DETERMINANTS OF ACUTE MALNUTRITION AMONG UNDER FIVE YEARS CHILDREN IN ILLELA LOCAL GOVERNMENT SOKOTO STATE, NIGERIA
ABSTRACT
Malnutrition is one of the major causes of mortality and morbidity among under-five children in Sub Saharan Africa. To understand the determinants of malnutrition among under –five children, a study was conducted in Arabaand kalmalo districts of Illela l/g to Understand the determinants in these districts
Majority of the children were aged 37-59 months 54(51.9%) and followed by those aged 13-36 months 44 (42.3%) respectively the average age of the children in months is 37 with a standard deviation of 6.4 months. Half of the children 52 (50%) were of birth order 1-2 with a few in the birth order of 3-4 being 26 (25%) and 5 or more order 26 (25%) respectively. Most of the children were of birth intervals equal or less than two years 46 (44.2%). There were also quite a large number of children born in the birth interval of 3-4 years 43 (41.3%)
More than half of the under-five children in the study were females 53 (51%) and on the other hand 51 (49.0%) were males Based on the age of the mother at birth, majority of the children had their mothers aged 30-39 years 42 (44.4%) while quite a significant proportion was also from children whose mothers at birth were aged 20-29 years 34 (32.7%). Few of the children were from mothers aged less than 20 years 16 (15.4%) and 40-49 years 12 (11.5%) at birth respectively.
In conclusion, it is worthy to note that the study is essential in pointing out the particular age-groups among under five children as well as the occupations that contribute to malnutrition in the districts of Araba and kalmalo. Based on the findings, the study recommends exclusive breast feeding and proper complementary feeding especially among those aged less than three years. Special arrangement could also be put in place to have children of mothers engaged in cultivation brought regularly for breastfeeding.
TABLE OF CONTENTS
DECLARATION ............................................................................................. i
APPROVAL BY SUPERVISORS .................................................................. ii
DEDICATION .................................................................................................iii
ACKNOWLEDGEMENTS ............................................................................ iv
ABSTRACT .................................................................................................... v
LIST OF ACRONYMS/ ABBREVIATIONS ................................................ ix
CHAPTER ONE: INTRODUCTION .............................................................. 1
1.1 Background to the study ............................................................................ 1
1.2 Problem Statement ..................................................................................... 4
1.3 Main objective ............................................................................................6
1.4 Specific objectives ......................................................................................6
1.5 Hypotheses .................................................................................................6
1.6 Scope of the study ........................................................................................7
1.7 Conceptual frame work ................................................................................7
1.8 Significance of the study .............................................................................9
1.9 Structure of the dissertation .......................................................................10
CHAPTER TWO:LITERATURE REVIEW .............................................11
2.1 Introduction .............................................................................................11
2.2 Malnutrition among under-five Children ...................................................11
2.3 Child related factors of under five malnutrition …………………………13
2.4 Maternal factors of malnutrition among under-five children ...................19
2.5 Summary of the literature review ............................................................ 27
CHAPTER THREE:METHODOLOGY................................................ 28
3.1 Introduction ..............................................................................................28
3.2 Study Population ................................................................................... 28
3.3 Data Source .......................................................................................... 28
3.4 Study Variable Specification ................................................................ 29
3.5 Anthropometric analysis ....................................................................... 31
3.6 Data analysis ...................................................................................... 32
3.7 Limitations of the study ....................................................................... 33
CHAPTER FOUR:MALNUTRITION AMONG CHILDREN UNDER FIVE YEARS ………………………………………………………………….. 34
4.1 Introduction ......................................................................................... 34
4.2 Background characteristics of children and caretakers ....................... 34
4.3 Levels of malnutrition among under five children .............................. 41
4.4 Relationship between child and maternal factors with malnutrition among under-five children ......................................................................................................... 44
4.5 Determinants of malnutrition among under-five children in Araba and Kalmalo districts. ........................................................................................................ 51
CHAPTER FIVE:SUMMARY, CONCLUSIONS AND RECOMMENDATIONS ...................................................................................................................... 55
5.1 Introduction .......................................................................................... 55
5.2 Summary of findings ...............................................................................63
5.3 Conclusion ..............................................................................................63
5.4 Recommendations ..................................................................................64
