted with this woman.For the child which is malnourished and which requires admission to the centre

detailed information is requested but for thé other children less information is needed. When more than one child is malnourished this detailed information raust be recorded for the most sévère case* For this child weights should be recorded every week while for thé other children weights should be recorded at admission and at discharge. Heights of ail thé children hâve to be meàsured only once,at admission*

C la Child, requirins admission or most sévère case ;

Name mâle

female

1

2 _oVs

Date of birth * Checked from

birth certificate

yes no

1

2 Is thé woman attending with thé child

thé natural mother(did she give birth to thé child) or does she fall in one of the other catégories?

mother co-wife gr andmo ther other relative other unknown 1 2

3

4

5

9

In thé case where thé woman is the

raother of thé child i

la this her youngest child ?

yes no unknown 1 2 9

* The date of birth must be recorded as precisely as possible»However, when thé woman is not able to tell thé month of birth,as an exception, thé âge of thé child may be r«corded«The same applies to thé other children»

(49)

Continue for the child requirinjg__admj.ss_ion or most sévère case

Ts the child still on rhe breast? breast .feeding only breast feeding with additional foods no longer on the breast at all unknown

Whon the child is'no longer on the breast at all: At what age did the raother completely l

stop breastfeeding this child? l

ové Degree of malnutrition none i rail d moderate sévère unknown 1 2 3

4

9 tji«

Was t|ie child seen by a doctor or médical assistant during

the stay at the centre?

If malnourished, type of malnutrition: marasmus marasmic/kwashiorkor kwashiorkor unknown yes no unknown i / :

t S

3

Did t.he child receive any immunisations during the stay at the centre

If yes, which ones? polio "L 2 3 ± 2 3 «t?7 DTP ± 2 3 4 5 6 vyi measles yes ! no unknowH / Z

3

7 Ismail pox ,j

E

~*— •• ' •»—— «ie a sur eraent s 1« at admission La» af ter 1 week

sa,

5« arter 2 weeks (u af ter 3 weeks OS» 5« at discharge OÉO dalte 1 . «™~~-~»^ weight .. . , , , , , , , .«*' ofâ

^

efe date height Follow-up :

(50)

t.

-6-ber children accompanying the above child record the following (When are more than 3 pther children record the three youngest of them belo 'iiy remaining older children only record name, s ex and date of birth at

ottom of the page):

2 «Name

Date of " birth Checked fr ofcj birth eert

om i f male f emale tcate yes no 1 2 t A Qb9

1

2 Signs of malnutrition I-f yes,describe : »t» yes no 1 2 j Measurements 1» at admission .- - «M, 2* at discharge ~~. ...,._.*« date weight

, ...„

-.

,

*»% WW date «& height ft

1f

Follow-up; 3 .Name Date of j male f emale

% birth Checked from

€>7*> [ birth certificate «ay /»t>.,4A

ye<u--yes no

1

2 *>fi i 2 Signs of malnutrition If yestdescribe jyes |no 1 2 Me a sûrement s 1« at admission ffa 2. at discharge date 1 weight j** 0«* date . «04 height ^ Follow-upj 4 «Name

Date oi' birth

e** male f emale Checked from birth certificate 1 2 yes no oSf

i

2 Signs of malnutrition If yes,describe: yes no 1 2 ««i j Measurements î ! l»at admission ! . ay*. •"• " *M1 2f at discharge date weight - - #Vt ,. ,*»* date «4.,-.,rheight , - »J? Follow-up: