ORIGINAL

Niger J Paed 2015; 42 (3):214 –217

Agbedeyi GO

Eke GK

Nte AR

Feeding pattern of children in day

care centres in Port Harcourt

metropolis

DOI:http://dx.doi.org/10.4314/njp.v42i3.8

Accepted: 11th May 2015

before 6 months in 613(39.8%)

and after 9 months in 181(11.7%)

children. The ages at starting day

care attendance which ranged from

Abstract: Objective: To deter-

mine the feeding pattern of day

care attendees aged 0-35 months

in Port Harcourt metropolis.

(

)

Agbedeyi GO1

Department of Paediatric,

Ebony Hospitals, Rumuola,

Port Harcourt, Nigeria

1

-25 months with 56.3% children

Methodology : Following appro-

priate approvals, a pilot-tested

questionnaire was used to obtain

the socio-demographic data and

information on the feeding pattern

of 10 day care attendees aged 0-

35 months who met the study

criteria selected from each of 200

schools using a stratified multi-

stage random sampling technique.

Data entry and analyses utilised

SPSS version 20 and statistical

significance was set at p<0.05.

starting before 11 months of age

statistically significantly influ-

enced the ages at which comple-

mentary feeding commenced (χ2=

Email: tagbedeyi@yahoo.com

Eke GK, Nte AR

Department of Paediatrics,

University of Port Harcourt Teaching

Hospital, Port Harcourt, Nigeria.

5

3.431, df = 8, p = 0.000). The

main foods fed to day care atten-

dees while at day care centres were

adult diet for 1152 (74.8%) chil-

dren and breast milk and/or cereals

for 389 (25.2%). Daily feeding

frequencies while at the centre

which ranged between 1-6 times

and decreased with the child’s age

an the age was statistically signifi-

cantly affected by the child’s age,

the feeding frequency (p = 0.000).

Conclusion: The feeding pattern of

these day care attendees did not

comply with the recommendations

of the National Infant and Young

Child Feeding Guidelines. This

situation at a national level may

contribute to the high prevalence

of under-five malnutrition and

calls for strategies to correct these

deficiencies.

Results: Between November,

2

011 and July, 2012, 1541 chil-

dren comprised of 766 (49.7%)

males and 775 (50.3%) females

were studied. They were aged 5-

3

4months (mean 23.78 ± 7.04

months, median 25 months and

modal 24 months) with 110(7.2%)

children aged less than 12 months

and 283(18%) aged less than 18

months. Although 102(6.6%) chil-

dren were still breastfeeding, none

of the 21 (1.4%) children aged

less than 6 months was being ex-

clusively breastfed. Complemen-

tary feeding commenced at age 6-

Key words: Feeding pattern, Day

8

months in 747(48.5%) children,

care attendees, Day care centres,

5

-7

Introduction

government or non-governmental agencies . The age

range of children in day care centres varies between

countries, developed and developing alike, but the com-

The period of a child’s life from birth till the age of

1

8

years are the formative years as it is during this time

mon age is 3 years . In Rivers State however, the cut off

age was fixed at 6 years even though children at this

age have usually started primary education. A child in

regular child care should spend at least 10 hours in care

per week . However, no duration was recommended in

9

that optimal growth and development take place. Moth-

ers are the most important humans who influence their

children’s feeding practices in these early years but with

the global economic recession more mothers now work

outside their homes. Consequently, their children are

entrusted to other caregivers either at home or in institu-

tions such as day care centres where they are cared for

10

9,11

relevant Rivers State and national policy documents

.

The World Health Organisation’s (WHO) Guidelines

leave the curricu₁l₂um for early child care at the discretion

of each country but it is expected that while in care,

children will be taught appropriate language and social

skills and have their basic nutritional and health needs

met.

2

,3

and fed .

There are different types of day care centres – institu-

tional or home day care and care given by a non-relative

in the child’s own home . They may be run by the

4

2

15

Day care attendance has been reported to impact varia-

bly on children with some studies reporting improved

intelligence quotient, development and academic grades;

cell disease and other chronic illnesses, or had a younger

sibling who had been recruited into the study at the same

centre.

