ABSTRACT
The difference between food
consumption and utilization determines the nutritional status of the
individual. Efforts have been made nationally and internationally by
governmental and non-governmental organizations to maintain normal nutritional
status but poor nutrition remains a major link to diseases and reduced
life-span. The study assessed the nutritional status of the under-five children
using anthropometric measurements, found out the level of awareness of mothers
about nutritional status of the under-five children, assessed the factors that
influence the nutritional status of the under-five and found out the feeding
practices engaged in by mothers of under-five children.
A cross sectional
study was done to assess the nutritional status of the under-five. Sample size
of 216 was determined using Leslie Kish (1965) formula. The respondents were
selected using simple random sampling. Weighing scale, stadiometer, and
Shakir’s tape were used to get data from the under-five children while a
self-structured questionnaire was used to get data from the primary care
givers/mothers of the under-five. Face and content validity of the
questionnaire were ensured by the researcher’s supervisor and other experts in
research and peadiatrics. The
reliability of the questionnaire was ascertained using test re-test. A mean coefficient value of 0.74 was
obtained which was considered high enough for the reliability of the
questionnaire. Data collected were analyzed using Emergency Nutrition
Assessment for Standardized Monitoring and Assessment of Relief and Transition
(ENA for SMART) software and Statistical Package for Social Sciences (SPSS) version 20. The research questions and
hypotheses were tested through descriptive and inferential statistics.
Findings showed that low weight for age
(underweight) affects 18.5% of the under-five, low height for age (stunting)
affects 20.4% of the respondents while low weight for height (wasting) affects
13.4% of the under-five. Lack
of awareness about the method of feeding the child properly, knowledge on the
type of food and non-availability of nutritious food in the locality were found
to be major factors affecting the nutritional status of the under-five. 73% of the primary care givers/mothers practiced exclusive
breastfeeding. 43.1% practiced complementary feeding for 12-18months. There was
significant association between the nutritional status and the age group of the
child (F4,211=2.955, p<0.05) but there was no significant
relationship between the nutritional status of the under-five and the
socio-economic status of the primary care giver/mothers of the under-five
(r=0.010, p>0.05).
There was need for frequent assessment and early
intervention of the nutritional related problems of the under-five. The
researcher recommended nutritional
counselling by Nurses and Nutritionists for the primary care giver/mothers to
reduce the prevalence of nutritional related problems, Nurses should take the
lead role in educating mothers about the need for exclusive breastfeeding for
the first six months of life and complementary feeding for 18-24months and
measures should be instituted by the government through provision of needed
social amenities to curb the menace of nutritional related problems.
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
The difference between food intake
and utilization determines the nutritional status of the individual. Change in
food consumption and the biological utilization will directly or indirectly
reflect in the nutritional status. The nutritional status can be normal, under
nutrition or over nutrition. The under and over nutrition are considered as
malnutrition. The nutritional status of the under-five might be affected by
some factors ranging from busy schedule of the primary care giver to inability
to provide enough food and needed health care to maintain normal nutritional
status. The determinants of the nutritional status may differ based on regions,
communities, or even over time. To proffer necessary recommendations or solve
any nutritional problem in an area, it will be important to determine the
nutritional status and the underlying causes.
Efforts have been made both
nationally and internationally by governmental and non-governmental
organizations to maintain normal nutritional status but poor nutrition remains
a major link to diseases and reduced life-span (Tette, Sifah & Nartey, 2015). According to Mamulwar,
Rathod, Jethani, Dhone, Bakshi, Lanjewar et al. (2014), one quarter of the under-five children are stunted. Many factors have been implicated to
influence the nutritional status. Poor diet and disease are
considered as immediate factors but there are underlying factors like food
security, caring practices of the mother, healthy environment and assessment of
health facilities. The underlying causes are also considered to have basic
causes which are seen as socio-economic and political conditions (Asegedech,
2014).
Nutritional
status of the under-five is of great importance since this period of life is
considered as pivotal for adequate growth (Badake, Maina, Mboganie, Muchemi,
Kihoro, Chelimo, & Mutea, 2014). Under-nutrition could be described as weighty medical
condition characterized by a deficient bodily nutrition (energy, essential
proteins, fats, vitamins, and minerals in a diet) as a result of inadequate
food intake or faulty assimilation. Over 10 million children of under-five are
lost annually due to diseases that can be prevented and even easily treated.
Most of these illnesses and majority of these deaths occur in developing
countries because of the poor economy of such Countries (Black, Morris &
Bryce, 2003). Malnutrition cause more over 30% of all children’s deaths who are
under-five(United Nations Children's Fund (UNICEF), 2009). According
to Badake, Maina, Mboganie, Muchemi, Kihoro, Chelimo and Mutea, (2014),
assessing the growth of children is a good parameter to look at the development
of the children and this also gives insight about food security in the area and
assess to good health services.
Poor nutritional status
has called for different programmes and interventions in different sectors in
order to improve the nutrition status. Sequel to this, experts from different
fields are strategizing and evaluating various interventions that have
nutrition components (Macias & Glasauer, 2014). Assessing nutritional
status is the easiest indicators for assessing the impact of interventions that
are nutrition focused and this can be done using various methods. Assessing
nutritional status entails a deep understanding of what people consume and the
determinants of people’s nutritional habits. The nutritional status can then be
traced to have a myriad of determinants.
Different factors have been
implicated to affect the nutritional status of the under-five and there are
repeated episodes of diseases that are often seen among these children. Some of
the factors include inadequate food availability, poor caring capacity of the
caregiver, lack of basic education, poor health systems, poor housing and
environmental conditions. Communities that are unable to satisfy the basic
needs of its citizens are likely to generate more individuals with poor anthropometric
indices.
Several
strategies have been put in place to maintain adequate nutritional status of
the children (e.g. exclusive breastfeeding). 17% has been found to be the
exclusive breastfeeding rate in Nigeria and it has also been documented that 21%
of mortality among the under-five can be traced to breastfeeding patterns that
do not follow the set standard (Ojofeitimi,
2016). Adequate diet and health care during first few years of life is
fundamental for child’s development and this help to maintain adequate or
normal nutritional status. Early in life, irreversible drop in linear growth
and psychological impairment can occur when there is problem with food
consumption or utilization (Alamu, Atawodi & Edokpayi, 2011). Growth is
most rapid in the early years of life and this may not be comparable to any
other time after birth. Since good nutrition has been identified to play a
pivot role in growth particularly in the early years of life, it is important
to assess the nutritional status of the under-five and the associated
determining factors.
The
need for food by mankind most especially the growing up children has been
emphasized over the years (Adegun, Ajayi-Vincent, & Alebiosu, 2013). The
nutritional status is solely dependent on the adequate and right consumption of
nutrients from foods and the body’s ability to make use of them adequately to
meet its metabolic needs of health and fitness. At early stage of growth,
several biochemical activities that affect growth and development are going on
in the body and these require nutrition. When there are inadequate nutrients
available for these activities then there is likelihood of developing stunted
growth and development (Adegun, Ajayi-Vincent, & Alebiosu, 2013).
To find
solutions to the nutritional related problems that are common in the early
stage of life, it is very necessary to determine the nature, magnitude and
determinants of malnutrition. Anthropometric measurements are accepted widely as key indicator of the
nutrition status of the community. Anthropometric indices are also suggestive
of the socio-economic level. The anthropometric measurements include
measurement of weight for age, height for age, weight for height and
measurement of mid-upper arm circumference (MUAC). The integrated management of
childhood illness (IMCI) approach for the classification of nutritional status
will be used in this study.
According
to Hunger Facts (2015), globally about 795 million individuals are
undernourished. The vast majority (98%) of these undernourished reside in the
developing countries. Under-nutrition among the under-five remains a problem
faced by different parts of the world. Close to 50% of all deaths among
under-five are attributable to under nutrition. This implies that there is
unnecessary loss of about 3 million young lives every year (Hunger Facts,
2015). In Sub-Saharan Africa, close to 50% of children particularly the
under-five are malnourished and deaths from such nutrition related condition is
on the increase (FAO, 2008). Nutrition related problem in Sub-Saharan Africa has added more to the
burden of childhood morbidity and mortality. However, the information available
on the nutritional status of the under-five in informal settlements can be
considered as little and inadequate (Olack, Burke, Cosmas, Bamrah,
Dooling, Feikin & Breiman, 2011).
Reducing
nutritional related problems among children particularly the under-five is a
huge challenge that is being faced by different countries particularly the
underdeveloped and the developing countries. In Kenya, the percentage of
stunted children among the under-five is 35%, 14% were considered to be
severely stunted while underweight was 16% (low weight-for age) and severely
underweight was 4%. The core factor responsible for all these nutrition related
health challenges as conceived by different researchers can be linked to food
access issue, infections of various degrees and forms, maternal/paternal
factor, socio-economic factors and other related factors.
Nigeria
(especially the rural areas) is one of the developing countries that are
affected by this nutrition-related problem. This might be related to causes
that are found in other regions of the world like poor access to food, primary
care giver factor, socio-economic factor, area of abode and other related
factors. The Nigeria Demographic and Health Survey (2003) put the rate of
stunted growth among the under-five years to be 38%, underweight to be 29%
while wasting was 9.2%. Several factors can be considered to have caused these
nutritional deficiencies. According to the Federal Ministry of Health (FMOH)
Nigeria (2007), 7% is the rate of compliance of mothers to exclusive
breastfeeding of their children who are less than 6 months.
According
to Adegun, Ajayi-Vincent, and Alebiosu (2013) there are not enough supporting
data on under-nutrition among children in schools in Ekiti State which can
easily be generalized but a closer look at the children in schools by different
investigators suggests the prevalence of nutritional related problems among
children in Ekiti. Common nutritional problems as faced by the under-five made
are protein energy malnutrition (PEM), anemia due to iron deficiency, vitamin A
and iodine deficiency respectively (Babatunde, 2003).
Factors including biologic, economic,
cultural, environmental and of disease origin have been found to affect
nutritional status. Inadequate food intake, food insecurity, poor distribution
of food in the household, poor storage pattern of the available food, wrong
food handling, nutritional taboos/ harmful traditional practices and different
types of infections among under-five children might make the children to be
most vulnerable to nutritional related problems. These factors might be seen to
have immediate, underlying biological and behavioural, underlying social and
economic, and basic influences on the children (Degarege, Degarege &
Animut, 2015). Understanding the causes and the effects of different
nutritional status will help proffer necessary recommendations.
1.2 Statement of the Problem
Nutrition related problems affect the
populace but the under-five and women are most susceptible to this condition.
The unique physiology of the under-five, socioeconomic factor, and other
related factors in the society might be implicated. Available
data shows that more than 2billion individuals are affected with different
degrees of nutritional related problems. Children that are up to 2.6million die
yearly following nutrition related problem. This accounts for about one third
of children’s deaths globally. Stunted children are highest in number in
Nigeria which makes Nigeria to have the highest stunted rate in Africa and
third globally having above 10 million citizens who are stunted. Within the
first 1,000days of life, malnutrition accounts for over one-third of deaths
among the under-five years and half of all child deaths worldwide (Malnutrition
and Child Survival in Nigeria, 2016).
North-Eastern
and North-Western parts of Nigeria where most of the food consumed in Nigeria
are cultivated have the increased number of cases of nutritional deficiencies
as compared to other zones (Nigeria Demographic and Health Survey, 2016). This
depicts that food production does not translate to food consumption. Several
under-five children would have developed micronutrient deficiencies before they reach the
age of 2years to the extent that their growth and development become impaired. Children
from families living below the poverty line have been proven to be at risk of
malnutrition four times more than people living above the poverty line. The
children from homes that are not poor too can be malnourished when the food
intake is not adequately and well combined. Food insecurity has been found to
be closely linked to hunger and malnutrition. 39% of people living in Nigeria
are considered to be living below the poverty live.
The
North-East and North-Western zones of Nigeria have witnessed a lot of
insurgents and the Niger Delta region too has been troubled by militancy acts.
