ABSTRACT
Childhood malnutrition continues to be a public health problem of school-aged children in resource limited countries. Nutritional status which is an important index for measuring quality of life especially in children is affected by food intake and incidence of childhood infections. The study so far assess the malnutrition among children 2 to 5 years in rural areas within Ikwuano LGA, Abia state. A cross sectional study design was employed. The study used multi-staged sampling technique to select 382 children for the study, Data for the study were realized using a structured questionnaire, while the anthropometric data was realized by taking the various measurements of the children such as (weight, height, and MUAC), after which the data were analyzed using descriptive statistics. The study revealed that a good number of the respondents (58.4%) were female. It showed that More than half (52.5%) of the participants were aged between 4-5 years. Birth weight between 3.0kg-3.4kg were predominant (50.4%), majority were immunized (92%), and majority did not practice exclusive breastfeeding (82.6%). In the anthropometric characteristics of the respondents based on age the result revealed that prevalence of wasting, stunting and underweight was 7.1%, 5.6%, 2.1% respectively. The result further revealed that majority (99.4%) of the respondents ate breakfast every day and ate three times in a day (82.3%). While, majority (99.7%) consumes snacks while all the snacks common to the area of study was usually consumed by participants (73.2). the result also observed that there was a significant (p> 0.05) positive correlation between fathers educational level and height for age Z-score (r = 0.235; p = 0.000) and weight for age Z-score (r = 0.243; p = 0.000) and there was a significant (p> 0.05) positive correlation between child’s age and height for age Z-score (r = 0. 0.156; p = 0.004), weight for age Z-score (r = 0.127; p = 0.019) and MUAC (r = 0.624; p = 0.000). the study recommends that the presence of adequate nutrient intakes and good nutritional status amongst the children especially those from families in this study demonstrates the effective and efficient of education and enlightenment on sustainable food and nutrition interventions aimed at improving dietary intake and diversity as well as countering poor nutritional status.
TABLE
OF CONTENTS
COVER PAGE
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGMENT iv
TABLE OF CONTENTS v
LIST OF TABLES ix
ABSTRACT x
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study 1
1.2 Statement of the Problem 3
1.3 Objective of the Study 5
1.4
Significance of the
Study 5
CHAPTER TWO: LITERATURE REVIEW
2.1
Nutrition
6
2.2 Child
Malnutrition
7
2.3
Nutritional Requirement for Infancy and Early
Childhood 9
2.3.1 Childhood Nutrition and
Malnutrition in
Nigeria 17
2.4 Micronutrient Malnutrition 20
2.4.1 Iodine
deficiency 20
2.4.2 Iron
deficiency 21
2.4.3 Vitamin A
deficiency 22
2.5 Methods for
Assessing Food Consumption Pattern of an Individual 23
2.5.1 Food
records 23
2.5.2 24-hour
dietary
recall 23
2.5.3 Food
frequency
questionnaire 24
2.5.4 Diet
history 25
2.5.5 Food
habits questionnaire
(FHQ) 25
2.6
Anthropometry 25
2.6.1
Weight 26
2.6.2
Height 27
2.6.3 Body
mass
index 27
2.6.4
height-for-age 28
2.6.5
weight-for-height 29
2.6.6 Body
mass
index-for-age 29
2.6.7 Waist
circumference
(WC) 30
2.6.8
mid-upper-arm circumference
(MUAC) 30
2.6.9 Head
circumference 30
2.7 Nutrition
and Food Security
Situation
31
2.7.1 Consequences of
malnutrition 33
2.8 National Nutrition Policies/Legislation,
Strategies and Initiatives 34
CHAPTER
THREE: RESEARCH METHODOLOGY
3.1 Study
Design 37
3.2 Study
Area 37
3.3
Population of the
Study 38
3.4 Sampling and
Sampling
Techniques 38
3.4.1 Sample
Size 38
3.4.2
Sampling Procedure 39
3.5
Preliminary
Activities 39
3.5.1
Preliminary visit 39
3.5.2
Training of research
assistants 39
3.5.4 Ethical
approval 40
3.6 Data
Collection 40
3.6.1
Questionnaire
Administration 40
3.6.2
Anthropometric
measurement 40
3.7 Data
Analysis 41
3.8
Statistical
Analysis 42
CHAPTER FOUR:
RESULTS AND DISCUSSION
4.1
Socio-demographic
characteristics 43
4.2
Anthropometric characteristics of the
participants 47
4.3 Food
habits of the
participants 49
4.4 Factors
associated with
malnutrition 50
CHAPTER FIVE: CONCLUSION
AND RECOMMENDATION
5.1
Conclusion 51
5.2
Recommendation 51
References
LIST
OF TABLES
Tables Pages
3.1:
Anthropometric status 42
3.2:
Mid-Upper Hand Circumference 42
4.1a. Socio-demographic characteristics of the
participants 44
4.1b.
Socio-demographic characteristics of the participants 45
4.1c.
Socio-demographic characteristics of the participants 46
4.2.1
Anthropometric characteristics of the
participants based on sex 47
4.2.1.
Anthropometric characteristics of the
participants based on age 48
4.3.
Food habits of the participants 49
4.4
Factors associated with malnutrition 50
CHAPTER ONE
INTRODUCTION
1.1
Background to the Study
Nutrition is a fundamental pillar of human
life, health and development across the entire life span (WHO, 2017). Nutrition is the sum total
of the processes involved in the intake and utilization of food substances by
living organisms, including ingestion, digestion, absorption, transport and
metabolism of nutrients found in food.(Melvin, 2018).
Adequate
nutrition during early childhood is fundamental to the development of each
child’s potential. From the
earliest stages of fetal development, at birth, through infancy, childhood,
adolescence, and on into adulthood and old age, proper food and good nutrition
are essential for survival, physical growth, mental development, health and
well-being (WHO, 2017). Despite the importance of proper nutrition, it sad to
note that malnutrition is estimated to contribute to more than one third
of all child deaths, although it is rarely listed as the direct cause (World
Health Organization, 2019).
The
World Health Organization (WHO) (2018), refers to malnutrition as “Failure of
cells to perform their physical functions due to inability to receive and use
the energy and nutrients needed in terms of amount, mix and timeliness.
Waterlow and Insel (2018) described malnutrition as “Failing Health that
results from long standing faulty nutrition that either fails to meet or
greatly exceeds nutritional needs. This description could mean
inappropriateness of the food taken. Again, Harrison and Waterlow (2018)
defined malnutrition as “The effects of any nutrient deficiency including
energy, protein and micronutrients.” Malnutrition can be operationally defined
as a lack of essential nutrients or failure to use available foods to best
advantage (Barasi, 2017). Malnutrition affects physical growth, morbidity,
mortality, cognitive development, reproduction and physical work capacity and
it consequently impacts on human performance, health and survival. A well-
nourished child is one whose weight and height measurements compare very well
with the standard normal distribution of heights and weighs of healthy children
of the same age and sex (Salah, 2018).Malnutrition in early childhood is
associated with functional impairment in adult life as malnourished children
are physically and intellectually less productive when they become adults
(Smith and Haddad, 2019).
The
World Health Organisation (2018) and United Nations Children’s Emergency Fund
(UNICEF) in 2019 reported that at least 99 million children were affected by
malnutrition. Among the survivors who are affected during the first two years
of life, their ability to resist disease, undertake physical work, study and
progress in school are all impaired (Shrimpton and Rokx, 2012). The interaction
between malnutrition and infection results in a vicious cycle of worsening
illness and poor nutritional status (UNICEF, 2019). Stunted growth and impaired
cognitive ability can also follow poor nutrition in the early years of a
child’s life (UNICEF, 2019). On the other hand, worldwide, an estimated 42
million children under the age of five years were affected by over nutrition as
at 2019 (WHO. 2018).
Rising
rates of over nutrition worldwide have been linked to a rise in chronic
diseases such as hypertension and type II diabetes (WHO, 2018). Three stages of
malnutrition have been clearly documented in literature to reflect the current
global nutrition trend. These stages correspond to epidemiologic and
demographic patterns in an environment. First is the stage of malnutrition which
is associated with a high prevalence of infectious diseases. The second stage
represents a phase of receding malnutrition as epidemiologic and demographic
changes associated with development occur. With development, increases in
chronic diseases such as overweight and obesity characterize the third phase
and malnutrition and infectious diseases become past problems (Kennedy, et al., 2016). Today, however, the
burden of disease and malnutrition do not fit neatly into these classic stages
but reflect a modified pattern, a fourth stage, referred to as the protracted
polarized model, where infectious and chronic diseases co-exist over long
periods of time (Kennedy, et al.,
2016). This invariably, is paralleled by co-existence of malnutrition and over
nutrition. Evidence of this has been documented in developing countries as
diverse as China and South Africa (Kennedy, et
al., 2016). This co-existence of malnutrition and over nutrition in a
population has been referred to as the double burden of malnutrition (Shrimpton
and Rokx, 2018). Sadly, most developing countries may now be faced with this
double burden of malnutrition. In Africa for instance, there is still high
prevalence of malnutrition (14-45%) (Babatunde, et al., 2018), while 7% of children were recently reported to be
overweight. Although there seems to be a clear evidence of the double burden of
malnutrition at the global level, most Nigerian studies had focused on one end
of the spectrum- under nutrition. This study seeks to highlight the burden of
both malnutrition among under-five children as well as the associated risk
factors.
1.2
Statement of the Problem
According to World Health
Organization (2018), In Nigeria, 37 per cent of children, or 6 million
children, are stunted (chronically malnourished or low height for age), more
than half of them severely. In addition, 18 percent of children suffer from
wasting (acutely malnourished or low weight for height), half of them severely.
Twenty-nine per cent of children are underweight (both acutely and chronically
malnourished and low weight for age), almost half of them severely. Stunting
prevalence remained relatively stable between 2017 and 2019, whereas wasting
has increased significantly, from 10 per cent in 2011 to 18 per cent in 2019.
Although underweight rates were stable between 2017 and 2011 at around 25 per
cent, the rate increased slightly to 29 per cent in 2019 (WHO, 2017).
Also, under-nutrition is an
underlying cause of 2.2million child deaths and 21% of disability-adjusted life
years lost in developing countries (Black et
al., 2017). High rates of malnutrition pose significant public health and
development challenges for the country. Stunting, in addition to an increased
risk of death, is also linked to poor cognitive development, a lowered
performance in education and low productivity in adulthood - all contributing
to economic losses estimated to account for as much as 11 percent of Gross
Domestic Product (GDP). A staggering 41% of all children under five in Nigeria
are chronically malnourished, 23% are underweight, and 14% suffer from acute
malnutrition. National Planning Commission (2010) shows that about 36%, 43%,
and 9% of under-five in Nigeria were underweight, stunted, and wasted
respectively (Food and Agricultural Organization, 2012).It was reported that
underweight (weight-for-age) are 27.2%, stunting (height-for-age) and wasting
(weight-for-height) were 43% and 11.2% respectively (NPC, 2004).
In recent years Nigeria has developed
a number of policies to tackle these issues, including the National Policy on
Food and Nutrition from 2001 (2004), with its Plan of Action (2004), as well as
the National Policy on Infant and Young Child Feeding (2018). However,
implementation has been weak with insufficient political support to transform
policy around improving nutrition into practice. Agencies on the ground are
supporting the Ministry of Health to treat children suffering from
malnutrition, but more is needed to scale-up this vital work, as well as to
tackle the root causes of malnutrition (Federal Ministry of Health, 2011).
Therefore the study will research on malnutrition among children 2 to 5 years
in Ikwuano LGA.
1.3
Objective of the Study
The general objectives of the study
is to assess the malnutrition among children 2 to 5 years in rural areas within
Ikwuano LGA, Abia state.
The specific objectives will be to:
i.
Assess the socio-economic
status of respondents in Ikwuano LGA, Abia state.
ii.
Assess the anthropometric
status of children 2 to 5 years in Ikwuano LGA
iii.
Determine their feeding
pattern and eating habit of children from 2 to 5 years.
iv.
Determine the
relationship between socio-economic status, anthropometric status, feeding
pattern and nutritional risk status among children 2 to 5 years in Ikwuano LGA,
Abia state.
1.5
Significance
of the Study
Malnutrition
has become a global problem which affects infants both the poor and affluent,
no family is left untouched according to report and findings of Food and
Agricultural Organization FAO, 2015). However, nutritional assessment is very
essential to achieve a healthy status and to combat malnutrition because it reveals
the current state of food and nutrient intake of infants. Therefore assessing
the nutritional risk in older adults will be of great importance to prevent the
high degree of morbidity and mortality rates among them.
This study will be of great benefit to medical
professionals which include nutritionist, dietitians and clinicians to educate
all the population groups on good dietary lifestyle which influences
nutritional status. Furthermore, encouraging them to maintain ideal body weight
which is the path to healthy living.
Parents
in the study area will use the outcome of the study to know the state of their
childs nutritional status.
Policy
makers and NGO will use the knowledge to know how they will transform their
actions towards solving the problem of malnutrition.
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