13

better communication with their mothers .Other studies

however, reported adverse effects such as increased inci-

dence of respiratory, gastrointestinal, skin, ear and other

The pre-tested study questionnaire was used to obtain

the socio-demographic data and information on the feed-

ing pattern from the parents/guardians and minders by

one of the authors with the aid of trained assistants. Ap-

provals for the study were obtained from Research Eth-

ics Committee of the University of Port Harcourt Teach-

ing Hospital, NAPPS- Port Harcourt Chapter, Day Care

Centre Proprietors and parents/guardians of participating

children. Parental and school authority’s counselling

was done for all children with inappropriate feeding

practices. Data obtained were entered vetted and ques-

tionnaires with incomplete data were excluded from

analysis. Data from properly completed questionnaires

were entered into a Microsoft Excel spreadsheet and

analysed using SPSS version 20 with statistical signifi-

cance set at p<0.05. Results are presented in tables and

charts.

14-16

bacterial infections

.

For optimal child growth, the WHO’s Infant and Young

Child Feeding Guidelines which have also been adopted

in Nigeria require a child to be exclusively breastfed till

6

months and thereafter, breastfeeding is continued with

compl₇e_,₁m₈entary feeding till the child is aged at least 2

1

years . Compliance with these guidelines have been

variable with very few studies evaluating the situation

13

even in Nigeria hence this study to determine the feed-

ing pattern of day care attendees aged 0-35 months in

Port Harcourt metropolis.

Materials and methods

This Port Harcourt-based cross-sectional descriptive

survey was conducted from November 2011 to July

Results

2

012.Day care centres in Rivers State are registered with

Of the 1541 children with complete data, 766 (49.7%)

were males and 775 (50.3%)females. They were aged 5-

34months (mean 23.78 ± 7.04 months, median 25

months and modal 24 months) with 110(7.2%) children

aged less than 12 months and 283(18%) less than 18

months. One hundred and two (6.6%) children were still

breastfeeding among whom were 55 (53.9%) who

breastfed during the hours they spent at day care.

the Department of Child Care in the State Ministry of

Social Rehabilitation as well as with the National Asso-

ciation of Proprietors of Private Schools (NAPPS).

However, while the NAPPS registered 500 centres, less

than 50 were registered with the government. These

centres are spread across the metropolis, and clustered in

2

0 zones,10 zones in each of the 2 Local Government

Areas (LGA) that make up Port Harcourt metropolis-

Obio/Akpor and Port Harcourt LGAs. The Rivers State

Government did not run any day care centre.

Although 13(61.9%) of the 21 children aged less than 6

months were breastfed while at day care, none was

breastfed exclusively. Additionally while 5.6% children

aged 20-23 months were still breastfeeding 12(0.7%)

children were never breastfed (Table 1). The median age

at which breastfeeding was stopped was 12 months.

Adult diet alone - consisting of foods such as rice, pasta,

tubers and plantain- was fed to 1152 (74.8%) children

aged 6 months and above while 389 (25.2%) children

were still being fed on breast milk and/or cereals. The

age of each child was a statistically significant determi-

nant of what he/she was fed with while at day care

(p=0.000). Parents prepared the meals eaten by 1209

(78.5%) children 21.5% children ate meals prepared by

other people such as their relatives and the minders. The

minders employed by the centres fed 1418 (92%) chil-

dren while 123 (8.0%) children either fed themselves or

were fed by their mothers. A cup/plate and spoon were

used for feeding 1449 (94.0%) children while 92 (6.0%)

were bottle-fed. The age of a child was statistically sig-

nificant determinant of who fed him/her while at day

care (p = 0.007) and the utensils used in feeding (p =

0.000) but not who prepared the food eaten while at day

care (p = 0.415).

The minimum sample size for the study was calculated

19

using the formula :

2

N = z (pq)/ e [z=1.96 at 95% confidence intervals, so

2

that z = 3.8416; p is the proportion of day care children

who were fed according to the IYCF age appropriate

recommended guidelines while at day care centres.

However, since the proportion of day care attendees who

were fed according to these guidelines was not available

either at local or national level, 50% was used (i.e. p=

0

=

.5),q is 1 – p = 1 – 0.50 = 0.5, while e is 0.05 giving N

z (pq)/e = 3.8416 x 0.5 x 0.5/0.025 = 1536.64 which

2 2

is approximately 1537 children].