These acts transform to the increase in malnutrition rate among citizens in
Nigerian because farming activities are hindered in these regions. This is
often clearly seen among the internally displaced persons (IDP) living in IDP
camps in the North-Eastern and North Western zones of Nigeria. People are now
confined to the IDP camps where they are made to struggle for little rations of
food available for consumption. Farming activities/ food production becomes
completely paralyzed. The largest percentage of people that bear these burdens
are the under-five children, women and the elderly.
There
are also cases of food availability but inability of the illiterate parents and
caregivers to combine the food sources correctly and give adequate diet to the
under-five still bring about malnutrition. Harmful traditional practices in the
community can also affect the nutritional status of the under-five and that of
the family as a whole which then translate to that of the entire nation. The
intellectual development of the child is at stake when there is poor
nutritional intake (UNICEF, 2016).
Managing the incessant illnesses of
children places economic burden on the family and government because the money
spent on these nutritional-related diseases (which would have been prevented)
could be used for other developmental projects (Kitinya, 2013). Poor school
performance and lower productivity could also be the impact of poor nutritional
status on the society. As a result of the magnitude of the identified
problem, the researcher is set to assess the major determinants of nutritional status
among under-five in Comprehensive Health Centre, Ado-Ekiti.
1.3 Objective of the Study
The
main objective of this study is to assess nutritional status of the under-five
children and find out the associated factors in Okeyinmi Comprehensive Health Centre,
Ado-Ekiti. The specific objectives are to:
1. assess
nutritional status of the under-five children using anthropometric measurements
in Okeyinmi Comprehensive Health Centre, Ado-Ekiti;
2. find
out the level of awareness of mothers about nutritional status of the
under-five children;
3. assess
the factors that influence the nutritional status of the under-five children
and
4. find
out the feeding practices engaged in by mothers of under-five children.
1.4 Research Questions
- What is the nutritional status of the
under-five children using anthropometric measurement in Okeyinmi
Comprehensive Health Centre, Ado-Ekiti?
- What is the level of awareness of mothers
about nutritional status of the under-five children?
- What are the factors that influence the
nutrition status of under-five children?
- What are the feeding practices engaged in
by mothers of under-five children?
1.5 Hypotheses
H01: There is no
significant relationship between the nutritional status of the under-five and
the
socio-economic factor of the primary
care giver.
H02: There is no
significant difference between male and female under-five nutritional status.
H03: There is no
significant association between nutritional status and the age group of the
child.
1.6 Scope of the Study
The
study was delimited to under-five children between the ages of 6months and
59months attending Infant welfare clinic of Okeyinmi Comprehensive health
centre, Ado-Ekiti. The study used anthropometric measurement only as the method
of determining the nutritional status of the child. The researcher delimited
the study to only 6months to 59months children because the MUAC tape/ Shakir’s
tape is usually used for children of this age group.
1.7 Significance of the Study
Findings
from this study provided data which reflects the nutritional status of the
under-five and this would help in decision or policy making process. This study
would help in early recognition of nutritional related problems of the
under-five which would allow the mothers of children with good nutritional
status to be praised and mothers with children with poor nutritional status to
be adequately counseled. Findings would also show the pattern/prevalence of
nutritional related problems among the under-five as revealed by anthropometric
measurement. Findings from this study would serve as relevant and reference
materials in the area of nutrition of the under-five by adding to the body of
existing knowledge. Recommendations from this work would serve as assistant to
the governments in making policies that might reduce the burdens of nutrition
related problems in the society especially among the under-five children.
1.8 Operational Definition of Terms
- Nutritional
status: This is the health status of the
under-five children as determined by anthropometric measurement.
- Associated
factors: These are the determinants of the
nutritional status of the under-five in Okeyinmi Comprehensive Health
Centre, Ado-Ekiti.
- Under-five
children: These are children whose ages range from
6months to 59months and are brought to the Okeyinmi Comprehensive Health
Centre, Ado-Ekiti.
- Anthropometric
measurements: These
are standard measurements to determine the nutritional status. This
includes measurement of weight for age (to determine underweight), height
for age (to determine stunting), weight for height (to determine wasting).
- Primary
care giver: This is anybody that brings the
under-five child to the infant welfare clinic of Okeyinmi Comprehensive
Health Centre, Ado-Ekiti. The primary care givers included the mothers,
fathers, or guardians.
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