5.5 Areas for further studies .........................................................................65
REFERENCES .......................................................................................... 66
APPENDICES .......................................................................................... 72
APPENDIX I: RESEARCH INSTRUMENT ........................................... 76
APPENDIX II: A MAP SHOWING STUDY AREA
LIST OF TABLES
Table 4.1: Under five Child factors .............................................................. 34
Table 4.2: Maternal factors of malnutrition among under-five children ...... 38
Table 4.3: Immunization status of under-five children in Araba and kalmalo Districts……………………………………………........................................ 40
Table 4.4: Levels of malnutrition among under five children in Araba and Kalmalodistricts ............................................................................................43
Table 4.5: Bivariate associations between child and maternal factors with malnutrition among under-five children ........................................................44
Table 4.6: Determinants of malnutrition among under five children in Araba andKalmalodistricts ................................................................................... 51
LIST OF ACRONYMS/ ABBREVIATIONS
AfrII: Africa Innovations Institute
BCG: BacilleCalmette-Guerin
BMI: Body Mass Index
CDP: Child Days Plus
DHS: Demographic and Health Surveys
EPI: Expanded Programme on Immunization
FAO: Food and Agricultural Organization
MAAIF: Ministry of Agriculture, Animal Industry and Fisheries
MoH: Ministry of Health
NPA: National Planning Authority
TASO: The AIDS Support Organization
UNICEF: United Nations Children’s Fund
WHO: World Health Organization
CHAPTER ONE
INTRODUCTION
1.1 Background to the study
The World Health Organization (2013) estimates that thereare 178 million children that are malnourished across the globe, and at any given moment, 20 million are suffering from the most severe form of malnutrition. Malnutrition contributes to between 3.5 and 5 million annual deaths among under-five children. UNICEF estimates that there are nearly 195 million children suffering from malnutrition across the globe. In 1997, the World Health Organization had observed that 60% of the deaths occurring among all the underfive children in developing countries were attributed to malnutrition (Murray and Lopez., 1997). Most of the damage caused by malnutrition occurs in children before they reach their second birthday, in the time when the quality of a child's diet has a profound impact on his or her physical and mental development.
It has been estimated by the global burden of disease study that under-five malnutrition alone has caused approximately half (15.9%) of the global loss of Disability Adjusted Life Years (DALYs) that is the sum of years of life lost from premature mortality years lived with disability adjusted for severity (Faruqueet al., 2008). This consequently affects the intelligence level of children, their behavior and school performance. The impaired mental development is taken as the most serious long-term handicap associated with underfive malnutrition.
Malnutrition among under-five children is one of the most important public health problems in developing countries especially Sub-Saharan Africa (Gulati, 2010) and about 35% of under-five deaths in the world are associated with malnutrition. An estimated 230 million under-five children are believed to be chronically malnourished in developing countries.
Similarly, about 54% of under-five deaths are believed to be associated with malnutrition in developing countries. In Sub-Saharan Africa, 41% of under-five children are malnourished and deaths from malnutrition are increasing on daily basis in the region. Malnutrition continues to be a significant public health problem throughout the low income countries, particularly in Sub-Saharan Africa and South Asia (Kimokoti and Hamer, 2008).
In Uganda, malnutrition remains a serious health and welfare problem affecting the under-five children to whom it contributes significantly to mortality and morbidity. According to Uganda Demographic and Health Survey of 2006, nearly four in ten Ugandan children under-five years of age (38 percent) are stunted (short for their age), six percent are wasted (thin for their height), and sixteen percent are underweight (UBOS &Macro International Inc, 2007).
The Nigerian Demographic Health Survey (NDHS).conducted in 2008 showed that the nutritional situation in Nigeria was 14% wasting, 23% underweight, and 41% stunting. Underweight levels increased when compared with the 2003 NDHS. Twenty four out thirty-six state (67%) had more than 2% severe Acute Malnutrition(SAM) level and 19 out 36(53%) had level of Global Acute Malnutrition (GAM) above 10%. The state most affected are in the north-east and north west zone of Nigeria, particularly the Sahel Regionbordering Niger and Chad with stunting level above 50% and wasting levels above 20%.
The Uganda food and nutrition policy focuses on nutrition and childhood development as one of the goals with an aim of improving child health especially among those under-five years.
This policy is being formulated to address nutrition priority problems with assistance from international and local agencies like UNICEF, Save the Children, Plan International and TASO. The 2004/2005 Uganda food and nutrition policy reform focuses on policies and guidelines on anaemia, breastfeeding, HIV/AIDS and a number of other nutrition related disorders prevalent in the country (MoH and MAAIF, 2005).
The Ugandan government has put in place tremendous efforts in reducing the prevalence of malnutrition in the country through effective nutrition programs which act directly on feeding practices. However, the yield would be more significant if the government acted through factors that affect under-five child malnutrition. In addition, addressing the plight of women by strategically targeting their economic, education, and health status can improve nutrition athousehold level since women are the principle providers and care givers of children at this level.
1.2 PROBLEM STATEMENT
Effective nutrition is one of the most important health determinants among citizens of any country including Nigeria. However, malnutrition remains a big threat to almost all regions of the country, highly in the Sahel region particularly north-west and north east zonein Nigeria.
Some children under-five years in Nigeria have shown signs of growth failure, irritability, swelling of body parts, thin gray-blond hair, diarrhoea, as well as poor hygienic conditions according to Ministry of Health (MoH and MAAIF, 2005). These children do not gain corresponding body weight whichleads to premature deaths later in life because vital organs are never fully developed during childhood. Malnourished children have lowered resistance to infection and therefore more likely to die from ailments like diarrhoea and acute respiratory infections (Nguyen and Kam., 2008).
Data from the previous five Uganda Demographic and Health Surveys (2011, 2006, 2001,1995, 1989) show that the nutrition indicators have not improved much over the past 15 years and some indicators have even shown a worsening trend (UBOS and ICF International Inc., 2012). For example the UDHS 2006 reported that 16% of children under-five in Uganda are underweight, 38% are stunted and 6.1% are wasted (UBOS & Macro International Inc, 2007).
An operation framework for nutrition in terms of child survival strategies was developed by the Government of Uganda in 2009. Additionally, the Government also launched the Uganda Vision 2040 and National Development Plan (2010-2015) that focuses also on nutritional wellbeing of children. The government has other several initiatives aiming at reducing under-five malnutrition especially the food and nutrition policy 2003 as well as the implementation of the global Millennium Development Goals (GoU, 2013; GoU, 2010).
Given the fact that a lot of studies on the determinants of malnutrition among underfive children have been conducted in the developing countries, there is need to examine if the same factors are responsible for malnutrition among children underfive years in the districts of Araba and kalmalo hence forming the research gap.
1.3 MAIN OBJECTIVE
The major objective of the study was to assess the determinants of malnutrition among under-five children in Araba and kalmalo districts in Illela local govt.
1.4 SPECIFIC OBJECTIVES
The study addresses the following specific objectives;
i. To ascertain the relationship between child factors and malnutrition of children under-five years.
ii. To ascertain the relationship between maternal factors and malnutrition among children under-five years.
RESEARCH QUESTION
1. Why is malnutrition one of the major causes of mortality and morbidity among under five year children?
2. Why malnutrition affect mostly the children aged 37-59month?
3. Why is the mother occupation affect nutritional status of children under five years of age?
1.5HYPOTHESES
The hypotheses to assess the determinants of malnutrition among under-five children are presented below;
i. There is no relationship between sex of a child and malnutrition among under-five children
ii. There is no association between age of the child and malnutrition among under-five children
iii. Birth Order of child and malnutrition among underfive children are independent
iv. There is no relationship between child birth interval and malnutrition among underfive children
v. There is no relationship between mothers’ age at birth and malnutrition among under-five children
1.6 SCOPE OF THE STUDY
The study considered children below five years living in Araba and kalmalo District. This is because children under-five years are normally the most at risk of malnutrition within households and communities in Illela.
1.7 CONCEPTUAL FRAME WORK
Figure 1.1 shows the conceptual framework on the determinants of malnutrition among under-five children inIllela taking a case study of Araba and kalmalodistricts.
In developing countries and particularly in Sub-Saharan Africa, under-five child malnutrition is normally determined by a large number of factors to the extent that it sometimes becomes difficult to predict the risk factors (Victoria et al., 1997). Such factors act through a number of interrelated proximate determinants to bring about underfive malnutrition that is stunting, underweight and wasting. The demographic (child factors) and socio-economic factors (maternal factors) such as age of child, birth order, mothers age at birth, mothers education level, marital status as well as maternal occupation work through proximate variables like the
Duration of breast feeding, sanitation and mother’s health seeking behaviors to determine Under fivemalnutrition.
Figure 1.1: Conceptual Frameworkshowing the determinantsof malnutrition among under-five Children
Child factors
Sex of child
Age of the child
Birth order
Birth interval
Mother’s age at birth
BACKGROUND FACTORS PRACTICE OUTCOME
PRACTICES
Breast feeding
Sanitation
Health seeking behavior
Malnutrition index (stunted = 1,
Wasting = 1,
Underweight = 1;
Otherwise = 0)
Maternal factors
Maternal education
Marital status
Maternal occupation
1.8 SIGNIFICANCE OF THE STUDY
The study provides information that could be used for nutritional surveillance and targeting programmes that would focus more on populations at risk particularly the under-fivechildren. The study also makes important contribution to future research by contributing to the existing literature particularly on nutrition among under-five children. The study further avails information that could be used in policy planning and implementation particularly in vulnerable groups.
1.9 STRUCTURE OF THE DISSERTATION
This dissertation is divided into five chapters which include; the introduction, literature review, research methodology, presentation of findings, summary of findings, conclusion and recommendations. Chapter one providesthe backgroundto the study, problem statement, study objectives, hypotheses, scope of the study, conceptual framework andsignificance ofthe study. Chapter twopresents reviewedliterature onthe determinantsof malnutrition among under-five children. Chapter three presents the methodology used in the study including measurements ofanthropometric measuresand limitations. Chapter four presents study results and interpretations. Chapter fiveis the last chapter and itpresents summary of results, conclusion, study recommendations and areas for further research.
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