With the assistance of the NAPPS, 200 schools were

selected using a stratified multistage random sampling

technique, based on the location of the school. In each

LGA, 5 out of 10 zones were selected and 20 schools

from each of the 5 selected zones. In each school, 10

children- 5 from each gender, aged 0-35 months who

met the study criteria were studied. The inclusion crite-

ria for the study were attendance at the day centre for at

least 3months(one school term), parental/guardian’s

consent/completion of the questionnaire, child’s assent

and the child being apparently well at the time of the

study. A child was excluded if the criteria were not met,

or had any pre-existing medical condition that could

affect the child’s growth such as multiple births, sickle

The daily duration of stay at day care centres was less

than 5 hours for 123 (8.0%) children, 5-10 hours for

1411(91.6%) children and 10-12 hours for 7(0.5%) chil-

dren. The daily feeding frequencies while at day care

ranged between 1-6 times (mean 1.85 ±1.039 and me-

2

16

dian 2) with 724(47.0%) children being fed once, 490 (31.8%) twice and 327 (21.2%) 3-6 times. The daily feeding

frequencies with cereals/adult food reduced as the child got older with 88 (5.8%) of the 110 (7.2%) children aged less

than 12 months being fed at least twice compared to 502 (32.6%) of the 973 (63.1%) children aged 24-35 months who

were fed once. The ages of the children significantly affected the daily feeding frequency while at day care centre (p =

0

.000).

Table 1: Feeding practices of day care attendees while at day care

Characteristics

Age range (months)

Total

N(%)

1541

(100)

0

-5

6-11

12-17

173 (11.2)

18-23

285

(18.5)

24-29

631 (40.9)

30-35

342 (22.2)

Age distribution N

21

89 (5.8)

(%)

(1.4)

1

. Breastfeeding practice among day care children while at day care [p = 0.000* (Fisher’s exact)]

Breastfeeding

13

42

29 (1.9)

3

9

6

102

N (%)

Not Breast –feedingN (%)

(0.8)

8

(2.7)

47

(0.2)

282

(18.3)

(0.6)

622 (40.4)

(0.4)

336 (21.8)

(6.6)

1439 (93.4)

144 (9.3)

(0.5)

(3.0)

2

Foods fed to day care attendees while at day care [χ = 68.89, df = 5, p = 0.000]

Breast milk / cereals N

%)

Adult diet

N (%)

21

(1.4)

0

24

(1.6)

65 (4.2)

32

(2.1)

141 (9.1)

61

(4.0)

224 (14.5)

163

(10.6)

468 (30.4)

88

(5.7)

254 (16.5)

389

(25.2)

1152 (74.8)

(

(0)

2

Who prepares foods fed at day care [ χ = 5.012, df = 5, p =0.415]

Parents N

%)

Others N

%)

20

(1.3)

1

68 (4.4)

130 (8.4)

226 (14.7)

59 (3.8)

495 (32.1)

270 (17.5)

1209 (78.5)

(

21 (1.4)

43 (2.8)

136

(8.8)

72

(4.7)

332

(21.5)

(

(0.1)

2

Who feeds the child while at day care[χ = 15.838, df = 5, p = 0.007]

Minders N

%)

Others N

%)

16

(1.0)

5

81

(5.3)

8

(0.5)

154 (10)

257 (16.7)

596

(38.7)

35 (2.3)

314

(20.4)

28 (1.8)

1418 (92.0)

(

19

(1.2)

28

(1.8)

123

(8.0)

(

(0.3)

2

Utensils used in feeding the child at day care[χ = 46.620, df = 5, p = 0.000

Cup/plate and spoon N

%)

Feeding bottles N (%)

15

(1.0)

6

74

(4.8)

15

160 (10.4)

273

(17.7)

12 (0.8)

608 (39.5)

319

(20.7)

23 (1.5)

1449 (94.0)

(

13

23

92

(

Feeding frequencies while at day care[χ =26.028, df = 10, p = 0.000]

0.4)

(1.0)

(0.8)

(1.5)

(6.0)

2

Once N

%)

Twice N

%)

Three or more N

%)

5

(0.3)

9

(0.6)

7

(0.5)

17

(1.1)

21

(1.4)

51

(3.3)

63

(4.1)

50

(3.2)

60

(3.9)

137 (8.9)

324

(21.0)

220

(14.3)

87 (5.6)

178 (11.6)

111 (7.2)

724 (47.0)

490 (31.8)

327 (21.2)

(

79

(5.1)

69

(

53

(3.4)

(

(4.5)

df = degree of freedom

*

soft foods is 6-8 months

Recommended age for ₂t₀he introduction of solid, semi-solid or

All the day care attendees, irrespective of their ages at

starting of day care, had been commenced on comple-

mentary foods with 747 (86.2%) of the 867 (56.3%)

children who started day care attendance by 10 months

of age having been started on complementary feeding by

age 6-8 months. Thus the ages at the commencement of

day care attendance statistically significantly influenced

the age at which complementary feeding was com-

menced (p=0.000) (Table 2).

Discussion

Compared to the 10.6% day care attendees age less than

21

6

months in the USA who breastfed while at day care,

1.9% of similar aged children in our study did so.

However in both settings, there was poor compliance

with the WHO IYCF Guidelines which had been

adopted in both settings. This was evidenced by lack of

exclusive breastfeeding among day care attendees aged

less than 6 mo₇n_,₁t₈hs and the cessation of breastfeeding

Table 2: Ages at commencing day care and introduction of

complementary feeds

Ages at which Complementary Foods were introduced

1

<

N (%)

6months

6-

8months*

N (%)

> 9months Total

before 2 years . The high level of poor compliance in

Age at com-

mencing day

care atten-

dance

N (%)

these series is similar to those documented from Osog-

22

23

bo , (Western Nigeria) and Sao Paulo whose authors

blamed the poor practices on lack of maternity leave and

the location of day care centres away from mothers’

work premises. Although the breastfeeding rate among

children aged 20-23 months in this study was low com-

(

months)

1

6

1 – 15

6 – 20

1 – 25

– 5

– 10

210 (13.6)

166 (10.8)

115 (7.5)

49 (3.2)

205 (13.3)

204 (13.2)

137 (8.9)

126 (8.2)

75 (4.9)

36 (2.3)

46 (3.0)

30 (1.9)

27 (1.8)

42 (2.7)

451 (29.3)

416 (27.0)

282 (18.3)

202(13.1)

190 (12.3)

1

2

24

pared to the 40% reported in Bogota it was higher than

the 0% recorded in Oshogbo which recorded a similar

median age of stopping breastfeeding.

73 (4.7)

2

Total (%)

613 (39.8)

747 (48.5)

181 (11.7) 1541 (100)

χ2= 53.431, df = 8, p = 0.000 [df = degree of freedom)

The similarity of our rate of early introduction of

2

17

complementary feeding with those reported by other

studies in Nigeria, Ghana, North and South America

may be attributed maternal feeling of breast milk inade-

quacy and ignorance of the be₂n₁_-e₂f₅its of breastfeeding as

Conclusion

Children who start attending day care centres at an early

age are less likely to be fed optimally as recommended

by the National IYCF policy especially if their mothers

are working at sites located far from the day care centres

where their children attend. Access to day care centres

in working environments, enforcement of the IYCF poli-

cies with monitoring and supervision of day care centres

are likely to promote compliance with these guidelines

and improve the feeding of day care attendees.

have been previously reported

. The prevalent use of

adult diet documented in this study, although not com-

pliant with the National IYCF policy has been reported

22

in Osogbo and may be explained by the lack of appro-

priate facilities at the day care centres to hygienically

prepare the recommended complementary foods and the

high cost of commercially available complementary

foods.This study has also demonstrated the adverse ef-

fect of early commencement of day care attendance on

the compliance with recommended optimal infant and

young feeding practices especially where the day care

Conflict of interest: None

Funding: None

26

centre is not located close to mother’s workplace .

References

1

2

3

.

United Nations Children’s Fund.

Choices to be made. The State of

the World’s Children 2001. UNI-

CEF. New York. 2001: 14-27.

United Nations Children’s Fund.

The Silent Emergency. The State

of the World’s Children 1998.

UNICEF. New York. 1998: 9-36.

Silva EMK, Miranda CT, Puccini

RF, Nobrega FJ. Day care centres

as an Institution of Health Promo-

tion among Needy Children: An

Analytical Study in Sao Paulo,

Brazil. Public Health Nut 2000;

10. U.S Department of Health and

19. Akpala O. Sample Size Determina-

tion. In: Akpala O, ed. Epidemiol-

ogical Research: A Practical Ap-

proach for the Medical and Nurs-

ing Sciences, 1994: 57-64.

20. United Nations Children’s Fund.

Statistical Tables (Nutrition). The

State of the World’s Children

2015. UNICEF. New York. 2015:

42-47.

Human Services, National Insti-

tutes of Health, National Institute

of Child Health and Human Devel-

opment (NICHD). The NICHD

Study of Early Child Care and

Youth Development, Findings for

Children up to 4 ½ years. January

2006, NIH Pub. No. 05- 4318.

11. Nigerian Educational Research and

Development Council and United

Nations Children’s Fund Nigeria.

National Minimum Standard for

Early Child Care Centres in Nige-

ria. Document, 2004:1-14

12. United Nations Educational, Scien-

tific and Cultural Organization.

Section for Early Childhood and

Inclusive Education, Division of

Basic Education, Education Sector.

Early Childhood Care and Educa-

tion in E-9 Countries: Status and

Outlook, prepared for the Fifth E-9

Ministerial Meeting in Cairo,

21. Li R, Darling N, Maurice E, Barrer

L. Breastfeeding rates in the

United States by characteristics of

the child, mother, or family: the

2002 National Immunization Sur-

vey. Pediatrics 2005; 115: e31-

e36.

22. Asekun-Olarinmoye EO, Lawoyin

TO & Asekun-Olarinmoye IO.

Effect of rearing environment on

the feeding pattern of under two

years old Nigerian children. Early

Child Development and Care

2011; 181(10):1331-42.

1

14: 385-8.

4

5

.

Howes C, Droege K. Child Care in

the United States and Industrial-

ized Nations. Pediatrics 1994; 94:

1

081-3.

Malkki RM, Chen J, Honegger D,

Simonnet C, Kushnir T, Soto J. A

Comparison of Child Day-Care

Settings in Four Countries. Pediat-

rics 1994; 94: 1100-1.

6

7

.

Puig M, Aular A, Lechin A,

Egypt, December 2003;23-4

23. Taddei JA, Cannon MJ, Warner L,

Souza P, Vitalee S, Palma D et al.

Nutritional Gains of Underprivi-

leged Children Attending a Day

Care Centre in Sao Paulo City,

Brazil: a nine month follow - up

study. Rev. Bras. Epidemiol. 2000;

3: 29-37.

24. Saenz-Lozada ML, Camacho-

Lindo AE. Breastfeeding and Sup-

plementary Feeding Practice in a

Child Day-care centre in Bogota.

Rev. Public Health 2007; 9: 587-

94.

25. Nti CA, Lartey A. Young child

feeding practices and child nutri-

tional status in rural Ghana. Int. J.

Cons. Studies 2007; 31: 326-32.

26. Benjamin SE, Taveras EM, Cra-

dock AL, Walker EM, Slining M,

Gillman MW. State and Regional

Variations in regulations related to

feeding Infants in Child Care. Pe-

diatrics 2009; 124: e104-11.

Lozada MA, Cumare Y. Nutri-

tional Status and Development of

Modified Formula-Supplemented

Pre-schoolers under the Day care

Multihomes Program. An Venez

Nutr 2004; 17: 57-72.

Tsiantis J, Caldwell B, Dragonas

T, Jegede RO, Lambidi A, Banaag

C et al. Development of a WHO

Child Care Facility Schedule

13. Zoritch B, Roberts I, Oakley A.

The Health and Welfare Effects of

Day-Care: A Systematic Review of

Randomised Controlled Trials.

Soc. Sci. Med. 1998; 47: 317-27.

14. Nafstad P, Hagen JA, Øie L, Mag-

nus P, Jaakkola JJK. Day Care

Centres and Respiratory Health.

Pediatrics 1999; 103: 753-8.

15. Lee WK, Young BWY. Infectious

Diseases in children admitted from

a residential child care centre.

Hong Kong Med J 2006; 12: 119-24.

16. Matson DO. Viral gastroenteritis

in day-care settings: epidemiology and

new developments. Pediatrics 1994;

(CCFS): a Pilot Collaborative

Study. Bull WHO 1991; 69: 51-7.

Ejieh MUC. Pre-Primary Educa-

tion in Nigeria: Policy Implemen-

tation and Problems. Elementary

Education Online 2006; 5(1): 58-

8

9

.

9

4: 999-1001.

6

4.

1

7. World Health Organization. Global

Strategy for Infant and Young Child

Feeding. WHO 2003: 1-30

8. Federal Ministry of Health. National

Policy on Infant and Young Child

Feeding In Nigeria, Federal Ministry

Of Health, Nutrition Division, Abuja,

Rivers State Child’s Right Law

No. 10, 2009.

1

2

007: 1-24